Migrants' Rights Network
From healthcare to an ‘atmosphere of fear’: New hearing for ‘hostile environment’ in NHS

From healthcare to an ‘atmosphere of fear’: New hearing for ‘hostile environment’ in NHS

The House of Commons’ Health Committee last Tuesday (16 Jan 2018) heard evidence reinforcing concerns that the Home Office’s ‘hostile environment’ policy has led to profound neglect and medical suffering, as marginalised migrants are often ‘too frightened’ to access healthcare services.

by Stewart Wheatley

The Health Committee session was considering the impact of the data-sharing agreement between the Home Office and NHS Digital, which according to a panel of experts had led to significant changes in care-seeking behaviour. Witnesses provided graphic details of migrants increasingly reluctant to visit GPs because immigration-sensitive information is now routinely being gathered by the NHS and shared with the Home Office to deport those without status. Marissa Begonia, speaking on behalf of the charity Voices of Domestic Workers, cited a case in which a domestic worker had suffer neglect and died because she was too afraid to seek hospital treatment.

An atmosphere of fear

The Committee learnt that communicable diseases risked going untreated, that pregnant women were increasingly reluctant to seek midwifery services, and that those with medical complications, such as cancer or pneumonia, were not receiving the preventative care needed.

Dr Lucinda Hiam, from Doctors of the World, reported on a case in which a woman from Eritrea who had been subject to serious sexual exploitation over a number of years, had been too scared to visit her GP or report her abuse. Dr Hiam spoke about an ‘atmosphere of fear’ and explained to the Committee that irregular migrants, who were often subject to abuse and exploitation because of their immigration status, risked losing the ‘safe place’ provided by GPs because of the data-sharing arrangements with the Home Office.

Migrants deserve patient confidentiality

A central issue in the debate is the confidentiality of patient information, a cornerstone of the doctor-patient relationship. Historically, the threshold to breach such confidentiality has been limited to very specific cases of serious harm, for example in cases involving rape or murder. However, the MoU between the Home Office and NHS Digital codifies a systematic process in which the fundamental rights of patients are being routinely breached for the lesser purpose of immigration control. MRN is seriously concerned at this unprecedented and flagrant denial of a patient’s right to privacy and confidentiality, and that as a consequence, marginalised and vulnerable migrants are being denied access to essential medical care.

In response, Lord O’Shaughnessy, Parliamentary Under Secretary of State for Health, considered such actions proportionate and lawful. However, figures provided to the Committee showed that in 2015/16, the Home Office received updated immigration information in only 195 cases (or 3.2% of approved trace requests). During the evidence session, Hugh Ind, Director General for Enforcement in the Home Office was unable to provide any further evidence to support the intelligence value gained from the MoU, but remained unwilling to consider any further review of the practice. 

Dr Joanne Bailey, speaking on behalf of the National Data Guardian, explained that there was a lack of published evidence from the Home Office regarding the value of these checks, despite assurances that this would be provided under the MoU agreement. This had reinforced concerns that the weighting between the public interest in an immigration service and public interest for a confidential health service was not being fairly balanced.    

The ‘hostile environment’ and why we need to challenge it

The systematic and widespread collection of personal data by NHS Digital for immigration-tracing purposes is part of the Home Office’s wider strategy to create a ‘hostile environment’ by forcing migrants into destitution and poverty. What is particularly concerning about this deliberate policy is that it extends across all aspects of a migrant’s life, from the right to live in a safe, secure home to the ability to access personal bank accounts to buy food or medicine.  This approach is totally wrong and undermines the fundamental principle that migrants should be able to live in the UK without suffering discrimination, harassment or inhumane or degrading treatment. Moreover, as the statistical evidence presented to the Health Committee shows, such practices fail to achieve their desired immigration purpose. Immigration tracing through a proxy service, such as the NHS simply doesn’t work. All it achieves is great pain to individuals and families, pushing vulnerable disadvantaged communities further underground. 

MRN is challenging the lawfulness of the data-sharing agreement between NHS Digital and the Home Office. We do not believe it is ethical or legal for the Home Office to have access to confidential patient information without consent. This agreement violates patient confidentiality and puts vulnerable migrants at risk because they are too scared to access healthcare service. You can help by supporting our legal challenge!

The Health Committee’s evidence session can be viewed in full on parliamentlive.tv.

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Fabien Cante

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