PATIENTS NOT PASSPORTS: Migrants Access to Healthcare During the Coronavirus Crisis | June 2020 Aaron’s experience Aaron (not his real name) is a migrant caseworker in the East Midlands, providing advocacy and support to migrants with a range of needs, from housing and education to healthcare. This support has continued during the lockdown via telephone appointments and email support. In the area where Aaron works, there is a specialist GP surgery for refugees and asylum seekers, which makes primary care much more accessible than in other parts of the country. However, problems begin to arise when people need to be referred to secondary care. Aaron described how some of the people he supports are fearful of being charged or reported to the Home Office because of their immigration status. This leads some to avoid seeking care and worsens health. When people know that there may be money involved, they are scared and they don’t approach it and they remain ill up until the point that it becomes critical.” People are scared of [data sharing], and they prefer to avoid contact.” Aaron also described how others, who are eligible for free care and exempt from charges, are incorrectly charged, because they do not have the right documents or because staff do not understand the rules. Although these charges are often challenged and overturned, it takes time and effort from both Aaron’s organisation and the health system. It causes unnecessary turmoil for the person in question and can deter them from seeking care in the future. Patients are not listened to, staff don’t understand the [eligibility] documents and then people get a bill.” Now a lot of our work is calling the NHS and challenging these bills. And I say that more than half of them are waived or not properly issued.” Respondents report that NHS charging and data-sharing leaves them in an impossible position, not knowing if advising people to access care may ultimately lead to unmanageable debt and immigration enforcement from the Home Office. 13