The risk arises because the Government wants
ID
Card checks to be undertaken when a patient registers with a
GP
practice or visits a hospital out-patients clinic
for the first time. However, those who have no right to remain in
the UK – the overstayers – might not register with a
GP
or visit a hospital if they fear their lack of
residency status could be drawn to the attention of immigration
authorities. The public health risk is increased if the
ID
Card does actually deter those individuals who have
contracted a notifiable diseases from accessing medical services to
treat their condition.
The
BMA
has particular concerns about failed asylum
seekers who need medical attention but have no means to pay for
treatment and who for whatever reason cannot be returned to their
countries. The
BMA
's Head of Science and Ethics, Dr
Vivienne Nathanson, told OUT-LAW that the
BMA
is not
opposed to an
ID
card system in principle – it could
even be useful in providing a non-bureaucratic method for
GP
s to assess eligibility to healthcare; but it has
reservations. Dr Nathanson explained that the
BMA
is
"worried about the practicalities of the system and more
importantly about vulnerable patients falling through the net and
not getting the treatment they need."
The
JCWI
, a voluntary organisation that campaigns
against racism in immigration and asylum law and policy, shares the
BMA
's concern. Spokeswoman Rhian Beynon told OUT-LAW
that the gradual introduction of the ID Card could help to drive
"undocumented people underground and dependent on an informal
health sector," possibly reliant on "struck-off doctors to deliver
primary care."
While stressing that the public health risks are not the top
concern of the
JCWI
and should not be exaggerated, Ms
Beynon did add that, in the
JCWI
's opinion, the
Government "has not undertaken a sufficiently detailed regulatory
risk assessment to take account of the possible health risks." The
Government's race and regulatory assessments of the
ID
Card, published on the Home Office web site, are silent on the risk
to public health.
The health concerns are amplified in the
JCWI
's
response to a Department of Health consultation concerning free
access to primary care facilities in general. The
JCWI
confirms that undocumented people are the "poor and/or vulnerable
members of society with little or no access to good housing, a
balanced diet or other factors associated with living a balanced
and healthy life". It says these individuals "will suffer illnesses
and poor health" and "will be denied all medical services until it
reaches crisis point". Undocumented people, if they contract a
notifiable disease, could thus unwittingly spread infection if they
do not seek access to medical help.
Last July, the
BMA
issued a statement about
ID
cards and access to healthcare in which it claimed
that it "has consistently raised questions about the public health
implications of denying certain groups access to health services".
Although the
BMA
continues to take a neutral stance
over the introduction of an
ID
Card, its statement
echoes the
JCWI
's view in stating that the Card's
introduction may "result in failed asylum seekers being abandoned
by the healthcare system".
As a result, the
BMA
wants to minimise some of the
public health risks by permitting some flexibility "so that doctors
can treat vulnerable individuals who are not eligible for free care
and do not fulfil the criteria for 'immediately necessary care'"
(this care is limited to life threatening circumstances in an
emergency).
The
BMA
's statement also called upon the Government
to seek advice from bodies with clinical expertise in this area,
including the Health Protection Agency (HPA). However, the HPA told
OUT-LAW that it was not aware of any consultative involvement on ID
cards.
The extent of the public health risk is uncertain because the
number of overstayers in the UK is unknown. During the recent
General Election campaign, press reports referred to one million
overstayers in the UK; the Government's own research suggested half
that number; whilst Migration Watch, the anti-immigration pressure
group, has published a figure of two million.
The fact that such overstayers could encounter problems
accessing health and other services was stressed to the Home
Affairs Select Committee. Even Nicola Roche, the Home Office
Director with responsibility for
ID
cards, told the
Committee: "When we move to the compulsory phase, everybody who is
legally here in the country would have a card. So those that were
here illegally would very quickly be identified and clearly
enforcement action would need to follow. For those who did not have
a card, life would be very uncomfortable in that phase because what
the Government has said that they would want to do is make access
to free public services accessed through an identity card. So if
you did not have one, life would become very difficult. We would
also expect that a range of private sector services would also use
the card".
Ms Beynon for her part believes the
ID
Card could
drive such undocumented people underground – "possibly to become
more dependent on people who are very exploitative," she says. Even
with the lowest estimates discussed during the Election Campaign,
the concern is that hundreds of thousands of people could be
affected.
