“We treat patients not passports.
I’m a Nurse not a border guard ”
1. “We’re nurses not border guards! @Jeremy_Hunt time to kick the hostile environment out the of the NHS! We’re joining @DocsNotCops to say #PatientsNotPassports“
“We treat patients not passports.
I’m a Nurse not a border guard ”
1. “We’re nurses not border guards! @Jeremy_Hunt time to kick the hostile environment out the of the NHS! We’re joining @DocsNotCops to say #PatientsNotPassports“
As Amber Rudd has resigned from the position of Home Secretary, Docs Not Cops notes that she resigned over misleading parliament regarding knowing of Home Office targets rather than over the scandalous treatment of British citizens and other people caught up in the immigration removal system. As some of our members are both part of and work directly with communities affected by the detention and deportation regime, and as up to 50 people wait to be forcibly deported via charter flight to Jamaica this week, we are doubtful that her departure signals a significant change to the Hostile Environment policy.
Our doubts are founded on the glaring fact that there has been no acknowledgement by this government – nor the opposition – that no-one should be punished with death or debilitating health because of their immigration status.
“The UK has committed an atrocious barbarism. It is time for doctors’ leaders to say so – forcefully and uncompromisingly”. That was The Lancet’s response to the deportation of Ama Sumani, a terminally ill cancer patient, to Ghana against the wishes of the Welsh community she lived in. Her deportation and subsequent death happened in 2008 – under a Labour Government. Ten years on it is becoming routine to deny cancer patients treatment: Sylvester Marshall (known as Albert Thompson in media coverage, was denied radiotherapy for six months because he couldn’t prove his immigration status, nor pay upfront – requirements introduced by Jeremy Hunt in October 2017. He will now receive treatment for prostate cancer without having to pay £54,000 – but only after a six month delay, a media scandal, and 420,000 petition signatures.
Docs Not Cops was created in response to the introduction of policies that restrict migrants’ access to free healthcare. This undermines a core principle of the NHS: treatment on the basis of need, not financial ability. We know that the imposition of borders within the NHS are only one facet of a complex and ever-expanding system. However, as healthcare workers and anti-racists, we see NHS restrictions as particularly symbolic of the inhumanity of our migration system.
This government’s attitude toward working class and particularly racialised migrants is to treat them with suspicion, presumed undocumented and a social parasite on the public purse until proven otherwise. It is this dehumanising culture, rather than particular targets, that has driven the growing presence of ID checks to restrict access to: healthcare; housing; employment; welfare; and even the ability to open a bank account. The Hostile Environment policy seeks to turn every UK citizen into a border guard, to encourage them to racially profile and police their neighbours, patients, students and tenants.
These policies have put documentation and the false idol of “secure borders” over the health of sick and vulnerable people, who deteriorate to their death. One woman with precarious immigration status died too frightened to seek treatment for pneumonia. Another man denied treatment at an early stage, died after his lung cancer progressed. Theresa May’s Home Office issued an “end of life plan” to deport Isa Muaza, while he suffered from multiple organ failure. Until the regulations requiring NHS Trusts to check ID are repealed, thousands of people will face upfront bills they cannot pay. Until data-sharing between NHS Digital and the Home Office is dropped, people will fear providing their details. Until the Immigration Health Surcharge introduced in 2014 is abolished, people will struggle to afford visas – people could be deported because of this.
The Windrush scandal reveals that determining individuals immigration status is often complex, and that it is regularly onerous for people who are legally resident to prove this. But the scandal also shines a light on Britain’s institutionally racist border enforcement system, showing it to be incredibly violent for anyone ensnared by it. The political consensus that allows this must be reversed, Docs Not Cops will continue to organise and work to build a popular culture where no-one is stigmatised as a drain on public resources but instead Britain acknowledges its wealth was built on the stolen labour and resources of its former colonies and subjects.
Xenophobia and racism should be regarded as an abominable relic of history not guide public policy. Many of us affected by this systemic violence are aware of this and fighting to make it a reality. We encourage all who agree to join us into making it a reality.
