Care for vulnerable migrants in the UK

Abstract

Health care for vulnerable migrants in the UK was thrown into disarray last week when the Court of Appeal ruled that failed asylum seekers are not entitled to free secondary care in the National Health Service (NHS). Under the new law, hospitals do have the discretion to provide treatment when there is no prospect of payment. The changes are complex. On April 2, the Department of Health issued a letter about the ruling to chief executives at NHS Trusts. It states that if a doctor deems their patient's treatment to be “immediately necessary” it must be provided, irrespective of a patient's status and ability to pay. However, if treatment is categorised as “urgent”, care can be provided depending on when the patient is likely to return home but should not be cancelled or delayed based on a patient's ability to pay. If treatment is “non-urgent” and can wait until the patient returns home, it should not be started. But if the patient is unlikely to return home for some time and the need for care remains non-urgent, treatment should be initiated after payment is received. Doctors can move patients to “urgent treatment” or “immediately necessary treatment” if their medical condition changes. Communicating the implications of the ruling will be a challenge. The Department of Health needs to clarify that the law only applies to secondary care; general practitioners are still able to register irregular migrants. The Department must also issue clear guidance to front-line hospital staff about what these rules mean in practice. For example, which patients are exempt? How do they expect clinicians to decide the status of their patients on a day-to-day basis? Crucially, it is clinicians who should make decisions about the urgency of their patients' treatment, not hospital administrators. Care must be provided when needed and doctors must not be encouraged to abandon patients. Failed asylum seekers are an extremely vulnerable group of individuals; many of them are destitute and homeless. Their care must be determined on the basis of clinical need alone.