1. The Asylum Process & Entitlement to Care for Women Seeking Asylum Lorna Gledhill Regional Asylum Activism Co-ordinator, Yorkshire and Humberside

2. What is a refugee? "A person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it..“ UN Geneva Convention, 1951

3. Everyone has the right to seek protection and claim asylum in a state outside their country of origin. An asylum seeker in the UK is somebody who has applied for refugee protection from the UK government, but is awaiting a decision on their claim. But what is an asylum seeker?

4. The Asylum Process Arrival in UK Applies for Asylum at Lunar House, Croydon Sent to Initial Accommodation Asylum Support Application Screening Interview Dispersal into Housing Reporting / Waiting Decision from Home Office Leave to Remain! Refusal (Appeal) Refusal (A.R.E) Removal / Vol Return Detained Fast Track Substantive Interview

5. After filing a claim for asylum, individuals can apply for financial and accommodation support from the Home Office: Section 95 : financial support & accommodation for asylum seekers during their claim. = £36.95 in cash for a single adult or child per week Section 4: highly conditional financial support & accommodation for refused asylum seekers. = £35.39 on pre-loaded card for a single adult per week People seeking asylum are not allowed to work. Financial Support

6. Housing is provided on a no-choice basis to those who are eligible for support. Glasgow: 2,462 L’pool: 1,437 B’ham: 1,113 Cardiff: 966 Rochdale: 804 Q2 2015 (Section 95 only) Housing

7. People seeking safety in the UK can have very complex health problems due to upheaval, family separation and trauma. Yet… 73% of patients seen by Doctors of the World in London were not registered with a GP even though they were eligible. 21% of their patients had been denied access to healthcare in the last 12 months. Why are we concerned about healthcare? The psychological health of refugees and people seeking asylum currently worsens on contact with the UK asylum system.” Royal College of Psychiatrists

8. Immigration Act 2014 The Immigration Act and DoH guidelines have: Changed the criteria for access to free care Created incentives and sanctions for secondary care providers to pursue payments. Proposed the extension of charging principles to emergency care and parts of primary care.

9. Immigration Act 2014

10. RefugeesAsylum Seekers in receipt of S95/S4 Refused Asylum Seekers (not on support) Primary Healthcare Free Secondary Healthcare Free Charged Emergency Healthcare Free Maternity CareFree Charged Current Healthcare Entitlements of Refugees and People Seeking Asylum

11. There are currently no regulations regarding charging for primary care, or eligibility for primary care. All GP’s have the discretion to accept or refuse any person as an NHS patient, but they must not discriminate. Access to Primary Care Therefore: -Immigration status is irrelevant when registering with a GP -No legislation or statutory guidance suggests people must be resident for a minimum length of time or have a visa in order to access primary care

12. Entitlement to free hospital treatment is based on whether you have ‘Indefinite Leave to Remain in the UK’ (since the passage of the Immigration Act 2014). There are patient-based exemptions and treatment-based exemptions. Treatment-based exemptions: A&E Family Planning Services Treatment of certain communicable diseases & sexually transmitted diseases Treatment required under the Mental Health Act Treatment of HIV Secondary Care: People Seeking Asylum

13. Patient-based Exemptions Asylum seekers on Section 4/95 Refugees EEA Nationals (state-to-state billing) Dependency visa Work/Student Visa (will have paid health surcharge) Survivors of trafficking who have been through the NRM Children in the care of local authorities Secondary Care: People Seeking Asylum exempt People currently seeking asylum are exempt from charges for NHS hospital care.

14. Refused asylum seekers, who are not in receipt of UKBA support, are liable to be charged for secondary care. However: Treatment received whilst ‘charge-exempt’ must be provided for its full course and not be chargeable. General exemptions for specific care still applies. Hospitals are obliged to provide ‘immediately necessary’ or ‘urgent’ treatment irrespective of a patient’s ability to pay. Secondary Care: Refused Asylum Seekers ‘non-urgent’ Only treatment which is ‘non-urgent’ can be withheld pending payment.

15. Maternity Care: Refused Asylum Seekers Maternity Care can never be withheld from someone who is unable to pay for treatment. Refused asylum seeking women CAN be charged for the care they receive. Maternity care is not exempt from charging, but is automatically classed as immediately necessary treatment. Maternity care includes antenatal care, birth and postnatal care and includes HIV treatment during pregnancy.

16. The majority of people seeking asylum will be entitled to free NHS care. However, fears – both perceived and real – of being charged for treatment have deterred many from accessing the care they are entitled to. Rather than improving access to healthcare, recent legislation has created more barriers to people to accessing the care they need. But what’s really going on…

17. Entitlements Your entitlement to free care is linked to your asylum claim. Healthcare needs do not change according to your immigration status. Charging Destitute refused asylum seekers are chargeable for secondary care, but unable to afford the charges. Deterrence Recent regulations on charging have created confusion amongst healthcare providers on who is eligible for what. Legislative Barriers to Healthcare

18. Difficulties registering with GPs Unwelcoming atmospheres in GP surgery Obstructive receptionists/administrative staff Fears of being reported to the authorities Fear of being charged for care Unfamiliarity with the structure of healthcare provision General difficulties in the asylum process Experiential Barriers to Healthcare

19. What impact does this have? Increased presentation at Accident and Emergency Decrease in preventative care pathways Loss of important advocacy support from GPs Lack of engagement in maternity services (as GPs are primary referral route) and late disclosure of FGM Less diagnosis of both communicable and preventable conditions Further barriers to accessing mental health support Increased pressure on health professionals

20. What next? Changes to healthcare entitlements will be rolled out over the next 18 months under the Department of Health’s ‘Implementation Strategy.’ December Consultation on extending charging to emergency care and parts of primary care… We can still kick up a fuss! Lobby decision-makers to call for a widening of exemptions Speak out about the importance of universal access to free healthcare for people seeking asylum Make sure that we empower people seeking asylum with knowledge of their rights and entitlements to healthcare.

21. The new healthcare proposals are “impractical, uneconomic and inefficient.” “GPs must not be a new border agency in policing access to the NHS.” Teamed up with Maternity Action to call for a exemption on NHS charging for all pregnant women and children.

22. Practical Actions of Welcome Smile! Take time to listen. Recognise the additional pressures and needs of people seeking refugee protection. Care should be provided on the basis of clinical need, not the patient’s ability to pay. Make proactive referrals to other forms of support.

23. “Depriving people of healthcare doesn’t make health problems go away.” For further information about campaigns, briefings and opportunities, contact Lorna Gledhill on 07557 982 498 or yandh@regionalasylumactivism.org