MIGRANT ACCESS TO HEALTHCARE – THE ISSUES Don Flynn

MIGRANT STATUS AND ENTITLEMENT TO HEALTHCARE – BASIC POINTS ● Entitlement to free healthcare on the NHS is dependent on residence status. ● Note that British citizens who are not normally resident in the UK are not entitled to free NHS treatment ● Permanent residents who are normally resident do not have to pay for treatment either with G.P.s or hospitals ● Access to primary healthcare in NOT dependent on a regular immigration status. G.P.s are free to register anyone for treatment. ● A status of legal residence in the UK for 1 year + entitles the migrant to free NHS primary and acute (hospital) services.

NOTE – SOME HEALTHCARE IS FREE TO EVERYONE Healthcare free to everyone is: ● treatment given in an accident and emergency (A&E) department or in an NHS walk-in centre that provides services similar to those of an A&E department; ● treatment for certain infectious diseases, including HIV/AIDS. ● compulsory psychiatric treatment; and ● family planning services. Asylum seekers whose application is still under consideration are also entitled to free free treatment. A few categories of visitor can receive treatment for conditions that occurred after their arrival in the UK. This includes residents of the European Economic Area, or of countries with which the UK has bilateral healthcare agreements.

FOR FURTHER INFORMATION British Medical Association document Access to health care for asylum seekers and refused asylum seekers – guidance for doctors which summarises the various entitlements and means of accessing healthcare for asylum seekers and refused asylum seekers in England and Wales, Scotland and Northern Ireland. For types of service in the NHS that are currently free of charge irrespective of country of normal residence see National Health Service (Charges to Overseas Visitors) Regulations 2011 If a GP refuses to register a patient they are obliged under clause of the Standard General Medical Services Contract and Schedule 6 Part 2.17 of The National Health Service (General Medical Services Contracts) Regulations 2004 to notify the applicant, within 14 days of its decision, in writing of the refusal and the reason for it. -

ANTICIPATED CHANGES – NEW IMMIGRATION ACT 2013 ● Limiting free NHS care for non-EEA nationals to those who have permanent residence. The ‘ordinarily resident’ definition would be changed so that only those with ‘permanent residence’, i.e. indefinite leave to remain, would be eligible for free NHS care. There would a short list of exemptions including asylum seekers and victims of trafficking. ● Introducing a system for non-EEA ‘temporary’ migrants (including students, family and economic migrants) to make a financial contribution in order to access NHS care. The preferred option is to introduce a ‘health levy’ by which migrants would have to pay a fee to be able to access NHS services while in the UK. The fee would be set at least at £200 per year. The fee would be paid when applying for an entry visa or an extension of stay visa. ‘Temporary’ migrant is defined as non-EEA migrants subject to immigration control who do not have Indefinite Leave to Remain and does not include short-term visitors. ● Requiring short-term visitors and irregular migrants to pay for NHS primary healthcare, including to see a GP. ● Implementing a system to record, identify and charge chargeable patients

QUESTIONS FOR DISCUSSION 1. How do access regulations interact with health outcomes? Are migrants aware of their entitlements to healthcare? Are G.P.s aware of their obligations to register all residents? 2. What are the problems with migrant use of healthcare services? Is there evidence suggesting a problem with 'health tourism'? How do we balance this against public health imperatives to provide the widest possible cover to populations? 3. What is needed to strengthen advocacy on the part of the health needs of migrant communities? Who can be involved in this work? What messages need to be got across about the nature of the healthcare needs of migrants and who needs to hear these?

THANKS – AND MORE INFORMATION SOURCES ➔ Migrants' Rights Network ➔ British Medical Association ➔ Royal College of General Practitioners Also, see the website of healthcare charities concerned with issues migrant health needs Don Flynn Migrants' Rights Network