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Who we are

GMIAU are proud to be joining the campaign Greater Manchester Patients Not Passports (GMPNP) to end the Hostile Environment within the NHS. We have formed a coalition with local organisations Medact Manchester and Greater Manchester Keep Our NHS Public (GMKONP) to fight for equal access to healthcare, which has even more relevance during the current pandemic. We’re calling on the Department for Health and Social Care (DHSC) to end the unjust policies of NHS charging and data sharing, towards the goal of a truly universal NHS.  

Living in Britain through a global pandemic has highlighted how proud people are of our National Health Service. When we hear stories of extortionate healthcare charges in other countries, we feel a strong sense of injustice alongside relief that we live in a country where healthcare is free and accessible. But, concealed from most, those same injustices are happening here. Individuals are being charged 150% of the price of care, or denied treatment when this is unaffordable, purely due to their immigration status. These new discriminatory rules fundamentally undermine the principles upon which our NHS is founded.  

NHS Charging

Rules introduced in 2015 and 2017 have drastically limited migrants’ ability to access the healthcare they need. The ‘immigration health surcharge’ (IHS) is now payable by those seeking visas to enter the UK, despite the fact they are often coming to work within, or pay taxes towards our public services. GMIAU protested the recent increase to this already inequitable charge in October 2020, at a time when we were all facing financial struggles due to the pandemic, which led to calls to scrap the IHS for all migrant workers. 

The new rules mean the NHS are now legally obliged to charge upfront for ‘non-urgent’ medical treatment for overseas visitors. So people are being refused preventative healthcare because they cannot afford the inflated prices. This often necessitates more costly, invasive treatment when their healthcare needs reach the point of ‘urgent’, which they are then charged for retrospectively. Such cruelty is encapsulated by Simba’s story, who was landed with a staggering £93,000 debt when he woke from a coma.  

We’ve seen the consequences first hand at GMIAU when we worked with someone who was diagnosed with prostate cancer. He was refused treatment for this serious health condition because his immigration status did not entitle him to receive healthcare and the asking costs were outlandish. He had lived in the UK for a substantial length of time and GMIAU successfully argued his Human Rights claim, finally achieving access to treatment for him. No one should have to experience the delay and unnecessary stress suffered in this case, where your health is dependent on a Home Office decision.  

Upfront charging embeds discriminatory practices within the NHS, turning healthcare workers into immigration officers asking for passports. This policy presents a real threat of racial profiling, normalising judgements on people based on how they look, how they speak or for having foreign-sounding names. Charging within the NHS creates a hostile healthcare environment, leading to distrust in the institution. Trust plays such an important role in the doctor-patient relationship that, without it, many do not seek the healthcare they need.  

Data Sharing

Another example of the hostile environment seeping into the NHS is the policy of data sharing. The NHS are now encouraged to report patients to the Home Office if they have a debt of over £500 for over 2 months. This can be used by the Home Office as a reason to reject future applications to stay in the UK. People are once again deterred from accessing the healthcare they need due to these fear-inciting policies.  

Complexity of Rules

The rules are extremely complex. They include exemptions for asylum seekers, refugees, victims of trafficking, in addition to exemptions for care needed due to domestic violence, or for infectious diseases including coronavirus. However, in practice, healthcare workers have been given no formal training on how to implement these new rules, nor to notify patients of the exemptions which may apply to them. ‘Overseas Visitor Teams’ have been introduced to NHS Trusts to send out invoices, which are often inaccurate, demonstrating their lack of understanding of their own rules. 

At GMIAU, we have experienced multiple cases of the people we support being wrongly charged for healthcare, because they in fact fall under one of the exemptions. One person was in receipt of asylum support because she was destitute, yet she received charges which all turned out to be invalid. GMIAU staff had to repeatedly chase the Overseas Visitor Team and explain their own rules to them, to ensure the charges were rightly cancelled. 

Another individual was a refused asylum seeker who had made a fresh asylum claim and required medical treatment whilst waiting for a decision from the Home Office. The Overseas Visitor Team suggested he should return to his country of origin for treatment- the country where he feared persecution. The Overseas Visitor Team failed to correctly identify when it is reasonable for someone to leave the UK, which is in line with Doctors of the World’s conclusions that the charging policies are too complex for NHS trusts to apply correctly.  

The purported rationale behind these harmful policies is to prevent so-called ‘health tourism’. However, the Home Office’s own figures show that deliberate health tourism amounts to only 0.3% of the NHS budget. This insignificant issue has been heavily exaggerated to justify introducing borders into our health service, under the guise of ‘protecting the NHS’. On the contrary, the implementation of these rules and the existence of the Overseas Visitor Teams are a waste of NHS time, money and resources. NHS Trusts are now using bailiffs to track down and intimidate vulnerable people with healthcare debts that they cannot afford to pay, meaning very little is recovered. The detrimental impacts created by these counter-productive policies far outweigh the non-issue they seek to address. 

Call to Action

We believe that healthcare is a human right, which should not depend on immigration status, reflecting the ethos of the NHS constitution. GMIAU are working towards the ultimate goal of ending the hostile environment altogether, and will continue to challenge the hostile healthcare environment alongside our allies in our area. The Greater Manchester Patients Not Passports Campaign has written an open letter to NHS trusts in Greater Manchester, the Greater Manchester Health and Social Care Partnership and Mayor of Greater Manchester Andy Burnham setting out our achievable demands including calling for the government to scrap NHS charges. We need people from all walks of life to sign to show the breadth of support for these changes. Please sign our letter here to support our campaign.