NHS: A great healthcare system but how accessible is it to migrants?

This article was exclusively written for The European Sting by Mr.Ahmed Al-Tameemi is a second-year Iraqi medical student at the University of Central Lancashire, UK. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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The United Kingdom’s National Health Service (NHS) is one of the leading healthcare systems around the world; However, it has its flaws. Upfront payment for some services and sharing patients’ records with the Home Office (the authority responsible for immigration) are the two main issues within the NHS when it comes to migrants’ access to healthcare. Around 14% of the 2016 UK population was not born in the UK and asylum-seeking peaked its highest since 2004 at 41% in 2016 ^{[1] [4] [5]}. Payment for chargeable services can be delayed but cannot be waived leaving migrants with debts they might be unable to pay leading to refusal of their immigration requests. The charging regulations are complex and not easily understood especially to new-comers to the country. Combining that with the fear of being charged even for exempted services represents a major hurdle accessing healthcare services. In addition to vulnerability and marginalisation, undocumented migrants face numerous other barriers to accessing healthcare ranging from poor English, unfamiliarity with the NHS and avoidance of interaction with governmental authorities including healthcare providers ^[2]. Chargeable services and the data-sharing policy with the Home Office erode the distinction between healthcare services and governmental authorities undermining the ability of healthcare providers to reassure patients that information discussed is confidential and that it is safe to talk openly. About 10% of patients avoided NHS services because of immigration enforcement. This along with other possible factors like poverty, overcrowding, poor housing and nutrition contribute to health deterioration of migrants leading to treatment at later stages which is more expensive, putting a greater burden on the NHS budget. Therefore, preserving confidential medical consultations without data-sharing policies and reducing charges or exempting migrants from paying for certain services, improve their health outcomes ^[3]. Other challenges include limited access to sexual and mental health services due to the stigma around these areas and the lack of establishing good sexual history including history of sex trafficking and sexual violence. Patients are also less likely to engage with the healthcare system if they have poor English as the NHS needs to provide interpreters who might be from the same local community as the patients’ creating a barrier to open communication with the healthcare provider because of fear of possible judgment or stigma by the interpreters. To overcome that, inclusion and diversity courses along with health awareness classes including sex education should be introduced in all institutions and schools. These courses raise awareness on personal care, hygiene, prevention measures and what services migrants can access and ways to access them. Such courses should also be delivered to migrants and newcomers along with English language courses easing their integration with their new environment and helping them access services especially healthcare ones without requiring interpreters reducing the financial burden on both the patient and the NHS. These courses would also reduce the effects of stigma and discrimination based on protected characteristics contributing to wider access to healthcare services as it promotes openly sharing information for better-quality care. References

1. Home Office. Asylum. GOV.UK. https://www.gov.uk/government/publications/immigration-statistics-july-to-september-2016/asylum. Published 2016. Accessed March 22, 2019.
2. Department of Health. Overseas chargeable patients, NHS debt and immigration rules. 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730171/Overseas_chargeable_patients__NHS_debt_and_immigration_rules.pdf. Accessed March 22, 2019.
3. Whelan I. The effect of United Kingdom immigration policies on migrant access to sexual and reproductive healthcare. BMJ. https://srh.bmj.com/content/45/1/74. Published 2018. Accessed March 22, 2019.
4. Migration Observatory. Migrants in the UK: An Overview – Migration Observatory. Migration Observatory. https://migrationobservatory.ox.ac.uk/resources/briefings/migrants-in-the-uk-an-overview/ . Published 2019. Accessed March 22, 2019.
5. Morgan P. Population of the UK by country of birth and nationality – Office for National Statistics. Ons.gov.uk. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/internationalmigration/bulletins/ukpopulationbycountryofbirthandnationality/2016. Published 2017. Accessed March 22, 2019.

About the author Ahmed Al-Tameemi is a second-year Iraqi medical student at the University of Central Lancashire, UK. He is involved with the IFMSA (International Federation of Medical Students’ Associations) as a certified international trainer and as the UK National Officer on Sexual and Reproductive Health and Rights including HIV and AIDS, part of the British Council: Active Citizen program operating in Iraq, Public policy alumni of the US embassy Iraqi Young Leaders Exchange Program (IYLEP), Branch president of Students for Global Health-UK and delivered Training Sessions on Sexual Health and Refugee rights in London, Cardiff, Leeds, and Slovenia.