- Fatima B. Wurie, migrant health evidence and delivery lead & inclusion health programme manager, honorary research fellow12,
- Claire Zhang, honorary researcher, doctoral candidate23,
- Yusuf Ciftci, head of refugee involvement4,
- Cherstyn Hurley, immunisation publications manager and infodemiologist5,
- Ines Campos-Matos, deputy director for inclusion health1
1Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care
2Institute of Health Informatics, University College London
3National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford
4British Refugee Council
5Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency
The UK has experienced a rise in net migration over recent years, with 606 000 migrants arriving in the UK in 2022.1 But are we doing enough to support migrants to access and navigate the health system? While migrants to the UK are less likely to die from the most common causes of death compared with the rest of the population, they are more likely to die of infectious diseases when compared to UK born populations.2 Covid-19 is a recent example of this.3 International migrants had a substantial increase in risk of death in 2020 from covid, much higher than those who were born in the UK and Ireland. The pandemic exacerbated pre-existing inequalities in the distribution of risk factors for ill health and poor healthcare access, demonstrating how over exposed and under protected these groups can be.
Evidence submitted by Doctors of the World to the Home Affairs Select Committee4 in April 2020 showed how a poor understanding of NHS charging exemptions among healthcare professionals can impede migrants’ access to health services. Despite clear NHS guidance, in July 2021, The Bureau of Investigative Journalism5 published stark findings showing that undocumented migrants face major barriers in accessing primary care with 62% of GP surgeries incorrectly refusing to register patients without proof of address, identification, or legal immigration status. This demonstrates how frequently some inclusion health groups6 who are entitled to healthcare in principle, are excluded from accessing healthcare and highlights the need to make NHS services more accessible to socially excluded people. A report by the Institute for Public Policy Research found further evidence of the adverse impacts of the current charging system and offers options to reform this system.7,8
Some newly arrived migrants to the UK are less likely to be immunised than the general population.91011121314 Recent examples of the health consequences of the under immunisation of vulnerable migrants include outbreaks of scabies and diphtheria in large migrant processing centres.151617 Such health protection incidents have raised concerns about the impact of the Illegal Migration Bill on healthcare accessibility and continuity of care.12 Ensuring timely vaccine provision for migrants is important for individual level health and the health of the wider community for the prevention of outbreaks of vaccine preventable diseases, such as diphtheria, measles, polio and Hepatitis A.
What NHS services are migrants entitled to? Access to primary care is free of charge to everyone regardless of immigration status. This includes routine vaccinations and covid-19 vaccination. Access to secondary care is free of charge to people who are ordinarily resident in England and for some migrants, including refugees and asylum seekers, and some services are free for all. All healthcare professionals should be equipped with this knowledge to recognise and respond to migrants’ health needs in a timely and culturally responsive manner. In order to make it easier for healthcare professionals to know about what NHS services and vaccinations migrants are entitled to, there are resources available. Improving healthcare professionals’ awareness of migrants’ entitlements to healthcare will ensure that accurate sources of information on access and navigation of NHS services reach patients and their wider communities.
Healthcare professionals have a collective responsibility to follow NHS and public health guidance and implement necessary steps to ensure groups often at the margins of society are not further excluded. This is key to improving dignified, equitable and inclusive access to health services and reducing health inequalities.
Further advice and guidance for healthcare practitioners on the health needs of migrant patients and can be found in the Migrant Health Guide https://www.gov.uk/government/collections/migrant-health-guide
References
- ↵
- ↵
Aldridge, R.W., et al., Global patterns of mortality in international migrants: a systematic review and meta-analysis. 2018. 392(10164): p. 2553-2566.
- ↵
- ↵
Written evidence submitted by Doctors of the World (UK) (COR0121) to the Home Affairs Select Committee. Home Office preparedness for Covid-19 (Coronavirus) (Inquiry). 7 May 2020.
- ↵
- ↵
- ↵
- ↵
- ↵
- ↵
- ↵
- ↵
- ↵
Deal, A et al. Immunisation status of UK-bound refugees between January, 2018, and October, 2019: a retrospective, population-based cross-sectional study, The Lancet Public Health, Volume 7, Issue 7.
- ↵
- ↵
- ↵
- ↵