Regardless of status, we believe that no-one should be denied their fundamental right to healthcare. If you want to join us in campaigning to end prohibitive healthcare charges for migrants, the Immigration Health Surcharge on visas, ID checks in hospitals and community care, and for healthcare for all: email docsnotcops AT gmail DOT com. We are particularly keen to hear from health workers, and patients affected by the hostile environment in the NHS.
DocsNotCops was born out of Act Up and the intersectional campaign for universal access to HIV medications. In the run up to World AIDS day on 1 December 2017, we join Act Up, Queer Bus Tours and other activists in the ongoing fight for access to healthcare for all, and celebrate, remember and claim, from the top of a bus, a history for HIV-positive people in London.
Our tour starts from Soho. Voices from the bus talk about sexual liberation and the claiming of queer space in the 1970s. We hear of activists rampaging down Charing Cross Road, overturning tables of the book Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask) for only showing heterosexual sex and ignoring gay women.
Trudy Howson, LGBTQ poet laureate recites her poem written to mark 50 years since the partial decriminalisation of homosexuality, remembering the time before: “There is danger in dark places/For men like us, there are no spaces/ Where we can be proud, where we can be free/ Where I can love you and you, can love me”
We set off from Soho to the old Middlesex Hospital, once a specialist unit for people, mostly young men, dying of AIDS. We’re asked to “turn to someone you don’t know and tell them about a person that you are remembering, a person you are thinking of today”. A former nurse talks of her experience of nursing those young men dying when the disease wasn’t understood: “we nursed them wearing plastic gowns, masks, they used paper plates – it took away their dignity”.
Those were days of mourning, but also organising. The fightback produced one of the most successful civil rights movement of the past 30 years: the incredible advances in HIV treatments were won through the bravery of individuals and the power of movements like AIDS Coalition To Unleash Power (Act Up), popularising the message that Silence = Death. But however great the success story was here in the Global North, access to anti-retrovirals globally in 2016 was only at 46%. Remembering the history of the movement is key to renewing the political project at the centre of HIV activism: healthcare as a right for all.
But in the NHS this right is being eroded. As from 23 October 2017, the latest phase of the implementation of the 2014 Immigration Act introduced upfront charging for hospital inpatient and outpatient services and some community services. This is being enforced with immigration checks at hospital appointments and in A&Es, building on a longer term political project to obfuscate the funding crisis of the NHS and blame migrants instead.
While HIV services are technically still free for all, regardless of immigration status, the confused implementation entrenches racial profiling, detaches hospital staff from a duty of care and frightens patients from accessing the services they need. Major HIV advocacy organisations, such as the National AIDS Trust have been very vocal about their concerns, recommending that the legislation be withdrawn.
They are among the growing number of organisations calling for upfront charging to be removed from the NHS. Among them, DocsNotCops is committed to fighting the hostile environment that turns hospital staff into border guards – agents of this government’s migrant scapegoating. DocsNotCops fights to promote free healthcare for all, available without judgement, prejudice or fear.
As we continue our bus tour, we hear the experiences of those whose HIV came from using drugs and the stigma they faced. We hear the stories of HIV-positive women, the effect on their families, their loved experience at the intersection of race, gender and HIV status. We hear the damage the 1989 public health campaign “Don’t Die in Ignorance” did to those it shamed for their sexuality. “Don’t ever let that happen again”.
London is experiencing an unprecedented fall in new infections, which one Dean Street support worker attributes to, among increasing campaigning and countering stigma, also the improved access to PrEP (Pre-Exposure Prophylaxis) an antiretroviral that at risk, HIV-negative individuals can take to stay that way. It’s been trialled very effectively in young men, but the NHS has not made it universally available across the UK. For many, PrEP remains only available if they pay for it themselves. We hear from a representative of the National AIDS Trust that PrEP trials are not focusing enough on other at risk groups, particularly at-risk women. Act Up is campaigning for greater access to PreP for all those at risk of transmission.
Most touchingly, we hear the testimonies of those with their own stories to tell, the stories of love, of drugs, of sex, of their moment of diagnosis. The bus, covered in the banners of Act Up, Docs Not Cops, statements of freedom of sexuality and choice for our bodies, pulls up at Dean Street – but the struggle continues.
