PATIENTS NOT PASSPORTS: Migrants Access to Healthcare During the Coronavirus Crisis | June 2020 1. The Hostile Environment deters people from seeking and accessing care In 2012 Theresa May, then Home Secretary in the Coalition Government, announced her intention to create what she called a ‘hostile environment’ for migrants. The aim was to restrict access to public services and to criminalise everyday activities in order to make life unbearable for undocumented migrants living in the UK. The Hostile Environment ushered in unprecedented levels of policing and criminalisation of services essential to living a safe and fulfilling life. Rebranded the ‘compliant environment’ by the current Government, the Hostile Environment includes measures that restrict access to schools, require landlords to check the immigration status of their tenants, and criminalise people for working or driving if they are undocumented. It turns nurses, teachers and landlords into border guards, and uses the data they collect to update Home Office records which are used by immigration enforcement teams to track, detain and deport people. The overall effect is the creation of a climate of fear that extends beyond the specifics of the policies. The threat of data-sharing with immigration authorities, destitution, and ultimately deportation, combine to trap people out of the society in which they live. It has affected not only undocumented migrants and those with a precarious immigration status, but all people treated or racialised as migrants, including British BAME people and those who have lived in the UK for many decades, as demonstrated by the Windrush Scandal. The UK High Court found that the Hostile Environment directly causes and exacerbates racial discrimination in the UK.4 The NHS is one of the primary targets of changes brought in under the Hostile Environment. The 2014 Immigration Act changed the definition of ‘ordinary residence’ so that a person was required to have indefinite leave to remain in the UK to qualify for care.5 This was the first time entitlement to the NHS had been tied to a person’s immigration status, ushering in a range of policies that have significantly changed the way the NHS operates, including: • The Immigration Health Surcharge. An additional cost attached to visa applications that requires people to pay for their use of the NHS for the duration of their visa. It must be paid in full upfront, and currently the cost is set at £400 per person per year with a planned rise to £624 on 1st October 2020. • Upfront charging and immigration checks. In 2017, the government introduced a statutory duty on all NHS Trusts to charge patients upfront for care that was non-urgent or did not otherwise meet an exemption from charging; in effect, imposing a requirement on NHS Trusts to formally determine a person’s immigration status as a routine part of their treatment. Care that is deemed ‘immediately necessary’ or ‘urgent’ is still chargeable, with payment recovered after treatment - this includes treatment provided in intensive care and other emergency services not provided in A&E. The charging regulations include exemptions of certain groups of people and for a range of communicable diseases, including Covid-19. As we show in the evidence section below, however, the complex nature of the charging regulations, and the difficulty of proving entitlement, mean that even those entitled to care face barriers to 8