This section is designed to gather together a variety of resources relating to health and sanctuary seekers.

Please let us know if you have any suggestions of useful resources to add by emailing [email protected]

Disclaimer: The information provided in this section is intended for guidance only. It is not a substitute for professional advice and we cannot accept any responsibility for loss occasioned as a result of any person acting or refraining from acting upon it.

Healthcare Charging and Entitlements

This briefing from Asylum Matters outlines the entitlements of refugees and asylum seekers to free healthcare:

Asylum Matters – Healthcare Access Briefing, May 2017 (updated Jul 2017)

It should be read in conjunction with the below information about the NHS Charging Regulations.

A presentation from Asylum Matters about barriers to accessing healthcare, recent healthcare charging changes and the patient data-sharing agreement between the Home Office and NHS Digital (March 2018). 

There is also information about accessing healthcare services on our Information for Sanctuary Seekers page.

Advice on healthcare entitlements

Free advice is available to the public/professionals from Doctors of the World’s national helpline: 020 75157534 (10am to 12pm, Mon to Fri). Outside of these times e-mail:  [email protected]

Maternity Action also provides free telephone advice to help women get the maternity care they need and on charging (0808 800 0041, Thurs. only 10am-12noon) & email advice at: [email protected]

NHS Charging Regulations (Aug 2017)

On 23 October 2017, new rules governing how people access healthcare in England and when they have to pay for it came into force (these were amendments to the National Health Service (Charges to Overseas Visitors) Regulations 2015).  

Asylum Matters Healthcare Regulations Briefing (Aug 2017)

The UK already charges some non-British patients, or their home countries, for most NHS secondary care (ie hospital care) after treatment. Patients who are not eligible for free care include short-term visitors, undocumented migrants, and some asylum seekers whose claims have been refused. There are already processes in place for hospitals to identify and bill these patients.

The 2017 Amendment Regulations extend NHS charges to community health services in England, and also introduce up-front charging. Under the new regulations, all hospital departments and all community services receiving NHS funding - including charities and social enterprises – are now legally required to check every patient before they receive a service to see whether they should pay for their care. In some circumstances, patients will be charged for accessing these services. The regulations introduce up-front charging for the first time into hospitals and community services, meaning those who cannot pay will have treatment withheld unless it is classified as urgent. 

The community health services affected include community midwifery, community mental health services, termination of pregnancy services, district nursing, support groups, advocacy services, drug and alcohol services, and specialist services for homeless people and asylum seekers. The Government have announced that school nursing and health visiting will not be chargeable. 
 
If a patient cannot prove that they are entitled to free care (and if they do not qualify for free care on the basis that they fall into an exempt category), they will receive an estimated bill for their treatment and will have to pay it in full before they receive any treatment other than that which is ‘urgent’ or ‘immediately necessary’, as defined by doctors on a case-by-case basis. Those who receive urgent treatment may still be billed after treatment has been given. 
 
GP services and Accident and Emergency services remain free for everyone, though Department of Health have indicated they are considering extending charging into these services in the future. A number of exemptions from charging exist. For a full list of exemptions, see the Guidance on implementing the overseas visitor charging regulations.
 
A broad coalition of organisations - including Asylum Matters - have led a national campaign against the extension of healthcare charging. 193 organisations and more than880 individuals - of whom over 300 are doctors and 50 are nurses - signed an open letter to the Secretary of State for Health warning that "by denying healthcare to the most vulnerable in our society, these regulations will have negative consequences for us all." A Debate about the regulations took place in the House of Lords on 16 November 2017. This culminated in the Government committing to carry out a review of the regulations, with a particular focus on the impact on vulnerable groups. For more information about this, and to discuss opportunities to submit evidence, please contact Estelle Worthington [email protected]

The following links provide the background / chronology to the campaign:

Briefing for 16 Nov 2017 debate on the motion to regret the regulations

Doctors of the World research briefing on the impact of the regulations (Oct 2017)

Open letter sent to Jeremy Hunt Oct 2017 asking for the withdrawal of the regulations

An article from 'Our NHS' on OpenDemocracy about protest against passport checks and upfront charges (Oct 2017)

Doctors of the World briefing on the Government Response to the consultation on further NHS Charging February 2017. 

Follow Asylum Matters on Facebook and Twitter for the latest updates.

The Immigration Act

The Immigration Act (2014)

The Immigration Bill, brought before Parliament on the 10th October 2013, included a range of legislative measures designed to restrict the access of migrants to a number of different public services.

Regional Asylum Activism Briefing on the Immigration Bill and Access to Healthcare (2013)

Regional Asylum Activism Briefing on Free Access to Healthcare for People Seeking Asylum (2015)

Free Movement blog on the Immigration Act 

Resources on Health Issues (A-Z)

General

Resource Hub - Resources for Professionals caring for Asylum Seekers and Refugees

This hub, hosted by Liverpool John Moores University, was launched to provide accessible and up-to-date information on the rights and well-being of asylum seekers and refugees for health professionals and students. It contains a wealth of information including on mental health, the needs of unaccompanied minors and access to and eligibility for health care. 

