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The Asylum Health Seeker Introduction Our freelance writer examined the assistance offered to asylum seekers by the National Health Service. In the midst of unnecessary bad publicity for asylum seekers and their requirement for NHS care, it is important to realise that the essence of British culture is to care for others. Often in the fast and furious state of capitalism, we tend to forget this. This is also the recommendation from the Geneva Convention and also the essence of the National Health Service - free healthcare for all. The majority of asylum seekers are people whose lives are in danger in their own country. They therefore enter this country for safety. It is inevitable that these people will have health problems. English is not their first language and the United Kingdom becomes an alien place to them. Services are hard to come by for British citizens therefore it is important to understand the lost world asylum seekers find themselves in. Moved from place to place with limited translation facilities, life is difficult enough without antagonism from us. Our job as doctors is to ensure we help these people as best we can. The job of the public is to assist people in need as best as they can. We have therefore formulated an article that will hopefully be of assistance to the general public. Any suggestions are always welcome. Email us at asylum@nhs-exposed.com . This article can be translated in any language using the links below.) Confusing Worlds
Print copies of this publication (ref 32143/Caring for Dispersed Asylum Seekers. A Resource Pack) may be obtained from: Department of Health Publications - PO Box 777 - London SE1 6XH - Tel: 08701 555 455
Registration difficulties
Asylum applicants awaiting an initial decision on their asylum claim, the outcome of an appeal or a judicial review as well as those who are granted refugee status or ELR/ELE have free access to all NHS accident and emergency, maternity and in-patient/out-patient services. The NHS trust providing the treatment is responsible for establishing if a person is entitled to free treatment. All patients are subject to the same registration process regardless of their legal status or nationality. Hospital staff may ask certain questions about the patient's residence in the UK, such as: a) - Have you been living in the UK for the past 12 months? B) - On what date did you arrive in the UK? C) - What is the basis of your stay in the UK? If further confirmation is required, asylum applicants and those with refugee status or ELR/ELE can show hospital staff their Home Office letter, which either confirms an asylum application has been lodged or refugee status or ELR/ELE been granted. Asylum seekers can also show them their Application Registration Card (ARC). There is a body dedicated to helping these foreign nationals. From 3 April 2000, on behalf of the DOH, the National Asylum Support Service (NASS) has been issuing asylum seekers who receive NASS support with HC2 certificates to obtain full help with health costs together with the first support voucher they receive. Although, under the Immigration and Asylum Act 1999, the majority of asylum applicants are not entitled to welfare benefits, they may still qualify for things such as - Free NHS prescriptions - Free NHS dental treatment - Free NHS wigs and fabric support - Travel costs to and from hospital for NHS treatment - Free NHS sight tests - Full value of a NHS optical voucher towards the cost of glasses or contact lenses - when it comes to health issues. They need to complete form HC1 in order to obtain a HC2 certificate for full help with health costs or a HC3 certificate for limited help with health costs. The HC1 form is 16 pages long and only available in English. Asylum applicants may need help in completing the HC1 form. Relevant information can be found on http://www.doh.gov.uk The HC2 and HC3 certificates are normally issued within five working days of posting the HC1 claim form, and they are only valid for six months. After six months, a new HC1 form must be completed. Health practitioners who come into contact with asylum seekers should encourage them to send off the HC1 form as soon as possible. The Department of Health has a section on its website dedicated to health access issues for asylum seekers, http://www.doh.gov.uk/hsd/asylumseekers.htm - and The London Health Observatory has information on health issues for refugees at: http://www.lho.org.uk/hil/refugee.htm Also, The British Medical Association has issued guidance papers on a range of medical ethics issues affecting asylum seekers and refugees. Select Ethics > Publications > Guidance when visiting their website at: www.bma.org.uk. In May 2002, the NHS London Region (now the Directorate of Health and Social Care for London) sponsored and supported the production of an information and resource pack for health workers on meeting the health needs of asylum seekers and refugees in the UK. The report can be found at: http://www.london.nhs.uk/newsmedia/publications/Asylum_Refugee.pdf Health for asylum seekers and refugees portal (HARP) was jointly launched by several bodies, to address health needs and health issues for asylum seekers and refugees. For further details, visit www.harpweb.org.uk There is, of course, a difference between what is referred to as primary and secondary health care. It may be that not all of the secondary health care costs are met by the regulations covering asylum seekers, but there are publications available that make things quite clear. The current regulations covering charges to overseas visitors for NHS hospital treatment came into force on 1 