PATIENTS NOT PASSPORTS: Migrants Access to Healthcare During the Coronavirus Crisis | June 2020 1.2 Denial of care As well as fear of accessing services, survey respondents report instances where care has been denied because patients are unable to pay for their treatment upfront or because they have been unable to prove their eligibility for free care. One respondent, for instance, describes clients who are “unable to access secondary healthcare treatment even though there has been a referral from the GP - this is because they are not eligible and don’t have the funds to pay”. The charging regulations place stringent requirements on people to prove that they are in one of the exempt categories, particularly for survivors of trafficking, torture, or domestic abuse. The institutional disbelief in people’s circumstances, combined with language barriers and the difficulty in obtaining the right documentation, has the effect of deterring people from seeking care altogether. Accessing health services is a last resort when people are desperately ill. Usually people suffer in silence and use home remedies or if possible over counter medications. People want to limit the scrutiny they have to go through in qualifying for medical exemption.” Based on our experience, initially, clients would not be overly aware of NHS charging at all, let alone categories that are exempt. They would come to realise it once charges are imposed on them or their family/friends, but then they would not be aware of certain exceptions.” Although Hostile Environment policies primarily target secondary care, they are having a knock-on effect on other services. Respondents cite instances of GPs unwilling to refer patients to secondary care: Client in [Yorkshire] was not referred to secondary care by his GP as the GP knew he wouldn’t be able to pay. The GP should not be making this decision. The person should be referred to the specialist to assess if the treatment is immediate and necessary.” Clients with no immigration status are barred from accessing secondary care. GPs either do not refer such individuals, or the referrals are turned down.” There are examples of people being asked to ‘prove their entitlement to care’ at the door of A&E or GP practices, in contravention of NHS guidance. One survey respondent clearly identified discrimination from staff as a factor deterring people from seeking care. Another details her experience of having to prove her entitlement to care: When I was pregnant, they didn’t believe me that I was Polish and entitled to health care as an EU citizen. I had to send a copy of my passport to the hospital and was taken to a different room for questioning. It was stressful because I didn’t know what was going on. Everything was a new system for me. … I left that visit in tears and thought about filing a complaint. It felt like discrimination.” One of the concomitant effects of the Hostile Environment is the proliferation of a culture in the NHS that prioritises the questioning of a persons’ entitlement to care, over and above their clinical need. In practice this often leads to racial profiling, with increasing reports of assumptions about a person’s entitlement or immigration status based on how they look, how they sound, or their name. 14