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the health debate

Asylum seekers are a drain on the NHS

The cost of HIV treatment for asylum seekers is depriving British people of essential medical services

Asylum seekers threaten to engulf Britain in ‘imported’ epidemics

Asylum seekers are health tourists coming to the UK to get free NHS treatment

Compulsory health screening of new asylum applicants would stop the rise of HIV and TB in Britain

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Asylum seekers are a drain on the NHS

Fact: Blaming asylum seekers for the larger problems of the NHS may be easy, but it is neither accurate nor fair. There are thousands of medically trained asylum seekers and refugees who could contribute to the NHS and ease its acute staffing crisis but this potentially valuable resource to the NHS is being wasted because of work or regulatory restrictions.

Asylum seekers, refugees and other immigrants can and do make an enormous contribution to the UK. Refugees bring with them a wealth of skills and experience which the Home Office has recognised and made a commitment, through its Integration Unit, to put such skills to good use. The NHS itself relies heavily on foreign labour. According to the Greater London Authority, in London, 23% of doctors and 47% of nurses working in the NHS were born outside the UK. The London Assembly’s health committee recently recommended recruiting more refugee doctors living in London to address the crisis-level shortage of GPs (1).

The British Medical Association estimates that the NHS is currently short of 20,000 doctors and consultants; at the same time, there are roughly 3,000 refugee doctors living in the UK who are unable to practise. It takes about 10 years and £250,000 to train a doctor from scratch, but only one year and £15,000 to refresh the skills of refugee doctors and get them up to speed with the NHS of the 21st century (2).

There is an acute shortage of trained nurses in the UK and it is likely that this will increase in the future, according to the Royal College of Nursing (3). Recent government initiatives have sought to meet this demand by recruiting trained nurses from overseas. In the last 3 years more than 30,000 new non-UK nurses have registered in the UK. Many refugee nurses are among those helping meet this demand and, given permission to work, many highly skilled asylum-seeking nurses could also contribute to the NHS.
According to a recent Home Office study carried out last year, migrants, including asylum seekers and refugees - are far from being a burden on UK tax payers and a drain on the UK’s public services. On the contrary, in 1999-2000, they made a net fiscal contribution of approximately £2.5 billion, worth 1p on income tax (4).

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The cost of HIV treatment for asylum seekers is depriving British people of essential medical services

Fact: The numbers of people we are talking about are very small. The total number of people living with HIV in the UK is 50,000. This accounts for just 0.28% of the total number of people living with a chronic disease in the UK (17.5 million) (5).

The cost of treating and caring for people with HIV is £440m, or 0.9 per cent of the total NHS treatment and care bill - less than we spend on treating diabetes or kidney disease.

Alcohol abuse costs the British economy £3.3bn a year, according to a report by Alcohol Concern (6). The NHS spends £200m every year treating drink related illnesses, while road accidents where drink is a factor account for a further £189m. Smoking costs the NHS approximately £1.5 billion a year for treating diseases caused by smoking. These are the most serous public health issues facing the UK (7).

GPs are mainly independent self-employed contractors to the NHS and are under no obligation to accept particular patients. If GPs feel they cannot cope with more patients, they do not have to accept new ones. Asylum seekers are not given preferential treatment over UK citizens when they apply to register with a GP (8).

A report by the All-Party Parliamentary Group on AIDS recently concluded an intrinsic link between what is happening at the national level and what is happening at the global level. It was recognised that we can no longer consider what is happening in the UK as being separate from the rest of the world. As HIV prevalence rises globally, it is inevitable that the number of individuals coming to the UK with HIV will also rise (9).

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Asylum seekers threaten to engulf Britain in ‘imported’ epidemics

Fact: Sexually transmitted infections such as syphilis, chlamydia and gonorrhea are spreading rapidly throughout Britain and the situation has been described by the parliamentary select committee on sexual health as a crisis (10). This poses a real threat to public health, not the relatively small number of HIV-positive people who come to the UK.

Syphilis infections rose by a staggering 63% between 2001 and 2002, according to recent figures from the Health Protection Agency (11). The sexual health of the nation is in decline with potentially serious consequences for infertility in young women and rising costs for the NHS in treating the long-term effects of sexually transmitted infections.
HIV and TB are both global epidemics which are inevitably going to have an impact on the UK and every other country. 2003 marks the 10th anniversary of TB being declared a global emergency by the World Health Organization. One third of the world's population - nearly two billion people - is infected with TB. Ten million people a year develop the active disease. Two million die (12).

There were 7,000 cases of TB reported in the UK in 2,000. In 1950 there were 50,000, which fell to all-time low of 5,745 in 1987. This has since risen as part of worldwide resurgence. About half of all TB in Britain occurs in British people born in the UK. Although anyone can get TB, it is more likely to affect those living in poor conditions or on poor diets, so it is more likely to affect homeless people or refugees. Rather than discriminate against these vulnerable people, we need to raise awareness of TB so more cases are diagnosed. TB is treatable and can be contained if diagnosed and treated.

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Asylum seekers are health tourists coming to the UK to get free NHS treatment

Fact: Asylum seekers come to the UK to seek refuge, fleeing the most unimaginable torture and persecution. There is no evidence that people come to the UK because of their health or HIV status, and clinicians tell us that people they see are unaware of their status until they are diagnosed.

The BMA has found that asylum seekers, far from arriving in the UK with diseases, are more likely to become ill once they have arrived in the UK due to poor living conditions and lack of money for basic needs (14).

A recent Home Office report on the decision making of asylum seekers concluded that there was no evidence to suggest that asylum seekers had a detailed knowledge of the UK’s asylum policies or welfare benefits. The report concluded that the main reasons why people seek asylum in the UK are their country’s historic, particularly colonial, links with Britain, the presence of family and friends and the fact that English is a global language (15).

The United Nations Convention Relating to the Status of Refugees, which Britain signed in 1951, states that host countries must provide those fleeing tyranny and persecution with access to health services, housing, education and employment. Asylum seekers are entitled to NHS services, like other residents and visitors to the UK.

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Compulsory health screening of new asylum applicants would stop the rise of HIV and TB in Britain

Fact: Medical experts believe compulsory screening would be ineffective and would cause those who know they are infected to go underground. If anything, this would merely increase the risk of infection spreading.

A TB screening pilot carried out in Dover tested around 5,000 asylum seekers over a six month period and found no cases of symptomatic TB. Doctors did however find evidence of maltreatment and torture - evidence of the reasons why people have fled countries and are seeking asylum (16).

Preventing people from entering the country on health grounds to claim asylum would breach the 1951 UN Refugee Convention.

For compulsory health screening of new asylum applicants to be at all effective we would have to introduce compulsory health screening for all tourists, visitors and students coming to the UK and for all British citizens travelling outside of the country. This would be enormously costly and probably unworkable.

The British Medical Association (BMA) criticised recent Conservative Party proposals for compulsory health screening saying that the suggestions were “poorly thought out” and that rather than focus on perceived threats from abroad we should focus on the most serious public health issues facing the UK, including cancer, coronary heart disease and the impact of smoking (17).

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Sources

1 Access to Primary Care report, London Assembly, 8 April 2003
2 The Guardian, 11 March 2003
3 “We need respect”: experiences of internationally recruited nurses in the UK, Royal College of Nurses, July 2003
4 “The migrant population in the UK: fiscal effects”, RDS Occasional Paper 77, 2002
5 Health Protection Agency
6 Britain’s Ruin, Alcohol Concern, 2000
7 Action on Smoking and Health (ASH)
8 Contractual arrangements in health care, General Medical Council
9 The Migration and HIV Report: Improving Lives in Britain, All-Party Parliamentary Group on AIDS, July 2003
10 House of Commons Health Committee report on sexual health, June 2003
11 Health Protection Agency statistics, July 2003
12 World Health Organisation statistics, March 2003
13 TB – Are you aware?, Department of Health
14 Asylum seekers: meeting their healthcare needs, British Medical Association, October 2002
15 Understanding the decision-making of asylum seekers, Home Office Research Study 243, July 2002
16 Home office press statement, May 2003
17 British Medical Association, August 2003

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