Select Committee on Health Written Evidence


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 seekers—including those from countries which the Government deems too insecure to return people to;

    —    Undocumented migrants; and

    —    Overstayers.

  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.

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