Immigration Bill

Written evidence from The Dover Detainee Visitors Group’s Ex-Detainee Project (IB 34)

1. Executive Summary

1.1. This Memorandum provides an analysis of the potential damage that the Immigration Bill in its current form poses to migrants, and to the wider community.

1.2. The Memorandum is limited to the Ex-Detainee Project’s area of expertise - issues affecting people who have been released from immigration detention - and does not fully consider the harmful impacts posed by the Immigration Bill to severely restrict rights of appeal, the ability to access bail and judicial oversight of the decisions of a deeply flawed public department.

1.3. The Immigration Bill is an insidious and divisive blunt instrument, which seeks to shore up ‘Fortress Britain’ by limiting the principles of natural justice and human rights of an already marginalised social group. Furthermore, the effect of this Bill will be trample the civil liberties of the general populace in order to create the ‘hostile environment’ for ‘foreigners’ that the Home Secretary wishes to engender.

2. Introduction

The Dover Detainee Visitor Group (DDVG)

2.1. DDVG was created in response to the opening of the Dover Immigration Removal Centre (DIRC) where over 300 men were held with little contact with the outside world. A group of volunteers set up DDVG in 2002, supported by Kent Refugee Action Network (KRAN), the Association of Visitors to Immigration Detainees (AVID), and Refugee Action.

2.2. DDVG has been operating as an independent registered charity since November 2004 - it is managed by a constitution and complies with all the policies and procedures that a charity must have. DDVG has evolved over time and according to our clients’ needs. We now operate several different projects including an Ex-Detainee Project, Legal and Awareness Raising Projects, as well as the Visiting Project initially envisaged.

The Ex-Detainee Project

2.3. The Ex-Detainee Project was launched in its current format in 2008 in recognition of a lack of provision for immigration detainees upon their release into communities in the UK.

2.4. The project has evolved over time and gone from helping 80 ex-detainees primarily released from Dover, to having an active client base of over 400 clients released from detention centres throughout England. To date we have helped more than 650 ex-detainees. We receive referrals and work in close partnership with local and national organisations across the country.

2.5. The Ex-Detainee Project functions primarily by the operation of a freephone telephone helpline for former immigration detainees. Our remit is extremely wide – anyone who has ever been in immigration detention can call us for advice and assistance.

3. Response to specific provisions


3.1. Paragraph 5 of Schedule 1 provides immigration officers a general power to use ‘reasonable’ force in the exercise of all powers under any of the Immigration Acts. This significantly widens the scope for the use of force. The case for these powers has not been made out.

3.2. The former UKBA has been widely criticised for its methods in applying force, such as the practise of ‘dawn raids’ and use of physical force against pregnant women and children. Instances of the use of force have resulted in death and injury.

3.3. Our clients frequently tell us that they report regularly as required but always with the feeling that they could be arrested and detained in a seemingly arbitrary fashion. Our experience is that this happens all too frequently. They are taken without warning, without their belongings and without any provision being made for their legal papers, clothes and other personal effects. This strips them of their dignity. Often they are released, again seemingly arbitrarily. They must then start again – try to access NASS support, or find a friend to stay with, build up some belongings and sufficient clothes for our British weather, as their old possessions have usually vanished.

3.4. The ability to use force in the exercise of powers should be a last resort and have sufficient checks, balances and oversight, rather than give the former UKBA carte blanche to achieve their aims. Parliament should scrutinise how existing powers are being used and the case be made to it for each additional power sought.

Appeals (Part 2 and Schedule 8)

3.5. Clause 11 of the Bill removes rights of appeal on any grounds other than asylum and human rights. It denies any independent review to anyone else who makes an immigration application. Many of our clients will be arguing to be allowed to stay on the grounds of family life, rather than as persons in need of international protection. Because of the severe cuts to legal aid, it is likely that they will be tackling these complex cases unrepresented.

3.6. Clause 12 provides the Secretary of State with the power to certify the appeals of "foreign criminals" so that they can be removed from the UK to their home country whilst their appeal is pending, if to do so would not cause him/her "serious irreversible harm."

3.7. Firstly, the term ‘foreign criminals’ is deceptive and covers a multitude of circumstances. The extent of criminality of many of our clients is that they have worked illegally in the UK. The reasons for this are varied and can be as simple of a person overstaying their Visa and never coming to the attention of the authorities, to a change of circumstances occurring in the country of origin during the Visa period resulting in a person becoming effectively a refugee sur place. Reluctance to return to their country of origin as a result of forming a life in the UK, or of becoming an ‘asylum seeker’ given the negative public perceptions and the impact an asylum claim would have on the right to work, accommodation etc mean that they break the law by working and by their illegal presence. Many of our clients are in this situation – they have admittedly worked without the requisite permission, but have in all other respects been productive and fully contributing members of society, paying taxes, fuelling the economy, and performing services. They have partners or spouses, children, friends, are members of their community and churches. These are the people that could be returned to a country where they may not have lived for many years, without the right to appeal whilst in the UK.

3.8. Other ‘foreign criminals’ to whom this legislation will apply are those who can be termed ‘home grown criminals’. We have clients that came to the UK as a small child and have been granted Indefinite Leave to Remain. They have lived in the UK and attended school and lived their formative years in this country but have, for a variety of reasons, fallen into criminality. Because they are ‘foreign’ and not British, they are not afforded the same opportunity to rehabilitate and instead face deportation to a country with which they are entirely unfamiliar. This amounts to out-sourcing UK social problems to (usually) poorer, undeveloped countries. This is just wrong.

3.9. There is already provision for cases that are clearly unfounded not to be brought until the person has left the UK. There is no need for an additional power in deportation cases. Deportation cases are of the utmost importance to the individual and families affected. They are highly complex and there is no legal aid for these types of cases – even without this provision there is a massive inequality of arms between the parties.

