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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2018/jul/23/nhs-doctor-ebola-medal-migrant-patients
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| As an NHS doctor this ‘hostile environment' has made me reject my medal | As an NHS doctor this ‘hostile environment' has made me reject my medal |
| (about 2 hours later) | |
| I was so proud to be a part of the Ebola response in west Africa after the outbreak in 2014. It was the best thing I ever did. I would go again tomorrow, and I hope Britain would send help too. To me, receiving the special Ebola medal symbolised the value placed on humanitarian work by our government, so I was happy to accept it. | I was so proud to be a part of the Ebola response in west Africa after the outbreak in 2014. It was the best thing I ever did. I would go again tomorrow, and I hope Britain would send help too. To me, receiving the special Ebola medal symbolised the value placed on humanitarian work by our government, so I was happy to accept it. |
| The real heroes, of course, were the west African people themselves. It was an immense privilege to witness their courage, risking everything – even life itself – to deal with the Ebola crisis. After international attention moved on, they were left with a devastated health system and worsening access to healthcare. One of these heroes even died, not of Ebola, but from childbirth complications. Seeing a woman die giving life is paralysing; it turns you inside out, and the world upside down. Collectively, as human beings, we should never allow anything to stand in the way of access to healthcare. | The real heroes, of course, were the west African people themselves. It was an immense privilege to witness their courage, risking everything – even life itself – to deal with the Ebola crisis. After international attention moved on, they were left with a devastated health system and worsening access to healthcare. One of these heroes even died, not of Ebola, but from childbirth complications. Seeing a woman die giving life is paralysing; it turns you inside out, and the world upside down. Collectively, as human beings, we should never allow anything to stand in the way of access to healthcare. |
| Unfortunately, since I returned to the UK from that crisis, I have seen how a political agenda has been allowed to stand in the way of patients accessing healthcare at home. The effects of the government’s “hostile environment” towards migrants in the NHS became clear to me when, as a children’s doctor, I saw a newborn baby girl become one of its victims. Her mother, an undocumented migrant living in the UK, had attended for an appointment in pregnancy, but was deterred from coming back for further maternity care because of the cost, which given the 150% markup for migrants , ranges from £4,000 upwards. | Unfortunately, since I returned to the UK from that crisis, I have seen how a political agenda has been allowed to stand in the way of patients accessing healthcare at home. The effects of the government’s “hostile environment” towards migrants in the NHS became clear to me when, as a children’s doctor, I saw a newborn baby girl become one of its victims. Her mother, an undocumented migrant living in the UK, had attended for an appointment in pregnancy, but was deterred from coming back for further maternity care because of the cost, which given the 150% markup for migrants , ranges from £4,000 upwards. |
| Many women have been sent intimidating letters while pregnant threatening Home Office intervention if bills were unpaid. After delivery, they are even subjected to court proceedings. Understandably, the woman I treated avoided antenatal care after that first encounter, but at the last minute, as contractions started, fear for her baby meant she did come to hospital. She gave birth to a newborn baby who had complications with permanent implications. This baby girl’s life has been changed forever, and it could have been avoided. What’s more, this ended up costing the NHS far more than if basic preventive care was provided to start with. | Many women have been sent intimidating letters while pregnant threatening Home Office intervention if bills were unpaid. After delivery, they are even subjected to court proceedings. Understandably, the woman I treated avoided antenatal care after that first encounter, but at the last minute, as contractions started, fear for her baby meant she did come to hospital. She gave birth to a newborn baby who had complications with permanent implications. This baby girl’s life has been changed forever, and it could have been avoided. What’s more, this ended up costing the NHS far more than if basic preventive care was provided to start with. |
| Episodes like this are recorded as involving women with “social issues”, who have “poor engagement with antenatal care”. Indeed the mortality rate of pregnant migrant women living in the UK is disproportionately higher than non-migrants, but the discussion about the policies that may be contributing to this is limited. Numerous barriers prevent the stories of my patient, as well as those of others, from being recorded or told. | Episodes like this are recorded as involving women with “social issues”, who have “poor engagement with antenatal care”. Indeed the mortality rate of pregnant migrant women living in the UK is disproportionately higher than non-migrants, but the discussion about the policies that may be contributing to this is limited. Numerous barriers prevent the stories of my patient, as well as those of others, from being recorded or told. |
| The Windrush scandal and experiences of those denied free NHS cancer treatment brought the effects of the government’s “hostile environment” agenda in healthcare to the front pages. But the NHS charging regulations which effectively excluded members of the Windrush generation from NHS treatment remain unchanged, and continue to deny even lifesaving care to many others. | The Windrush scandal and experiences of those denied free NHS cancer treatment brought the effects of the government’s “hostile environment” agenda in healthcare to the front pages. But the NHS charging regulations which effectively excluded members of the Windrush generation from NHS treatment remain unchanged, and continue to deny even lifesaving care to many others. |
