Healthcare access for children and families on the move and migrants

Abstract

BackgroundThe United Kingdom (UK) National Health Service (NHS) charging regulations have increasingly restricted migrants’ healthcare access, in the context of a wider national policy shift over the past few years intending to create a ‘hostile environment’ for migrants. With an estimated 144 000 undocumented children living in the UK and increasing public concern that these regulations are negatively impacting migrant health and well-being, as well as contravening international child rights agreements, it has become imperative to understand their implications.MethodsA mixed methods digital survey, covering attitudes towards and understanding of UK healthcare charging, and giving space for relevant case submission, was disseminated through communications channels of the Royal College of Paediatrics and Child Health (RCPCH) to their members. Quantitative data were analysed on Stata, and basic proportions were calculated for each response proportion. Qualitative data were analysed using a framework analysis approach.ResultsThere were 200 responses, from a range of healthcare professional backgrounds. The majority were not confident in interpreting and applying the charging regulations. One-third (34%) reported examples of the charging regulations impacting patient care, analysis of which elicited seven key themes. Our survey gathered 18 cases of migrants being deterred from accessing healthcare, 11 cases of healthcare being delayed or denied outright, and 12 cases of delay in accessing care leading to worse health outcomes, including two intrauterine deaths.DiscussionOur results describe a range of harms arising from the current NHS charging regulations contributing to delays in or denials of healthcare, due to patients’ fear of charging or immigration enforcement, including potential deportation, and confusion around entitlements. This harm affects individual patients, the migrant community and the NHS – often in multiple simultaneous ways. Many patients eligible for NHS care, such as trafficking victims, are not being identified as such. We found the current charging regulations to be unworkable, and that harm could not be eliminated simply through improved awareness or implementation.

Healthcare access for migrant children in England during the COVID-19 pandemic

“…2 These unresolved concerns and subsequent serious child health consequences have been echoed repeatedly by leading health and migrant support experts. 3 The global COVID-19 pandemic and impacts of mitigation policies have dealt multiple blows to the health and well-being of many sectors of the population, particularly those already living precarious lives. Migrant families and children are recognised as a group already burdened with health challenges and barriers to healthcare access which risk further exacerbation during and beyond the COVID-19 pandemic.…”

“…Migrant families and children are recognised as a group already burdened with health challenges and barriers to healthcare access which risk further exacerbation during and beyond the COVID-19 pandemic. 3 The ongoing public health crisis presents an urgent and distinctive opportunity to permanently address the unacceptable hostile policy and practice environment that restricts equitable healthcare access, endangers child health and so poorly enables the rights of migrant children to be realised.…”

“…22 Murphy et al demonstrated that healthcare professionals have recorded recent instances of profound harm to migrant families and children, including interuterine death and delayed treatment of childhood cancer where access to necessary healthcare has been deeply feared and avoided, denied (without payment) or delayed. 3 Testing and treatment of COVID-19 have been decreed free of charge and exempt from immigration status checks, 23 yet urgent and substantial concerns remain that these exemptions cannot mitigate the extensive barriers to migrants accessing healthcare and the subsequent severe mistrust in the integrity of the NHS generated by hostile policies. 24 Possible symptoms of COVID-19 are diverse in presentation and severity, particularly in children, 25 and many will be deterred from accessing the help they need risking increased community transmission, health complications, inappropriate use of home treatments and avoidable deaths.…”

“… 22 Murphy et al demonstrated that healthcare professionals have recorded recent instances of profound harm to migrant families and children, including interuterine death and delayed treatment of childhood cancer where access to necessary healthcare has been deeply feared and avoided, denied (without payment) or delayed. 3 …”

Migrant health charges: A scandal amidst the crisis

“…The charges have been around in law since 1977 at least, but only really implemented since 2015, with upfront charges since 2017. In the middle of a pandemic, hostile environment policies such as health charges make even less sense.Indeed, from a public health perspective they are profoundly absurd, with particular concerns regarding vulnerable groups such as the disabled, people with mental health difficulties and in relation to maternal and child health (seeMurphy et al, 2020). Thus, even if there is an immediate promise that people will not be charged for treatment of COVID-19, there is a huge disincentive to seek treatment given the mistrust and exclusions that are already established within the hostile environment.…”