Over the past week, Birmingham’s local press has been commenting on the case of a GP practice manager prosecuted for providing treatment, at a cost, to ‘health tourists’. [ http://www.birminghammail.co.uk/news/sparkbrook-nhs-practice-manager-caught-8318308?ICID=FB-Birm-main ]
One of the interesting- and unreported- facts about the case is that the treatment received by the patients in question, who were charged up to £800- apparently GP registration and associated primary care services- are not actually covered by the Department of Health’s Overseas Charging Regulations in the first place. Bluntly, as things presently stand, everybody, irrespective of their immigration status is eligible to register with a GP’s surgery- and, indeed, GPs are responsible for facilitating such registration for the members of the communities they serve, and particularly more vulnerable members of such communities.
The situation, however, becomes considerably more complex when a patient with irregular immigration status requires hospital treatment- secondary health care. One such patient is ‘Mary’, a client of ASIRT’s. Mary’s history is a troubling and complex one. There are intimations of human trafficking and sexual exploitation about which she is, entirely understandably, reluctant to talk. Mary has developed a serious and debillitating health condition, apparently as a direct result of this history.
When she was first referred to ASIRT, Mary was almost entirely destitute. She had, some six weeks previously, given birth to her son ‘Joseph’. Again, the circumstances around Mary’s relationship with Joseph’s father are far from straightforward, though he has repeatedly made it plain that he does not wish to be in a relationship with Mary and has no intention whatsoever of taking on care responsibilities for their son. He has, however, agreed to be named on Jospeph’s passport, and thereby confer his British citizenship to him.
ASIRT assisted Mary to make a ‘Zambrano’ application to the Home Office. This was, as usual, refused on the basis that Joseph could reasonably be expected to live with his father, irrespective of that man’s refusal to care for him. [ http://asirt.org.uk/wordpress/?p=187 ]
We are now seeking to submit a further application on Mary’s behalf, concentrating on the ECHR Article 8 aspects of the situation, and the Home Office’s own internal guidance that parents with genuine and subsisting relationships with British citizen children should not generally be expected to leave the UK if the consequence of such a removal would be against the best interests of that child.
However, we have been presented with yet another obstacle in the form of an invoice for £2500, presented to Mary by the NHS Trust providing the maternity services. Mary’s only income at present is a section 17 Children Act payment of around £70 per week. She is prohibited from paid work, her Zambrano application having been refused, and has no recourse to public funds. She is in no position whatsoever to pay off such a debt- and particularly until her immigration status difficulty is resolved
Yet under the Immigration Rules, the Home Office can refuse her application for regularisation, precisely on the basis that she has an outstanding debt to the NHS of over £1000. [ https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/346910/Appendix_7.pdf ]
Mary is not the ‘health tourist’ of tabloid legend, whose parasitical presence in the UK these charging regulations are supposedly designed to deter. She is a vulnerable and abused woman whose life to date has been chacterised by an almost complete loss of control- and who is being yet further denied such control effectively as a consequence of being unable to pay what she legitimately regards as ‘a fine’, levied for the ‘crime’ of giving birth.
It is literally impossible to see whose best interests are served by this Kafkaesque state of affairs. Joseph is, of course, a British citizen. His life, for the foreseeable future, is here in the UK. Denying his mother the right to regularise her status, to work, and to provide for him simply consigns him to the poverty and marginalisation of section 17 support. The links between childhood poverty and the likelihood of entering the criminal justice system in later life are well documented. Whatever short-term economic gain might be imagined from denying the families of children like Joseph their citizenship rights could not conceivably outweigh the long-term economic consequences of such social exclusion.
As we move into 2015, and the ‘tough’ rhetoric on immigration becomes ever more ramped up, it is important to bear in mind just who the primary victims of this ‘tough’ posturing are: children like Joseph, who have essentaily committed no greater sin than existing.