At 8.30am on 5th April, the entrance to the Department of Health (DoH) was blocked by a makeshift immigration checkpoint, manned by NHS patients and staff protesting plans to introduce upfront charging for care throughout the NHS.
The disruptive action, organised by campaign group ‘Docs not Cops’ comes after Jeremy Hunt’s announcement that, as of April 2017, NHS trusts would be legally required to check patients’ eligibility upfront and demand payment before providing secondary care.
Although the government positions this as a cost-saving measure, the figures don’t add up. The DoH’s own estimate is that ‘deliberate health tourism’ costs only 0.03% of the NHS budget annually. Docs not Cops believe this policy will lead to discrimination and racial profiling, and will destroy patients’ relationship with NHS workers.
These checks will prevent those most in need of care from getting the treatment they need. This is already evident in the case of pregnant migrant women, where some destitute refugee women are being frightened away from maternity services due to NHS trusts issuing letters demanding payment of thousands of pounds. Docs not Cops, a group formed by NHS workers and patients to combat racism in the NHS, encourage all healthcare workers to sign up to their pledge to refuse to comply with the new policy.
We believe no one should be afraid to access the healthcare they need, either because they can’t pay or might be punished, and that NHS workers should not be forced to police the people they treat.
“This policy will completely undermine patients’ trust in the NHS, which in turn will put people’s lives at risk. We are calling for a campaign of non-compliance because it’s the right thing to do for our patients and for the future of the NHS.”
Zoe, Academic Clinical Fellow Obstetrics & Gynaecology at Addenbrooke’s and The Rosie Hospitals, Cambridge.
“Jeremy Hunt keeps saying this will balance the NHS budget, but the numbers just don’t add up. This shameful exercise is about Jeremy Hunt shifting the blame and the cost of austerity onto the most marginalised and vulnerable people.”
Helen, Docs Not Cops Organiser
This April the changes documented in the Government’s ‘Making a fair contribution’ proposal will come into force.
They are the latest round of measures introduced into the NHS to extend UK borders inland, and ask doctors, nurses, and allied healthcare professionals to question their patients’ immigration statuses.
As of April:
These measures will make people afraid of accessing the care they need.
They are based on racist ideology, not evidence. They will lead to racial profiling and discrimination within the NHS. They are violent.
These changes will build upon the already harmful effects of the government’s Immigration Act 2014, which has seen hundreds of migrant women made terrified of accessing antenatal care and threatened by the very hospitals they need to help them.
No racism in the NHS!
Keep immigration checks out of the NHS!
Join us on Wednesday 5th April in creating a Twitter and email storm between 10am-12pm (but please start earlier and continue after should you wish!). We’re asking people to tweet the Department of Health (@DHgovuk), NHS England (@NHSEngland), and the Health Minister Jeremy Hunt (@Jeremy_Hunt) using the hashtags #PatientsNotPassports and #DocsNotCops. We’ve included some sample tweets below which we welcome you to customise as you see fit:
We know that some trusts such as St George’s NHS Trust (@StGeorgesTrust) have piloted these schemes and Barking, Havering, and Redbridge Unversity Hospitals NHS Trust (@BHR_hospitals) have sent threatening letters to women unable to pay for their maternity care, we welcome you to ask them why they are complicit in these racist acts of violence.
We’ve made some graphics to help the storm get more attention. We welcome you to share or post any of the images below on your social media page (click to enlarge and save):
Please help us to highlight the insidious introduction of immigration checks to the health service. These measures are racist, these measures are violent, these measures will cost people their lives.
Can you help?
If you are an NHS worker, patient, or anybody else who believes passionately that the care you receive should not be dictated by your place of birth or immigration status follow us on twitter @DocsNotCops, or contact us via email: firstname.lastname@example.org
Please join our twitter storm and hold the government to account, we are Docs not Cops!
In response to the House of Commons Public Accounts Committee report on NHS charging for overseas patients:
FEBRUARY 2017: The Migrants’ Rights Network (MRN), Docs Not Cops and health professionals are concerned by the recommendations of the Common Public Accounts Committee (PAC) in their report (1 Feb 2017), which states a need for a more radical approach to recoupment of charges for NHS treatment of overseas patients. We believe this report, besides admitting that the government is failing to meet its own targets, outlines an unworkable, impractical and discriminatory system – one that needs eliminating not expanding.
