Join the campaign for our health

We all need care when we’re unwell. But right now, some of the most at-risk people in our community find it almost impossible to get medical help.

As the pandemic has clearly shown, this affects us all. If you agree that nobody should die because they can’t see a doctor this winter, join the campaign.

What we are calling for

As we face the greatest public health challenge in recent history, it’s more important than ever that everyone in our community can see a doctor or nurse when they need to. But right now, some of the most excluded and at-risk communities struggle to access NHS services, a situation that has only been exacerbated by COVID-19.

Whether we see a migrant living in fear of being deported, a sex worker facing stigma, or a person experiencing homelessness cut off by red-tape – too many people are excluded from healthcare in the UK.

The pandemic has made it clearer than ever – leaving just one of us exposed puts us all in danger. With winter around the corner, we must make sure nobody falls through the cracks.

Hands Up for Our Health is a coalition of organisations fighting for everyone in the UK to have the chance to access healthcare, during COVID-19 and beyond.

We have three main objectives:

Suspend NHS charging during the pandemic:

Immediate suspension of the NHS charging regulations, giving everyone the chance to see a doctor or nurse when they need to. This public health change is needed urgently as charging migrants for hospital services threatens the health of both individuals and the population as a whole during the COVID-19 pandemic.

Investigate the impact of NHS charging:

Call for research and an investigation into the impact of the NHS charging regulations on individual and public health, including during the first wave of the COVID-19 pandemic. Coalition partners will be invited to take part in joint action to bring about long-term reform of the charging policy.

Encourage the government to build back better:

Drive work to improve access to all NHS services for everyone living in the UK, including developing policy alternatives to the existing NHS charging regulations.

What this means

For patients 

People who can’t access the NHS are forced to manage health problems alone. Often their condition becomes much worse than if they’d had the help and support of a doctor or nurse at the right moment. In normal times, this endangers the person’s life and recovery. During a pandemic, it is even more terrifying and isolating.

For doctors and nurses

When people are cut out of health services, doctors and nurses’ workload goes up, not down. Most illnesses are easier and quicker (and cheaper!) to treat early on. People who can’t see a doctor easily usually end up in emergency services with very simple medical problems that could have been treated before their condition worsened.

For our communities
This is not about others; it is about all of us. COVID-19 has shown we are only as healthy as our community; if one of us gets sick, we are all at risk. We need to pull together and make sure everyone in our neighbourhood can see a doctor when they need to. Right now, this is truer than ever, but good public health (ensuring the whole population is kept well and healthy) has always been very important.

Patient stories

FGM campaigner Saloum was denied hospital care after being diagnosed with multiple tumours and lung cancer because of his immigration status. Photo by Fabio de Paola.
Saloum was 44 years old when he fled his home country The Gambia after risking his life by challenging the widespread practice of female genital mutilation (FGM).

He spent 10 hard years living in the UK as an undocumented migrant. Without a GP, Saloum took paracetamol for his headaches. He had no idea he was ill until he suddenly collapsed in the street one day.

Saloum was rushed to hospital where he was diagnosed with two brain tumours and lung cancer and given just days to live.

After his diagnosis, Saloum received treatment for several days. But he was soon told that as an undocumented migrant, he was not eligible for further NHS treatment unless he could pay for it.

Unable to afford his care, Saloum was discharged and told to leave the hospital by midday.

“It is so inhumane to treat someone with brain tumours and lung cancer in this way. We know his condition is terminal. When he was diagnosed from the hospital, we were told he only had about five days to live,” Saloum’s friend Fatou said.

Fearing he would be discharged onto the streets, Saloum’s friends and local community raised money to rent a small bedsit. They looked after him in shifts as he became weaker, constantly drifting in and out of consciousness.

Whilst in pain and unable to look after himself, Saloum received a bill from the hospital for £8,397 for the treatment he received before his care was terminated. He had no way of paying.

“I ran away from my country to come here after I spoke out against FGM,” Saloum said. “I’ve never done anything wrong and I’ve never been in trouble with the police.”

Sadly, Saloum died a few weeks later. He was eventually admitted back into hospital, but right up to the end of his life, he was haunted by the fear that medical care would be withheld again.

“Last night, just before he died, he became panicked and anxious and I could see he was scared he might be discharged again because he could not pay for his treatment,” said Fatou.

This is an excerpt from a story originally published by The Guardian. Photo by Fabio de Paola.

Djibril (not his real name) came to the UK to seek asylum after fleeing political persecution in his home country.

When his asylum claim was refused, the Home Office tried to deport him, but his home country refused entry. After 17 years of living in limbo, unable to regularise his immigration status in the UK and unable to leave, Djibril was diagnosed with cancer.

Djibril’s doctors warned the cancer may spread if he did not have surgery, but the hospital refused to treat him unless he paid thousands of pounds first due to his immigration status.

Again, it was because of his immigration status that Djibril struggled to find work and he was forced to depend on a friend for a place to sleep and food to survive. He had no way of paying the hospital bill.

One year later and only with help from Doctors of the World and a lawyer, Djbril was able to challenge the hospital’s decision, and he received the surgery he needed. But this was not the end of his troubles.

Following the surgery, Djibril was constantly chased for payment for his treatment. Debt collectors and High Court Enforcement Officers threatened to take possession of goods from his friend’s house where he was staying if he did not pay the £3,900 the hospital said it was owed.

