Demos: Migrant health access fears put vulnerable people at risk

– One in six vulnerable UK migrants avoid seeing GP or seeking medical advice for fear of immigration control consequences
– Demos calls for ‘all-in-one advice centres’ co-locating GPs with advice support to encourage unregistered patients to seek risk-free advice
– Think-tank report argues it would reduce health costs and improve NHS data
A new report by the think-tank Demos urges the Government to set up ‘all-in-one’ centres combining GPs with advisors to encourage migrants to seek health treatment despite concerns over their immigration status.

The report argues that encouraging earlier detection of health conditions amongst migrant communities would reduce NHS spending on treatment and reduce the wider public health risk by catching transmittable diseases early.

The ‘all-in-one’ centres would bring together frontline NHS staff with expert advisors from support agencies, such as Citizen’s Advice or the Mary Ward Legal Centre, who would confidentially be able to inform patients what they are eligible for, where they can access care and what charges they might incur.

The research, published today, builds on evidence from a Doctors of the World survey of 1,000 migrants – which found 90% have not registered with a General Practitioner even though they were eligible to do so.

20% of those who didn’t register – the equivalent of more than 100,000 people (close to 1 in 6 of Britain’s estimated 580,000 undocumented migrant population) – said they were deterred from seeking care for fear of the immigration control consequences.

The report responds to concerns about Government proposals for extra NHS charges for migrants that could deter even more vulnerable people from accessing the healthcare they need.

Previous Demos research also found a significant number of the 850,000 migrants who cannot speak English struggle to access public services.

The report goes on to say that if migrants are put off from accessing healthcare the NHS will struggle to build up an accurate data profile of emerging trends in healthcare needs.

The centres would act as a ‘first port of call’ and would function on a triage basis referring patients to further treatment as required. Demos suggests they could be located primarily in areas with high ethnic minority populations, alongside existing services or premises in an effort to minimise costs.

The report also recommends:

– Blanket exemptions for children in NHS eligibility criteria, both for ethical reasons and to also catch conditions early enough to prevent serious, expensive treatment.
– One-way information sharing that allows health professionals to access information held by the Home Office, without permitting the reverse – thus reassuring any migrants that seeking treatment will not lead to questions over residency.
– The Government carries out rolling impact assessment of the changes to understand the effect on frontline medical staff and review additional data obtained through the centres to more accurately plan the assignment of healthcare resources in future.
– The NHS implements a campaign to educate administrative staff about the charging system and people’s entitlements.

Max Wind-Cowie, Demos associate and author of the report, said:

“You don’t have to approach this issue ideologically to see the wider risks of discouraging migrants from accessing healthcare.

“The potential costs to the system of delayed treatment and risks to public health of missed opportunities for diagnosis speak for themselves – we do not want to inadvertently push up the price of healthcare in a misjudged effort to tackle perceptions of abuse and misuse.

“The current Ebola outbreak puts this issue in extremely sharp focus. It would be morally indefensible to leave vulnerable people – from children and young people to unwell but undocumented migrants – at risk of going untreated when we should be doing everything possible to protect public health.”

Leigh Daynes, Executive Director of Doctors of the World UK, said:

“Volunteer doctors at our London clinic see a steady stream of vulnerable migrants who – despite being entitled to it – are denied access to NHS care or are too afraid to try.  This includes people with serious illnesses like cancer, parents with small children and heavily pregnant women.

“The patients we see are not health tourists, they live here – on average for more than four years before seeking a doctor’s help.

“Protecting the NHS from alleged misuse must not compromise a doctor’s duty to treat the patient in front of them, regardless of income or status.

“There must be a way to achieve the political imperative to manage migration whilst ensuring equitable, sustainable access to healthcare for everyone living here.”



The report, Do No Harm, by Max Wind-Cowie and Claudia Wood is published by Demos on Monday 20 October 2012.

This research was supported by Doctors of the World.

British migrant figures according to The Migration Observatory at the University of Oxford: