Hostile Environment risks public health during Coronavirus outbreak

• Liberty, Medact, JCWI and others demand immediate suspension of the hostile environment which stops migrants from accessing healthcare
• Tiered health system is undermining Government efforts to protect public health during the coronavirus outbreak, groups warn
• Letter to Home Secretary calls for immediate suspension of NHS charging and data-sharing with the Home Office

The Government’s hostile environment is stopping migrants from accessing healthcare – making them acutely vulnerable to the coronavirus, rights groups have warned.

Liberty, Medact and JCWI are among more than 30 groups to warn this not only puts the most vulnerable at risk – it also undermines the Government’s attempts to control the coronavirus and protect public health.

In a letter [1] to the Home Secretary, the coalition is calling for an immediate suspension of all NHS charging and data-sharing between the NHS Trusts and immigration enforcement [2]. This is necessary so that migrants can access healthcare free from the fear that their details could be handed to the Home Office and put them at risk of detention or deportation.

The letter also calls for a public information campaign reassuring people it will be safe for them to access care, and urges the Government to remove other barriers which stop migrants seeking help like NHS charging.

The letter warns there is significant evidence migrants don’t access healthcare – even in instances where exemptions exist for infectious diseases – because the fear of NHS charging and data-sharing between the Home Office and the Department of Health and Social Care is so ingrained.

The groups have also called for a number of measures to ensure migrants’ rights are protected during the coronavirus outbreak, including immediately suspending ‘no recourse to public funds’, making provisions to extend or modify visas if necessary, and giving assurances that migrants unable to attend immigration appointments will not be penalised.

The letter states:

“We are concerned that adequate steps have not been taken to protect migrant populations at risk of COVID-19. Inaction from the Government on this issue will worsen a health crisis that requires a truly public health-led response, not a tiered system which serves some and shuts out others.”

Gracie Bradley, Liberty policy and campaigns manager, said:

“This is a concerning situation, especially for vulnerable communities. We’re particularly worried about those who can’t access essential services either because they’re isolated or because they’re scared to for fear of being shopped to immigration enforcement.

“A public health crisis demands a public health response – not the UK’s tiered system which is rigged to help some but shut others out. To protect public health the Government must make sure everyone can seek healthcare when they need it – that means implementing an immediate data firewall between the NHS and immigration enforcement, and scrapping all healthcare charges.

“Any steps the Government takes must be accompanied by an information campaign to reach affected communities so people know they are safe to seek help when they need it.”

Dr Jessica Potter, public health researcher and Medact member, said:

“We have long warned that NHS charging and data-sharing fundamentally undermines people’s trust in the NHS. As healthcare workers that trust is absolutely vital to our work, ensuring people feel safe and supported by us when they need our care. Simply adding coronavirus to the list of exemptions is not enough.

“My research shows how the hostile environment, including NHS charging, makes people avoid seeking treatment, even when their condition is exempt. This crisis reveals how important it is that everyone living in our society should be able to access the care they need, when they need it. You cannot rebuild trust overnight but we can make a start by ending NHS charging and instituting a fire wall between the NHS and the Home Office.”

Satbir Singh, Chief Executive of Joint Council for the Welfare of Immigrants said:

“The evidence could not be clearer – restricting any group’s access to healthcare is bad not only for their health, but for that of the wider public too. We are only as protected as the least protected among us. In the midst of this unprecedented global health crisis, the Government must not only allow, but proactively encourage migrants to seek the healthcare they need.”

Contact the Liberty press office on 020 7378 3656 / 07973 831 128 or pressoffice@libertyhumanrights.org.uk

Notes:

1.

Dear Home Secretary,

RE: Protecting migrants from COVID-19

We are concerned that adequate steps have not been taken to protect migrant populations at risk of COVID-19. Inaction from the government on this issue will worsen a health crisis that requires a truly public health-led response, not a tiered system which serves some and shuts out others.

We believe the Home Office should urgently work with other government departments and take steps to:

• Immediately suspend all NHS Charging and data-sharing with the Home Office for the purposes of immigration enforcement,  and mount a public information campaign reassuring people that it will be safe for them to access care during this global public health emergency.
• Immediately suspend ‘no recourse to public funds’ conditions to ensure that everyone can access the support they need to stay safe and where necessary cease working in order to self-isolate.
• Make provision to extend or modify visas where necessary to prevent people being forced to ‘overstay’ their visa due to being self-isolated or unable to return to a country that is not safe to travel to.    
• Make assurances that migrants unable to attend reporting appointments, court dates, or interviews whilst self-isolating will not be penalised.
• Release everyone detained under immigration powers to reduce the risk of COVID-19 entering the detention estate and causing avoidable harm.
• Provide specialist support for those housed in shared Asylum Accommodation to enable safe access to medical services, testing, and where necessary, re-housing for particularly vulnerable people.