3.10. Clause 14 seeks to codify the weight that should be given to various factors – ability to speak English and being financially independent are in the public interest because people possessing these attributes are purportedly less of a burden on the taxpayer and are better able to integrate into society. The preferences of the Secretary of State are already known given the requirements for the Life in the UK test and the specific immigration rules relating to financially independent people. The European Convention on Human Rights requires that decision-makers undertake a fact-sensitive analysis of each case and to weigh up the rights of the individual against the State. Any attempt to codify weight to be given to various factors completely misses the point.

3.11. This legislation is deeply offensive and discriminatory. It suggests that the only migrants wanted in the UK are wealthy English speakers.

Access to services (Part 3 and Schedules 3 and 8))

3.12. Part 3 contains provisions that will inextricably link immigration status to the ability to rent property, access health services, open bank accounts or obtain a driving licence. This will result in a system of identity checks for all, since it is necessary for British citizens or persons with permanent residence to prove that they are lawfully present in the UK.

3.13. British citizens, EEA nationals and third country nationals will be required to produce identity documents at many junctures in order to access essential services. This is excessively intrusive, violates civil liberties and will inevitably result in discriminatory practices.

Private rented accommodation (Clauses 15-32 and Schedule 3)

3.14. The idea behind these provisions are that those people who cannot prove that they are lawfully in the UK (some of whom will be undoubtedly be British citizens) will not be able to rent property at all. Those who rent to them face fines, against which they can protect themselves by carrying out document checks. This means that landlords, who have no training in immigration law, are being made to decide on complex issues of immigration status.

3.15. There is real potential in these provisions for discrimination against black and ethnic minority people, whether British or subject to immigration control, and will make it more difficult for anyone who does not hold a British passport (including many British citizens) to rent properties. Landlords will choose the simplest, most direct method least likely to cause them problems, and rent to the person whom it is simplest to check: the British passport holder who presents as British.

3.16. Many of our clients who have overstayed Visa’s and have extant applications based on Article 8 of the ECHR, or long residence, live in privately rented accommodation. Often their rent is paid by family and friends, or church groups, as they have no permission to work. These provisions will mean that, certainly in the case of families with dependent children, Local Authorities will then be required to accommodate and support these families.

3.17. Those without dependent children, non-resident parents and others who have no recourse to public funds, such as individuals seeking to challenge a deportation decision, will have no accommodation. They are prima facie ineligible for asylum support as they have no protection claim. There is a power under Section 4 (1) of the Immigration and Asylum Act to accommodate people in these situations but it is a power that is seldom exercised, and the threshold for this is extremely high. We have clients with extant immigrations matters under consideration that are sleeping in sheds or who are in potentially exploitative situations in order to avoid sleeping on the streets. A female ex-detainee called us after being assaulted by the man that was ‘helping’ her after release from detention on Temporary Admission because she rejected his sexual advances. She actually considered staying with him after that to avoid being street homeless. Thankfully, we were able to refer her to a women’s refuge that would accept a woman without recourse to public funds.

3.18. Mainstream homelessness projects cannot assist people who have no recourse to public funds. They rely on the ability to claim Housing Benefit in respect of their residents to sustain their projects.

3.19. We have clients who have experienced homelessness resulting from the gap between the withdrawal of asylum support and the receipt of status papers. Asylum support accommodation ceases before status documents are issued, leaving people granted international protection because of their particular vulnerability, including victims of torture, on the streets and unable to feed themselves.

3.20. The outcome of these provisions will be to make a class of people homeless and without any means of supporting themselves. That is indeed a hostile environment for migrants. It is also completely unacceptable in modern society.

3.21. In light of this, we advocate for widening the scope for provision of Section 95 support (Immigration and Asylum Act 1999) to include migrants with extant immigration applications (not just protection claims) who satisfy the destitution test, and those who cannot be returned to their country, coupled with the abolition of the cashless Section 4 system. [Please see our submission to the Home Affairs Select Committee Inquiry into Asylum on the topic of Section 4, appended to this Memorandum.] We also advocate for permission to work for these groups.

National Health Service (Clauses 33 and 34)

3.22. The Bill contains enabling provisions to restrict entitlement to the National Health Service to British citizens and settled persons (clause 34) with the entitlements of others to be controlled by regulations (clause 33). Some people not automatically entitled will be able to secure entitlement to all or some services by paying a health levy.

3.23. We refer the Committee to our response to the NHS Charging Migrants Consultation appended to this Memorandum. These proposals will impact both public health and the health of individuals. Further restricting access to health services will result in ill-health and costly late interventions. It will result in unnecessary deaths and suffering, including high infant mortality.

Driving licences (Clauses 41 and 42)

3.24. These provisions give the former UK Border Agency new powers to revoke licences of people without leave to remain in the UK. This will result in people driving whilst ineligible, invalidating any insurance. This will have significant implications for people involved in road traffic accidents.

3.25. If a person is wrongly refused leave to enter/remain, and has no right of appeal, they will lose their licence whilst pursuing judicial review. The position of persons seeking asylum, and those with extant applications under human rights legislation need to be considered. They may face a lengthy wait for a decision and will meantime lose valuable skills, not to mention experience significant difficulties in maintaining contact and relationships with non-resident children and other family members, undertaking caring responsibilities and so forth. These provisions appear ill-thought out.

Marriage and Civil Partnership (Part 4 and Schedules 4, 5 and 8)

3.26. Under Article 12 of the European Convention on Human Rights, ‘Men and women of marriageable age have the right to marry and to found a family, according to the national laws governing the exercise of this right. The Home Office already has the power to deny people an immigration benefit if a marriage or civil partnership is deemed to be a sham or one of convenience. It is not for national authorities to interfere unnecessarily in the private affairs of citizens. These provisions infringe on the civil liberties of citizens and foreign nationals to no purpose whatever. The issue here is the immigration benefit, rather than the marriage or civil partnership, thus this provision is wholly unnecessary and likely violates both Articles 8 and 12 of the Human Rights Act.

