The representation of migrants in policy and parliament: A Bacchian analysis of the UK's immigration health surcharge

Immigration and health in the UK

BackgroundThe NHS Charges to Overseas Visitors Regulations 2015 outline when healthcare costs should be recuperated from overseas visitors in England. National and global stakeholders have expressed concerns that charging may exacerbate health inequalities and undermine public health efforts especially among vulnerable migrant groups. This review aims to systematically describe the evidence regarding the impact of NHS charging regulations on healthcare access and utilisation and health outcomes for migrants in England.MethodsA systematic search of scientific databases and grey literature sources was performed. Quantitative and qualitative studies, case studies and grey literature published between 1 January 2014 and 1 April 2021 were included. Screening, data extraction and quality appraisal were carried out in accordance with PRISMA guidelines.ResultsFrom the 1,459 identified studies, 10 were selected for inclusion. 6 were qualitative, 3 were mixed methods and 1 was quantitative. The evidence is lacking but suggests that fears of charging and data sharing can deter some migrants from accessing healthcare. There is also evidence to suggest a lack of knowledge of the charging regulations among patients and healthcare professionals is contributing to this deterrence.ConclusionsFurther independent research supported by strengthening of data collection is required to better understand the effects of charging on healthcare and health outcomes among vulnerable migrants. Our findings support improved training and communication about NHS Charging Regulations for patients and professionals.

THIS essay is to use tourism to illustrate some fairly representative difficulties of 'social planning'. The label is not important; in practice it means the whole range of decisions and administrative practices which are concerned with the search for solutions to social and economic problems in a defined spatial framework. Tourism is taken in a very wide sense.! Tourists are simply transients -non-residents. A London tourist is anyone who visits the area. The tourist may come for a day (then sometimes called an excursionist),2 or a month. He may come from elsewhere in the British Isles, or abroad. He may have come on business, or for a holiday, or, quite often, for more than one reason.3 He may stay in a hotel, a private boarding house, or on a camp site; or he may rent a furnished flat, or lodge with friends.4 In what follows 'tourists' refers to both British and overseas visitors to London, but we mainly mean those who stay overnight, and on other occasions mainly to overseas guests. There is a large literature on the subject, much of it filled with statistical tables (including forecasts), financial accounts, and the results of surveys.5 Although it will be necessary to quote some of these, they are not central to the approach adopted here. (But see Tables I and 2.) There was a 'tourist problem' when London saw five million visitors a year; there were supposed to be 7.6 million overseas visitors in 1976 and 1977 may bring ten million.6 Some forecasts refer to 15 and 20 million per annum.7 We are not here concerned with the debates about the contribution of overseas visitors to Britain's balance of payments (though this aspect enters into the policy debate).8 Nor are we concerned with visitors' attitudes and complaints.9 Most of the existing literature deals with a particular problem area or field of departmental responsibility. The few general surveys (like that of Sir George Young)l° tend to see the subject as one which is basically amenable to our normal processes of legislative compromise and gradual adjustment to market forces. Here it will be postulated that there are some areas of planning policy where there is an inherent conflict of interests which cannot be resolved satisfactorily by conventional methods. There is no 'best' way of dealing with the situation in the sense of laying down a strategy which will at once meet the needs of all sections of London's resident population, and accommodate the maximum number of visitors so as to increase Britain's foreign currency earnings. No hotel location or employment policy will at the same time improve the economic base of the London area and reduce traffic congestion caused by visitors.

To understand if, and how, Australian ultra-processed food industry actors use Twitter to influence food and health policy debates and produce a conceptual framework to describe such influence. Twitter data of prominent industry actors were defined through purposive sampling and inductively coded to investigate possible influence on food and health policy debates. These are described using descriptive statistics and coded extracts. Australia. Twitter accounts of nine prominent ultra-processed food industry actors, including major trade associations. Ultra-processed food industry actors actively used Twitter to influence food and health policy debates. Seven overarching strategies were identified: co-opting public health narratives; opposing regulation; supporting voluntary, co- or self-regulation; engaging policy processes and decision-makers; linking regulatory environments to the need for ongoing profitability; affecting public perceptions and value judgements; and using ignorance claims to distort policy narratives. Each lobbying strategy is underpinned with tactics described throughout and captured in a framework. The current study creates a framework to monitor how food industry actors can use social media to influence food and health policy debates. As such, social media appears to be not only an important commercial determinant of health for brand marketing, but also an extension of lobbying practices to reshape public perceptions of corporate conduct and policy-making.

Hospital managers who are responsible for charging overseas patients for NHS treatment asked some general practices to help them identify whether patients were eligible for free care, the BMA has...

Some people in the United Kingdom are struggling to access routine medical care, including consultations with GPs and antenatal care, because they are wrongly being labelled as “health tourists,” says...

