PATIENTS NOT PASSPORTS: Migrants Access to Healthcare During the Coronavirus Crisis | June 2020 The deterrent effect of NHS charging Client had serious foot problems - swelling in the feet due to poorly controlled diabetes. The client was quite reluctant to go to hospital due to fears of being charged for NHS care.” We know of people who have delayed accessing services because of charging fears; these include scans/tests for cancer.” They’re most worried about costs. Because of the large debt but also they often know it can have an impact on future immigration applications. It’s also quite common for our women to want to minimise the costs by not going to all antenatal appointments and/or leaving hospital early after having the baby.” Refused, destitute asylum seekers had been told that they have to pay for secondary health care. They don’t have the funds to do so, so they don’t access health care for fear of the bills which will be reported to the Home Office and could cause them to be deported.” One previous client was hurt in a car accident and was collected by the ambulance. When she was in hospital, she fled before she could be treated for fear of racking up an NHS debt and being reported to the Home Office.” I teach an antenatal class aimed at asylum seekers and refugees and have come across a number of refused asylum seekers who have been charged for antenatal care. They have shared in the antenatal group that they are frightened to see their midwife again because of fear of the bills.” NHS charging policy impacts people formally entitled to care under the regulations, through ‘incorrect’ upfront charging, misapplication of the exemptions, and deterrence from seeking free emergency care provided in A&E. Healthcare workers are often unfamiliar with regulations limiting migrants’ access to healthcare and ‘over apply’ restrictions, with the knock-on effect that migrants then assume they are not entitled to care. People ‘Incorrectly’ charged There is ignorance amongst health professionals of patient eligibility for [care] & ignorance amongst client group[s] about their entitlements [to] primary and secondary health care.” The charging system is not well organised. Often people with poor English, or who do not understand how the system works are considered by NHS admin. as ‘visitors’ and are issued with claims to pay substantial amounts of money.” We provide health advice and advocacy and have numerous examples of people being wrongly refused treatment, being charged wrongly, unable to pay bills for essential treatments and being fearful of deportation as a result.” 11