For the past decade, MRN has been worried about the creep of immigration enforcement into public services, like health and education. After years of raising awareness, we decided to take action. On 9 November 2017, we launched our first ever legal challenge to contest a data-sharing agreement between the Home Office, Department of Health and NHS Digital. This back-door arrangement, like others that have been uncovered, is part of a process whereby the Home Office is co-opting other Government departments to do their ‘dirty work’. Beyond the scandal of data protection exemptions, deals like the one we are challenging, put the lives of vulnerable migrants at risk.
By FIZZA QURESHI
Backdoor Immigration Enforcement
The creation of a ‘hostile environment’ for migrants was announced in 2012, but it has since been uncovered that data-sharing for immigration enforcement has been in practice since as early as 2008. By trawling the databases held by other Government departments, the Home Office has found a back-door route to pursue its disputable objectives of immigration enforcement. Beyond the objectives, however, the method itself is highly questionable – amounting, in effect, to widespread deception. This is particularly clear in the data-sharing agreement we are challenging in court. This agreement allows the Home Office to access patient information held by NHS Digital for purposes of immigration enforcement. The agreement was signed in secret, without consulting the public or NHS professionals.
As a result, migrants are unaware that their data is being harvested for immigration enforcement when they use health services. Health professionals are also deceived. They are often unaware that the information they gather on their patients is being used by other Government departments, with ulterior motives.
It is worth noting that a review of NHS Digital’s data-sharing practices was released two days before MRN and its legal advisers submitted their legal challenge. This review took into consideration “the appropriateness, effectiveness and efficiency of the tracing services provided by NHS Digital.” It revealed that, over the past two years (2014-2016), there were in total 10,275 requests from the Home Office for immigration reasons. 55% of all the data requests received by NHS Digital came from the Home Office in 2015-16.
Surprisingly, the review argues that there is no confidential patient information being shared. The information that NHS Digital do share with Government departments – a patient’s name, date of birth, gender, area they are registered, and last known address – is deemed to be merely administrative data, not confidential or sensitive information. But this is this contrary to how the British Medical Association (BMA) itself labels confidential patient information.
It also flies in the face of common sense. When have you been able to call a GP surgery, and find out if someone is registered without that patient’s consent? You can’t! This is because health providers understand that this information is as confidential and sensitive as a patient’s medical information. Imagine the situation of a domestic violence victim fleeing from an abusive partner, or a trafficking victim that is trying to remain hidden from the traffickers: what kind of protection would they be getting if all it took to track them was a call to a health provider?
Evidence of a Deterrence Effect?
The review further noted that several public bodies expressed concerns over NHS Digital’s data-sharing agreement. Public Health England’s (PHE) Health Migrant and Visitor Health team, BMA Ethics representatives, and other NGOs argued that such data-sharing may deter vulnerable people from seeking healthcare. If any contact with the NHS might lead to detection by the Home Office, in other words, migrants might well avoid using health services altogether.
In its response to the review, for example, PHE stated that: “If patients have concerns that their personal information, even simple identifiers, could be shared with law enforcement or immigration enforcement agencies… then this risks creating a real barrier to their engagement. Any barriers, actual or perceived, to patients accessing healthcare can have serious consequences … [this] is concerning from a public health and personal healthcare perspective”
The review found no evidence that data-sharing deals deterred migrants from using the NHS. Yet this is contradicted by Doctors of the World UK. In their witness statement for MRN’s legal challenge, Doctors of the World stated that “…service users are either stating that they will only register if they are sick (foregoing access to preventative medicine) or will not register with a GP in any event… Even before the [most recent data-sharing agreement], more than 1 in 10 of DOTW’s patients did not access NHS services for fear of immigration enforcement.” If this isn’t clear evidence of a deterrence effect, then what is?
The data-sharing agreement clearly risks spreading distrust between migrant communities and the health services. In addition, the agreement is in its very nature discriminatory. It exclusively targets non-British people, stripping them of their data privacy rights. There is also ample ground to suspect that those most affected by the agreement will largely come from already-marginalised BME communities. We know that many from BME communities already avoid public services such as health and social care, and therefore end up with poorer health outcomes.
With upfront charging and checks in hospitals and community health settings, there is plenty already there for migrant and BME communities to wonder if they are ever going to be welcome to access health services without being questioned about their immigration status. Add to this, the burden on health professionals to act like immigration officers is only getting heavier.
In sum, the data-sharing agreement between the Home Office and the NHS undermines the patient-doctor relationship, entrenches existing discrimination, and might lead vulnerable people to avoid seeking vital care for fear of being profiled. The health risks for individuals and communities are huge. Driving people underground and making them fearful of health providers, putting themselves and others at risk, is surely not the kind of society we want.
For these reasons, we felt it was MRN’s duty to challenge the Home Office/NHS data-sharing agreement – morally, legally and publically. We hope that you will join us by supporting our legal challenge, and pledging your support. It’s time we remind the Home Office that they cannot pick on vulnerable migrants without opposition.