During the COVID-19 crisis, the government has announced changes and exceptions to the rules regarding healthcare access. All migrants can now access certain essential healthcare services free of charge and free of immigration checks. As such, non-UK residents in England can get free care with regards to COVID-19, irrespective of their immigration status. This includes free access to COVID-19 testing, treatment and vaccination for all overseas visitors to England, including non-residents and those living or staying in the UK without permission.
In early February, it was officially announced that COVID-19 vaccines would be made freely available to all adults in England, Scotland and Wales, regardless of their immigration status. Thus, all adults are eligible to get the vaccine, including those with no recourse to public funds (NRPF), those who are undocumented, those who are only in the UK short-term, those who have overstayed their visa, and those who normally have to pay for NHS treatment. This open policy is very different from the general approach to migrants, for whom certain public and health services are normally restricted.
Generally speaking, visa applicants for all visa types except visitors and those with indefinite leave to remain have to pay a fee known as the NHS surcharge in order to access National Health Services (NHS) services. In addition, some temporary migrants are also liable to be charged up to 150% of costs for secondary healthcare interventions.
The “no recourse to public funds” (NRPF) rule, then, is generally imposed on people with limited leave to enter or remain in the UK, prohibiting those such limited status from accessing certain defined public funds, such as Universal Credit or benefits. Those with outstanding asylum applications and undocumented residents are similarly barred from accessing public funds. If a person claims public funds despite not having the right status, that is considered a criminal offence, which may well carry consequences for their future immigration applications: any existing leave can be curtailed, and any future application refused as a consequence. In May 2020, this policy was found partially unlawful, as the High Court ruled that the government must make it easier for migrants to access the welfare system if they are about to become destitute.
Finally, the hostile environment policy deters migrants from accessing healthcare they are entitled to. Until 2018, the NHS functioned as a “gatekeeper” for the Home Office, sharing patient information to help the Home Office track down people thought to be violating immigration rules. This is no longer the case – data-sharing with Home Office immigration enforcement teams is now limited to cases of deportation for serious crimes only – but the culture of fear produced by such measures persists, not only preventing the NHS from fulfilling its function but also putting public health at risk.
Against the backdrop of the hostile environment, it is not surprising that migrant take up of the vaccine has been slow. Long-standing barriers to healthcare and lack of trust in public authorities lead many migrants to be afraid to access services even though they have the right to do so in this specific scenario. As such, most migrants who are entitled to free NHS care and still report feeling afraid of the repercussions of actually accessing the service. Among migrants who do have a visa and are in the UK lawfully, 30% still reported being fearful of seeking healthcare. For undocumented migrants, the situation is even more dire, as their data may be passed from NHS trusts to the Home Office, which can result in them being targeted by immigration enforcement. Such reluctance to get vaccinated could make a significant dent in vaccination totals, as an estimated 1.2 million people live in the UK without official documentation, and the real number is likely to be higher.
Migrants Right groups including the Refugee Council and the Joint Council for the Welfare of Immigrants (JCWI) have warned that many could still be left unvaccinated unless concrete action is taken to roll back aggressive policies such as data-sharing, NRPF and NHS surcharges as part of the hostile environment. In order to raise awareness and pressure government into making changes, the JCWI campaign to protect migrant rights during the COVID-19 pandemic has a list of resources and action points for those wanting to help.