URBC Statement Concerning Upfront Charges & the Hostile Environment Policy in the NHS. #PatientsNotPassports

Two people standing in front of banners that say "Unis resist border controls" "patients not passports" and "no borders in the NHS." The person on the left holds a sign that says "healthcare is a human right." The person on the right in a mobility device is holding a small sign.
2017 #PatientsNotPassports protest in Manchester.

The hostile environment has no place in any of our institutions. We reject it as it continues to urge us to act as border guards, monitoring our colleagues, neighbours and in the case of the NHS, requiring health care professionals to seek out immigration status of their patients before providing treatment. Docs Not Cops, who work to oppose these measures in healthcare, have invited us to organise this vigil to mark the expansion of charges at the point of access of the NHS, and to highlight the deadly effect it has had as a barrier to healthcare to those already vulnerable.

The Conservative party’s marketisation of the NHS, and continued attacks on access to free healthcare, have been much documented by organisations like Keep our NHS Public. As is often the case, migrants were among the first to be affected by this marketisation agenda.  While New Labour had previously indicated that non-resident migrants were to be charged for healthcare, in practice this was rarely enforced, and applied to a relatively small population (although it still had significant consequences for precarious migrants). Under the 2014 Immigration Act, the Coalition government significantly expanded the groups of migrants considered to be ineligible for free care at the point of delivery, and mandated visa checks in hospitals to enforce this. 

On the 6th April 2015, the Immigration Health Surcharge came into effect, and a healthcare levy was applied to spousal, work, and student visas.  On the 23rd October 2017, two years ago today, Theresa May’s Conservative government introduced upfront charges for secondary NHS treatment where patients are unable to prove their eligibility for free care. As Docs Not Cops states, undocumented migrants and failed asylum seekers “became “chargeable” upfront (rather than after treatment, as had been the case previously), if their condition is deemed ‘non-urgent’. This situation applies to an estimated 600,000 people, including 120,000 children, 65,000 of whom were born in the UK.”

Upfront charges have affected the Windrush generation and others who may have a difficult time proving their status in the UK. The violence caused by the Hostile Environment in the NHS is illustrated by stories like that of Winston Howard, who came to the UK from Jamaica over 60 years ago, and waited three years following a spinal injury to actually access NHS care, because he would  “rather risk paralysis from the neck down than go to a hospital for fear that he would be discharged to immigration detention and possibly deportation”.  Then, we have the story of Kelemua Mulat, who had advanced breast cancer but was denied potentially life-saving cancer treatment for six weeks amid confusion about whether she should be charged by the NHS. Kelemua Mulat died aged 39 as a direct result of the brutal violence caused by upfront charges and the hostile environment policy in the NHS.


These upfront charges for secondary NHS treatment have also created a climate of fear. Even where patients can only be charged after receiving treatment, debt owed to the NHS is grounds for denying a visa.  Maternity Action has found that pregnant women who are asylum seekers or undocumented are afraid of accessing the NHS due to the risk of of being reported to the Home Office and incurring more debt. This is especially worrying and harmful, as migrant women already have higher rates of maternal mortality and miscarriage than average. Similarly, some migrants living with HIV are also being deterred from seeking care and attending screenings, despite these being exempt from charges.

“Yet, we also believe that campaigns to make universities pay for NHS surcharge fees for non-EEA lecturers alone will not end the hostile environment policy. It merely transfers the responsibility of payment from non-EEA lecturers on to the university. Meanwhile, non-EEA migrants and asylum seeker students, and migrant university workers continue to shoulder the responsibility of NHS surcharge fees and upfront charges that directly affect their health and safety and that of their families.”



In our work in Higher Education, we have seen the effects of the NHS surcharge fees. Indeed, Unis Resist Border Controls (URBC) has seen a growing movement of non-EEA lecturers advocating for UK universities to pay for their NHS surcharge fees. We agree that these fees are exorbitant and are against the ethos of Nye Bevan who established the NHS in 1948 making it free at the point of use, available to everyone who needed it. Yet, we also believe that campaigns to make universities pay for NHS surcharge fees for non-EEA lecturers alone will not end the hostile environment policy. It merely transfers the responsibility of payment from non-EEA lecturers on to the university. Meanwhile, non-EEA migrants and asylum seeker students, and migrant university workers continue to shoulder the responsibility of NHS surcharge fees and upfront charges that directly affect their health and safety and that of their families. This is why, since the creation of URBC four years ago, we have worked with and supported campaigns that are fighting to end the hostile environment policy and xeno-racist immigration laws. We continue to work with Docs Not Cops, a grassroots organisation made up of health professionals fighting to end the hostile environment policy in the NHS, in co-hosting events and supporting their #PatientsNotPassports pledge. We call on academics, students, and university workers to support initiatives called by URBC & Docs Not Cops to end the hostile environment policy in our schools, universities, the NHS, and workplaces.

This statement has been endorsed by Docs Not Cops.

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