This chapter examines the rhetoric of government and opposition in the Parliamentary debate over the 2010 NHS White Paper ‘Equity and Excellence.’ It treats the debate as a process of deliberative argument in which Secretary of State Andrew Lansley justifies his reorganisation and explores the extent to which his policy argument was scrutinised by both the opposition and by members of his own Coalition government. The chapter suggests that Lansley offered an unjustified reorganisation based on market-based governance and decentralised accountability, which would at the same time generate substantial savings in a time of financial austerity. This is contrasted with the often fragmented arguments offered by voices in the opposition. The authors ask questions about the extent to which parliamentary debate is able to adequately scrutinise governmental proposals of the complexity of healthcare reorganisation, especially at the beginning of a new term in office.

Editor's Introduction

Towards better health for refugee children and young people in Australia and New Zealand: The Royal Australasian College of Physicians perspective

Background: NHS Regulations were amended in 2004, restricting access to secondary healthcare for refused asylum applicants. In recent years there have been substantial numbers of unsuccessful asylum applications from Zimbabwean nationals. HIV-positive Zimbabweans with insecure immigration status in the UK occupy a precarious medico-legal position, especially since HAART is not available to most in Zimbabwe. There has been little research on these policies or their effects on the lives of Zimbabwean HIV-positive women in the UK. Objectives: This thesis examines the development and implementation of UK policy relating to access to HIV-related services by Zimbabwean HIV-positive women with insecure immigration status, and explores how these policies influence women's healthcare. Methods: Three separate strategies were used for data collection. Policy analysis scrutinised 35 publicly available documents and additional material obtained through Freedom of Information (FOI) requests. Data for policy analysis were also collected through semistructured interviews with 24 HIV/immigration key informants. Further qualitative data were collected through semi-structured interviews with 13 Zimbabwean HIV-positive women with insecure immigration status. These different approaches allowed for data 'triangulation'. Results: Policy restricting access to healthcare for migrants is situated within three immigration control strategies of deterrence, internal control, and 'enforced discomfort'. Implementation of the policy has been limited by staff who interpret it to suit their own agendas. Access to HIV-care for Zimbabwean women seems to bear little relation to these policies, but their access to other health services and their wellbeing was influenced by a number of other socio-structural barriers associated with their immigration status. Conclusions: These results offer new evidence and theoretical models on the politics of immigration policy, the role of street-level bureaucrats as mediators of the gap between policy and practice, and on access to healthcare for migrants. There is a disjuncture between policy on entitlement and clinical practice, which may reflect a conflict between clinicians' duty of care and UK policy. Zimbabwean women's HIV- and migrant-status places them in a periphery, reducing the resources available to them that could mitigate some of the barriers they face.

Migrant women are at higher risk to face access barriers to perinatal care services and to experience worse pregnancy outcomes compared to native. Assessing the perception of migrant women and health providers discloses a multifaceted view on migrant-friendly care, a multidimensional concept in itself. This study aims to compare self-perceived assessments of migrant women and directors of obstetrics and gynaecology (GYN/OBS) departments on equitable migrant-friendly perinatal healthcare quality and access during the intrapartum and postpartum period at public maternities in Portugal. In this cross-sectional study, two indicators on Healthcare access and Quality of care were developed to compare how adult migrant women who gave birth between April 2017 and March 2019 and GYN/OBS department directors assessed offered care. The one-sample Wilcoxon test was used to compare directors' with migrants' assessments and the Kruskal-Wallis one-way analysis of variance to test for country regional differences. A stratified analysis by sex, spoken language, and country of birth tested for potential effect modifiers. Migrants rated Healthcare access significantly better (P<0.05), but perceived Quality of care worse (P<0.01) than GYN/OBS department directors. Migrants' and directors' perceptions differed significantly according to directors' gender (P<0.05). Migrants' and directors' assessments on Healthcare access (P<0.05) and Quality (P<0.01) changed significantly across regions. Migrants' and directors' self-perceived appraisal of Healthcare access and Quality of care significantly varied. Identifying these discordances allows to deliver insights into existing barriers in access and provision of care and raises awareness to improve quality assurance, essential to inform practice and policies.

