If an NHS doctor divulged personal information about a patient, they could be struck off. But the government pays the NHS to do just this. A patient’s name, date of birth and address are among the data which are passed on to the Home Office. If you are in the UK illegally, they can find you and force you onto a secret chartered plane before your lawyer has even had breakfast.
Buried in the recent constitutional uproar over the triggering of Article 50 and President Donald Trump’s flurry of objectionable executive orders, was the news that the NHS has been passing on data to the Home Office so it can track down people who are living in the country illegally and deport them.
According to Health Service Journal, the government justifies this because “these people” are a potential threat to society. In any case, NHS Digital – the “trusted national provider of high-quality information, data and IT systems” for health and social care, which prides itself “in looking after your health and care information” and has a “duty to ensure patient data remains confidential” – doesn’t have to give up the data if it does not think the Home Office has argued its case well enough. But if there is any disagreement as to whether a request is in the public’s best interest or not, the decision is referred to the Department of Health, as an independent arbitrating body, which clearly it is not.
If that isn’t enough, as part of the government’s “visitor and migrant NHS cost recovery programme”, financial incentives have been introduced to encourage NHS Trusts to identify chargeable patients. What is more, if they fail to collect this information, sanctions are threatened.
This is a gross violation of the trust that exists between health services and patients. Confidentiality is part of the Hippocratic oath and is a key component of the General Medical Council’s duties of a doctor. Protecting patients’ right to confidentiality underpins my entire practice and that of all healthcare professionals. If we break this, even unintentionally, we risk being struck off.
Increasing the public health risk
In 2014 the Immigration Act introduced an NHS surcharge for migrants and altered the definition of “normally resident” to ensure that people previously exempt from paying, such as students or long-term migrants, will now have to pay £150 to £200 a year, irrespective of whether or not they already pay tax and national insurance. Both this policy and the new agreement between NHS Digital and the Home Office are justified by the narrative that it is in the best interest of the general public. But what if, by increasing the barriers to accessing healthcare through migrant charges, and now the very real threat of deportation, the risk to the general public was in fact increased?
I am researching the health-seeking experiences of people who recently move to the UK and then develop tuberculosis (TB). TB is infectious, passed from one person to another through coughing. It kills more people worldwide than any other infectious disease - 1.8m people died from TB in 2015. Because it is a potential public health risk, tuberculosis treatment in the UK is free for everyone.
However, when people become unwell with TB they don’t walk around with a huge sign around their neck saying “I’ve got TB”. It can be difficult to diagnose. It can affect any part of the body and has non-specific symptoms such as sweats and weight loss. People often end up in a TB clinic via circuitous routes through NHS services.
Some patients I’ve talked to as part of my research told me they are afraid. There is a stigma attached to TB and yet another attached to being a “migrant”. Now there is the added fear of their details being passed on to the Home Office. Is it any surprise that this stops them from seeking help when they become unwell? And the longer TB goes undiagnosed, the greater the risk that it will be passed on to other members of the community, the sicker the individual will be and the greater chance of death. So the government’s argument that using health information to track migrants down is in the public interest is really not the case.
I have spoken to many people about this issue recently. Some have suggested that because these foreign nationals have committed the crime of being in the country illegally then perhaps using information provided by the NHS is an acceptable way to identify them. But breaching the right to confidential healthcare and the potential risk to the general public are the two main arguments against this.
Health without fear
Putting aside the government’s contradictory stance on the right to confidential healthcare and the evidence that if you penalise people for seeking help you risk the health of the general public, there is a third argument here and it is ideological. These are people. Human beings. They are not some sort of homogenous entity under the term “migrants”.
Life is tough for so many people. Services are cracking, wages are being squeezed, and benefits cut. Reports of “immigrants taking jobs” make headlines. However, I also see data showing that NHS tourism is a drop in the ocean when it comes to the cuts the service is facing and the work it has to do. Without foreign nationals to work for it, the NHS would fall in a day.
As doctors, citizens and fellow human beings, I want us to live in a society that respects the right to life, the right to healthcare, the right to freedom from persecution. I want to live in a society where everyone can come to my clinic and say “I am unwell and need help” without fear that by doing so they will receive a call from the Home Office.