The government’s dehumanising “earned” settlement proposals will entrench damage to the NHS by locking out marginalised communities from accessing basic healthcare and undercutting a health service reliant on migrant workers. Read more in this statement from the Patients Not Passports campaign, which is organising nationwide to end racist immigration controls in the NHS.
The Patients Not Passports campaign opposes the current government’s proposals for ‘earned’ settlement and the accompanying consultation process as fundamentally racist, classist, and xenophobic, in line with the statement made by the Joint Council for the Welfare of Immigrants (JCWI) and other rights groups. We contend that settlement is a basic right, and condemn the conception of ‘earned’ settlement as a dehumanising discourse that ignores how migration to the UK is conditioned by the violences of capitalism and empire. As a campaign calling for the abolition of borders in healthcare, we condemn in particular the proposal that migrants must have no outstanding NHS debt to be eligible for settlement.
The proposal to make settlement contingent on a lack of medical debt contravenes the founding principles of the NHS as an institution for the delivery of healthcare to all. It also further enshrines a state policy of criminalising and punishing migrants for the audacity of being sick. The current policy of charging migrants for healthcare results in oppressed communities being afraid of accessing the care that they need; leaves vulnerable individuals trapped in immiseration and debt; disproportionately impacts communities of colour; forces healthcare workers to act against their consciences by deputising them as border control agents; and leaves communities sicker, more fragmented, and divided between those who ‘deserve’ treatment and those who don’t.
NHS debts are often levied against those with the least ability to pay: from the £120,000 invoice that Simba Mujakachi, who was eventually granted refugee status, received for his surgery; to the £76,000 bill given to Omisha Shrestha, who was diagnosed with liver cancer at 10 months old, for her treatment. Many of those in debt are already destitute, living with bills that hang indefinitely over their heads; others are threatened by debt collectors, or locked into payment plans that will last the rest of their lives. And this is only taking into account those migrants who receive NHS treatment – the punitive charging regulations require migrants to pay upfront for chargeable treatment that is not “urgent or immediately necessary,” forcing many to go without care. By making a lack of debt to the NHS a condition for settlement, the government will only ensure that even more migrants in the UK live in a permanent state of precarity. These policies are deadly, and contravene the fundamental right of all people to healthcare.
Despite these major ramifications for the lives of migrants throughout the UK, the proposed change making eligibility for settlement contingent on a lack of NHS debt is not even up for comment in the government consultation – no questions in the consultation touch on this item. Forgoing any democratic procedure, the incumbent government seems to be treating this change as an already established fact.
Such punitive changes will also do nothing to uplift an already overburdened, underfunded NHS. Instead, they will manage to lock out even more marginalised individuals from accessing basic healthcare, while also undercutting an NHS workforce that is reliant on migrant healthcare workers to function. Previous changes to salary thresholds for the Health and Social Care visa have already devastated the lives of migrant workers in NHS Trusts throughout the country – these proposals will only entrench the damage, and demonstrate a striking lack of foresight when it comes to the future capacity of the NHS.
As a campaign, we know that the only just way forward is abolition: the abolition of border controls and info-sharing with the Home Office in the NHS; the abolition of charging for healthcare, including the Immigration Health Surcharge; and the abolition of a system that treats migrants as less-than-human, with its proposals to measure their right to live, work, and exist against a set of fundamentally racist, classist metrics. As such, we are calling on the health community to come out and oppose these proposed changes, not only through responding to the government consultation, but also through organising, direct action, and an ongoing commitment to fight for all of our freedoms.
Patients Not Passports is a nationwide campaign organising to end racist immigration controls in the NHS.
Migrants Organise is a platform for migrants and refugees to organise for dignity and justice. Join our mailing list.
