Joint letter on the Health impacts of changes to the move on period for new refugees

22 November 2023

Dear Home Secretary,

Health impacts of changes to the move on period for new refugees

Our warmest congratulations on your new role, which you take up at a time of real significance for migrants and refugees in our country.

As organisations representing a wide range of health professionals and others on the frontline of the response to homelessness, we are compelled to join others in asking you to urgently reverse the recent changes in practice to give people only seven days’ notice to leave asylum accommodation.

These changes are driving refugees into homelessness and destitution, with dire consequences for their health and the health of the population as a whole. They will place further serious, avoidable burdens on an NHS already battling winter pressures and ongoing Covid recovery. Exposing people to these avoidable risks, at the coldest time of the year, is ill-advised and will lead to a spiral of poor health and loss of life.

The extreme impact of street homelessness on human health is well established. The average age of death for men who sleep rough is 45 and for women it is 43. People sleeping rough face violence, abuse and other threats to their life on the street. Being homeless accelerates ageing: one recent study showed people in a London hostel with a mean age of 55.7 were as frail as 89-year-olds in the general population. Street homelessness is associated with increased risks of serious infection, of heart disease, of COPD, of mental illness and shockingly high risks of suicide.

At the same time, the barriers to access to healthcare for people exposed to these risks are extremely high. People facing homelessness and vulnerable migrants often experience very poor access to primary care. While those in asylum accommodation may have been registered with a GP, this connection to care will be lost when they move out of the area. With no time to arrange alternative accommodation, they will find it difficult to register with a new practice, breaking their link to this key public service and forcing them to rely on emergency services.

This will put more pressure on hard-pressed Emergency Departments, when winter pressures on the NHS are at their worst. People who sleep rough visit A&E up to six times more often than the rest of the population, and stay in hospital three times longer.

By forcing refugees onto the street at the coldest time of the year when risks to health are highest, these changes put people directly into dangerous situations that threaten their health, while disrupting their access to key services such as primary care. Most will not be entitled to the provision of interim accommodation by a local authority while steps are taken to relieve their homelessness, as they will not be judged ‘priority need’ under the legislation. This means that many will be pushed into rough sleeping. The situation will only get worse as the backlog of asylum claims is processed more quickly and, without proper co-ordination with housing and health services, more people are driven into homelessness and destitution.

To avoid this human cost, and to protect the NHS, we urge you to:

• Immediately work to restore the minimum 28-day period before refugees are required to leave their Home Office accommodation. This will allow for more time for homelessness prevention assistance and transition planning for primary care and housing.

• Ensure that refugees receive all their documentation at one time. People should receive their refugee grant letter, their Biometric Residence Permit, the letter containing the date when their asylum support will end, and the notice to quit their accommodation on the same day. The 28-day notice period should not begin before this point.

• Stop all evictions during very low temperatures, at the very least when Severe Weather Emergency Protocol arrangements are activated.

• Work urgently with primary care and refugee support organisations to develop solutions for access to primary care for evicted refugees.

In the longer term, we urge you to commit to working towards extending the move-on period to at least 56 days, in line with the Homelessness Reduction Act and the timescales for applications for Universal Credit.

If you do not intend to reverse these changes, could you advise us of your plans to involve NHS providers of emergency services and specialist street outreach services in preparing for the rapid rise in need for emergency care that will result from this practice.

Refugees want to integrate and settle in their new communities, and go on to make a valuable contribution to our society. This must be what the Government wants too, but it requires creating the conditions for them to flourish and enjoy the access to healthcare that the rest of us take for granted. Practice that forces new refugees onto the streets runs contrary to the founding principles of the NHS and is a waste of human life and potential. Reversing this would be an excellent start to your tenure as Home Secretary and we look forward to working with you to achieve this.

 

Yours sincerely,

 

Alex Bax, CEO, Pathway

Matt Downie MBE, CEO, Crisis

Polly Neate CBE, CEO, Shelter

Mick Clarke, CEO, The Passage

Michael Chandler, CEO, Groundswell

Emma Haddad, CEO, St. Mungo’s

Anna Miller, Head of Policy and Advocacy, Doctors of the World

Jean Templeton, CEO, St. Basil’s

Jess Turtle, Co-founder, Museum of Homelessness

Rick Henderson, CEO, Homeless Link

Jo Carter, CEO, Glass Door Homelessness Charity

Jacob Quagliozzi, England Director, Housing Justice

Bridget Young, Director, NACCOM

Amanda Dubarry, Chief Executive, Your Place

Tom O’Connor, CEO, Providence Row

Pam Orchard, CEO, The Connection at St Martin-in-the-Fields

Dr Adrian Boyle, President, Royal College of Emergency Medicine

Dr Lade Smith CBE, President, Royal College of Psychiatrists

Dr Sarah Clarke, President, Royal College of Physicians

Professor Kamila Hawthorne MBE, Chair of Royal College General Practice Council

Professor Al Story, Collaborative Centre for Homeless and Inclusion Health, University College London

Dr Chris Sargeant, Secretary, Faculty of Homeless and Inclusion Health

Pat Cullen, General Secretary & Chief Executive, Royal College of Nursing

Dr Crystal Oldman CBE, Chief Executive, Queen’s Nursing Institute

James Gore, Chief Executive, Faculty of Public Health

Dr Laura Neilson, Shared Health