Memorandum by Joint Council for the Welfare
of Immigrants (HA 21)
This Memorandum is submitted in respect of part
one of the terms of reference: the consequences of the proposed
changes in charges for overseas patients with regard to access
to HIV/AIDS services.
The JCWI (Joint Council for the Welfare of Immigrants)
is an independent national organisation which has been providing
legal representation to individuals and families affected by immigration,
nationality and refugee law and policy since 1967.
We actively lobby and campaign for changes in
law and practice and our mission is to eliminate discrimination
in this sphere. Access to services including healthcare for those
individuals affected by immigration laws and policies is therefore
of central importance to JCWI. This is why we offer this statement
to the Health Select Committee in respect of the proposals to
exclude overseas visitors from free primary care and their consequences
for persons with HIV/AIDS.
We feel the Department of Health's consultation
document on the proposals to restrict free primary care is misleading
in its continual reference to "overseas visitors" whereas
those potentially affected include:
Failed asylum seekersincluding
those from countries which the Government deems too insecure to
return people to;
Undocumented migrants; and
The above categories of people are already prone
to exploitation in the unregulated economy and have progressively
become devoid of civic and social rights. Consequently their health
needs may be greater. We are opposed to restricting eligibility
to primary medical services to these groups for a variety of reasons
but view HIV/AIDS sufferers as among those particularly vulnerable.
We raise three issues in respect of them:
1. Pregnant women are usually routinely
tested for the HIV virus. If a mother is HIV+ the disease may
be passed on to their unborn child. The risk of transferring the
virus can be reduced through for example treatment during pregnancy,
opting for a caesarean section birth, avoiding breastfeeding and
ability to take informed decision about health. Although HIV diagnostic
testing is not excluded in the proposals put in this consultation,
even assuming that a pregnant woman would approach an STD clinic
for testing, this will be of very limited value if no treatment
is available to the woman and if the mother has to pay thousands
of pounds for a caesarean section birth. Preventing mothers with
HIV from accessing ante-natal and HIV treatment could impact on
the number of babies born with the virus. The incidence of HIV/AIDS
could increase further among the immigrant population.
2. Persons with HIV may incur a delay in
obtaining treatment as a consequence of perceived restrictions
on access to treatment. Research from the US suggests that, for
individuals with tuberculosis, a perception that restrictions
may apply, delays in seeking care are likely to result and consequently
the period of transmission be prolonged.
3. Non-, or delayed, treatment could contribute
to development of drug resistance. Barriers, whether real or perceived,
to care for chronic communicable diseases may result in erratic,
delayed, or intermittent treatment. These promote the development
of drug resistant strains of disease. The public health challenge
that results from drug resistant communicable diseases may be
substantial and very costly both in financial and human terms.
The proposals, if implemented, not only jeopardise
the government's overall preventative approach to health, including
in regard to HIV/AIDS, but also puts at risk those who are already
on the margins of society and deserve the protection of a basic
safety net of health care which will not be provided by "emergency
or immediately necessary treatment".
There is a perception that because some migrant
persons are not documented they present a burden on services paid
for by UK nationals through taxation. Whether migrant workers
are documented or not, they pay VAT on goods, and are generally
ineligible for social security benefits, tax credits or full employment
rights that UK nationals draw on. As both the former Home Secretary
David Blunkett and the Immigration Minister Des Browne have publicly
acknowledged the functioning of the UK's dynamic and flexible
economy depends on their participation across a range of sectors.
It contributes to the reasons for their presence here before they
may realise they have any need to access primary health care services.
JCWI is concerned that the Government is making
these proposals without concrete evidence of figures in relation
to the cost of so-called "health tourism" and without
an analysis of the impact of recent changes in eligibility to
secondary care that came about on 1 April 2004. There does not
appear to be any concrete evidence to show that these proposals
will bring about a reduction in costs to the NHS. The Government
needs to differentiate between so called "Health Tourism"
and the vulnerable groups discussed in this document.
We are also worried about the impact these proposals
are likely to have on immigrant communities. It is feared that
while there is not a discriminatory intention behind these proposals
nevertheless the changes could make people feel that they are
being discriminated against, if for example eligibility checks
are made on people with foreign-sounding names.