Fears of a Windrush scandal in the NHS for EU citizens

Doctors of the World is extremely concerned about the impact that the Withdrawal Agreement Bill will have on the health of vulnerable EU citizens and public health as a whole.

MPs are currently debating the Bill in Parliament. If passed, it will entrench the EU Settlement Application route into UK law. EU nationals and their families will become subjected to the Hostile Environment.

This could create a new, larger, Windrush scandal. And the most vulnerable will be facing the higher risks, such as elderly people and people experiencing homelessness.

EU nationals who have not been able to apply for pre-settled or settled status will lose their lawful status in the UK. They will risk being excluded from healthcare and will be charged up-front for their care, or have treatment withheld if they can’t pay. This policy is likely to result in serious harm being done to patients: hospitals, which are already struggling to implement the current charging regulations, have denied lifesaving care to patients. Even those eligible for care are likely to face obstacles in accessing treatment.

Under the Settlement Application scheme, EU citizens could have one of six types of immigration status, each corresponding to different entitlements to access NHS services. EU citizens will have to prove their status to be able to access secondary care, and hospitals will be put under the huge burden of having to check patients’ eligibility for care.

In our London clinic, we see regularly cases where lifesaving care is withheld because it is classified as not urgent. Those affected include some of the most vulnerable in our communities, such as victims of trafficking, asylum seekers, and undocumented migrants. Last December, an elderly woman was wrongfully refused potentially life-saving treatment because she couldn’t afford to pay £150k upfront. A few months before, a young man died after having been denied a heart transplant, and a patient with multiple tumours was refused palliative care and discharged on the street.

The government is aware of the harm the charging regulations have created. Yet, they are willing to expand its reach to an even wider part of the population.

We urge MPs to:

• Withdraw all charging, so that services are always given on need rather than ability to pay.
• Allow everyone who has lived in the UK for 3 months or longer to receive free NHS care.
• Guarantee that EU nationals will be exempt from health charges, including the IHS, after Brexit.
• For those who are charged for NHS care, set healthcare bills at the NHS tariff (rather than 150%) and allow patients on lower incomes to pay NHS bills in installments.

We also urge NHS Trusts to

• Ensure exempt groups are not charged for their care
• Use clinical discretion to classify treatment as “urgent or immediately necessary”, when appropriate
• Encourage engagement with treatment despite charges