Mayor John Biggs and Dr Jackie Applebee, the chair of the Local Medical Committee for Tower Hamlets, have written to the Secretary of State for Health to warn that the Government’s ‘hostile environment’ policies in relation to the NHS may lead to ‘dangerous situations.’

The policies mean that hospitals must check whether patients are eligible for free treatment, placing extra burdens on over-stretched NHS staff and putting people off from accessing vital healthcare, even patients who are eligible to receive free treatment.

The letter points out that the policy perversely costs the NHS more in the long-run as patients are put off from accessing health services until much later and end up relying on emergency treatment, which is free for everyone and not subject to eligibility checks. The Mayor and Dr Applebee highlight that it is cheaper to treat illnesses early on, and putting patients off from accessing healthcare only stores up major problems for the individual and the NHS.

Barts Health Trust took part in a pilot for the policy and asked some new patients to prove their eligibility. The pilot found that only 1/180 people – about 0.5% – who were asked were actually ineligible, meaning a negligible amount of money recovered for the NHS despite the administrative costs of carrying out the checks.

Recently the Department of Health indicated that hospital trusts across the country should be prepared, as part of Brexit preparations, to introduce checks on EU citizens “immediately after exit day.”

Mayor of Tower Hamlets John Biggs said: “The Government’s hostile environment policies have been rightly criticised for the harm they cause and yet the NHS, one of our most valuable and trusted institutions, is forced to conduct these counterproductive eligibility checks, barring people from accessing vital healthcare services. It simply cannot be right that healthcare is denied to people who need it.”

Dr Jackie Applebee commenting in a personal capacity said: “Charging overseas visitors for NHS Care instils fear of destitution and deportation in migrant communities. It is not cost effective and goes against the founding principles of the NHS as a comprehensive, publicly funded, publicly provided health care system, free at the point of delivery for all. Nye Bevan never intended them to pay, he asked ‘how do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified.’

“Charging for health care impacts disproportionately on the most vulnerable and marginalised, this hostile environment must end.”

Councillor Amina Ali, Cabinet Member for Adults, Health and Wellbeing, said: “These policies only serve to marginalise and intimidate people, the vast majority of whom are perfectly eligible to receive free treatment anyway. Putting up barriers to healthcare won’t solve anything and indeed only means extra costs for the NHS in the long-run. The Government must think again about their deeply harmful hostile environment policies, and the impact they have on some of the most vulnerable people in our society.”


Full text of the letter:

Dear Secretary of State

The Government’s ‘hostile environment’ policies in relation to the NHS have had a major impact on more diverse communities such as ours in Tower Hamlets. While we have been informed that the intent is wanting to stop the small numbers of people who deliberately set out to defraud the NHS, the impact of many of these policies has been to marginalise and intimidate people who fear they are no longer eligible for treatment they should be able to legitimately receive. The requirement to check payment eligibility and potential immigration status of patients clearly also has a demoralising and emotional impact on already stretched medical staff.

As you will know the new directives from Government put an explicit legal duty on hospitals to establish if charges apply to patients. While different Trusts have adopted slightly different approaches in practice the Government’s new policy has left Trusts with relatively little room for flexibility if they are to act within the law.

We are deeply concerned that while the current framework is clear that emergency and maternity services are provided without reference to eligibility, the understandable anxiety caused by the potential for immigration challenges or even deportation for those here from abroad, even those with a legitimate right to access services, can discourage uptake and lead to dangerous situations.

At the same time there is a wealth of evidence that charging migrants for health care leads to negative impacts for those who are charged and for the wider population. We are concerned that the pathways that hospital trusts use to ascertain a patient’s eligibility for free health care could lead to fear and consequent delay in seeking the treatment that they need.

Our local trust, Barts Health, took part in a pilot which was implemented in the Renal Department at Whitechapel and the Maternity Unit at Newham General Hospital. They asked all new patients for documents to prove their eligibility for NHS Care. The results of which showed that only 1/180 people asked were deemed ineligible. As a result, the amount of money recovered by overseas visitors departments is a tiny proportion of the total NHS budget. However, the fear that a medical visit may flag someone to the Home Office and risk deportation erodes trust, even among those who have a legitimate right to access services.

The risk is that people stop seeking treatment as a result or that the relationship of trust between doctor and patient breaks down. Charging means that people may delay treatment until it becomes urgent.

Emergency treatment is free for everyone, but emergency treatment is less likely to be effective than it would have been earlier in the disease process and also, perversely, ends up costing the NHS more than if the condition had been treated in a more timely manner.

The legislation risks having significant negative impacts on access to free NHS health care at time of need to many of the most vulnerable in our community.

We strongly urge the Government to think again about how this policy is enacted and the impact it has, intentional or not, on discouraging legitimate access to NHS services.


Yours sincerely,

Mayor John Biggs – Executive Mayor of Tower Hamlets

Dr Jackie Applebee – Chair of Local Medical Committee for Tower Hamlets and Secretary of TH BMA Division


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