The illusion of compassion
In the last few weeks, I have begun to help out at a charitable drop-in centre for destitute asylum seekers. Some have waited for years for their asylum applications to be processed, and are not allowed to work in the mean time. Others face deportation as ‘failed’ asylum seekers, in spite of having suffered appalling abuse, including torture and gang rape, in countries like Sudan and the Congo. They all suffer from multiple disadvantages in terms of trauma, displacement and language skills. Although some seem to have GPs, most do not, and virtually all of them seem unclear about their exact rights to health care while in the UK. Although this might only make a marginal difference to many of them, compared with their other problems, I decided to find out more about their entitlements to free health care and prescriptions, and how to help them claim these.
I was surprised to find out how much confusion there is on the subject. I spoke to a number of doctors who thought that anyone applying for asylum can register with a GP, claim free prescriptions or attend hospitals, but that failed asylum seekers could not do any of these things. Others thought differently. I logged on to the Department of Health website to look up the rules, and followed a number of links to a 42-page booklet: ‘Help with NHS costs’. On page 28 of the booklet, I found the section relating to ‘People from Abroad’. Here is a typical extract:
‘People seeking asylum, who are not in one of the groups listed on pages 5–7 and are not supported by IND or failed asylum seekers need to make a claim under the NHS Low Income Scheme—read pages 23–27.’I began to understand why the people I had spoken to were so confused. The rules are not exactly transparent.
Next, I entered ‘asylum seekers’ in the search box instead, to see if this might make things clearer. This took me to a different page that sets out the specific rights of various kinds of asylum seekers to NHS treatment.1 The ‘Table of Entitlement’ is written densely in small print, and its language is scarcely less opaque than the leaflet. Some of its stipulations are draconian, while others appear devious. According to the table, people awaiting asylum do seem to have full rights to free health care but, once refused asylum, they cannot get any free hospital treatment except in an emergency. GPs are discouraged from registering people after a refusal of asylum, but do still have the discretion to do so if they wish (although this is under review and may soon be withdrawn.) However, all asylum seekers can claim free prescriptions on the grounds of low income, and this includes failed asylum seekers as well—assuming they can still find a GP willing to see them. In order to claim, they have to complete a Form HC1, like anyone else with low income, and request an exemption certificate.
Form HC1, it turns out, is 17 pages long and in ten parts. Among the more challenging parts, one contains questions relating to the ownership of premium bonds, income or capital bonds, shares, national savings certificates, unit trusts, PEPs, ISAs, and the value of any overseas property. My heart sank once more, not only because of the impossibility of any asylum seeker—failed or otherwise—being able to complete such a form, but also because of the moral dilemma that the last question might raise for some applicants, since they might have property abroad that they would possibly never see again. It was at this point that I realised we would have to offer an advocacy service in the drop-in centre to help our clients fill in the forms. I returned to the website, and found the numbers I needed to phone for supplies: 08701 555 4555 for the forms and 0845 850 1166 for the envelopes. It was unclear to me why the same department could not supply both.
I spent half an hour on the phone trying to make a order. After being passed back and forth between several different numbers, politely reading out the regulations from the website several times, and using two mobile phones simultaneously, I managed to place different orders for a hundred forms and a hundred envelopes. I gave my NHS address, since attempts to explain the nature of the charitable centre appeared to lead to bewilderment. It remains to be seen if the forms will arrive, whether it proves feasible to help asylum seekers to complete them, or if the exemption certificates arrive at their home addresses before they are forced to move on by the immigration authorities, or worsening poverty, or deportation.
If someone like myself—with time, full electronic resources, and the typical social and literacy skills of a middle-class professional—finds it such an effort to navigate the system, what earthly hope is there for the people who attend the drop-in centre? The experience has left me feeling embarrassed to have practised medicine for so many years without any real understanding of the obstacles faced by some of my most deprived patients when they try to obtain the medicines I prescribe. I have also become aware how closely the system for claiming free treatment actually mirrors the asylum system itself. In both, there is a plausible façade of compassion and due process, but the regulations and procedures are so obsessionally cautious and bureaucratic that they defeat their avowed purpose, and end up causing further injustice.
References
1. Department of Health. Asylum seekers and refugees. [http://www.dh.gov.uk/en/policyandguidance/international/asylumseekersandrefugees/index.htm] Accessed 2 October 2007.
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