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Access and entitlement to NHS care for new migrants

Access and entitlement to NHS care for new migrants. Dave Newall Consultant in migration and migrant health. Key principles. The NHS was established to be free at the point of access for individuals in the local population.

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Access and entitlement to NHS care for new migrants

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  1. Access and entitlement to NHS care for new migrants Dave Newall Consultant in migration and migrant health

  2. Key principles • The NHS was established to be free at the point of access for individuals in the local population. • The NHS Outcomes framework - preventing people from dying prematurely and positive experiences of care. • The health system recognises that there are some groups who experience greater health inequalities. • Universal access to health care based on clinical need remains an underlying principle of the NHS.

  3. The challenges of migration • Increasing migration into the West Midlands since 2001. • 5.2 % of the regions population was born outside the UK and arrived since 2001. • Immigration status increasingly effects access and entitlement to employment, education, housing, social welfare, social care and health services. • Communities contain a mix of people who may come from the same country of origin but who have different reasons for migration and legal status in the UK. • Commissioners and providers of services don’t necessarily understand these distinctions.

  4. New Migrants – who are they? Asylum seekers Refugees Refused asylum seekers Economic Migrants - European Economic Area (EEA) - pre 2004 European Union - A8 nationals - A2 nationals - Croatian nationals - Non EEA nationals Family reunion/ formation e.g. spouse visas Overseas students Undocumented migrants Victims of trafficking

  5. Percentage of total population of non UK born residents in selected West Midlands Authorities (2011 Census)

  6. Barriers to health care for new migrants • Language • Understanding the UK health system • Problems with GP registration processes • Poverty and its affect on access/ transport • Destitution and homelessness • Discrimination • Legal restrictions • Expectations of health service and health seeking behaviour • Working hours • Mental health or experience of trauma

  7. Access to Primary care • Access to primary care IS NOT affected by the charges for oversees visitor regulations. • Anyone should be provided with urgent and immediately necessary treatment for 14 days even if the GP is unable to register them as a patient. • EEA nationals are entitled to receive the same level of health care provided to UK citizens whilst they are in the UK. • Visitors are entitled to receive treatment for any urgent or emergency treatment whilst in the UK.

  8. GP Registration • Anyone can ask to register with a GP. • GPs have the discretion to register individuals as a temporary or a permanent patient, not to deny registration. • Proof of ID or Immigration status is not a requirement. • Lack of documents is insufficient grounds to refuse registration. • Refusal on reasonable grounds – but beware of your equalities duties. • Individuals must receive a letter explaining reasons for refusal within 14 days of the practices decision.

  9. Entitlement to Secondary Care • New regulations in force from 1st August 2011 • Ordinarily resident & Lawfully present in UK. • Some services are always free of charge – A & E, family planning, communicable diseases, STI’s, detention under Mental Health Act 1983. • Urgent & Immediately necessary treatment should not be withheld whilst clarifying liability for payment. • Non-urgent care - will not be provided for ineligible individuals without prior payment. • Some groups are always exempt from charges. • Children of ineligible migrants are not entitled to free secondary care.

  10. Proposed changes to migrant access to the NHS in England • Controlling Immigration, regulating migrant access to health services in the UK. • Sustaining Services, Ensuring fairness: migrant access and financial contribution to NHS provision in England • Permanent residency (ILR) to replace ‘ordinarily resident & lawfully present’ criteria for access to secondary care. • Temporary migrants to pay an ‘immigration health surcharge’ to cover access to the NHS for the period of their stay in the UK.

  11. Proposed changes to migrant access to the NHS in England • Visitors and undocumented migrants to pay for NHS services (Currently secondary care). • Vulnerable groups, such as asylum seekers to retain exemption. • Review of bi-lateral arrangements with non-EU countries • Better recording of EEA national health use under EHIC scheme and review of whether economically inactive EEA nationals could loose free NHS care.

  12. What services may be charged for in the Future? • GP consultations will remain free of charge • Department of Health will publish new guidance in March 2014. • Primary Care services, including pharmacy, dental, optical and community services will become chargeable (from 2015/16). • Secondary care charges will come into force for those new groups deemed to be ineligible for free treatment when Immigration Bill is passed (April 2014)

  13. What services may be charged for in the Future? • Proposal to extend charging for A & E services from some time in 2016 (or later). • Services provided by other healthcare providers will also become chargeable. Clarity from the Department is required on what these might be. • A new registration system which identifies eligibility for free NHS treatment. GPs will be required to cooperate with this.

  14. Points for the health sector in the West Midlands to consider How do NHS England, CCGs and Public Health teams need to respond to such changes? What might the Impact of changes be on: • Health seeking behaviour of migrant communities? • Approaches that target reduction in health inequalities? • Access and use of mental health services • On the provision of Public Health? • On the use of A & E and urgent care and the ability of some migrants to follow the ‘choose well model’? • Impact on the Choose well approach? What systems are in place to pick up changes in migrants access and use of health services within your area?

  15. ‘Understanding the local migrant population and their access and entitlement to health services’ The course provides : • An overview of migration populations at a local level • It explains the different migration statuses and their effect on rights and entitlement to public services • It explores the attitudes to migration and migrants. • Clarity on the current and proposed entitlement of different migrant groups to NHS services • The opportunity to identify barriers migrants may face in accessing health services and possible solutions at a practice level. Accredited by LfPH and delivered by ASIRT & me over the past 3 years to PCTs, CCGs, LINKs and Vol sector agencies. For further information please contact me on 07514486515 or email training@asirt.org.uk

  16. Useful links • HPA Migrant Health Guide – http://www.hpa.org.uk/MigrantHealthGuide/ • BMA guidance – http://bma.org.uk/practical-support-at-work/gp-practices/overseas-visitors-and-primary-care • Department of Health guidance on implementing the overseas visitors hospital charging regulations - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/254530/ovs_visitors_guidance_oct13a.pdf • Sustaining Services, Ensuring Fairness consultation and government response - https://www.gov.uk/government/consultations/migrants-and-overseas-visitors-use-of-the-nhs

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