This left Djibril distressed and on the brink of street homelessness.

“This unexpected visit at the address to collect the money makes me feel very uncomfortable,” he said. “Not only I do not have the money but also I cannot cope with the unbearable stress of being chased up at the house… I have explained over and over again that I am an asylum seeker, not working, with no income and no support from the state. I just live on handouts from friends here and there, living from day to day.

“Even worse the friend who houses me will kick me out immediately if I bring any problem to her house.”

Djibril eventually collapsed from a stroke and died. He was 49.

As the Hands Up for Our Health campaign progresses, we will continue to share the stories of people who cannot get medical care.

How you can help

Will you put your hand up for our health?

Over the coming weeks and months, the Hands Up for Our Health coalition will be urging the UK Government to act on our three asks:

  1. Suspend the NHS charging regulations
  2. Investigate the impact
  3. Commit to improving access to all NHS services

There are many ways you can support the campaign, such as:

If you’re an organisation interested in joining the coalition, drop us an email at hello@handsupforourhealth.org.uk. With a united voice, we can call for better health for all.

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FAQ

Who has difficulty accessing NHS services?

A number of factors influence our ability to get healthcare and many people may experience challenges accessing NHS services at some point in their life. However, some people find it more difficult than others because of the systematic barriers they face. This includes (but is not limited to):

  • Refugees and asylum seekers
  • Undocumented migrants
  • People experiencing homelessness
  • Gypsy, Roma and Traveller communities
  • Sex workers
What are the main reasons people cannot access NHS services? 

There are many reasons people are unable to access NHS services. Some people cannot register with a GP because they don’t have identity documents or proof of address, or language barriers mean they can’t fill in the required forms. Some people are not entitled to receive most NHS hospital and community services because of their immigration status so are forced to go without treatment unless they pay 150 percent of the tariff in advance. And some people simply feel unwelcome in health services because of stigma or because they worry they will be reported to the Home Office immigration enforcement unit if they consult a doctor.

How does this affect the general public in a pandemic?

Excluding people from healthcare services is never a good idea, but it’s incredibly dangerous during a pandemic when we want everyone to feel safe and able to come forward to NHS services for testing and treatment. Tests for COVID-19, and treatment following a positive test, are free for everyone regardless of their immigration status. However, this exception has limited effect. Research shows that during the pandemic, people experiencing homelessness, refugees and migrants, sex workers and Gypsy, Roma and Traveller communities have struggled to get medical help and advice when they need it. And, after years of the NHS charging regime, some people are afraid to seek treatment and worry they will be charged for treatment if it turns out that their illness is not COVID-19. 

Why isn’t everyone entitled to NHS services?

The NHS was established on the principle that healthcare should be available to all regardless of your ability to pay. Everyone is entitled to free primary care despite their immigration status but there have been restrictions on access to NHS secondary care services for non-citizens living in the UK for many years. In 2015, the UK government introduced new regulations that force NHS trusts in England to charge migrants living in the UK for most hospital services. Migrants on a visa generally have to pay a surcharge – £425 a year – while undocumented migrants are charged an inflated 150 percent of the tariff for their treatment. As of 2017, NHS trusts must withhold treatment until a patient has paid in full – unless their situation makes their treatment “urgent” or “immediately necessary”.

What happens if a person not eligible for NHS services does not have the money to pay for treatment? 

If a person is not eligible to receive an NHS service for free, they will not receive treatment and will be discharged until they are able to pay. If treatment has already been provided – because it was urgent or considered immediately necessary by the hospital – the patient will receive a bill for 150 percent of the cost of their treatment. However, urgent or immediately necessary treatment is often wrongly refused due to the complexity of the charging rules. If the patient cannot pay the bill in two months, they are reported to the Home Office’s immigration enforcement team. 

How much does it cost to provide NHS services to migrants?

In 2013, research commissioned by the government estimated the cost of providing NHS services to migrants was £1.7 billion – 1.92 percent of the total NHS budget in the same year (2012 and 2013). This estimate includes migrants on a visa (who pay an annual surcharge to access NHS services) and EU migrants (whose healthcare costs could be recovered from their EU state) as well as undocumented migrants.

Who is impacted by NHS charging?

Unfortunately, this policy mostly affects people in vulnerable circumstances, like asylum seekers with refused claims, survivors of human trafficking, people who came to the UK to work without a visa, but also those with expired visas and people who came to the UK as a child with undocumented parents.

There are also cases where British people and others with permission to reside in the UK have been targeted by the migrant charging rules and faced delays getting treatment.

Who are undocumented migrants?

There are many reasons why a person may become undocumented. They may be unable to renew their visa because they can’t afford the expensive legal fees, which leads to them becoming undocumented. In England, an asylum seeker whose claim is rejected is also considered undocumented. A lack of free legal advice means asylum seekers often submit their claim without a lawyer and it can take them many years to regularise their immigration status. Some people with rejected asylum claims are stuck in the UK in limbo, unable to return to their country of origin and unable to sort out their status in the UK. Others arrive in the UK without immigration status. This includes people who have been trafficked into the UK and people hoping they can get a visa and find work upon arrival. Undocumented migrants also include people brought to the UK as children without immigration status and children born to undocumented migrants.