Today marks the day when a founding principle of the NHS is destroyed – and doctors like me are being told to help

We doctors are trained to make decisions based on the best evidence and that will cause the least harm and it’s no mistake that the damaging policy of checking patient passports is being kept from us

Jessica Potter
Monday 23 October 2017 18:14 BST
As someone who studies public health I can tell you that the risk to the public is all too real
As someone who studies public health I can tell you that the risk to the public is all too real

Today you are waking up to a new NHS. An NHS where you will be faced with racial profiling and discrimination at every outpatient appointment. An NHS where you are forced to show your passport before being given “non-urgent” care. An NHS where you will be charged upfront if you cannot prove your eligibility through right to remain or nationality.

You almost certainly haven’t been told this and most doctors I have spoken to, including senior consultants, had no idea this was about to happen. For the Conservative Government to push it through virtually unannounced at best smells of shame, at worst, deceit. The Department of Health’s lack of communication with front-line staff suggests they know they’d be in for an uphill battle.

These checks are being introduced without meaningful consultation with doctors and without any thought as to the true clinical impact. Despite 20 hospitals being involved in piloting the policy, there has been no formal process for doctors to evaluate the scheme. How can they when most of them don’t know it’s happening? We are trained to make decisions based on the best evidence and that will cause the least harm and it’s no mistake that this damaging policy is being kept from us.

While some patients, like those with TB, are supposed to be exempt from charging, we know this will provide no antidote to the fear this policy instils. These measures have been designed to stop people accessing healthcare, and as someone who studies public health I can tell you that the risk to the public is all too real.

If someone is too afraid to access healthcare for fear of being deported or charged, this means they will access emergency care (which will remain free at the point of access) when their symptoms have reached crisis point, and, in the case of infectious diseases, this means that the health of the rest of the public is at risk.

The common assumption is that this policy is about tackling hordes of people from other countries who are flouting the rules to take advantage of “soft-touch Britain” and our health service.

This is wrong. According to the Government’s own figures health tourism amounts to only 0.3 per cent of the NHS budget, nothing close to the £2bn often inaccurately quoted by those that support the policy.

As a doctor I know the human cost is going to be much higher. The impact will fall on communities already marginalised by society – those who cannot afford to pay bills that run into thousands of pounds. BBC2’s Hospital featured the story of Priscilla, who gave premature birth (by 20 weeks) to quadruplets while in transit through the UK. Sadly, two of her babies did not survive. While grieving the loss of two of her children, she was slapped with a £500,000 bill, which she will realistically never be able to pay back.

It is a fundamental shift in the way we deliver healthcare in the UK and forms part of the Government’s wider anti-migrant agenda and the creation of a “hostile environment”. From the limited evidence that exists it is clear that patients receiving letters regarding demands for payment are those with foreign-sounding names – suggesting we are giving way to discriminatory profiling within the NHS. There have been no reports of “John Smiths” being asked for upfront payment or proof of ID.

It’s clear that this policy isn’t being introduced because the UK has a problem with health tourism. It is being introduced as a convenient distraction to the massive cuts that the Tories have been carrying out since 2010.

While this is a government policy, it relies on NHS Trusts to enact it. These public bodies, who are supposed to ensure the wellbeing of the population, are now being forced to restrict care and facilitate discrimination. Their silence is complicity. For me it is the NHS Trusts that should be taking a leading role in resisting this policy.

As a doctor I want to see patients, not passports. I want to be a caregiver not a border guard. I want NHS Trusts to stand up in defiant noncompliance and I want the scapegoating of migrants to stop. Saving the NHS doesn’t mean stopping people from using it, it means a return to publicly owned free healthcare for all.

Dr Jessica Potter is a member of Docs Not Cops and Med Act Refugee Solidarity Group. She also researches public health and migration

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