Fees (Clauses 59 – 60 and Schedule 8)

3.27. Our clients often call us for assistance in securing funding for the various immigration applications that they need to make. We are unfortunately not in a position to assist with this, having very limited funds. Likewise, there are no charities or funds that we are aware of who are able to assist with this particular problem. We have families who ought to make applications for settlement for the main applicant and all dependents, but who cannot because the cost of the applications is prohibitive, and must instead do this piecemeal. Current legislation necessitates that applications not including the required fee are deemed to have not been made. This leaves people in the position of ‘overstayers’ - committing an immigration offence - which then negatively impacts their immigration history for any renewed application.

3.28. Fees for immigration applications for non-EEA nationals are already prohibitive. EEA applications are for the most part cost-free, as EU legislation requires this. In our view, non-EEA national applications already fund the cost to the former UKBA of EEA applications. The current provisions in this Bill do not provide sufficient information on cost increases and our fear is that there will be a year on year increase which will impact negatively on our client-group.

3.29. We welcome the provision in Clause 59(9)(b) which provides for the Home Office to reduce, waive or refund all or part of a fee provided for in this clause. We strongly recommend that the ability to waive/reduce fees be circumscribed and include circumstances where applicants are destitute, have no recourse to public funds or have a disposable income of less than the income support level.

4. Recommendations for Action

4.1 In light of our experience in dealing with the problems experienced by individuals and families that have been affected by immigration detention, we recommend the following amendments should this Bill proceed through both Houses:

· Abolish Section 4 of the Immigration and Asylum Act 1999 in favour of Section 95-type cash support for any undocumented migrant who satisfies the destitution test and has an extant application or who cannot be returned to their country, not only those that have claimed asylum;

· Raise the level of support provided to at least 70% of income support level and provide for asylum support to be uprated in line with mainstream welfare benefits uprating;

· Repeal Schedule 3 to the Nationality, Immigration and Asylum Act 2002 which restricts support local authorities can provide to persons under immigration control.

· Permit the right to work for those who are awaiting an immigration decision for longer than 6 months, or who cannot be removed to their country of origin through no fault of their own.

· Remove those provisions within this Bill which relate to access to services, including accessing health services, bank accounts, driving licences and marriage and civil partnerships.

· Ensure that fees for immigration applications remain affordable for the majority and ensure that fee waiver/reduction is available for those with reduced ability to pay.

November 2013



1. The Home Affairs Committee INQUIRY into Asylum

MEMORANDUM by The Dover Detainee Visitors Group’s Ex-Detainee Project

2. ‘Charging Migrants’

NHS Consultation response by The Dover Detainee Visitors Group’s Ex-Detainee Project



The Home Affairs Committee INQUIRY into Asylum

MEMORANDUM by The Dover Detainee Visitors Group’s Ex-Detainee Project

1. Executive Summary

1.1. This Memorandum provides an analysis and evaluation of the sufficiency and effectiveness of

the current system of Section 4 support for failed asylum seekers and those released on bail

from immigration detention.

1.2. We conducted a survey on a representative sample of 25 former immigration detainees who

are currently in receipt of Section 4 support under the provisions of the Immigration and

Asylum Act 1999. The data generated provides a snapshot of what life is like for people in

receipt of Section 4, through the qualitative evidence of former immigration detainees, as well

as quantitative data which highlights issues of concern.

1.3. The Memorandum is limited to the difficulties people currently in receipt of Section 4 face,

and does not consider the difficulties that exist for some people in accessing even this level

of support, although it is a real concern that people can be released from detention onto

the streets on Temporary Admission and not qualify for any kind of government support


1.4. Section 4 runs parallel to Section 95, but is a much tougher regime, in that those in receipt

of it have no access to cash, may live in Section 4 indefinitely and do not have any means

or opportunity to improve their lots in life. They must merely subsist. We recommend that

Section 4 be abolished in favour of the already functioning Section 95 system of support, that

permission to work be reinstated and that the level of asylum support reflect the true cost of


2. Introduction

2.1. The Dover Detainee Visitor Group (DDVG)

DDVG was created in response to the opening of the Dover Immigration Removal Centre (DIRC)

where over 300 men were held with little contact with the outside world. A group of volunteers

set up DDVG in 2002, supported by Kent Refugee Action Network (KRAN), the Association of

Visitors to Immigration Detainees (AVID), and Refugee Action.

DDVG has been operating as an independent registered charity since November 2004 - it is

managed by a constitution and complies with all the policies and procedures that a charity

must have. DDVG has evolved over time and according to our clients’ needs. We now operate


several different projects including an Ex-Detainee Project, Legal and Awareness Raising

Projects, as well as the Visiting Project initially envisaged.

2.2. The Ex-Detainee Project

The Ex-Detainee Project operates as a project of the Dover Detainee Visitors Group. It was

launched in its current incarnation in 2008 in recognition of a lack of provision for immigration

detainees upon their release into communities in the UK. DDVG was increasingly receiving calls

for help from ex-detainees released from Dover to all over the country that were homeless,

struggling to meet their basic needs and feeling isolated and confused upon their release. The

Ex-Detainee Project was set up in response to that need.

The project has evolved over time and gone from helping 80 ex-detainees primarily released

from Dover, to having an active client base of over 300 clients released from detention centres

throughout England. To date we have helped in excess of 600 ex-detainees. We receive

referrals and work in close partnership with local and national organisations across the country.

The Ex-Detainee Project functions primarily by the operation of a freephone telephone helpline

for former immigration detainees. Our remit is extremely wide – anyone who has ever been in

immigration detention can call us for advice and assistance.