The report outlines the failures of the NHS charging system to recoup costs incurred by EEA patients through reciprocal agreements, as well as the low levels of return on bills sent to non-EEA patients. They are not even managing to reach the figure they intend to recoup – £500 million, actually a tiny figure at less than 0.5% of the overall NHS budget.The PAC report argues that these low “gains” are due to a lack of identification of chargeable patients, although it admits that forcing patients to prove their eligibility or entitlement is likely to penalise and discriminate those that are in need of dire medical attention. Discrimination in the NHS charging system has been well documented, and we believe that drawing more health professionals into the system to identify chargeable patients is not the answer.
The PAC recommends that GPs are recruited to identify chargeable patients. GPs, a group who are already overstretched because of an under-resourced NHS and additional responsibilities should not now also be pushed to identify patients who ‘may’ be chargeable, because they are ill-equipped to understand and apply the entitlement rules for free NHS care because of the complexity of the current UK immigration system. Their inclusion fundamentally undermines medical professionalism and confidentiality and will only lead to more discrimination and inappropriate refusal of treatment, or charging people in error.
Dr Philip Abiola, GP said: “It is unfair to blame overseas patients as the cause of the stresses on NHS resources, this is clearly due to an inefficient system that is unable to recoup costs through its reciprocal agreements, as well as a wider picture of underfunding. Pursuing patients in GP surgeries to prove they are allowed to access healthcare will drive them into emergency services, which are more costly than primary care. Any expansion of this system to involve GPs, will undermine my professional duties and deter vulnerable and ill patients from accessing healthcare they are entitled to.”
Dr Aislinn Macklin-Doherty, cancer doctor and researcher, said: “This overblown blame on Health Tourism for the current NHS crisis is evidence of yet more spin from this Government to distract from the real problems facing the NHS. The £500 million quoted spent on Health Tourism is dwarfed by the £22 billion being intentionally cut from the NHS by the current Government by 2020 and the 10s of £billions that leak out of the NHS into the bank accounts of private companies every year. Introducing charges or checks for eligibility we know would cost more than the relatively small amount it would recoup, and would also undermine the universality of treatment by forcing doctors to focus on “policing” who they care for rather than delivering care. My duty is to treat patients, not to be a border guard.” ()
Fizza Qureshi, Director of MRN said “Scapegoating migrants, when the real issue is systematic underfunding, is unreasonable and divisive, as is expecting healthcare professionals to act as the unofficial border police.”
For further information, please contact Fizza Qureshi on 020 7336 9407 or us at email@example.com; www.migrantsrights.org.uk and www.docsnotcops.co.uk
TREAT, don’t POLICE!
Our Tory government seeks to create a “hostile environment” for migrants in the UK. This means that they have devolved border control from the Home Office into every corner of our lives: employment, renting, and healthcare. They are essentially creating an army of informants to dob in the most vulnerable, those who often have no legal protection.
We have seen this happen at Byron. We are also seeing it happen in the NHS.
Under the Immigration Act, non-EEA patients are chargeable at 150% of NHS costs. Patients with outstanding bills have their details shared with the Home Office, which can lead to requests for leave to remain being denied, or even to detention. This is an increasingly popular tactic: this year, the Home Office requested three times as much data from the NHS than in 2013, as shown below.
Vulnerable people are less likely to access health services if they fear charges or punishment on the grounds of immigration status. This constitutes a public health and human rights issue.
Byron colluded with the Home Office to avoid a massive fine. It seems they knew who was working for them illegally, and set them up for their own benefit. Healthcare workers are different. Ideally, they provide free access to sensitive, non-judgemental care. They cannot be asked to police instead of treat.
The Home Office is turning us all in to border guards, policing each other and fuelling fear and racism. We can’t allow this to happen! At DocsNotCops, we are working to repeal the Immigration Act within healthcare. The BMA stands with us, and you can too! Find us on Facebook, Twitter or www.docsnotcops.co.uk
We are so happy! Motion 328 asking the BMA to denounce the Immigration Act and to promote the value immigrants bring to the NHS has passed!
