Experiences Among Undocumented Migrants Accessing Primary Care in the United Kingdom

Abstract

Immigration is a key political issue in the United Kingdom. The 2014 Immigration Act includes a number of measures intended to reduce net immigration, including removing the right of non-European Economic Area migrants to access free health care. This change risks widening existing health and social inequalities. This study explored the experiences of undocumented migrants trying to access primary care in the United Kingdom, their perspectives on proposed access restrictions, and suggestions for policymakers. Semi-structured interviews were conducted with 16 undocumented migrants and four volunteer staff at a charity clinic in London. Inductive thematic analysis drew out major themes. Many undocumented migrants already faced challenges accessing primary care. None of the migrants interviewed said that they would be able to afford charges to access primary care and most said they would have to wait until they were much more unwell and access care through Accident & Emergency (A&E) services. The consequences of limiting access to primary care, including threats to individual and public health consequences and the additional burden on the National Health Service, need to be fully considered by policymakers. The authors argue that an evidence-based approach would avoid legislation that targets vulnerable groups and provides no obvious economic or societal benefit.

Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study

“…Of more concern is the possibility that medical care was not sought when children were in need. Existing evidence suggests that migrants in more vulnerable circumstances, such as undocumented migrants, experience substantial barriers to care [24][25][26][27].…”

The Visitor and Migrant Cost Recovery Programme – A threat to health?

“…Fear as a deterrent to healthcare access among migrants has been well documented in several countries including the UK (24,36). In 2012 the government made clear their explicit intention to create a "really hostile environment" for those living in the UK without the legal right to do so (37).…”

National Health Service Principles as Experienced by Vulnerable London Migrants in "Austerity Britain": A Qualitative Study of Rights, Entitlements, and Civil-Society Advocacy

“…29,40,62 Several issues warrant improvement, including accessibility, communication, and clarity on migrant entitlements and GP responsibilities. 18,58,63 Concerns have been raised about potential public health impacts 25 and the human impact of changes to NHS entitlements and charging policy (eg, consequences of forcing health-workers to 'police' access, the extent changes may violate patient confidentiality or human rights). 28 In principle, NHS rules on health service entitlement do comply with international conventions on access, though some migrants will be charged for the care they receive.…”

“…8 Considerable literature documents migrant and other ethnic minority experiences with the National Health Service (NHS) before and during austerity, showing many inequities as systemic and longstanding. [9][10][11][12][13][14][15][16][17][18] While austerity measures are not responsible for inequities in service access and quality, combined with rapid recent demographic changes, patterns of social exclusion, and increasingly restrictive immigration policies, austerity leaves some migrants increasingly vulnerable to inequitable health services provision. 7,[19][20][21] The British NHS, established in 1948, is a publicly-funded healthcare system providing universal coverage for users.…”