3. Factual Information

3.1. The Section 4 Survey

Our sample group was drawn at random from our client list of 334 active clients and the

findings included are from the first 25 clients that we were able to make telephone contact

with that were still living on Section 4 support. Clients were interviewed for between 15 and 45

minutes depending on the length of their responses and were asked to provide specific factual

information as well as qualitative data, based on their perceptions and experiences. (Survey

questions contained in Appendix 1)

3.2. Length of time on Section 4 support

Section 4 support is meant to be a short-term provision. There are real concerns for health

and well-being when people are required to live for extended periods of time at such a basic

level. In fact, many people live on Section 4 for extended periods of time – often years. In our


Longest time on section 4 support: 5 years

Shortest time on section 4 support: 3 months

Average time on section 4 support: 20mths 12 days (mean)


3.3. Nationality breakdown

Many of the people who are in receipt of Section 4 support have outstanding matters under

consideration with UKBA or the courts, while many others’ claims have been finally determined

but they cannot be removed to their countries of origin through no fault of their own. Iranian

nationals fall into this category – the lack of diplomatic relations between Iran and the UK

mean that it is practically impossible for Iranian nationals to be documented and returned to

Iran when their asylum applications have failed. However, they are expected to live on Section

4 support indefinitely. Many feel that their lives are wasting away and they are powerless to

improve their lives as they are not permitted to work and provide for themselves. Almost a

quarter of the clients we surveyed were Iranian nationals, however, nationals of several other

countries are also virtually impossible to document or remove to – for example Somalia, China

and Palestine.

Iran 6 -24%

Iraq 3 -12%

Algeria 3 -12%

Somalia 2 -8%

Nigeria 2 -8%

Cameroon 2 -8%

DRC 2 -8%

Jamaica 1 -4%

Guinea 1 -4%

Ivory Coast 1 -4%

Sierra Leone 1 -4%

Bangladesh 1 -4%

3.4. Gender breakdown:

We predominantly assist single men that are in receipt of Section 4 support, which is reflected

in the gender breakdown of the survey. We also support single women on Section 4 support,

though the numbers are much fewer. Families tend to be supported under Section 95 of the

1999 Act, although not exclusively. Section 95 has significant shortcomings which are outside

the scope of this Memorandum, however, we would refer the Committee to the Parliamentary

Inquiry on Asylum Support for Children and Young People published in January 2013.

24 males

1 female

3.5. Placement areas

The Ex-Detainee Project has a wide remit and supports former detainees all over the UK. The

breakdown of placement areas from the Section 4 Survey accurately reflects the geographic

spread of our active client-group throughout England and Wales. Although the government’s


dispersal policy is supposed to mean that people on Section 4 are moved out of London and the

Southeast, this is not reflected in our experience, or in the survey findings.

Outer London 14 -56%

Essex 6 - 24%

Liverpool 3 -12%

Ipswich 1 -4%

Leeds 1 -4%

What has happened however, is that people on Section 4 are moved to urban sprawl areas on

the outskirts of London and other cities, where there is extremely limited provision in terms

of support organisations, compounding. The fact that when accommodation providers change

under UKBA/Home Office contracts, people are moved wholesale to areas where no provision


All 25 of the ex-detainees interviewed advised that there are no services near to

them specifically for refugees/migrants.

3 people interviewed attend weekly support groups/charities and are provided with

a travel ticket by that charity as they are over an hour’s travel away by bus.

1.6.Section 4 Accommodation

The quality of the accommodation provided under Section 4 appears to be almost universally

poor. Single people lived in shared accommodation with strangers who often share different

cultural beliefs and practices. There is no incentive to maintain the spaces and people

living in Section 4 have no surplus funds to purchase items that might serve to make their

accommodations more livable, as their weekly provision is sufficient only for food and essential

toiletries. Not one of the 25 clients that we surveyed was satisfied with the accommodation.

Most common problems with Section 4 accommodation:

· Sharing with others -

People using drugs; people not cleaning up after themselves; noise late into the

night; cultural differences.

· Sub standard housing -

Grimy; broken doors; filthy toilets; broken showers; broken washing machine;

rundown property.

· Lack of facilities -

Not enough cooking equipment, i.e. one saucepan for seven men sharing

accommodation; no kettle; small fridge with two shelves for up to 7 people; lack of

cleaning provisions; no vacuum or mop provided.


· Accommodation providers -

Difficult to contact; do not answer phone calls; state they will sort out problems, but

either not done or can take a number of weeks until action is taken.

Specific qualitative examples of problems with accommodation:

"It took two months for somebody from Clearsprings to look at the broken shower, I was told it

had been fixed, but it is still not working properly. I have told my manager this and he said he will

sort it out, this was over a month ago."

"My son’s bed was old and broken, it has been 7 months since I reported this to Clearsprings and

nothing has been done. My son has been sleeping on the floor all this time."

"The cooker wasn’t working, it took 6 weeks for Clearsprings to replace the cooker."

"I called my manager to let him know the boiler wasn’t working. It was snowing and cold and we

didn’t have any heating. It was 2 weeks before they fixed the boiler."

"I have complained to my manager at SERCO many times about sharing with people who are

on drugs, smoking cannabis in the kitchen which we all use, and who urinate in the communal

stairwells, they have never spoke to the people who I have to share with."

1.7.Being moved

Section 4 accommodation is provided on a ‘no-choice’ basis and subsistence is not provided

separate from accommodation. Therefore, individuals with family or friends and support

networks cannot live with those contacts and receive subsistence support for their own food

and toiletries, unlike Section 95 support. Essentially, those living in Section 4 do so at the whim

of UKBA – they can be moved at any time and cannot refuse. Any support networks and efforts

at integration into their local communities that they have made may be rendered ineffective if

they are told they will be moved and they cannot refuse, as Section 4 in ‘no-choice’.

Total number of section 4 accommodations lived in by all interviewees: 54

Average number of accommodations lived in: 2 (2.16)

1.8.Azure card

The Azure card is a payment card that can only be used in certain supermarkets and provides

the subsistence element of Section 4 support.

Average time taken to walk to the closest shop where the card is accepted:


35 minutes.

