Refused Asylum Seekers and NHS Debt

Asylum seekers who have travelled to the UK have often spent many months without access to decent food, medicine, and healthcare. Often, female asylum seekers are pregnant and/or nursing young children.

Healthcare availability to asylum seekers is not widely discussed. And what about those who have had their application for asylum rejected? If the NHS treats them, a debt incurs, which can affect their ability to seek out another immigration route to remain in the country.

People who have fled their home country seeking asylum in the UK are often not fluent in English and have little knowledge of the culture and healthcare structure. For example, who do you call if you feel unwell? Do you need to be registered with a GP, and if so, how can you register if you are waiting for your asylum application (which can take months, sometimes years) to be decided upon?

Last year it was revealed that the NHS was using private debt collecting firms to chase treatment costs from overseas patients and refused asylum seekers.

One doctor of the World patient was a refused asylum seeker from Guinea who couldn’t be deported as Guinean authorities refused to accept him.

A month later a bailiff turned up at the friend’s house he was staying at, demanding £3,900 relating to the treatment he had had a year earlier at London’s Royal Free hospital.

He told Doctors of the World at the time:

“I have explained over and over again that I am an asylum seeker, not working, with no income and no support from the state. I just live on handouts from friends, living from day today.

“This unexpected visit at the address to collect the money makes me feel very uncomfortable. Not only I do not have the money but also I cannot cope with the unbearable stress of being chased up at the house.”

Some of the most distressing cases of refused asylum seekers being hounded for debt involve vulnerable pregnant women. Some women have been harassed by phone calls from debt firms for the costs of maternity care. The charity Maternity Action told The Guardian.

Carla Montemayor, its spokeswoman, said:

“We’re talking here about women who’ve just given birth, or in one case just had a miscarriage, so they were already traumatised, and then they received these phone calls making threats.

“It’s repeated phone calls pressuring them to pay. And for those whose immigration status is insecure; it brings up the possibility of deportation … Because it’s the policy of NHS trusts that any debts coming above £500, unpaid within two months, will be reported to the Home Office.”

This is undoubtedly a frightening situation for an asylum seeker or refused asylum seeker. Although anyone in England, regardless of nationality or immigration status is entitled to register with a GP and to receive NHS services provided by the GP free of charge, only the following types of care are free of charge to refused asylum seekers:

• Accident and emergency (A&E) services up until the point that you are admitted as an inpatient (outpatient services are chargeable).
• Family planning services (except pregnancy terminations)
• Diagnosis and treatment of certain contagious diseases e.g. TB or HIV
• Diagnosis and treatment of sexually transmitted infections
• Treatment of any physical or mental condition caused by torture, female genital mutilation (FGM), domestic violence or sexual violence (as long as you did not travel to the UK for the purpose of seeking that treatment).

Maternity care is available at no cost to asylum seekers or refused asylum seekers in some circumstances, including, but not limited to those who:

• have claimed asylum, humanitarian protection or temporary protection or article 3 protection and are waiting for a decision on your claim or appeal,
• have been refused asylum or article 3 protection and have made an in-time appeal and are awaiting the outcome.
• are receiving asylum support under Section 95 of the Immigration and Asylum Act 1999,
• have been granted refugee status, or humanitarian protection or article 3 protection or temporary protection,
• are being held at an immigration detention facility

If you are refused asylum and your appeal/judicial review is unsuccessful, you will need to pay for maternity care and/or all other types of healthcare not listed as free of charge above.

Can I be refused leave to remain if I have an outstanding NHS debt?

Paragraph 320 (22) of Part 9 of the Immigration Rules says that an application for entry clearance should normally be refused:

“where one or more relevant NHS body has notified the Secretary of State that the person seeking entry or leave to enter has failed to pay a charge or charges with a total value of at least £500 in accordance with the relevant NHS regulations on charges to overseas visitors”.

The use of the wording “normally” means that the Home Office has the discretion to grant leave to remain where “there are compelling or compassionate circumstances or human rights considerations that would make refusal inappropriate because discretion should be exercised in the person’s favour.”

What should I do if I am a refused asylum seeker and have an NHS debt?

The most crucial step to take if you wish to apply for leave to remain is to talk to experienced immigration lawyers. There are many factors they will consider when examining the best route to take to secure leave to remain for you, despite your NHS debt. These include (but are not limited to):

• The date of the treatment you received.
• The nature of the treatment.
• The total amount of debt.
• Whether any human rights factors should be considered by the Home Office.

Even if the NHS debt has been paid, you may be refused leave to remain. The policy document states:

“You must consider whether the applicant has sufficient funds to support themselves in the UK, given that they previously had an outstanding healthcare debt. You must also consider whether they intend to access further NHS treatment without paying, unless such access is permitted on the route under which they are applying.”

Such a decision, if challenged, has a high chance of success. However, it is vital to instruct experienced immigration solicitors to ensure you have the best advice and representation possible.

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