April 1989 through the Statutory Instrument 1989 No. 306. This was updated in the Statutory Instrument 2000 No. 602 as amended by the NHS (Charges to Overseas Visitors Amendment regulations 1991 No. 438 and the NHS Charges to Overseas Visitors regulations 1994 No. 1535). These statutory instruments can also be located at: www.legislation.hmso.gov.uk/stat.htm. Simply choose the relevant year and select the relevant number. Asylum in Bristol Bristol is a city whose problems with asylum seekers and health care are symptomatic of those experienced nationally. Before the introduction of the NASS removed applicants from the main welfare system, at its peak, the Bristol support service was handling the welfare needs of 500 asylum seekers. Although less than 0.2% of the city's population are asylum seekers, their presence has created extra pressure on both social and health services. The North Bristol NHS trust describes providers such as the Charlotte Keel health centre - with a language team for more than a decade - as "continually stretched" in providing support services. It began when Somalian refugees started registering eight years ago. Now there are substantial numbers of Turks, Afghans, Iraqis (mainly Kurdish) and Kosovans. In addition to 700 asylum seekers, around 1,000 refugees now live in the city, mainly in the area where the Charlotte Keel centre is located. "It takes considerably longer to work with someone whose first language is not English, and yet there's no accounting for that in the workload distribution or resources," says Liz Murphy, a GP at the health centre. "We are working flat out all the time. So when something takes up a bit more time, there's a hint of 'Oh, these people', and I began to see a little of that." Many of the problems faced both by asylum seekers and service providers are caused by a lack of information, whether it concerns cultural differences, and simply about the support available. There is often a gulf in understanding because of language problems, but again, many of the help sites listed can provide insights into what can be done about that. Doctors, be they GP's or hospital practitioners, are understandably as confused, at times, as the asylum seekers who want their help, and this can only add to the already too great pressures under which they work. There is, however, a wealth of helpful material available to those who need it. The question is one of simply knowing where to look. RESOURCES Translator Links The Foreign Word Free Translation Related Links Health Policy Failing Asylum Seekers Asylum Seekers - A BMA Report MPs Warn Against Forced HIV tests No Luxury Healthcare for Asylum Seekers Asylum Day Effects on the NHS Tories Defend Health Tests MPs reject Asylum White List Health of Asylum Seekers Refugees and Asylum Seekers in London Healthcare of Refugees Speech by Jean Lambert - Protection of Asylum Seekers How institutional failure encourages abuse of the National Health
Service Medical Foundation for the Care of Victims of Torture, January 2000 BNP's Views on Asylum Seekers Public Opinion Mental Health Implications of Detaining Asylum Seekers
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Perhaps
one of the most confusing problems facing a foreign national, who
seeks asylum in the UK, is that of health care, and what entitlement
they have to it. Like other UK residents, persons with an outstanding
application for refuge in the UK, are entitled to use NHS services
without charge. Asylum seekers are often from very different cultures,
may not understand the principles behind our health system, may not
speak English and may have complex healthcare requirements.
There
are many misconceptions about Asylum Seekers and Refugees. These terms
cover a huge range of people from different countries and cultures,
people of different ages, some on their own, some with their families
- all of whom have come to the UK to seek refuge. The Department of
Health, and the Refugee Council, has worked together to produce a
Resource Pack, to create a greater understanding of cultural
difference and expectations both of those who seek asylum, and those
that provide asylum seekers with health and social care.
Its
main aim is to help local health and social care agencies to meet the
needs of asylum seekers who are dispersed to their areas. Key concepts
and entitlements are set out along with examples of good practice.
Initiatives such as local development schemes, personal medical
service pilots and the development of health assessments for asylum
seekers at induction centers are all covered.
DOH
circular HSC 1999/018, paragraph 27, outlines eligibility for overseas
visitors to receive free primary care services. Spouses and any
dependant children aged 16 or younger or at school in the UK up to the
age of 19 are exempt from payment, and can be found on the
publications section of the DOH website at
For
many of these people, paperwork is intimidating, based on previous
experiences, so they may be relieved to know that asylum applicants
are not required to show official documentation, when they register
with a GP. Staffs have no right to demand sight of an asylum seeker's
passport, or indeed any other identity documentation. They can get the
patient's address from a Home Office letter, bill or similar document
addressed to the asylum applicant.
If
an asylum applicant is unable to register with a GP after a third
attempt, they should be advised to contact their local Primary Care
Trust, which can allocate a GP to them. The Primary Care Trust can
also provide local information on community dental services and
dentists for patients receiving treatment under the NHS. NHS Direct,
on 0845 4647 (