Furthest a person must walk to use his/her Azure card: 1 hour 30 minutes

1.8.1. Specific qualitative examples of difficulties with Azure card:

"Each time I go to the supermarket I am stopped by the cashier who doesn’t know what an

Azure card is, the manager is nearly always called and I have to explain, in front of a queue of

people, that I have no money and the card is given to me. It’s embarrassing and I feel like a

second class citizen. I know everyone in that queue is looking down on me."

"I am African and I wish I could buy some traditional African food to eat, like the produce

available in nearby outside markets. In the supermarket there is hardly any choice and it is so


"I have my child to visit every week, it is horrible for her as I share with lots of men. I can’t even

take her to the local shop to buy a chocolate bar as they do not accept the Azure card."

1.9.No Cash

There are highly significant difficulties inherent in living without access to the currency of the

land, aside from the stigma and issues related to the Azure card itself. How can a person travel

on public transport? How can a person get a haircut?

1.9.1. Our clients told us in the Survey that:

· Having to buy food at designated supermarkets is expensive.

· Not being able to travel out of the areas they live in makes them feel isolated, as

does not being able to top up a telephone to call solicitor/family/friends.

· They suffer from boredom and loneliness - they cannot access support groups as

most dispersal areas out of main cities and cannot travel due to not having any cash.

Due to no choice in the dispersal area s they are sent to, they have no friends, and

are lonely.

· If they had the right to work- along with a sense of responsibility every day, they

would have cash, would feel part of society, would feel part of the community.


In answer to the question ‘What is the most difficult thing about living on section 4

support?’ every single individual surveyed mentioned having no cash.

1.9.2. Specific qualitative examples of difficulties inherent in having no access to cash:

"I am diabetic and have been told to attend the advice clinic regularly. I don’t have any money

for travel and it is over an hour’s walk away. It is embarrassing to have to keep asking charities

to pay my travel to all the medical appointments I have, but I don’t have any choice."

"I have been on section 4 support for over two years, I would have liked to have been able to buy

some shoes and clothes for myself , just from a charity shop, but because I don’t have any cash I


"For three years I have lived in four different section 4 accommodations, all in different areas

of the country, meaning I have been unable to make good friends or feel part of a community.

All the places have been the same, filthy, unkempt, crowded houses in rundown areas of large

towns/cities. I would love to be able to travel to see the countryside, but I don’t have any cash or

anyone to take me. I am Iranian and the Home Office won’t let me stay but they also won’t send

me back. This isn’t living, it is just surviving. I cannot see an end to this. "

3. Recommendations for Action

In light of the findings of the Survey, and in line with our experience we recommend the following:

· Abolition of Section 4 in favour of Section 95-type cash support, including the separation of

subsistence and accommodation elements;

· Raising the level of support provided to at least 70% of income support level;

· Permission to work for those who are awaiting a decision for longer than 6 months, or who

cannot be removed to their country of origin through no fault of their own.


Appendix 1

Survey of living on section 4 support

Initially establish if client still living in Section 4 accommodation - if new address, please make a note

of this and if it is a Section 4 address. Advise we are collecting this information in order to provide

evidence on the difficulties ex-detainees face living with on Section 4 support in the UK.

Survey Questions

Q1. How long have you lived in Section 4 accommodation?

Q2. How many Section 4 accommodations have you lived in?

Q3. Have all of the accommodations been of the same standard?

Q4. What are the main problems (if any) with the accommodation?

Q5. Have you approached your accommodation provider about the problems?

Q6. If yes, what was the outcome?

Q7. How close is the nearest shop in which you can use your Azure card?

Q8. How often do you have to report with the UKBA?

Q9. How do you travel to your reporting centre, and how often are you required to report?

Q10. What is the most difficult thing about living on Section 4 support?

Q11. Are there any services for refugees/migrants that you know of near to you?

Q12. If yes, please identify



‘Charging Migrants’

NHS Consultation response by The Dover Detainee Visitors Group’s Ex-Detainee Project


Submitted on 2013-08-27 17:37:47.090583

1 What is your name?


Christine Oliver

2 What is your email address?


3 What is your organisation?


The Dover Detainee Visitor Group

4 Are there any other principles you think we should take into consideration?

Use this box to enter your response:

The principle of universality should be taken into consideration. The NHS is not, and never has been, a contribution based system and has always existed on the

principle that healthcare is provided free of charge and according to need. The NHS is funded through general taxation - therefore everyone in the UK already

contributes to the NHS through VAT, income tax, as well as National Insurance contributions. The term 'everyone who benefits from it's services' is misleading.

Society benefits from increased public health.

5 Do you have any evidence of how our proposals may impact disproportionately on any of the protected characteristic


use this box for your response:

Yes, in particular foreign nationals that have experienced immigration detention with the protected characteristics of race, and/or pregnancy and maternity. The

Dover Detainee Visitor Group's Ex-Detainee Project supports people who have been released from immigration detention into UK communities nationwide. Part

of our remit is to support people in accessing their entitlements to healthcare and welfare support.

We feel that the proposals will impact disproportionately on our client group, who are already vulnerable and marginalised by virtue of their status as 'foreigners'

and who have limited entitlement to social support. Our clients include asylum-seekers, 'failed' asylum seekers, 'overstayers', people liable to deportation action,

and foreign national ex-offenders, amongst others. They have been released from detention because they are awaiting a final determination of their immigration

case or because they cannot be removed to their country of origin through no fault of their own.

We conducted 2 pieces of research that are of relevance to the proposals under consideration. Firstly, in 2012 we surveyed our active clients on the issue of

access to G.P.'s. 69% of respondents reported having medical problems. They also reported 3 main difficulties in accessing healthcare with roughly a third of the

respondents experiencing difficulties in each of the following area - finding a G.P.; G.P.'s surgeries refusing to register them; and, inability to register because

they could not comply with the requirement for identification. These findings demonstrate the difficulties that this already marginalised and vulnerable group face

in accessing primary healthcare under the present scheme. We anticipate that the current proposals will compound this problem, with the ultimate result being

poorer health in migrant communities and more costly (to the NHS) late interventions.