| Regulations have increasingly restricted access to care for undocumented migrants, hardening in 2014 and 2015, and culminating in the upfront charging regulations so far applied to NHS England since October last year. These regulations were introduced despite opposition from 193 organisations. They enforce refusal of treatment to any adult or child unable to prove their immigration status, unless they can pay 150% of the cost of treatment. This applies to secondary care and a range of community services. Although urgent or immediately necessary treatment may go ahead before payment, it is still chargeable later. Those who cannot pay are referred to the Home Office for potential detention and deportation. The effect is not only to deny treatment, but to threaten people when they are sick. | Regulations have increasingly restricted access to care for undocumented migrants, hardening in 2014 and 2015, and culminating in the upfront charging regulations so far applied to NHS England since October last year. These regulations were introduced despite opposition from 193 organisations. They enforce refusal of treatment to any adult or child unable to prove their immigration status, unless they can pay 150% of the cost of treatment. This applies to secondary care and a range of community services. Although urgent or immediately necessary treatment may go ahead before payment, it is still chargeable later. Those who cannot pay are referred to the Home Office for potential detention and deportation. The effect is not only to deny treatment, but to threaten people when they are sick. |
| Patients with treatable and exempt conditions have died because they were put off by the cost from seeking care | Patients with treatable and exempt conditions have died because they were put off by the cost from seeking care |
| We do not need a government review to know that creating fear and mistrust in the health services is bad for public health. It should come as no surprise that denying healthcare to undocumented migrants means they get sicker, and die. I know of cases of patients discharged to die with completely curable conditions. We already know that exemptions are not working, and asylum seekers, refugees, victims of trafficking and others have been wrongly charged or deterred from care. Exemptions for certain infectious diseases are also flawed, as patients with symptoms don’t necessarily know what disease they have, with charging deterring them from seeking diagnosis and treatment, leading to worsening public health. Patients with treatable and exempt conditions have died because they were put off by the cost from seeking care. | We do not need a government review to know that creating fear and mistrust in the health services is bad for public health. It should come as no surprise that denying healthcare to undocumented migrants means they get sicker, and die. I know of cases of patients discharged to die with completely curable conditions. We already know that exemptions are not working, and asylum seekers, refugees, victims of trafficking and others have been wrongly charged or deterred from care. Exemptions for certain infectious diseases are also flawed, as patients with symptoms don’t necessarily know what disease they have, with charging deterring them from seeking diagnosis and treatment, leading to worsening public health. Patients with treatable and exempt conditions have died because they were put off by the cost from seeking care. |
| Undocumented migrantsare human beings, and we will continue to live together. Other countries recognise this, and explicitly provide free care to them. In contrast, hospitals in the UK now spend significant resources trying to identify and refuse healthcare to thisgroup. | Undocumented migrantsare human beings, and we will continue to live together. Other countries recognise this, and explicitly provide free care to them. In contrast, hospitals in the UK now spend significant resources trying to identify and refuse healthcare to thisgroup. |
| The NHS has abandoned its founding principles in service of a political agenda. Nye Bevan, the founder of the NHS, warned about the pernicious “health tourism” arguments , which despite costing minute proportions of NHS spending, would be used to justify restricting access to migrants who actually live in the UK. Indeed the charging regulations may even result in greater costs than savings, due to bureaucracy and an increased need for complicated and emergency care when preventive care is missed. | The NHS has abandoned its founding principles in service of a political agenda. Nye Bevan, the founder of the NHS, warned about the pernicious “health tourism” arguments , which despite costing minute proportions of NHS spending, would be used to justify restricting access to migrants who actually live in the UK. Indeed the charging regulations may even result in greater costs than savings, due to bureaucracy and an increased need for complicated and emergency care when preventive care is missed. |
| Having seen so much death, it’s heartbreaking to see the excellent lifesaving care the NHS can provide being denied. I cannot keep a medal from a government whose policies are directly harming my patients. The human right to health must be restored as the ultimate principle of the NHS. Healthcare workers elsewhere have defended that right for undocumented migrants. Those of us who are now handing back our medals are hoping to achieve the same. | Having seen so much death, it’s heartbreaking to see the excellent lifesaving care the NHS can provide being denied. I cannot keep a medal from a government whose policies are directly harming my patients. The human right to health must be restored as the ultimate principle of the NHS. Healthcare workers elsewhere have defended that right for undocumented migrants. Those of us who are now handing back our medals are hoping to achieve the same. |
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