People are demonstrating over a government policy that endangers migrants

23rd October 2018

Hundreds of healthcare workers and patients are protesting today, a year after the government introduced ID checks and upfront NHS costs for medical care for some migrants.

Before the introduction of checks and upfront costs — known as the hostile environment policy — bills were sent to patients once their treatment had been completed. Primary care remains free for all, but secondary care, community care and anything deemed to be “non-urgent” now requires migrants to demonstrate their eligibility to pay up-front or foot a substantial bill before receiving treatment.

This means that while a visit to A&E or a GP visit remains free to access, migrants trying to access midwifery, abortion services or who end up on a ward after an accident will have their ID checked and be liable to pay the cost of their treatment in full.

The hostile environment policy is a set of measures designed to make staying in the UK as difficult as possible for people without leave to remain, in the hope that they may “voluntarily leave”.

In the year since this policy was introduced, the Windrush scandal revelations have demonstrated clearly the devastating effects the hostile environment can have on people’s lives.


Sylvester Marshall, who came to the UK from Jamaica as a teenager and has lived here for several decades, was last year denied radiotherapy treatment for prostate cancer as he couldn’t produce a UK passport, despite being in the UK legally. Marshall was told he wouldn’t be able to receive treatment unless he paid £54,000, but after his story received national attention thanks to reporting by the Guardian, Marshall’s case was resolved.

Critics say requiring some people to pay for treatment is a false economy, as the cost of processing, administering and chasing the payments can be high. In fact, the government’s own research has been unable to determine whether the public purse has gained or lost anything from charging overseas visitors.

Compounding this is that waiting lists are already long in many areas, and when people put off medical treatment — which they often do when required to pay for it — their medical issues become worse and require more treatment, lengthening waiting lists for everyone. When it comes to infectious diseases like drug-resistant TB, which many migrants do not know are treated free under the current system, studies have proven this increases the public health risk.

This morning saw staff and campaigners man stalls at three London hospitals — Royal London, Newham and Whips Cross — and this afternoon, healthcare workers and patients around the country have taken to Twitter to join the #patientsnotpassports and #docsnotcops hashtags, to show their support for the day of action. Workers, campaigners and patients will congregate for a rally this evening at the Royal London Hospital in Whitechapel, where many will share their experiences and feelings about the introduction of these discriminatory and damaging practices.

Undocumented migrants are charged 150% of the cost of the treatment, which is completely unaffordable to the majority

This day of action isn’t the first instance of healthcare workers and patients displaying their disapproval of these policies. Hundreds gathered in London last year, between the announcement of the policy and its introduction, in hopes of forcing the government to reverse their decision. And in May this year, a number of healthcare workers hailed as “heroes” for their work fighting the Ebola virus handed back medals given by the UK government in protest against the measures.

Dr Sonia Adesara is an NHS doctor and co-chair of the Young Medical Women International Association. She spoke to The Overtake, to explain a few of the risks and problems posed by this policy, and why she’s backing the #patientsnotpassports campaign.

“Vulnerable migrants, including victims of trafficking or abuse, are too scared to access healthcare due to fear of being referred to the Home Office, and undocumented migrants are charged 150% of the cost of the treatment, which is completely unaffordable to the majority.

“Due to mandatory charging, many pregnant women are not seeking maternity care. This puts the health and safety of the mother and newborn at risk. An example is HIV, which should be tested for at an antenatal appointment. If women are found to have HIV, they can be given treatment to ensure it is not passed on to the newborn. Without such treatment, the newborn is at risk of getting HIV.”

In many cases people are forced to choose between destitution and good health

James Skinner is an Access to healthcare campaigner at Medact. He says: “Neither the Department of Health and Social Care, nor any of the trusts involved in the pilot scheme have evaluated the impact on people trying to access care.

“We know from the stories that have come to light that it is having a devastating impact on people. In many cases, people are forced to choose between destitution and good health. Any other policy that caused this much harm would have been scrapped by now. Trusts have a duty to stand up for the people they serve and to tell the Government that this policy is completely incompatible with the principles of the NHS.”

23rd October 2018