All of our clients have experienced immigration detention. This has a recognised impact on mental health ('Mental health implications of detaining

asylum-seekers: systematic review' K. Robjant, R. Hassan, C. Katona, BJP 2009). In 2013 we surveyed our active clients on the issue of mental health. 92% of

(64) respondents reported that mental health had affected their mental health with 75% of those reporting that their mental health was still adversely affected. this

demonstrates that migrants who have experienced immigration detention have complex needs, almost certainly exacerbated by detention, and their immigration

status in the UK should not prevent them from accessing healthcare, as per Article 25 (1)of the Universal Declaration of Human Rights -

'(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical

care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in

circumstances beyond his control.'

Asylum-seeking women who are pregnant already face significant barriers to accessing adequate healthcare and continuity of care. ('When maternity doesn't

matter' Maternity Action / Refugee Council, Jan 2013.) The current proposals will create a new hurdle, with women having to prove permanent residency in order

to get a G.P.'s appointment. Any increase in pre-screening is likely to deter women from seeking care and as G.P's are the most common referrer onto maternity

services, have a detrimental effect on the health of pregnant women and that of their babies.

We feel that many migrants, particularly those that have experienced trauma in their home countries, and/or immigration detention in the UK are particularly

vulnerable, both in terms of their physical and mental health. Their lack of status (or permanent residency) and their limited access to social support makes them

disproportionately more vulnerable to ill-health. Further limiting the potential of these people to access the healthcare that they require is effectively treating them

as less than equal.

6 Do you have any views on how to improve the ordinary residence qualification?

use this box for your response:

The ordinary residency qualification is far too restrictive and will severely limit the ability of many migrants to access the healthcare that they need, when they

need it. Indefinite Leave to Remain as an immigration status is an extraordinarily high threshold and achieving it can take many years. People are ordinarily

resident in the UK when they live here. Those who are awaiting the outcome of immigration decisions are 'ordinarily resident', those who cannot be returned to

their countries are 'ordinarily resident'. The government restricts the ability of many groups to contribute financially to society through NI contributions - for

example, most ex-detainees are either awaiting a decision or cannot be removed, but they are not entitled to work. Often people will contribute through

volunteering and unpaid community work, but the current proposals do not recognise this as a valuable contribution. Restricting their access to healthcare when

they have no ability to pay is quite simply discrimination. The ordinary residence threshold should retain it's current meaning.

7 Should access to free NHS services for non-EEA migrants be based on whether they have permanent residence in the



use this box for related comments:

No. For the reasons outlined above, the ILR threshold is far too restrictive. Linking NHS entitlement to permanent residence does not reflect either the

commitment or contribution of the migrants who will be affected by these proposals. Although most immigration routes leading to settlement should render

migrants eligible for permanent residence after five years, additional requirements to apply for ILR (such as the Life in the UK Test or the minimum income

requirement for partners) means that in practice many migrants take much longer to acquire permanent residence. There will be migrants who have lived in the

UK for many years and contributed greatly, without qualifying for NHS access.

8 Do you agree with the principle of exempting those with a long term relationship with the UK (evidenced by National

Insurance contributions)? How long should this have been for? Are there any relevant circumstances under which this

simple rule will lead to the unfair exclusion of any groups?

use this box for your response:

Firstly - this is not a simple rule, if implemented it will be highly complex, difficult to administer and run contrary to the overarching principles. Some people will

have been long-term residents of the UK without having paid the required 7 years NI contributions, for reasons including disability and caring responsibilities, and

no permission to work. To base entitlement on NI contributions is therefore not only unnecessary but highly likely to discriminate against many groups with

protected characteristics. This is a concerning precedent for NHS access, which if extended to the resident population would undermine the current purpose and

function of the NHS, redefining it as a contribution-based health system.

9 Do you support the principle that all temporary non-EEA migrants, and any dependants who accompany them, should

make a direct contribution to the costs of their healthcare?


use this box for related comments:

Migrants who come to live in the UK for extended periods of time (more than six months) already contribute to the NHS through their regular taxation (VAT,

income tax and National Insurance contributions). They also contribute to revenue through their visa fees prior to entering the UK. Department of Health evidence

suggests that immigrants are generally younger, and use healthcare services less than British citizens.

Former detainees (many of them 'irregular migrants') will not be in a position to make any financial contribution to the cost of their healthcare because they may

only have entitlement to very limited state support, if any, and have no permission to work.

10 Which would make the most effective means of ensuring temporary migrants make a financial contribution to the

health service?

Other – please enter your response in the box below

Other – do you have any other proposals on how the costs of their healthcare could be covered? Please also use this box for any other related


We believe that temporary migrants already contribute greatly to the UK and the economy, thus are already funding the NHS, so additional means of generating

revenue are unnecessary. A health levy might in fact have the opposite effect and will encourage temporary migrants to get their money's worth, or encourage

people to travel to the UK to access healthcare.

11 If we were to establish a health levy at what level should this be set?

Other amount (please specifiy below)

Other - please specify an amount and make any related comments in this box:

If a levy is going to be introduced, it should reflect the proposed length of stay, on a sliding scale. For example, visit visas for up to a month £10 levy, up to 6

months £60. Low enough to not deter tourism.

12 Should a migrant health levy be set at a fixed level for all temporary migrants? Or vary according to the age of the

individual migrant?


Use this box for any related comments:

If a levy is introduced it should be fixed, to fit with the principles of equality and universality.

13 Should some or all categories of temporary migrant (Visa Tiers) be granted the flexibility to opt out of paying the

migrant levy, for example where they hold medical insurance for privately provided healthcare?


Use this box for any related comments:

No, we do not agree with it's introduction, but if a levy were to be introduced, it should be a levy for all, or for none.

