Opinion

Charging migrants for primary care will harm individual and public health

Volunteer nurse Sally Watts gives her view on why charging migrants for care will impact on public health and vulnerable people.
Migrants

As well as working as a practice nurse I volunteer with Doctors of the World UK (DOTW) in our drop-in clinic in Bethnal Green, East London. In the clinic I work to ensure that excluded people, including migrants, can overcome barriers to accessing healthcare.

The UK government is consulting on proposals to charge overseas visitors and migrants for NHS primary medical care, emergency department visits, prescriptions as well as dental care, ophthalmic services and ambulance services.

This consultation follows concerns the NHS is overly generous to those who only have a temporary relationship with the UK. Evidence has been taken from a 2013 report titled Quantitative Assessment of Visitor and Migrant Use of the NHS in England. It was based on estimations

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As well as working as a practice nurse I volunteer with Doctors of the World UK (DOTW) in our drop-in clinic in Bethnal Green, East London. In the clinic I work to ensure that excluded people, including migrants, can overcome barriers to accessing healthcare.

Migrants
Migrant in primary care. Picture: Alamy

The UK government is consulting on proposals to charge overseas visitors and migrants for NHS primary medical care, emergency department visits, prescriptions as well as dental care, ophthalmic services and ambulance services.

This consultation follows concerns the NHS is ‘overly generous to those who only have a temporary relationship with the UK’. Evidence has been taken from a 2013 report titled Quantitative Assessment of Visitor and Migrant Use of the NHS in England. It was based on estimations of the true cost of migrant use of healthcare, which even the authors, admit to be ‘uncertain’.

A restrictive healthcare system

I believe that extending charges into primary care and emergency departments will have a negative impact on vulnerable groups including victims of torture, trafficking, modern-day slavery, FGM, domestic and sexual abuse. The changes would make the NHS one of the most restrictive healthcare systems in Europe for undocumented migrants.

In 2014, 97% of people who visited the DOTW’s clinic had experienced barriers in accessing healthcare and 83% were not registered with a GP. If the proposed changes are implemented the numbers will increase, putting the health of the most vulnerable in our society at greater risk. \It would become harder for these people to register with a GP.

As a practice nurse I am concerned about the negative impact extending charges into primary care will have on public health.

Primary care is the frontline of early detection of diseases that if left could worsen or become more complicated to treat, requiring expensive secondary or emergency care. Any policy that restricts, deters or acts as a disincentive to people living in the UK from accessing this care will increase costs for public health providers and make it more difficult to control the spread of diseases.

Delays in treatment

Cast study

Our service users already experience delays in accessing care, for instance the Sri Lankan man in his forties we treated recently. After his brother and friends were killed in the civil war he fled, eventually coming to the UK four years ago. He had headaches and eyesight issues. He had lost a large amount of weight but had not sought medical care in the UK before.

He also had numbness in his feet, glycosuria and high blood pressure and told us that one of his parents might have been diabetic. Clinical investigation quickly led to a diagnosis of type 2 diabetes.

The delay meant that his diabetes had already had some irreversible effects. The GP prescribed temporary medication and I gave lifestyle and diet advice. We were able to find a GP to register him and carry out further tests.

Without our intervention his condition would have worsened. If the changes are put into place more people like him may be deterred from accessing care.

The DOTW strongly recommend the government keeps free access to primary, emergency and other essential care for everyone living in the UK, with no one charged for primary, out of hospital or emergency care.


Doctors of the World UK is part of the global Médecins du Monde network, visit www.doctorsoftheworld.org.uk

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