Training - No Recourse to Public Funds

posted: 20/05/2011

No Recourse to Public Funds (NRPF) Training will be provided in Manchester on Tuesday 7th June (10am – 4.30pm) for Local Authority representatives with responsibilities for people with NRPF.

There will be NRPF training specifically for the voluntary sector in London, on 10th June. Details about Voluntary Sector NRPF Training are here

Voluntary sector people are also welcome at the Manchester training but in Manchester the training focuses on social services assessments.

This training is provided by the No Recourse to Public Funds network.

Limited places available

The cost of the training is £125 per person and will take place at Manchester City Council. Limited places are available. To book a place, please complete the booking form and return it to No Recourse to Public Funds at Islington. The training terms and conditions are here.

The Manchester training for local authority workers covers key issues, legislation and social services assessments, for adults, children and families, and includes human rights obligations.
 

• No recourse to public funds - introduction and overview
• Key legislation
• Assessing eligibility for support
• General considerations in assessments of need - adults, children and families, human rights
• Community care and community mental health assessments
• Child in need and human rights assessments
• Good practice in assessing and supporting people with NRPF
• National NRPF Network and the policy context of NRPF
• Case studies

Booking Form

Terms and Conditions

Enquiries and bookings to nrpf@islington.gov.uk

More information on the No Recourse to Public Funds training programme for Local Authorities

More information on the No Recourse to Public Funds training programme for Voluntary Sector

More information on No Recourse to Public Funds from the network

More information on No Recourse to Public Funds from UK Border Agency
 

Charging Migrants for HIV Treatment

posted: 04/04/2011

The government has said it will soon change the rules about charging people from abroad for most treatment at NHS hospitals in England. At the moment the rules do not affect many people in North West England with HIV but that is likely to change. New Rules will probably appear in June.

The government has also announced another, bigger review of NHS charges. This will look at anything and everything and is intended to save the NHS a lot of money.

The next step is the department of health will publish the new rules for NHS hospital and clinic charges and guidance quickly – probably before June.

They have just published their response to a public consultation so now we know something about what the new rules from June will probably say. George House Trust gave evidence and comments to this consultation.

The Department of Health's plans for the June rules are 

• They won’t change which treatments will be charged for yet – but may do so later.
• The rules will be changed to make it clear that refused asylum seekers who get Section 4 and Section 95 payments do not pay for NHS treatment
• Unaccompanied children will no longer have to pay, but children with parents here can be charged
• They will make clear in the new rules that anyone who has begun HIV treatment that is free of charge (e.g. because they have an asylum claim which has not been finally decided) will continue to receive free HIV treatment
• They will keep putting up posters about charging for treatment in hospitals and clinics, even though they know this frightens some people that need treatment away and can lead to discrimination by hospitals
• They will change the guidance that tells doctors to think about the cost of treatment, because this encourages discrimination
• They will start a new system of telling the UK Borders Agency about the people who owe the NHS money. This will mean people will be refused permission to stay longer, applications for citizenship may be refused and people will be refused a visa to return to the UK if they leave
• They will consider introducing a rule that will force visitors from overseas to have health insurance
• They will look at charging people for primary care (treatment by family doctors)

Free HIV treatment for all?
The Government still has not decided whether to make HIV treatment free for everyone who needs this on public health grounds, like for all other sexually transmitted infections. They say they are still considering this and will report “in due course”.

Next, an even tougher review
They have also announced another major review which is designed to save the NHS a lot of money. This will look at

• Changing the residence rules, including the definition of ordinary residence
• Changing some or all of all the types of treatment and types of people who do not have to pay for NHS treatment
• Making people pay for primary care (that is treatment by family doctors and dentists)
• Changing which bit of the NHS has to pay when people cannot pay
• Making the procedures for checking who should pay tougher before treatment begins
  Making the procedures for collecting charges tougher
• Using new ways to collect charges 
• Requiring migrants to have health insurance 
• They will consider anything and everything else.