I chose ‘access’ as my watchword for this ICN Quadrennium. By this I mean access by populations to health care, including primary health care (PHC), access by nurses to contemporary education programs, and access by governments and policy makers to nursing advice. The last notion is my focus for this column. More than ever before nurses are crucial to building and strengthening the health care systems within which they work. Nurses are the principal providers of PHC in the developing nations of the world. Their role will inevitably be enhanced as demographics change due to ageing populations and the increased incidence of chronic disease. Thus nurses must be central to the process of building and strengthening health systems. Whilst it may seem to be a ‘no brainer’ for governments to engage nurses in decision-making for health, the reality is often very different. In some situations nurses and their associations cannot gain access to the policy debate on which decision-making is predicated without forming partnerships with other groups. These groups may be other nursing bodies, consumer or employer groups, or organisations representing other health professionals with similar interests in the specific issue. Collaborating with other groups is not without risk as there may only be a narrow convergence of goals and lobbying activity will need to be contained. On the other hand, a consortium can often exert more power than a single group acting alone. Nurses and consumers are a formidable alliance and too often this potential grouping is overlooked. For such an alliance to be effective, both groups need well-articulated and congruent goals. Nurses can provide valuable perspectives on the population health needs of communities as well as on wider health system design. The International Council of Nurses (ICN) through contact with its more than 130 members is aware of many examples of nurses influencing access by consumers to health care at the country level. Let me illustrate the breadth of nurses’ influence by offering a few examples of lobbying and engagement efforts that resulted in enhanced health systems for consumers. In Denmark, nurses providing care for patients with back problems maintained regular contact with them by telephone, which had the effect of reducing hospital admissions by half. This program both increased access by patients to health care and reduced inpatient costs. In the area of tuberculosis care, nurses in Lesotho and the Philippines have led their countries in the prevention, care and treatment of tuberculosis, thus facilitating access by their populations to health care. An outstanding example of nurses’ power can be seen today in the United States. The American Nurses Association lobbied long and hard along with others to achieve passage of the Affordable Care Act, which contains provisions for extended health insurance coverage for people who were previously uninsured. Nurses’ engagement in this debate was critical since they understood the health system from a consumer perspective and saw how it needed to be changed to increase access to care. Another example is the successful campaign for reform of aged-care waged over some years by the Australian Nursing Federation in collaboration with a range of groups with similar goals. The campaign culminated in a significant increase in funding for all aspects of aged care benefiting both the aged population and aged-care nurses. These examples constitute but a snapshot of the power of nurses to influence the policy debate and decisions in health care. Nurses must continue to be engaged even though such involvement takes time and energy and may not always succeed. Because governments change, a key challenge for nursing organisations is to maintain the right level of exposure and interest in the health policy debate so that apolitical nursing advice can be sought. In most countries nurses constitute the largest group of health professionals. We have a unique role to play in health policy development and we must ensure that we fulfil it for the benefit of the populations we serve. It is critical that we share our successes and provide support to our colleagues across the globe.

Adaptation to the health effects of climate change and mitigation of the associated health risks is a global health policy issue that requires local and regional cooperation along with adequate resource allocation. However, following the withdrawal of the USA from the Paris climate accord, a new model of global climate response needs to be enforced, considering the urgency of these health effects among the low-income and middle-income countries (LMICs) of the global south.1Watts N Adger WN Ayeb-Karlsson S et al.The Lancet Countdown: tracking progress on health and climate change.Lancet. 2017; 389: 1151-1164Summary Full Text Full Text PDF PubMed Scopus (202) Google Scholar Regional, national, and local actors need to be involved, thinking globally and acting locally. Although building capacity in local and regional policy leadership necessitates the involvement of educators, the multisectoral nature of the problem demands the use of learning approaches that are interprofessional and inquiry-based. Hence, we propose the use of academic, parliamentary-style health policy debates for building capacity in climate leadership among today's students—ie, the policy leaders of tomorrow. Many such debates in the past have mimicked the World Health Assembly and its global scope. However, simulations of regional and local diplomatic bodies allow for a focused deliberation and the voicing of relevant, evidence-informed arguments. In an example of a regionally focused health policy debate, an interprofessional group of students from both health and non-health professions participated in the Manipal Model WHO 2018 (at the Manipal Academy of Higher Education, Manipal, India), where they debated approaches for adapting to and mitigating against the health effects of climate change in the south Asian region.2The Hindu Students debate climate change, health at Manipal Model WHO.https://www.thehindu.com/news/cities/Mangalore/students-debate-climate-change-health-at-manipal-model-who/article22758003.eceDate: Feb 16, 2018Google Scholar By receiving targeted instruction in health research literacy, parliamentary debate procedure, public speaking, and drafting policy documents, students showed key interprofessional and leadership skills to reach mutual consensus on the way forward. By building on existing generic WHO frameworks, they developed and voted on draft resolutions that presented region-specific policy plans to address local health effects. Similar health policy debates in education for health professionals have also been done in other LMICs, such as the Medical Model UN (ie, MedMUN 2014 and MedMUN 2015) in Malaysia involving only issue-appropriate nations.3Godinho MA Murthy S Ali Mohammed C Debating evidence-based health policy in an interprofessional classroom: an exploratory study.J Interprof Care. 2018; (published online Oct 31)DOI:10.1080/13561820.2018.1541873PubMed Google Scholar Likewise the National Health System 2017, a national health assembly simulation in Sudan,4Godinho MA Murthy S Ciraj AM Health policy for health professions students: building capacity for community advocacy in developing nations.Educ Health. 2017; 30: 254-255Crossref PubMed Scopus (3) Google Scholar debated domestic and regional issues specific to the region. These examples show that the local expertise for organising and conducting such debates is available in LMICs. Disseminated efforts and targeted interventions to mobilise this expertise can provide much needed opportunities for building local and regional policy leadership to address the health effects of climate change, specifically in LMICs. We declare no competing interests. The Lancet Countdown: tracking progress on health and climate changeThe Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be “the greatest global health opportunity of the 21st century”. The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. Full-Text PDF

Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers. We conducted a scoping review of the peer-reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation-by-scope category. The final yield included 44 peer-reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry-motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin-motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission-motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission. In our scoping review of the 340B program, the highest-quality evidence indicates nonprofit, DSHs may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy discussion regarding the 340B program.

Offline: The UK's child health emergency