NHS services – inaccessible asylum process – dispersal

Still human still here1. Access to urgent & immediately necessary care

The NHS’ guidance issued in 2013 is still valid and provides the framework for establishing when urgent and immediately necessary treatment must be provided to overseas visitors who do not have an entitlement to free care and cannot pay for it.

The information below is a summary of the key paragraphs from the guidance on the issue. The full report is available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/254530/ovs_visitors_guidance_oct13a.pdf

4.3 …Whilst treatment provided in an Accident and Emergency Department is free to any person, further emergency treatment after admission as an inpatient is not. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998. Urgent treatment should also be provided to any patient, even if deposits have not been secured. Non-urgent treatment should not be provided unless the estimated full charge is received in advance of treatment.

4.5 “Immediately necessary treatment is that which a patient needs:

– to save their life, or

– to prevent a condition from becoming immediately life-threatening,

or – promptly to prevent permanent serious damage from occurring.”

4.6 Relevant NHS bodies must always provide treatment which is classed as immediately necessary by the treating clinician irrespective of whether or not the patient has been informed of, or agreed to pay, charges, and it must not be delayed or withheld to establish the patient’s chargeable status or seek payment.

4.8 Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the person can be reasonably expected to return home. Clinicians may base their decision on a range of factors, including the pain or disability a particular condition is causing, the risk that delay might mean a more involved or expensive medical intervention being required, or the likelihood of a substantial and potentially lifethreatening deterioration occurring in the patient’s condition if treatment is delayed until they return to their own country.

4.9 For urgent treatment, relevant NHS bodies are strongly advised to make every effort, given the individual’s circumstances, to secure payment in the time before treatment is scheduled. However, if that proves unsuccessful, the treatment should not be delayed or withheld for the purposes of securing payment

4.12 The decision on whether a patient’s need for treatment is immediately necessary, urgent or non-urgent is only for clinicians to make. However, in determining whether or not a required course of treatment should proceed even if payment is not obtained in advance, or if it can safely wait until the patient can return home (i.e. whether it is urgent or non-urgent), clinicians will need to know their estimated return date.

4.17 For undocumented migrant patients, including failed asylum seekers, the likely date of return may be unclear and will have to be assessed on a case-by-case basis, including their ability to return home. Some may be prevented by travel or entry clearance restrictions in their country of origin, or other conditions beyond their control.

4.18 For some cases relating to undocumented migrants, it will be particularly difficult to estimate the return date. Relevant NHS bodies may wish to estimate that such patients will remain in the UK initially for six months, and the clinician can then consider if treatment can or cannot wait for six months, bearing in mind the definitions of urgent and non-urgent treatment given above. However, there may be circumstances when the patient is likely to remain in the UK even longer than six months, in which case a longer estimate of return can be used.

Thank you to Mike Kaye – Still Human Still Here

2. MSPs express concern over further submission changes

The Scottish Refugee Council have published an article on the increasing inaccessibility of the asylum procedure, as recently in the changes to rules on further submissions. The article highlights a Motion laid by Ken MacIntosh MSP, Scottish Labour’s spokesperson on equalities and communities, tabled on 9 February on this issue. The motion already has support from more than 25 MSPs and has the cross-party required to make it eligible for a full Chamber Debate, which is likely to take place in March. For more details see the SRC article at:

3. BBC Radio programme on dispersal

A BBC File on Four programme on dispersal in Liverpool and the North West was broadcast on 10 February.  To listen the programme go to: