Doctors of the World intervene in migrant healthcare rights case in the High Court

Doctors of the World has provided evidence and legal arguments in an important case – about denying healthcare to people living in the UK without secure immigration status – which was heard in the High Court on 16 November 2021.

The judicial review, brought by an undocumented migrant, challenges the lawfulness of an NHS trust’s decision not to provide scheduled haemodialysis under the NHS (Charging of Overseas Visitors) Regulations 2017 (“the Charging Regulations”). Doctors of the World were granted permission to intervene in the case.

The Secretary of State for Health and Social care was also been granted permission to intervene in the case.

Doctors of the World hopes the case will provide clarity on the application of the Charging Regulations to ensure that people with serious medical conditions who are living and settled in the UK are not denied the urgent healthcare they need.

Doctors of the World provided evidence and made legal submissions to the High Court which drew upon their policy expertise and case examples from the organisation’s Hospital Access Project, where treatment had been withheld or partially withheld from undocumented migrants.

Doctors of the World UK, represented by Janet Farrell of Bhatt Murphy Solicitors, will intervene by way of written and oral submissions. The claimant is represented by Deighton Pierce Glynn.

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

“Managing a serious health condition alone, without the support of a doctor or access to medication is a horrendous situation that nobody should be placed in. In Doctors of the World’s experience the case before the court is far from unique so we are glad the court recognises the organisation’s considerable experience of the Charging Regulations and supporting people denied medical care and granted us permission to intervene.

“This case is an example of Doctors of the World’s key concern with the Charging Regulations, namely how they should be applied to people who are not visitors to the UK but long-term residents. In our clinic the people we see are people who are living in this country, and often have been for decades, people who are part of our communities, with families, children and their whole lives in this country.”

Amardeep Kamboz, Head of Services at Doctors of the World:

“Optimal health is essential for a person’s wellbeing and quality of life, and to be able to fulfil their personal ambitions and their potential in society. It is a right no one should be denied. At DOTW we have met many people with conditions such as cancer, heart conditions, kidney diseases or serious reproductive health issues that have been denied treatment or given a sub-standard level of care solely based on their immigration status.

“Many people that we meet at DOTW have lived in the UK for many years with family, friends and communities around them. Most are attempting to navigate a highly complex immigration system, often over very long periods of time. Through our clinic services we have witnessed on multiple occasions how the current Charging Regulations fails to recognise the complexity of people’s individual circumstances and in doing so, does not mitigate against dangerous precedents being set by NHS Trusts in which it is acceptable for some people in our communities to not get the medical care they need.”

Dr Hannah Fox, from Doctors of the World:

“At Doctors of the World, we have mounting evidence that the complex charging laws are misunderstood and misapplied by NHS Trusts, leaving people without essential and often lifesaving treatments. I have read letters from consultants imploring senior managers to allow them to treat a patient in urgent need of medical care. There is no doubt that these regulations are applied unfairly, cause great harm and are at odds with the founding ethos of the NHS.”

Janet Farrell, Solicitor, from Bhatt Murphy Solicitors:

“This case raises important issues about the meaning of “urgent treatment” within the NHS charging regime. Doctors of the World UK have serious concerns about whether migrants are able to access to urgent treatment as is permitted by the regulations, and they welcome the opportunity to intervene in this case. It is plainly of critical importance to many very vulnerable people that NHS Trusts get this right.”

-ENDS-

Notes to editors

About the case

In 2017 the UK government introduced new restrictive laws placing duty on NHS trusts to withhold NHS secondary care services from undocumented migrants living in the UK if the patient does not make payment before receiving the service unless doing so would prevent or delay the provision an immediately necessary service or an urgent service. There are exceptions for some services, such as A&E and in the case of communicable diseases, and for very vulnerable individuals, such as victims of trafficking.

Doctors of the World’s casework and research evidences urgent healthcare services being withheld from migrant patients who are living and settled in the UK. In many cases, patients’ faced a legal or practical obstacle which meant they could not leave the UK yet urgent healthcare was withheld. This includes people with an outstanding legal claim for leave to remain in the UK, which meant they could not be removed until their case had concluded and may result in them being granted permission to stay in the UK indefinitely.

The NHS (Charging of Overseas Visitors) Regulations 2017 form part of the Government’s hostile environment policy which aims to reduce the size of the UK migrant population by limiting access to public services and making life difficult for people living in the UK without immigration status. Charities and medical organisations have voiced concern about the negative impact of the Charging Regulations on patient care and clinical staff, calling for their suspension. According to a survey of British Medical Association members, doctors face pressure when making clinical judgements regarding a patient’s need for care.

It is hoped the case will provide much needed clarity on the application of the Charging Regulations and urgent treatment, minimising scope for misunderstanding and the withholding of medical care from people with serious medical conditions who cannot reasonably be expected to leave the UK.

About DOTW’s intervention

Doctors of the World UK is intervening in the case to assist the court by providing its experience of how the Charging Regulations are applied to undocumented migrant patients.

The case raises important issues in relation to how the charging regulations are applied to seriously ill patients who have been living in the UK for long periods of time and cannot reasonably be expected to leave the country anytime soon, for a variety of reasons. Based on DOTW’s considerable experience of the Charging Regulations, the case is not unique and illustrates a broader level of misunderstanding and adverse risk to vulnerable patients.

Doctors of the World UK provide health clinics for people excluded from NHS services and, since 2018, have run a specialist service for people refused NHS secondary care services to address problems arising from the Charging Regulations. The organisation has supported over twenty people in the past two years who are being denied medical care, including cancer treatment, surgery and dialysis and gynaecology services, having been assessed as not “ordinarily resident” in the UK. The work of the service and Doctors of the World UK’s policy expertise has formed the basis of the intervention.

About Doctors of the World

Doctors of the World UK is part of the Médecins du Monde international network, an independent humanitarian movement. Doctors of the World UK supports the rights of everyone, regardless of immigration status, to claim their right to health and medical care. In the UK the organisations runs and runs services providing medical care, information, and practical support to people unable to access NHS services. Our patients include refugees, asylum seekers, survivors of human trafficking, people experiencing homelessness, sex workers, migrants with insecure immigration status and Gypsy, Roma, and Traveller communities.