14 Should temporary migrants already in the UK be required to pay any health levy as part of any application to extend

their leave?


Use this box for related comments:

This would be unfair.

15 Do you agree that non-EEA visitors should continue to be liable for the full costs of their NHS healthcare? How should

these costs be calculated?


Use this box for related comments:

The current system of charging for secondary care is not successful in recouping the costs of treating Overseas Visitors and in fact leads to greater costs on the

NHS by encouraging migrants to avoid seeking healthcare until they are seriously ill. It is not cost-effective and creates significant costs in administration.

As observed in the 2012 Review of Overseas Visitors Charging Policy, the majority of migrants currently affected by NHS charges are people living in the UK

without the required immigration clearance or documentation. This includes refused asylum seekers and visa 'overstayers'. Many of this group will do some form

of work but only very few would be able to afford to pay the charges for healthcare they access. In reality, the charging regime means that they are likely to avoid

accessing healthcare until they are seriously ill. This has consequences for their health, increasing the likelihood of needing to access more costly treatment in

future (which they have a right to access but the charges for which they will not be able to pay). In the case of communicable disease, this will also have a major

impact on the health of the community.

These migrants are not ‘health tourists’, nor are those short-term visitors who come to the UK and then fall unexpectedly ill or have an accident. If it were possible

to identify genuine ‘Health Tourists’ – those who come to the UK on a short-term basis for the express purpose of receiving free NHS care – it would be

acceptable to charge them directly for the services they use. However, the current system captures a much broader group of patients, with both financial and

health costs to the NHS.

16 Do you agree we should continue to charge illegal migrants who present for treatment in the same way as we charge

non-EEA visitors?


Use this box for related comments:

There are strong arguments against charging irregular migrants to access secondary healthcare. In the first place it is not financially viable to do so as this group

are generally unable to pay and will usually only present when their condition is serious and nearing the threshold for urgent treatment. The Department of Health

itself concluded that recovering charges from illegal migrants is difficult and "in most cases the burden falls on the state".

This group also includes a high percentage of people who are extremely vulnerable. For example, a survey of 20 destitute refused asylum seekers who were

represented by the Asylum Support Appeals Project between July 2011 and January 2012 found that while 85% of the individuals were between the ages of 19

and 44, a total of 45% were suffering from mental or physical health problems. This evidence reflects our own findings in our survey on mental health amongst

former detainees.

The charging regime increases the risk that there will be a failure to identify and treat early symptoms of a mental ill health and that more expensive and less

effective treatment will then be needed at a later stage. Similar risks exist around infectious diseases and the protection of public health.

It is therefore clear that identifying and charging this group conflicts with the principles established for the review in that it places undue burdens on staff, is cost

ineffective and does not adequately protect the interests of vulnerable patients or the public health of the wider community.

17 Do you agree with the proposed changes to individual exemptions? Are any further specific exemptions required?


Are any further specific exemptions required? Please also use this box for other related comments.:

We agree with current exemptions listed, but further exemptions are required for those asylum seekers granted Humanitarian Protection (HP) and Discretionary

Leave to Remain (DLR). HP and DLR provide temporary protection, which may well become permanent protection, to people who have not proved that they are

individually being targeted for persecution, but where the Government has found that they would be at serious risk of harm if returned to their own countries due

to conflict and widespread human rights violations, or that there are other exceptional and compassionate reasons for allowing them to stay in the UK. The vast

majority of these people will be unable to pay for their healthcare if they are charged.

All children and young people should be exempt from charging, as is consistent with the UK’s obligations under the UN Convention on the Rights of the Child.

Maternity services should also be exempt from charging.

18 Do you agree with the continued right of any person to register for GP services, as long as their registration records

their chargeable status?

Don't know

Use this box for related comments:

We support the right of any person to register for free GP services.

19 Do you agree with the principle that chargeable temporary migrants should pay for healthcare in all settings, including

primary medical care provided by GPs?


Use this box for related comments:

Maintaining universal access to primary care is vital to both individual and public health. Unlike secondary care services, which are restricted to only those with

specific, identified needs, the purpose of primary care is to assess the broadest range of health needs and identify how best to meet them.

The consultation question asks about ‘temporary migrants’, but this is a deceptive term for a broad group of people who are living in the UK for up to 5 years

before being considered ‘ordinarily resident’. Extending charging to primary care will also affect the many people living in the UK on a long-term basis who have

irregular migration status.

Anything which deters people living in the UK from seeking medical advice early, through primary care, will cost the NHS more when they eventually become ill or

develop complications. This is particularly concerning when one considers the importance of early treatment for:

• Infectious diseases: Treatment for HIV and TB is free and can prevent onwards transmission, but this benefit can only be gained if the infection is first

diagnosed. Rates of undiagnosed HIV and late diagnosed HIV are 25% and 50% respectively. Primary care is also the site of immunisation programmes, for

example for MMR, where 95% herd immunity is needed.

• Maternity care: Women who commence antenatal care early in their pregnancy have better maternal and child health outcomes that those commencing care

later and reduced need for costly interventions.

• Progressive conditions: There are considerable efforts to improve the ability of GPs to diagnose cancer early, when it can be treated more effectively. When

detected early, diabetes can be treated inexpensively, compared to treating complications arising from unmanaged diabetes.

There is already significant confusion around eligibility with patients who are entitled access being denied it, as evidenced by our survey on accessing primary

healthcare amongst our client group. This will only become more difficult if the proposals are introduced. In addition, some migrants who are entitled to treatment

may avoid attending primary care if they learn from others in their community that some migrants are charged for their treatment.

Access to primary care is a lynch pin for a number of health-related rules within the asylum and immigration system. For example:

• Victims of domestic violence who are seeking permission to remain in the UK after the breakdown of the relationship with a partner who was sponsoring them

must provide proof of the domestic violence. GP are an important source of evidence.

