Migrants at risk of vulnerability, living in the UK may have little or no access to healthcare – creating a major threat to their well-being, a new report reveals.
Experts from the University of Birmingham analysed the well-being of migrants at risk of vulnerability, before and during the pandemic, mainly living in London who engaged with Doctors of the World UK (DOTW UK), in research funded by the Nuffield Foundation.
The report studies individuals who are at significant risk of harm while lacking the ability or means to protect themselves. Degrees of vulnerability for an individual vary in different contexts and at different points in time, but asylum seekers and undocumented migrants are considered at particular risk of vulnerability.
It is vital that migrants at risk of vulnerability have access to healthcare and high levels of wellbeing. Our analysis shows just how difficult it can be, even for trained volunteers to get individuals to register with a GP. DOTW UK’s volunteers have had to assist thousands of migrants to access healthcare over many years."Laurence Lessard-Phillips - University of Birmingham
The researchers found that the wellbeing of migrants at risk of vulnerability was quite poor, and that asylum seekers tended to have more negative wellbeing. Many had no access to healthcare, requiring help with GP registration, with significant barriers preventing them from dealing with their health issues and having a negative impact on their wellbeing – a situation likely to be replicated outside London.
The most common barriers to accessing healthcare included: individuals not understanding the system and their rights (25.4%); bureaucracy (25.1%); language difficulties (13.6%); fear of arrest (10%); and denial of health coverage (7.5%). Just over 15% of service users reported having their access to healthcare denied.
Furthermore, the wellbeing of asylum seekers in hotel and barracks accommodation was of particular concern, with individuals experiencing high levels of mental distress. This type of accommodation is presenting major concerns for health and access to healthcare. Given current trends in the housing provision for asylum seekers these findings have major implications for asylum seeker housing policy.
The ‘Vulnerability, migration, and wellbeing: investigating experiences, perceptions, and barriers’ report is published today and set out a number of recommendations including:
- All people resident in the UK, regardless of immigration status, should receive clear information about access to healthcare (in multiple languages), should be registered with a GP, with asylum seekers automatically registered on arrival in the country;
- GP surgeries must be made aware that they cannot refuse registration on the basis of an absence of documentation or immigration status;
- Asylum seekers should automatically receive an HC2 certificate valid for a minimum of 12 months – entitling them to free NHS prescriptions and dental treatment;
- All asylum seekers must receive information about access to healthcare in their own language, when they submit their claim for asylum;
- Health providers should offer alternatives for those vulnerable groups unable to connect through digital services;
- Asylum accommodation should be a last resort and short-term measure;
- People in asylum accommodation should have automatic access to a GP and have access to emergency, secondary and ancillary health services as needed;
- Asylum accommodation should provide Wi-Fi to allow individuals to connect with digital services;
- Accommodation providers must provide nutritious food and meet special dietary requirements.
Report co-author Laurence Lessard-Phillips, from the University of Birmingham, commented: “It is vital that migrants at risk of vulnerability have access to healthcare and high levels of wellbeing. Our analysis shows just how difficult it can be, even for trained volunteers to get individuals to register with a GP. DOTW UK’s volunteers have had to assist thousands of migrants to access healthcare over many years.
“Given that thousands of asylum seekers are dispersed outside of London in places where DOTW UK are unable to offer a service, there is a strong possibility than many are not accessing the healthcare they need and are entitled to.”
Ella Johnson, Interim Associate Director of Research – Doctors of the World UK said: ‘The people we work with are repeatedly met with barriers to accessing healthcare and preventing the escalation of their needs. Unsafe accommodation, combined with legal delays, hostile attitude, lack of information and routes to appropriate care, amount to the decline of people's physical and mental health, when they often present with existing vulnerabilities. It is critical that all people living in the UK have access to healthcare, regardless of their circumstances. ‘
Following consultation with DOTW UK, the report authors identify a range of suggestions for specific UK public bodies. These suggestions include:
- NHS England - introduce an accountability mechanism to ensure GP surgeries do not discriminate against migrants;
- Home Office - require accommodation providers to help residents to register with a GP and provide information about accessing wider NHS services and getting an HC2 certificate;
- Quality Care Commission - ensure routine inspections of asylum accommodation assess the health access needs of asylum seekers are being met; and
- UK Government - In the event of a future public health crisis, such as the COVID-19 pandemic, produce accessible public health resources in a variety of languages; and
The need for this project arose from the overall lack of an evidence base about the wellbeing of groups at risk of vulnerability about whom very few datasets exist.