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An introduction to migrant health

Watch Yannis Gourtsoyannis introduce the healthcare barriers to migrants and points to consider to ensure the wellbeing of all patients.
In Autumn 2017, the government introduced new binding legislation with regards to the monitoring charging of so-called overseas visitors who access the NHS. This new legislation has compromised the safety and dignity of vulnerable patient groups. It undermined the universalist ethos of the NHS. Doctors and other health workers have been coerced into complying with this government directive. Patients who needed care were denied care because of their inability to pay. I think it’s no exaggeration that, from the perspective of some undocumented migrants and other vulnerable patient groups, the NHS has, in effect, become part of the hostile environment we’ve heard so much about.
NHS trusts are now, as of 2017, required by law to withhold non-urgent treatment from chargeable overseas visitors, unless they pay upfront. And even patients receiving immediately necessary and urgent care will have to pay up at the end of their hospital stay. Ward patients, ICU patients, outpatients, they will be charged thousands of pounds, and they will be penalised and reported if they are unable to do so. I personally have witnessed a patient anxiously awaiting imminent surgery, nil by mouth in their hospital bed, and yet being presented with a 9,000 pound bill and coerced into signing a promise that they will pay that sum of money.
I have witnessed a young Eritrean migrant with severe diabetic complications being hurriedly discharged from hospital dangerously early. I’ve witnessed a young man of Eastern European origin admitted for a life threatening asthma attack and then presented with a 4,000 pound bill on the third day of his admission, and I’ve witnessed several patients needing lifesaving renal dialysis care, and those patients were denied that care. Now, the coercive and exclusionary and discriminatory thrust of some of this government policy towards migrants is obvious. However, what is a little less obvious is that this coercion is also being deployed against doctors. Doctors who refuse to comply with this hostile environment policy are being targeted by hospital finance departments.
I’ve worked in trusts, where doctors have been told that they must notify the finance department if there is even a hint of suspicion that the patient may not be ordinarily resident in this country. In the article on this page, I will sign post for you some key ethical considerations that you should be aware of and will also signpost sources of support and advice for you if you find yourself advocating for your patient’s right to receive health care. I think it is self-evident that we as health professionals all have an ethical obligation to uphold the health and well-being of our patients.

In this video, Dr Yannis Gourtsoyannis will take a look at migrant health care and point to some resources below to help healthcare professionals provide the best care possible.

‘Overseas visitors’ and the NHS

In autumn 2017 the government introduced new binding legislation with regards to the monetary charging of so-called “overseas visitors” who access the NHS.

Spurious economic rationales were deployed in the justification of this policy. This new legislation has compromised the safety and dignity of vulnerable patient groups and undermined the universalist ethos of the NHS.

Doctors and other health workers have been coerced into complying with this new government directive and patients who need care have been denied care because of their inability to pay or because of their immigration status.

This is ethically unacceptable.

As health professionals, we all have a duty and obligation to uphold the health and wellbeing of our patients.

Points to consider to ensure the health and wellbeing of all patients

Were you to witness patients being inappropriately harassed by Trust finance departments or denied care which you feel is necessary, here are seven points to consider:

  1. This is the key government document you need to be aware of. Read it thoroughly and understand how they are used and misused by hospitals to inappropriately deny care. For example, learn about the exemptions that would potentially allow you to advocate successfully on behalf of your patients.
  2. Nobody has the right to stop you (the clinician) from seeing your patient and treating them. As a clinician, you are the sole arbiter of your patient’s urgent needs. Non-clinicians cannot prevent you from treating your patient.
  3. With the patient’s permission, consider a referral to the hospital PALS service and to the safeguarding lead if you feel that their safety and dignity is at risk.
  4. Enlist the support of the rest of your medical colleagues in standing up for your patients’ rights in the face of harassment and discrimination. Do not be afraid to escalate your concerns about a patient’s wellbeing.
  5. If you are a doctor, consider using the resources of your trade union, the British Medical Association (BMA). The BMA has campaigned against discriminatory legislation and affirmed patients’ right to healthcare according to need. It is BMA policy that doctors should not be coerced into acting as UK Border agents or deeming patients ineligible for care. Helpful resources include the Refugee and Asylum seeker patient health toolkit and the Refugee and Asylum seeker resource June ‘19.
  6. Reacquaint yourself with the GMC’s duties of a doctor statement:
    • Make the care of your patient your first concern
    • Take prompt action if you think that patient safety, dignity or comfort is being compromised
    • Treat patients as individuals and respect their dignity
    • Never discriminate unfairly against patients or colleagues
  7. Various grass-roots UK campaigning groups do good work on this issue. Get involved in the wider fight against racism and campaign for the rights of migrants (regardless of immigration status) to access free healthcare migrant health , MEDACT and Docs Not Cops

Ultimately it comes down to this: The manner in which immigrants are treated in society is a marker of the civility of that society as a whole. It is also a warning. A kind of smoke alarm. The exclusion of certain groups from the NHS is a first step in the direction of excluding other groups, resident in the UK, from comprehensive and free health care. Health is a human right. Be prepared to defend it.

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Infection Prevention for Vulnerable Patients

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