They try to soften this tough new cost-saving review by saying “the NHS is, and must remain, ultimately a humanitarian organisation. In undertaking the review, we will be mindful of the NHS’s core values, in particular its obligations to provide urgent treatment to any person irrespective of their status or ability to pay, to protect the vulnerable and respect our obligations on healthcare provision under international treaties . There is no intention to consider policies that would deny access to any group, only whether an individual should be charged. It will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. In addition, we will ensure that public health considerations are fully factored into proposed rules and processes (ensuring in particular that access policies do not compromise the identification and control of infectious diseases).”

A comprehensive package of confirmed proposals will be put to full public consultation on completion of the review work, in 2012. We may consult separately at an earlier stage on some options, such as primary care charging.
 

You can read the details of the government's proposals for the June regulations and this new review here. The new review details begin on page 24. 

Proposals and Review report

HIV Migrants Detained and Denied

posted: 14/03/2011

UPDATED  4 April 2011

In their new report Detained and Denied: The clinical care of immigration detainees living with HIV, the charity Medical Justice produce evidence showing that their experience is that most HIV+ immigration detainees are denied HIV medication and care.

This study is the first ever comprehensive analysis of the UK's treatment of 35 HIV+ immigration detainees who were supported by Medical Justice. Eight independent expert clinicians assessed the detainees's health and needs, and there are also legal documents and testimonies from detainees.

Is HIV detention illegal? - Appeal Court will decide

The evidence in this report will be heard in the Court of Appeal in April when three HIV-positive migrants seek to have their detention ruled unlawful because of the centres' failure to treat them properly.

The key findings in Detained and Denied are :

• The British government treats HIV+ detainees’ health beneath contempt : 60% had breaks in their HIV treatment due to their detention, and many developed drug resistance. 77% were deported with little or no medication.
• The government may well have shortened detainees’ lives and prematurely orphaned children
• The process of detaining people who are HIV+ inherently puts them at risk
• The denial of medication has in some cases meant that detainees developed drug resistance, necessitating more complex drug combinations, which are rarely available in many countries
• The government is willing to deport people who may die within a few years as a consequence of that drug resistance.

Detained and Denied - Medical Justice report 

Chronic Indifference is a similar study, about the experience of HIV+ migrants who were detained and denied in the USA.

NAT (National AIDS Trust) points out that the Government has a special duty of care to people it detains. All detainees and prisioners are entitled to the same level of healthcare as is available to everyone else, particularly for a serious life-threatening condition like HIV.

Instead the report shows people with HIV are continuing to face unacceptable neglect. NAT worked with the British HIV Association (BHIVA - the professional association for HIV clinicians) to produce best practice advice on HIV treatment at Immigration Removal Centres precisely to prevent these problems. It is a disgrace that the advice is being ignored in so many cases.

Deborah Jack, Chief Executive of NAT (National AIDS Trust), said:

'NAT welcomes the important report from Medical Justice, 'Detained and Denied', on the treatment of people with HIV in immigration detention, and deplores the continuing failures in care. The NAT/BHIVA best practice advice is there to assist those responsible to provide equivalent high quality care to that available in the community - not to do so is inexcusable.

‘NAT has asked the UK Border Agency to work with us on a 12-month audit of every person with HIV who goes through the immigration detention process, to assess the quality of their care. We are still waiting for a response. The Medical Justice report underlines how urgent it is for such an audit to take place and concerted action to be implemented to address problems identified. We urge the Government to agree to the HIV audit as soon as possible.'

NAT call on the Government:
 

• To investigate the breaches of care outlined in the Medical Justice report 'Detained and Denied’
• In particular, to investigate the failures at Yarl's Wood and in advance of this and any resulting action, to immediately stop using Yrarl's Wood for detaining anyone with HIV
• To commission centrally healthcare in Immigration Removal Centres through the planned NHS Commissioning Board
• To agree to a 12-month collaborative audit with NAT of all those with HIV detained at any Immigration Removal Centre

GP Guide - Migrants' Health

posted: 26/01/2011

The Migrant Health Guide is a free new online “one stop information shop” for GPs and practice nurses who are working with migrants.

It comes from the Health Protection Agency who have produced it because migrants health needs are often more complex than for other people. HIV is included.

The online guide gives doctors and nurses easy access to the facts, so they can improve their patients’ care and quality of life.
 

