Migrants in England who need NHS care are being denied treatment for an average of 37 weeks, despite suffering from conditions such as cancer, heart problems or kidney failure, according to research.
One in three end up waiting between six and 12 months, some face even longer delays and in one case a woman with a serious heart complaint could not access care for more than four years, a report found.
The people affected are refugees, asylum seekers and others to whom the NHS in England has denied care, often in breach of the rules, because it deems them “not ordinarily resident” in the UK under the Westminster government’s “hostile environment” approach to immigration.
Delays are just one week shorter on average for migrants whose poor health means they need what the government calls “urgent or immediately necessary” treatment, according to the charity Doctors of the World.
Despite the seriousness of their condition they have to wait on average for 36 weeks after diagnosis before receiving healthcare and in one case urgent treatment was withheld for two and a half years.
The findings are contained in the first detailed audit (pdf) of the delays faced by 27 migrants seeking NHS care between 2018 and 2020, and wrangling over their eligibility to receive it.
“These long delays involved a protracted period of all-consuming extreme uncertainty, and anxiety and distress for patients with cancer, kidney failure and heart problems, who end up in a state of horrendous limbo,” said Anna Miller, head of policy and advocacy at the charity, which provides healthcare to people who cannot access NHS services.
The delays are in stark contrast to the maximum 18-week waiting times within which people in England should be treated by the NHS. Until the Covid pandemic, 80% were being seen within that timeframe.
The report prompted renewed calls for the government to scrap the requirement it introduced in 2017 for migrants to pay 150% of the cost of normal NHS care upfront before they can receive it, despite usually being penniless.
Labour, the Liberal Democrats and key health organisations including the British Medical Association, the Faculty of Public Health and the Royal College of Emergency Medicine have voiced unease about the charging regime denying people potentially life-saving care.
Dr Chaand Nagpaul, chair of council at the British Medical Association, which represents doctors, said: “It is alarming and disturbing that this report highlights the scale of delays and obstruction to urgent care facing migrants who are seeking asylum in our nation, including those who are entitled to free NHS care. Safeguards must be in place to protect people in vulnerable situations from inhumane delays to treatment, as well as ensuring that those who need immediate treatment aren’t deterred from seeking it.”
The audit highlights how the Royal Derby hospital told Saloum, an anti-FGM campaigner from Gambia who was destitute and homeless, that it would not give him palliative chemotherapy for two brain tumours and lung cancer unless he paid upfront. It also charged him £8,397 for initial treatment he received after collapsing and falling unconscious.
The Guardian previously reported on the situation facing Saloum, 54, who was an undocumented migrant and had fled Gambia fearing political persecution. He died in April 2019. A spokesman for University Hospitals of Derby and Burton NHS foundation trust said last year that it was unable to comment on the care of individual patients due to patient confidentiality.
All but one of the 27 people in the new audit were destitute and had no income. It concludes that the data from the charity’s hospitals access project “shows that the NHS charging policy is being applied to destitute individuals with no realistic prospects of being able to pay for the NHS services they receive”, adding: “It raises questions abut the cost effectiveness of the current policy as NHS staff time used for charging and pursuing destitute individuals for NHS services is likely to be a waste of resources.”
Miller said: “Migrants needing healthcare struggle to understand why one day a doctor tells them that their treatment is urgent and needs to start tomorrow and the next day they receive a letter from the hospital’s overseas visitors office seeking many, many thousands of pounds upfront, which obviously being destitute they can’t do.”
The audit found that care was delayed in six cases because hospitals wrongly concluded that someone who was eligible for free care was ineligible. Sixteen other people were said to have been mistakenly denied “urgent and immediately necessary care” because NHS trusts wrongly applied the rules on when someone could be reasonably expected to leave the country and gave care elsewhere, it added.
A Department of Health and Social Care spokesperson said: “Urgent treatment should never be withheld. Services such as NHS 111, primary care and A&E continue to be free of charge to all patients – including those from overseas.
“Many migrants to the UK are entitled to free NHS care because they are ordinarily resident here or exempt from charge. This includes vulnerable people like refugees, asylum seekers and victims of modern slavery.”