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

Abstract

Background: Recent British National Health Service (NHS) reforms, in response to austerity and alleged 'health tourism, ' could impose additional barriers to healthcare access for non-European Economic Area (EEA) migrants. This study explores policy reform challenges and implications, using excerpts from the perspectives of non-EEA migrants and health advocates in London. Methods: A qualitative study design was selected. Data were collected through document review and 22 indepth interviews with non-EEA migrants and civil-society organisation representatives. Data were analysed thematically using the NHS principles. Results: The experiences of those 'vulnerable migrants' (ie, defined as adult non-EEA asylum-seekers, refugees, undocumented, low-skilled, and trafficked migrants susceptible to marginalised healthcare access) able to access health services were positive, with healthcare professionals generally demonstrating caring attitudes. However, general confusion existed about entitlements due to recent NHS changes, controversy over 'health tourism, ' and challenges registering for health services or accessing secondary facilities. Factors requiring greater clarity or improvement included accessibility, communication, and clarity on general practitioner (GP) responsibilities and migrant entitlements. Conclusion: Legislation to restrict access to healthcare based on immigration status could further compromise the health of vulnerable individuals in Britain. This study highlights current challenges in health services policy and practice and the role of non-governmental organizations (NGOs) in healthcare advocacy (eg, helping the voices of the most vulnerable reach policy-makers). Thus, it contributes to broadening national discussions and enabling more nuanced interpretation of ongoing global debates on immigration and health.

Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys

“…8 The latter can however also act as barrier to accessing health care, so lowering utilization, 9 alongside uncertainty about eligibility for health care among service users and providers. 10 Other reasons for lower utilization include the relatively younger ages of migrants, 4,11 the 'salmon-bias effect' where migrants return to their country of birth when they become ill, or to access health care, and the 'immigrant health-advantage' where migrants have better health relative to native-born populations in the host countries.…”

The north-south policy divide in transnational healthcare: a comparative review of policy research on medical tourism in source and destination countries

“…Public debates have been shaped by political rhetoric largely centred on immigration, access to free healthcare for migrants and visitors, and the role of the NHS. While there is little evidence that this compromised the care of vulnerable populations, it has created confusion and uncertainty among care providers and consumers [67]. Many assumptions driving policy on these issues have been contested by recent research.…”

Austerity or Xenophobia? The Causes and Costs of the “Hostile Environment” in the NHS

“…In 2017, up-front charges were introduced with the aim of improving cost recovery, requiring chargeable NHS patients to pay for their care before receiving it [77]. Over the course of just a few years, access to the NHS for migrants has been drastically reduced, and the range of different entitlement categories has multiplied [64].…”