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 GPs 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.
