Resolution: Health care provision for refugees and those seeking asylum

This resolution passed.

Approximately 89.3 million people are forcibly displaced worldwide (United Nations High Commissioner for Refugees, 2022). Refugees are exposed to circumstances that may increase suicide risk and face barriers in accessing health care due to institutional discrimination and restricted use of health services (Ingram et al., 2022; World Health Organization, 2022).

In the UK, conditions within asylum processing centres present significant challenges to the provision of health care. A report into centre conditions found that there were significant issues with health care governance and that detainees were regularly held more than 24 hours in non-residential accommodation. Detainees with a wide range of needs were not designated at risk and did not receive coordinated care pathways (HM Inspectorate of Prisons, 2022).

In recent years, there has been an increase in the use of temporary accommodation for people seeking asylum, where access to health care is limited (Jones et al., 2022). Reports suggest that residents are unable to access prescriptions, support for acute medical conditions and care for pregnant women and children (Jones et al., 2022). Conditions also raise public health concerns. For example, a high court judgement determined that a major outbreak of COVID-19 in Napier Barracks was inevitable due to overcrowding and poor hygiene facilities (Tobin, 2022).

The complexities of the NHS charging system can deter people seeking asylum from accessing health care (Morris and Nanda, 2021). Across the UK, people without ‘ordinary residency’ may be liable to pay for secondary care (Office for Health Improvement and Disparities, 2022). While refugees and those seeking asylum are exempt, in England those who have had an asylum case denied may be liable to pay (Office for Health Improvement and Disparities, 2022). These rules can negatively alter the way staff deliver treatment and interact with patients (Morris and Nanda, 2021).

In Scotland, those given refugee status by the UK government and asylum seekers judged to be eligible for health care by the UK government (for example, they have been means tested), are entitled to access health care provided by the Scottish government. 

However, the Scottish government’s New Scots: refugee integration strategy 2018 to 2022 goes further than UK government policy in saying that: “The Scottish government has been clear that everyone, who is a resident in Scotland, is entitled to access health care on the same basis. This includes all refugees, asylum seekers and people whose claim for asylum has been refused” (Scottish Government, 2018, p.57).

In Northern Ireland, the Provision of Health Services to Persons Not Ordinarily Resident Regulations (Northern Ireland) 2015 designates the legislative framework for the delivery of health care services to refugees and people who are seeking asylum. Originally developed and piloted by the Public Health Agency, the Northern Ireland New Entrants Service offers nurse-led health care advice and initial health assessments for those not registered with a GP. 

Reading list for this debate available at rcn.libguides.com/congress2023.

References

HM Inspectorate of Prisons (2022) Report on an unannounced inspection of the short-term holding facilities at Western Jet Foil, Lydd Airport and Manston. Available at: https://www.justiceinspectorates.gov.uk/hmiprisons/inspections/short-term-holding-facilities-at-western-jet-foil-lydd-airport-and-manston/ (Accessed 16 March 2023).

Ingram J, Lyford B, McAtamney A and Fitzpatrick S (2022) Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff, International Journal of Mental Health Systems, 16(24), https://doi.org/10.1186/s13033-022-00534-x

Jones L, Phillimore J, Fu L, Hourani J, Lessard-Phillips L and Tatem B (2022) “They just left me”: Asylum seekers, health, and access to healthcare in initial and contingency accommodation. Doctors of the World. Available at: https://www.doctorsoftheworld.org.uk/wp-content/uploads/2022/04/DOTW-Access-to-healthcare-in-initial-and-contingency-accommodation-report-April-2022.pdf (Accessed 16 March 2023).

Morris M and S Nanda (2021) Towards true universal care: reforming the NHS charging system. Institute for Public Policy Research. Available at: https://www.ippr.org/research/publications/towards-true-universal-care (Accessed 16 March 2023).

Office for Health Improvement and Disparities (2022) NHS entitlements: migrant health guide. Available at: https://www.gov.uk/guidance/nhs-entitlements-migrant-health-guide#vulnerable-migrants (Accessed 16 March 2023).

Provision of Health Services to Persons Not Ordinarily Resident Regulations (Northern Ireland) 2015 (SR 2015/27). Available at: https://www.legislation.gov.uk/nisr/2015/27/2022-07-07 (Accessed 16 March 2023).

Scottish Government (2018) New Scots Refugee Integration Strategy 2018 to 2022. Available at: https://www.gov.scot/publications/new-scots-refugee-integration-strategy-2018-2022/ (Accessed 16 March 2023).

Tobin J (2022) The use of Napier Barracks to house asylum seekers: regret motion. House of Lords Library. Available at: https://lordslibrary.parliament.uk/the-use-of-napier-barracks-to-house-asylum-seekers-regret-motion/ (Accessed 16 March 2023).