I volunteer as a GP in Doctors of the World’s clinic, helping people in vulnerable circumstances access care. There, I met Sara*.
When I first saw her, I thought she was cuddling a baby under her cardigan and that she had brought her sick child to see us. I was terribly wrong.
Sara hadn’t seen a doctor in a very long time. Terrified of having to pay a huge bill or being deported, she had waited as long as she could before asking anyone about the lump in her breast. Sara had waited so long that now her lump was weeping, infected and enormous.
A few months ago, her cancer might have been curable, but now it was too late. Sara had waited for such a long time that there was nothing left for me to do but try to help her get palliative care. I have been a family doctor since 1984 and I thought I was an experienced GP, but nothing prepared me for the day I met her.
This is the reality for many people in this country. Borders and immigration checks have infiltrated the NHS so much that this woman was so afraid of being reported to the Home Office and charged that she waited until there was nothing else left to do.
Questions about immigration status are now routine in registering at a GP, attending A&E or hospital appointments.
For Sara, her immigration status had been put before her health by policy makers, even though doctors just want to treat patients and fulfill their Hippocratic oath.
At Doctors of the World’s clinic we see people in urgent need of care, including cancer patients and heavily pregnant women, who are refused treatment or simply too afraid to even approach the NHS.
The current charging regime means that some people will be asked to pay upfront, before receiving care. While in urgent cases this should not happen, due to pressures on hospitals, mistakes are being made and patients have been denied urgent and necessary care. Even if they do receive care, they can be chased to pay for the debt, which can amount to tens of thousands of pounds.
The healthcare of EU citizens has become the victim of a political game, with little or no regard for those it will put at risk.
I have seen the harm that charging has caused to patients, and that hospitals, struggling to cope with the pressure, have withheld lifesaving care from patients time and time again.
And now, despite calls from all angles of society to scrap the charging regime it’s looking increasingly likely that EU citizens are going to face problems accessing healthcare after Brexit.
As part of the government’s preparations for a no-deal Brexit, hospitals appear to have been informed that, after exit day, EU citizens must pass an ‘ordinarily resident’ test to be entitled to free NHS care, and providers should ‘follow existing guidance on upfront charging’.
This suggests that EU citizens in the UK short term and those with irregular immigration status risk having healthcare withheld if they cannot pay.
It also raises questions about access to NHS services for all EU citizens. It is difficult to see how the already overstretched NHS will manage to distinguish between EU citizens with a right to NHS care and those who will have to pay – especially as two million settled EU citizens do not have settled status paperwork yet. We risk a repeat of the Windrush scandal.
Despite reassurances by the Department of Health, I remain concerned about those who might struggle to provide proof of identity, people who are homeless or living in vulnerable circumstances, about hospitals being overwhelmed by this workload, and urgent care being wrongfully denied
The healthcare of EU citizens has become the victim of a political game, with little or no regard for those it will put at risk. Anyone who works in the NHS knows the fundamental role timely healthcare plays in protecting patients, NHS resources and society as a whole.
These policies, which deliberately frustrate this fundamental principle of effective healthcare delivery, are short-sighted and dangerous.
This decision will impact society and public health as a whole. When someone waits before seeing a doctor, their health condition is likely to worsen.
Untreated diabetes might lead to blindness, heart conditions and even amputations, which are all expensive to treat. A small lump might become untreatable breast cancer. NHS resources should be preserved and well employed, but this policy does the opposite.
Hospitals and the whole NHS will also be put under immense pressure. I’ve seen how hospitals are already struggling to implement the current rules, often making mistakes and denying treatment in cases where it was urgent and necessary.
Doctors have been pressured by administrative staff into making decisions about a patient’s need for care, their workload has increased and it’s having a negative impact on public health.
I’m incredibly concerned that hospitals are being ordered to charge EU patients with irregular immigration status straight away in the event of no-deal Brexit.
The current charging system is a shambles and patients like Sara have been too scared to get the help they so urgently needed. This policy is unethical and unworkable. Now millions of EU citizens are at risk of being thrown into this dangerous system.
*Name has been changed.
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