Some excellent additional points were made, including how the Immigration Act raises safeguarding issues, how the infrastructure being implemented could eventually be used to charge all, regardless of immigration status, and the contractual difficulties that arise from asking doctors to act as border guards.
To see all of the action go down, please watch the following video from hour 3 exactly. It is about 10 minutes long.
Thank you to our colleague to Dr. Megan Parsons for presenting the motion. And thanks to you for supporting!
If you can, please do spread the message!
Motion by MEDICAL STUDENTS CONFERENCE. This conference is concerned about the impact of charging migrants for NHS services.
We ask the BMA, the Chair of BMA Council and the Chair of the International Committee to:
i) Run training workshops for BMA members about the influence immigration legislation has on doctors’ clinical practice.
ii) Commission a report into the negative impacts of the Immigration Act on patient care and access to health services.
iii) Run a public awareness campaign (including the production of materials, online infographics) on the value of migrant health workers to the NHS.
iv) Engage with other health unions and professional associations to issue cohesive guidance to all NHS staff (including administrative staff) advising them not to partake in any process of monitoring or deciding upon a patient’s migration status.
We, the undersigned, are concerned about the the impact of the charges for migrants using NHS services laid out in the Immigration Act 2014 and its proposed updates. We support the British Medical Association (BMA) in renouncing the Bill at the forthcoming conference.
Currently, many non-EU residents pay a health surcharge (on top of their NI and tax contributions) to access NHS secondary and tertiary care; still more people living and working in the UK are now required to pay per-service, as the Act outlined charges at 150% of what it costs the NHS and made collection of debts by NHS trusts mandatory. A government consultation put out earlier this year has suggested extension of these policies so that primary and emergency care, as well as ambulance services, will also be chargeable.
The Act is inflammatory, pandering to anti-immigration sentiment, and falsely blaming the crisis in NHS funding on migrants who already contribute, or who could contribute to society. The charges and top-ups create a two-tier system that, for now, distinguishes between migrants and British citizens, but in the years to come could be used to distinguish insured from non-insured.
The legislation is discriminatory, and it must be recognised that decisions on who should be paying are often made on the grounds of racial profiling. There is no consistency on the interpretation of the eligibilities for care, and many who should be exempt are being charged falsely or opportunistically. Moreover, those that are eligible are confused as to what services they can and cannot access. And for those who know that they might be charged, or if undocumented, even deported for accessing NHS care, it means delaying accessing care, and often delaying too long, as in the tragic case of Dalton Messam who died as a consequence.
The Act states that doctors should be responsible for making decisions about eligibility. The Act even asks clinicians to, quote “bear in mind individuals’ ability to pay” when considering a management plan. This fundamentally undermines the founding principles of the NHS to provide universal healthcare that is free at the point of access.
A commonly applied argument against this case is that of preventing health tourism, which costs, according to Government estimates that have been strongly criticised by The King’s Fund, anything from £70 million to £2 billion. We argue that these figures fail to recognise the net gains that immigrants living and working in the UK provide to our country, especially when one considers the number of NHS workers who were born and trained abroad. In any case, migrants are not the largest drain on NHS resources, compared to PFI debts and competition between NHS and private providers.
DocsnotCops is a coalition of concerned medical professionals, journalists and laypeople. We seek to raise awareness of this damaging Act and ultimately to repeal it. The BMA is holding a conference in Belfast on 19-23 June. We are appealing for them to promote the value that migrant workers bring to the NHS and stop forcing healthcare workers to act as border guards. The full text of the motion is reproduced below. The motion is currently on the secondary list, so there is a chance it may not be heard. Please add your support to raise awareness of this important issue and put pressure on the BMA to debate it!
We have to fight for civilized principles, to defend our NHS, and that’s why we have to defend migrants, and everyone’s access to free care at the point of need.
NOW IS THE TIME TO ACT!
The Immigration Act came into force on the 6th of April 2016. The UK government introduced an immigration health surcharge and threats of fines for trusts that do not comply with charges. Click here to find out more.