Although most migrants to the UK are healthy, TB and HIV and other conditions are more common.

The guide supports diagnosing and managing a range of typical migrant health conditions. Early diagnosis and prompt treatment of HIV and other conditions is important for the health of the individual and to reduce onward transmission.
 

Produced by experts working with primary care practitioners, it comes with the blessings of the Royal College of General Practitioners and the Royal College of Nursing.

Key Recommendations

• Know your local migrant population and their rights to care
• Teach patients how the NHS works
• Assess new patients using the checklist and their country page
• Vaccinate and immunise as normal
• Watch and test for infectious diseases and conditions typical of their country
• Check and advise on any plans to visit friends and relatives abroad.

The Migrant Health Guide has

• detailed information for each country
• tools for assessing migrant patients – new patients, patients with symptoms, identifying more vulnerable patients
• how to talking about the NHS with migrants – explaining it, migrants rights to treatment, languages and interpreters, cultural awareness
• sections about migrant health conditions (including HIV), infectious diseases, vaccinations

Migrant Health Guide

HIV in Primary Care : The best HIV guide for GPs and primary care is (free download) HIV for non-specialists, by MedFash.

Free Treatment for All Works

posted: 13/01/2011

A French government enquiry shows that free healthcare for all migrants, even those without official papers, works well. By contrast, in England, some migrants with HIV have no right to free HIV treatment and can be charged thousands of pounds.

The Department of Health in London has repeatedly claimed (without evidence) that migrants with HIV abuse the NHS. Treatment of HIV is the only sexually transmitted infection in England which anyone has to pay for.
 

In France, right-wing politicians make similar claims to our own Department of Health, that fraud and abuse infects their system of free healthcare for undocumented migrants.

This French enquiry disproved this and says that adding any new restrictions (like charges) will be harmful. Restrictions would discourage people from testing and treatment at the best time, resulting in worsened health for individuals and the spread of infectious diseases.
 

The English Department of Health could learn useful lessons from this French enquiry.
 

HIV organisations condemn ‘scandalous concealment’
HIV non-governmental organisations AIDES, ARCAT, ActUp Paris, Sida Info Service and Solidarité Sida, are among those condemning the "scandalous concealment" of the French enquiry report from trhe French National Assembly and call for the new charge of €30 to be suspended.
 

The French model
France has an unusual system, with easy rules. The person simply has to show that

• he or she is living in France
• has lived in the country for at least three months, and
• is poor (monthly income below €634, about £530).
   

Then the person (and his or her family members) gets a wide range of free healthcare for one year, after which time he or she must re-apply.

While the French right wing has attacked this system for years, HIV and health non-governmental organisations point out that healthcare is a fundamental and universal right, that the people forced by circumstances to use this system are among the poorest and most socially excluded. They argue that any restrictions undermine HIV testing, boost late diagnosis, worsening individual’s health and the public health.
 

The real problem : migrants avoiding healthcare
The government asked two official bodies (of auditors and of social care inspectors) to see how well the system works. The French government seems to have disliked the message from the enquiry, and suppressed the reports until New Year’s Eve, after the National Assembly had already debated reforms and added a new charge.
 

The auditors found almost no evidence of fraud or abuse. They said that the real problem is that many migrant people avoid healthcare to save money. Most of the people with a right to free healthcare have not joined the scheme. Most only apply when their health gets very poor and when they need urgent treatment.
 

Reforms and charges
The auditors looked into possible reforms to the French system, including making an annual charge of €30. They found this charge would only raise €6 million, about 1% of the annual cost of €500 million, but would deter even more people from seeking healthcare, be costly to administer, and increase total health costs even more (people will put off getting simple early treatment and then need expensive hospital care later). The charge would worsen public health - tuberculosis and other infectious diseases are common among people entitled to the help; these infections will spread.
 

The social inspectors report decided charges are a mistake for the people, administratively complex, and risk harming public health.

Hiding this report meant the National Assembly was kept in the dark and voted for the charges, which will begin in April. HIV protests continue.
 

UK healthcare and migrants rights information
Information about access to healthcare for migrants in the UK is in NAM’s Social and Legal Issues for People with HIV.

Source, with reference