In the run-up to the election, immigration is already one of the main topics and part of the debate involves the NHS being abused by so-called ‘treatment tourists’. In an attempt to tackle this supposed threat, the government has been restricting the availability of free HIV treatment to asylum seekers and other migrants.
In February 2005, the Conservative Party stimulated the debate on immigration and health by proposing the introduction of screening measures at UK borders for those entering from outside the EU, to prevent those with either tuberculosis (TB) or HIV from gaining entry. Its arguments rested on the cost burden to the NHS and the savings which could be gained by such measures.
As EU citizens may enter the UK regardless of their health status, it seems that the targets of any such legislation would be those from Africa or Asia. The Conservative Party has already stated that the majority of people diagnosed with heterosexually transmitted HIV in the UK are thought to have been infected in Africa. But are the Tories pushing at an open door?
For the government has already introduced TB screening for migrants who want to reside for over a year. In addition, as of April 2004, any individual whose asylum claim failed or who overstayed a visa, or was an illegal immigrant or living in the UK ‘without proper authority’ was to be refused free HIV treatment.
Experts mount criticism
What has been dubbed the government’s ‘excessive actions’ to curb ‘health tourism’ have been debated by a panel of experts on HIV and Aids. Reporting to the All Party Parliamentary Group on Aids in a report entitled ‘Treat With Respect’ , published on 8 March 2005, they claim that the practices of good public health management would be at risk through a policy of screening all asylum seekers for HIV/Aids. Such measures, they argue, founder on the grounds of impracticality, cost and the likelihood of breaching human rights laws. The panel also expressed concern that asylum applications of those who were found to be HIV positive would be more likely to fail. (Such a policy would, of course, satisfy the Conservative stance on screening measures.)
The expert panel also called upon the National Asylum Support Service (NASS) to take into consideration the health needs of asylum seekers. At present, NASS is not obliged to consider health concerns when relocating asylum seekers, some of whom are dispersed at 24 hours’ notice. The result may be to increase the chances of HIV transmission and risks to individuals’ health. Doctors argue that their ethics do not encompass the duty of refusing treatment according to immigration status and this burden should not fall on them. Confusion over the regulations has led to cases in which patients have been refused health treatment, despite their entitlement to it. The Terrence Higgins Trust has highlighted instances where pregnant women have only been granted the treatment to which they were legally entitled following the involvement of outreach workers. It is likely that migrants will be less likely to come forward for essential treatment lest their immigration status be questioned and there is the added potential humiliation of being refused such treatment.
Those patients not eligible for free HIV treatment inevitably incur huge costs. Costs that, according to the Terrence Higgins Trust usually remain unpaid for lack of funds. A vicious circle sets in, of unemployability, leading to failure to access health treatment for fear of its cost, leading to even greater severity of illness, leading to emergency treatment which carries a higher cost for the NHS.
No evidence of health tourists
The Health Select Committee also reported, on 21 March 2005, on the question of withholding HIV treatment for failed asylum seekers. Its report reiterates that there is no evidence that people are migrating to the UK to take advantage of the health care system. The Committee found those claiming asylum were unaware of their HIV status, discovering it only after falling ill in the UK. A small-scale study conducted by the Terrence Higgins Trust showed that at least 75 per cent of migrants waited nine months before having an HIV test, tests followed the onset of illness.
Issues of both public safety and humanitarian principle are relevant. The report draws attention to the risk posed by untreated HIV-infected individuals who are more likely to burden the NHS by needing expensive emergency treatment, a service which they are allowed to access freely.
In time, the government is hoping to extend the restriction on treatment to the primary health care services; thus those who are not eligible will be refused an initial health assessment. The National Aids Trust has already argued that such a policy would lead to the proliferation of other illnesses needing urgent treatment, such as TB. On grounds of public health, humanitarian principle and even the public purse, it would seem from the reports considered above that that the trend of current policy needs to be reversed.