• Refused asylum seekers applying for Section 4 support on health grounds must be assessed by a doctor (usually a GP)

• Asylum seekers asking for an exemption from reporting requirements on health grounds must also provide evidence from their doctor.

20 Do you have any comments or ideas on whether, and if so how, the principle of fair contribution can best be extended

to the provision of prescribing, ophthalmic or dental services to visitors and other migrants?

Use this box for your response:

We do not believe that charging should be extended to these services.

21 Should non-EEA visitors and other chargeable migrants be charged for access to emergency treatment in A&E or

emergency GP settings?


Use this box for related comments:

Charging for emergency treatment is unethical. It also raises practical issues above and beyond those already highlighted in this response. Firstly, it is extremely

difficult to obtain information from a patient during an emergency or when they are acutely ill. Trying to obtain detailed information on their immigration status

would often be impractical even if NHS staff had the specialist knowledge required and the patient spoke adequate English to be able to explain their status. Even

in these circumstances patients would be unlikely to be able to provide evidence that they had ILR.

It is already recognised that A&E departments are struggling to cope with existing commitments, seeking to extend charging in A&E will increase delays, putting

individuals’ lives at risk. There is also the risk that follow-up checks and the pursuit of charges levied will further waste NHS resources, particularly as many

people will be either wrongly charged or unable to pay.

22 What systems and processes would be needed to enable charging in A&E without adversely impacting on patient flow

and staff?

use this box for your response:

We do not believe that charging can be introduced without having an adverse impact.

It is also likely that staff will not have the level of immigration expertise required to correctly assess entitlement and this may lead to people being wrongly charged

or discriminated against as staff seek to make quick decisions because of time and resource pressures. Medical staff should not have to consider questions of

healthcare eligibility on top of existing pressures to meet competing, urgent needs in a very challenging healthcare environment.

23 Do you agree we should extend charges to include care outside hospitals and hospital care provided by non-NHS



Use this box for related comments:

Many of these services are specifically established to try and encourage vulnerable and hard to reach groups to access health services (e.g. homeless people,

destitute asylum-seekers) and introducing charges will completely undermine this work.

24 How can charging be applied for treatment provided by all other healthcare providers without expensive

administration burden?

Use this box for your response:

It would not be possible to extend charges to non-NHS providers without significantly adding to the administrative burden on those providers and on the NHS as a

whole. In addition, this would require sharing of patient information with a much greater range of agencies, which will be extremely difficult to do while respecting

data protection principles, not to mention putting the health of patients at risk and increasing discrimination and health inequalities.

25 How else could current hospital processes be improved in advance of more significant rules changes and structural


Use this box for your response:

There should be an increased focus on making current systems and procedures function efficiently in relation to recouping costs from pre-existing insurance and

the EHIC. No significant rule changes or structural redesigns should be introduced until this happens.

26 How could the outline design proposal be improved? Do you have any alternative ideas? Are there any other

challenges and issues that need to be incorporated?

Use this box for your response:

We do not believe the current proposals are workable or consistent with the overarching principles. In particular, we do not think the proposals will be efficient,

cost-effective or ensure the safe delivery of quality healthcare. We also consider that they are extremely likely to place undue burdens on staff and increase

health inequalities.

The only way to determine eligibility for NHS services in a way which does not contravene equality law is to check everyone. This will be extremely costly to

administer, is likely to involve the issuing of healthcare ID cards to the whole population and will have health costs as many patients, including British citizens, will

not re-register. I.D. also cards raise significant the civil liberties issues.

27 Where should initial NHS registration be located and how should it operate?

Use this box for your response:

The overall proposal of a new system NHS (re)-registration is extremely problematic. NHS registration should remain with GP practices, in line with the principle

of meeting patients’ immediately necessary health needs. If someone is required to register with an external agency completely separate from health services,

prior to visiting a GP, there is a risk they will not get to see a doctor and these needs will not be met in a timely way. However, initiating a mass re-registration for

all patients at GP surgeries will place an unreasonable administrative burden on these services. From a purely administrative perspective, registration in such a

system would require a dedicated external agency. This would be costly to set up, and will continue to generate additional administrative costs for GPs, who will

still need to check eligibility of all patients at each visit. An external agency is also likely to act as an additional barrier to people accessing primary healthcare

services and will add a further layer of bureaucracy to the NHS.

28 How can charges for primary care services best be applied to those who need to pay in the future? What are the

challenges for implementing a system of charging in primary care and how can these be overcome?

Use this box for your response:

There are many significant challenges associated with charging for primary care services, which, considered together, clearly show that such a proposal is


• It is unclear how much patients will be charged for primary care access and how these rates will be set – centrally, or by individual GP practices.

• However the system is administered, it will inevitably lead to discrimination against people who appear more ‘foreign’ and are targeted for eligibility checks.

• The system is unethical, as it may lead to patients being stopped at the point of reception, and never getting to see a doctor. Many undocumented migrants

already experience this, despite having primary care entitlement.

• Charging is in conflict with the need to provide immediately necessary treatment where needed, as it is not always obvious to patients or administrative staff

whether their health needs meet this test. This can only be established after the patient sees the GP – but if they are chargeable they may never overcome that


• Barriers to primary care access will inevitably lead to greater pressure on A&E, both from people who are seriously ill and from those with less critical health

needs which nevertheless must be met.

• Many of those working in the NHS who will be responsible for implementing the system disagree with charging on ethical grounds and will not wish to participate

in charging.

• Many working in the NHS who will be responsible for implementing the system will they themselves be subject to the rules.

29 Do you agree with the proposal to establish a legal gateway for information sharing to administer the charging

regime? What safeguards would be needed in such a gateway?


Use this box for your response:

We are very concerned that protection principles will be contravened and sensitive personal data will not be protected.

30 Do you agree that we should stop issuing S1 forms to early retirees and stop refunding co-payments and if not, why?

Don't know

Use this box to give reasons for your response:


Prepared 18th November 2013