Communication

Language Interpretation: Advice and guidance on the health needs of migrant patients for healthcare practitioners - information from gov.uk about using interpreters to communicate with patients

The Refugee Phrasebook has a Medical Phrasebook with useful words and phrases in different languages (this is under development and help is needed to build some of the languages)

Exercise and Wellbeing

Problems and solutions to undertaking regular physical activity and exercise for asylum seekers

#refugeeswelcome in parks resource book (2017) and conversation club pack from the Young Foundation

A-Z

Detention

'Locked up, locked out: health and human rights in immigration detention' - a 2017 report from the BMA (British Medical Association)

FGM (Female Genital Mutilation)

How we care for women with FGM in Leeds Maternity Service (2014), a presentation by Sarah Bennett, Specialist Midwife

UNHCR Guidance notes on refugee claims relating to FGM (2009)

HIV / AIDS

NAT (National AIDS Trust) information on Immigration and Asylum

NAT blog on '3 ways the UK asylum system fails people living with HIV'

Maternity

Please see the Maternity Stream site for specialised resources relating to maternity.

Maternity Action has a Maternity Rights Advice Line for advice about rights and entitlements (0808 800 0041, Thurs. only 10am-12noon) & email advice at: [email protected]

Mental Health

Our Mental Health Resource Pack covers a range of issues relating to sanctuary seekers and mental health.

'Mental Health Commissioning with Migrant Communities': This manual from Mind is designed to help local decision makers, commissioners and service providers better understand and assess the needs of vulnerable migrant communities. This can lead to improved local services access and culturally sensitive support for vulnerable migrants. The manual will provide the guidance and information needed to achieve this. Sustained and meaningful engagement with service providers, migrant community members, and commissioners to improve understanding of the problems vulnerable migrants face and can lead to creative, inclusive and viable solutions.

Parenting

Resources from Parenting and Families Research Group at the University of Manchester – research on parenting experiences of Syrian refugee families to raise awareness and support refugees through various stages of flight.

  • Film in collaboration with independent film-maker Hafsah Naib  highlighting parents’ will and commitment to protect, engage and raise their children through war and displacement.
  • Exhibition featuring drawings from children in Syria
  • Leaflet, available in various languages, outlining the psychological impact as a result of war. While it is mainly targeted for parents with bite-size coping strategies and parenting advice, it would be useful for anyone who would like to gain a better understanding of the psychological impact of war.

PTSD / Memory

The Centre for the Study of Emotion and Law (CSEL) has a lot of resources (many of them very academic) relating to how people behave and respond to trauma and how this intersects with the law eg. reluctance to disclose experiences and the impact this can have on credibility assessments

Sexual Health

'Sexual Health, asylum seekers and refugees' is a handbook for people working with asylum seekers and refugees in England, produced by the Family Planning Association (FPA)

TB (Tuberculosis)

The toolkit is designed to be used locally to assist programme implementation by local stakeholders as well as individual providers who may be involved in any part of the process. The intended audience includes TB control boards, health and wellbeing boards, local medical councils, primary care practitioners: GPs, practice nurses, practice managers, commissioners: CCGs, local authorities, local PHE teams, TB services, local authority departments such as public health, housing, environmental health and third sector organisations working with eligible groups.

Trafficking / Modern Slavery

Modern Slavery is the recruitment, movement, harbouring or receiving of children, women or men through the use of force, coercion, abuse of vulnerability, deception or other means for the purpose of exploitation.   Individuals may be trafficked into, out of or within the UK, and they may be trafficked for a number of reasons including sexual exploitation, forced labour, domestic servitude and organ harvesting.

This online resource provides an overview of the issue of modern slavery.  It is aimed at helping all healthcare staff recognise the signs that someone has been trafficked, and to take appropriate action with confidence.

Links to organisations and specialist services

National

Freedom from Torture provides clinical consultation and care as well as medico-legal reports for victims of torture.

Doctors of the World help excluded people to access NHS healthcare in the UK.  They have a clinic in London and a national helpline where they can provide advice on issues such as GP registration and access to hospital care. 

Refugee Council has a Therapeutic Casework service in London and regionally.

London

Doctors of the World runs a clinic in Bethnal Green for excluded people

Yorkshire & Humberside

Bevan Healthcare CIC is a specialist GP service for those that are homeless or seeking asylum in Bradford and Leeds

Solace is a Leeds-based charity that provides psychotherapy, complementary therapies and advocacy support to survivors of persecution and exile living in the Yorkshire and Humber region

Refugee Health Professionals

Refugee Council Building Bridges programme is an NHS funded partnership for Refugee Health Professionals living in London.

Reache North West was set up to help refugee health professionals in the North West register their qualifications in the UK and find work.

Hidden Talents is a pilot run by Growing Points which has placed refugee women in Leeds in apprenticeships as Clinical Support Workers. It was covered by the Guardian in Oct 2016.

Mental Health Resource Pack

National resource pack on refugee mental health

This resource pack is designed to help people understand the journeys that refugees and asylum seekers have been through that put pressure on their mental health. It aims to help people in frontline services such as council offices and doctor’s surgeries recognise issues and help signpost them to available support.

Mental Health ResourcePack