Free HIV Treatment Plans

posted: 27/07/2009

The government may relax the rules on which migrants can have free HIV treatment in England, the junior health minister Ann Keen announced in the House of Commons last week.

The government also announced some other plans:

• that access to primary care services should not bar refused asylum seekers or others (the recent consultation on this produced furious opposition to tougher rules),
• that a limited number of refused asylum seekers should be exempt from all charges, and
• that foreign nationals with large debts to the NHS could be refused permission to remain in the UK or to re-enter the country.

Health and Home Office review

These plans have emerged from a joint review by the Department of Health and the Home Office, and were briefly described in a statement to the House of Commons and in a Department of Health press release.

Some propositions are in one of these documents, but not in the other. None are final decisions - consultations are likely to take place later in the year. The plans are only for England (Wales and Scotland decide their own health policy). 

Commons statement on HIV treatment for migrants

In the statement to the House of Commons, Ann Keen reiterated the government’s commitment that “immediately necessary and other urgent treatment should never be denied or delayed from those that require it” and confirmed that NHS guidance is being revised to ensure that this is made clear.

Moreover she made the following statement on HIV specifically:

“The Government recognise that clinical evidence on treatment, including their role in prevention, is developing constantly. Moreover, HIV is a major global problem, the control of which creates significant financial as well as human costs. We will therefore undertake further analysis of the latest medical and public health evidence together with consideration of how the current policy on treatment aligns with the Government’s wider international aid strategy for HIV. This analysis will inform a future decision on whether the current treatment policy (that only initial diagnosis and counselling is offered free of charge to non-UK residents or individuals who are not otherwise exempt) should be revised.”

This follows an earlier statement in the House of Lords.

Primary care

She also announced that she did not plan any change to the current system of access to primary care services for foreign nationals, which is at the discretion of the general practitioner. Over the last two years, the government consulted about and made it pretty clear it intended to restrict the access to primary care for irregular migrants and other foreign nationals. The outcry seems to have halted this plan.

Section 4 support eligible for free treatment?

She also proposed that those refused asylum seekers who are receiving ‘section 4 support’ should be able to access all NHS services without charge. Section 4 support is given to individuals who are destitute and whose asylum claim has been refused, but are unable to return to their country (often because of war or instability, or because the individual is ill or pregnant). Some newspapers reported that this change would affect one million individuals; in fact only 10,850 people currently receive section 4 support.

Unaccompanied children

The government is also proposing making treatment free-of-charge to all children who are in the country without a parent or guardian.

Bad news in the press release but not Commons staement

HIV advocates may be less encouraged by some other suggestions which were not included in the Commons statement, but described in the press release:

• working with the UK Border Agency to recover money owed to the NHS
• exploring options to amend the Immigration Rules so that visitors will normally be refused permission to enter or remain in the United Kingdom if they have significant debts to the NHS
• investigating the longer-term feasibility of introducing health insurance requirements for visitors.

The British Medical Association unhappy at restrictions

Dr Vivienne Nathanson, Head of Science and Ethics at the BMA, said:

“There are many people who have had an asylum claim refused, cannot return home, and need urgent treatment. This announcement, while positive, applies to only one group of people in this situation, and does not go far enough.

“We believe no-one whose asylum claim has been refused should be turned down for care which cannot be delayed, and which clinicians determine they need. Doing so affects our ability to control communicable disease, and ultimately puts additional pressure on the NHS, particularly on emergency services.

“The role of clinical staff is to determine what care a patient needs, and how urgently they need it - not to assess their immigration status. More must be done to ensure that those who need urgent care can access it.”

Dr Nathanson welcomed the proposal for additional research on the policy of charging non-residents for HIV treatment beyond diagnosis:

“The policy of refusing non-resident HIV patients treatment after diagnosis has public health implications. It carries the risk that their health will decline to the point at which costly emergency treatment is required. We would expect further research to cover these areas. A research-base to support policy in this area would be welcome.”

Commons Statement by Ann Keen

Department of Health press statement

Section 4 statistics

Source

 

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