Intended for healthcare professionals


New rules on treating failed asylum seekers “do not go far enough,” says BMA

BMJ 2009; 339 doi: (Published 22 July 2009) Cite this as: BMJ 2009;339:b2982
  1. Deborah Cohen
  1. 1BMJ

    New proposals from the government give some failed asylum seekers in England access to free NHS treatment, but the BMA has criticised the proposals for “not going far enough.”

    A joint review by the Department of Health and the Home Office has said that some asylum seekers whose claims have been refused but who cannot return home should not be denied free NHS treatment.

    Most failed asylum seekers will still be charged for secondary care services. But unaccompanied children (including those in local authority care) and failed asylum seekers who are getting UK Border Agency support because they have children or have legitimate reasons for being unable to return to their home countries will be exempt from charges.

    Changes to the National Health Service (Wales) Act 2006 meant that from 15 July failed asylum seekers in Wales were able to get the same free health care as someone ordinarily resident in the United Kingdom (BMJ 2009;339:b2704, 6 Jul, doi:10.1136/bmj.b2704).

    Commenting on the proposals for England, Vivienne Nathanson, the BMA’s head of science and ethics, said, “There are many people who have had an asylum claim refused [or] cannot return home and need urgent treatment. This announcement, while positive, applies to only one group of people in this situation and does not go far enough.”

    The government review said that immediately necessary and urgent medical treatment should never be withheld from any overseas visitor, that treatment in emergency departments should remain free, and that no charge should be made for treatment for specified infectious diseases.

    Dr Nathanson remained critical. “We believe that no one whose asylum claim has been refused should be turned down for care which cannot be delayed and which clinicians determine they need. Doing so affects our ability to control communicable disease and ultimately puts additional pressure on the NHS, particularly on emergency services,” she said.

    “The role of clinical staff is to determine what care a patient needs and how urgently they need it, not to assess their immigration status. More must be done to ensure that those who need urgent care can access it.”

    The review also focused on other aspects of NHS care for visitors from overseas or UK residents living overseas. UK residents may be absent from the country for up to six months in a year before being considered for charges for NHS hospital treatment, the review said.

    The Department of Health also said it would work with the UK Border Agency to recover money owed to the NHS. It would explore options to amend the immigration rules so that visitors will normally be refused permission to enter or remain in the UK if they have major debts to the NHS.

    In addition, research on the current policy to charge for treatment for HIV beyond the initial diagnosis and counselling will be commissioned.

    Speaking about the changes, the health minister Ann Keen said, “These changes will support a clearer and fairer system of access to free NHS services that will maintain the confidence of the public and prevent inappropriate access while maintaining our commitment to human rights.

    “These measures strike the right balance between controlled access, the protection and promotion of wider public health, and ensuring that the healthcare needs of the most vulnerable groups are protected.”

    A full public consultation document will be launched in the autumn.


    Cite this as: BMJ 2009;339:b2982

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