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HSPH > Healthcare for Vulnerable People > Flashcards

Healthcare for Vulnerable People Flashcards

1
Q

Why is migrant access to healthcare important

A
  • its a human right
  • It is important for public health
  • cost effective
  • there are barriers for this group in accessing healthcare
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2
Q

What are the NHS views to access to healthcare

A

NHS treatment “based on clinical need, not ability to pay” (1948).

NHS value: “everyone counts: make sure nobody is excluded, discriminated against or left behind.”

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3
Q

what makes access to healthcare a basic human right

A

International Covenant on Economic, Social and Cultural Rights.

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4
Q

What are SDGs

A
  • Sustainable development goals
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5
Q

why is access to healthcare financially efficient

A
  • early diagnosis and treatment save lives and cut treatment costs
  • health inequalities cost - in England the cost of treating illness and disease arising from health inequalities has been estimated at £5.5 billion a year
  • Resource burden of checking and charging patients - operating an overseas visitors charging system is costly
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6
Q

How much does migrants cost the NHS

A

£1.95 billion during 2012-13
- Estimated cost to the NHS of EEA and non-EEA visitors, temporary migrants, students, British ex-patriots, “deliberate health tourists” and those “taking advantage”

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7
Q

What does doctors of the world do

A

Primary care clinic in East London for people with difficulty accessing mainstream NHS;

Staffed by volunteer GPs, nurses & support workers;

Advocacy service for GP registration and secondary care;

they try to influence health police and practise

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8
Q

What is the definition of an asylum seeker

A

A person who has left their country of origin and applied for asylum in another country but whose application has not yet been concluded

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9
Q

What is the definition of a refugee

A

Someone whose asylum application has been successful; the Government recognises they are unable to return to their country of origin owing to a well-founded fear of being persecuted for reasons provided for in the Refugee Convention 1951 or European Convention on Human Rights.

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10
Q

What is the definition of a refused asylum seeker

A

A person whose asylum application has been unsuccessful.

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11
Q

What is the definition of an undocumented migrant

A

Someone who enters or stays in the UK without the documents required under immigration regulations.

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12
Q

Who are undocumented migrants

A

Survivors of trafficking

Refused asylum seekers

People who don’t claim asylum due to lack of legal advice.

People who come to work without a visa.

People whose visa has expired (student/working)

Domestic workers on expired visas which employer doesn’t renew

People on spousal visas whose relationship breaks down

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13
Q

What problems do unregulated migrants have accessing primary care

A
  • Lack of ID/proof of address - dont need a home address to register at a GP
  • Immigration status
  • Fear of the home office/arrest
  • language
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14
Q

How many patients were refused by GP clinics after attempts were made after the doctors of the world

A

Out of the 2873 attempts by DOTW to register patients with their local GP in 2019, 787 were refused

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15
Q

What is not relevant to GP registration

A

Nationality and immigration status are not relevant to GP registration

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16
Q

Why is nationality and immigration status not relevant to GP registration

A

“anybody in England may register and consult with a GP without charge”

“all asylum seekers and refugees, overseas visitors, students, people on work visas and those who are homeless, whether lawfully in the UK or not, are eligible to register with a GP practice”

“A patient does not need to be ‘ordinarily resident’ in England to be eligible for NHS primary medical care

17
Q

Why do you not need documentation for registration with a GP practise

A

“there is no regulatory requirement to prove identity, address, immigration status or the provision of an NHS number in order to register”

Lack of proof of address/ID “would not be considered reasonable grounds to refuse to register a patient” or withhold appointments

“Where necessary, (e.g. homeless patients), the practice may use the practice address to register them if they wish”

18
Q

What happens when you refuse to register

A

“If a practice suspects a patient of fraud (such as using fake ID) then they should register and treat the patient but hand the matter over to the NHS Counter Fraud Authority (NHSCFA)”.

“If a practice refuses any patient registration then they must record the name, date and reason for the refusal and write to the patient explaining why they have been refused, within a period of 14 days of the refusal”.

“This information should be made available to commissioners on request.”.

19
Q

What are the 7 steps for safe patient registration

A
  • Don’t insist on proof of address
  • Don’t insist on ID
  • Never ask about immigration status
  • Keep information safe
  • Use an interpreter
  • Display Posters
  • Empower frontline staff
20
Q

Why are safe patient registration protections important

A

Some patients living in the practice area will be unable to prove it.

Some patients will not have any proof of ID.

Immigration status queries deter undocumented patients.

New rules (charging and checks) in hospitals limit access to specialist care.