There is significant evidence that both NHS charging and data-sharing between the Home Office and the Department of Health and Social Care stops migrants from accessing healthcare, even in the case where exemptions exist for infectious diseases. There is clear evidence the Hostile Environment deters individuals with tuberculosis from accessing care and that migrants are deterred from accessing healthcare advice for fear that they will be charged for treatment, or that interaction with the NHS could lead to them being targeted by immigration enforcement.

Whilst the government has introduced an exemption for COVID-19 diagnostic tests and treatment, the charging system still acts as a deterrent  for migrants that will be charged for other tests and treatment for any comorbidities that are not exempt. The threat of charging is not the only deterrent and neither the Home Office nor the DHSC will give assurances that patient data will not be shared for immigration enforcement purposes.

Healthcare practitioners including the Faculty of Public Health have long raised concerns about underdiagnosis and undertreatment of infectious diseases arising from charging policy. At a time when COVID-19 presents an increased risk to public health, it is vital that all those who are in need of treatment are able to access healthcare without fear and without incurring charges. Simply adding COVID-19 to the list of exempt conditions is not enough, to be effective this must be accompanied by commitments to end data-sharing and a public information campaign designed to reassure people that accessing care is safe.

We welcome steps taken by the Department for Work and Pensions to ensure that extra support will be in place for workers and benefit claimants affected by self-isolation. However, most migrants have no recourse to public funds, leaving them unable to access support should they either contract COVID-19 or need to self-isolate. It is vital that NRPF conditions are lifted so that migrants are equally able to take the necessary time off to stay at home if they are suffering from COVID-19 or to prevent its spread.

Similar assurances must be made to migrants who may be forced to miss regular reporting to the Home Office, court hearings, interview appointments or are unable to submit documentation during this time. Similarly, if legal representatives cannot attend court hearings then the Home Office presenting officer or legal counsel should agree any extension that is required.  Migrants should not be forced to make a decision between accessing healthcare or risking their immigration status.

In addition, anybody who needs to self-isolate must be granted an automatic visa extension in cases where their visa may expire during their isolation period, irrespective of their nationality. Without this provision, people will fall out of status and become vulnerable to the Hostile Environment. This must also apply in all cases where migrants reaching the end of their visa period would need to return to areas with a high risk of infection, where the government has advised British citizens against all but essential travel. Although there is a policy providing for a limited automatic extension of visas, it only applies to Chinese nationals. This is no longer tenable in light of the global nature of the pandemic. The policy should apply to all migrants who are affected. The policy should also be updated urgently to extend beyond 31 March 2020.

There is also a very serious risk that the virus could spread quickly throughout all immigration removal centres. COVID-19 is highly infectious and such diseases tend to spread more quickly in prisons and other sites of incarceration. Immigration detainees are also frequently moved between different immigration removal centres and so the infection is likely to spread rapidly across the entire detention estate. In order to prevent the disease spreading rapidly among detainees, custody officers, healthcare staff and all others in Immigration Removal Centres, the government should immediately release all immigration detainees. In doing so the government should also ensure there adequate provision for healthcare in place for those people being released who have been receiving care in detention.

Asylum seekers housed in shared accommodation are similarly at risk from often overcrowded and unhygienic conditions. Independent health assessments of all asylum accommodation and relocation of persons at heightened risk from the virus must be urgently implemented alongside increased specialist healthcare provision for people in accomodation, including mobile clinic services.

The above measures must be accompanied by a wide-ranging public information campaign to ensure that migrants are able to safely access the healthcare they need during a public health crisis.

Yours sincerely,

Medact

JCWI

Liberty

Doctors of the World

Helen Bamber

Docs Not Cops

Bail for Immigration Detainees

Quakers

Lewisham Refugee and Migrant Network

Immigration Law Practitioners’ Association

Praxis

Hackney Migrant Centre

Right to Remain

Women for Refugee Women

Akwaaba

Another Europe is Possible

Migrant Voice

Human Rights Consortium Scotland

UKLGIG

Runnymede Trust

New Economics Foundation

Pecan

English for Action

Housing Action Southwark and Lambeth

MSF UK Take Action Group

Migrants Organise

Doctors for the NHS

Soas Detainee Support Group

Asylum Matters

Keep Our NHS Public

Health Campaigns Together

For further information on the impact of NHS charging and data-sharing please read:

• Medact (2019) Patients Not Passports: Challenging healthcare charging in the NHS
• Liberty (2018) Care Don’t Share – Hostile Environment data-sharing: Why we need a firewall between essential public services and immigration enforcement.

cc. Health Secretary, SSWP, Home Affairs Select Committee, ICIBI, HMIP

2.

In 2018, NHS England suspended some data-sharing with the Home Office, but not all. Currently, when a person owes a debt of more than £500 an NHS Trusts share their details with the Home office, this information is then used to prejudice applications for leave to remain, and their address is shared with immigration enforcement.