Fear of being reported to the Home Office is justified

21
Q

In secondary care what do undocumented migrants have to pay for and what services are free

A

Paid for
Undocumented migrants are charged for some services – this includes refused asylum seekers in England
- Charges must be paid before treatment.

Free
Some services are always free - A&E, communicable diseases and family planning.
“Urgent or immediately necessary” treatment to be provided regardless of ability to pay

22
Q

What are the groups of undocumented migrants that are exempt from charges

A
  • Refugees and asylum seekers

Refused asylum seekers receiving “section 4” support - those destitute and prevented from returning to country of origin

Survivors of trafficking

Children looked after by a local authority

People treated under the Mental Health Act

People in immigration
detention.

Treatment caused by sexual or domestic violence, FGM, or torture

23
Q

What is immediately necessary care

A

Life saving, will prevent a condition becoming life-threatening or will prevent permanent serious damage

  • E.g. maternity services are always immediately necessary
  • everything else is based on the treating clinicians decision
24
Q

What are examples of immediately necessary care in childhood

A
  • acute renal disease requiring 3 times dialysis a week

- maternity services

25
Q

Do patients have to pay for immediately necessary care

A

Immediately necessary care must be given regardless of ability to pay but patient will be charged after receiving care

26
Q

What is urgent care

A

Care that cannot wait until the person leaves the UK. Should take into account pain, disability, and the risk of the delay exacerbating their condition

27
Q

What is establised in urgency care

A

First, the OVM establishes date they are “reasonably expected to leave the UK

  • For undocumented migrants - the likely date by which the person can be reasonably expected to leave the UK may be unclear, but trusts estimate that such patient will remain in the UK initially for 6 months
  • However there may be circumstances when the patient is likely to remain in the UK longer than 6 months in which case a longer estimate can be used
28
Q

are you charged for urgent care

A

Urgent care must be given regardless of ability to pay but patient will be charged for the care.

29
Q

Give an example of urgent care

A

Eg Undocumented migrant unlikely to leave the UK in the next year with a non-melanoma skin cancer – treatment (cryotherapy) is urgent

30
Q

Why is charging a barrier to healthcare

A

Deterrence
- Patients fear ID checks & unaffordable bills. Debts of £500+ are reported to the Home Office after two months – affects immigration applications.

Incorrect / untransparent assessments of urgency
- OVMs or clinicians wrongly apply definitions or use unrealistic return date, and deny urgent care.

Gatekeeping by admin staff
- Reception staff delay or deny access to doctor due to ID checking bureaucracy / incorrect record of patient’s immigration status.

31
Q

What is the best practice fr clinicians to think that if the patient is exempt from charging

A

Are they an asylum seeker or refugee?

Are they a victim of modern slavery or trafficking?

Is it diagnostics/treatment for communicable disease or family planning?

Is treatment a result of torture, sexual or domestic violence or FGM?

32
Q

What is a good place to identify victims of trafficking

A

Health services are a good place to identify victims of trafficking

33
Q

Who can provide a letter confirming status or recognised victims of modern slavery and trafficking

A

The Home Office or UK Human Trafficking Centre provide a letter confirming status of officially recognised as victims / suspected victims

34
Q

In terms of trafficking victims if you are awaiting a decision are you exempt from charges

A

apply to be recognised as a victim are not exempt from charges. Individuals still in a trafficking situation, those awaiting a decision and those who do not

35
Q

If you suspect your patient is a victim of slavery or trafficking who should you talk to

A

If you suspect your patient is a victim of slavery or trafficking, talk to your safeguarding lead for advice.

36
Q

What should you do if your patients treatment is caused by one of these types of violence

A

If you think your patient’s treatment is caused by one of these types of violence include it in your referral letter / inform the OVM.
- Includes mental health srevices

37
Q

If you think the patients care is urgent or immediately necessary what should you do

A

This decision must be made by the treating clinician, not the OVM.

Care should not be withheld
until the clinician confirms that it is non-urgent care

Diagnostics required to 
establish whether a service is 
“Urgent” or “immediately 
necessary” should not be 
withheld
38
Q

How do you decide when your patient will realistically return home

A

To decide whether care is urgent, an accurate date of return is essential. The OVM will establish the date of return.

Remember: this is not a fitness to fly test.

Remember: refused asylum seekers and undocumented migrants often face many obstacles to leaving the UK.

Challenge the date of return if you think its not reasonable.

39
Q

If you are sectioned do you need to pay

A

No

HSPH (26 decks)

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