Plans to create a new digital tag for the records of NHS patients from overseas has caused concern among doctors, as well as privacy and migrants’ rights campaigners.
A new data category called Overseas Visitor Charging would be created in national NHS records under proposals the Labour government has inherited from its Conservative predecessor.
Sunday was the deadline for responses to an NHS England consultation on the proposals, which would enable the Department of Health and Social Care (DHSC) to see more information about how often hospitals are charging migrants for accessing services.
However, the plans will also present a test of the Labour government’s approach to the sharing of migrants’ NHS data, which had been at the centre of controversies under the Tories when it came to concerns about privacy rights and the expansion of the “hostile environment”.
Anna Miller, head of policy and advocacy at Doctors of the World, which runs clinics for undocumented migrants, victims of trafficking and asylum seekers, said: “Major data-sharing arrangements like this one make it very difficult for us to reassure patients that hospitals are safe places and that patient confidentiality will be respected.”
“Every day in our clinic we see patients who are too afraid to go to NHS services because they worry they will be reported to immigration enforcement.”
People with an active asylum claim are always exempt from NHS charges. While trusts have some discretion on how they apply charges to other users of NHS services, such as migrants, they don’t have the ability to waive them completely.
Trusts must raise an invoice for charges incurred. If they assess a person is unable to pay, then guidelines advise not pursuing the bill but the patient remains in debt to the trust. The notification of the debt is passed on to the Home Office, which can then use it as a ground to refuse certain immigration applications.
Other concerns about the proposals were raised by medConfidential – a health data privacy campaigner – which said the new data would let DHSC challenge the decision of a doctor and a hospital that someone’s care is free at the point of use.
Sam Smith, coordinator of medConfidential, said: “If there’s a mistake in the government’s databases, you’d have no way to know about it until a large bill arrives. The previous Conservative governments’ ‘hostile environment’ is still watching every patient in every hospital.
“The Department of Health in England can decide patients owe ‘the NHS’ without the patient having any idea that it happened until they next apply for a visa or try to enter the country again.”
The British Medical Association (BMA) said its members were “fully aware” of what the doctors association descried as the “deterrent impact of the charging regime and associated data sharing policies – meaning some of the most vulnerable people in society are forced to avoid seeking healthcare that they desperately need.”
Dr John Firth, BMA international committee chair, added: “Healthcare and immigration enforcement should be completely separate. Doctors want to provide care to the person in front of them, not act as an extension to the border force.”
A Department of Health and Social Care spokesperson said: “It is right that overseas visitors and those who are not lawfully settled here contribute towards their treatment costs, as our health service is a residency-based system.”
A previous scheme using NHS data to track down patients believed to be breaching immigration rules was abandoned after a legal challenge in 2018 by parties including the Migrants’ Rights Network (MRN).
Mary Atkinson, campaigns and networks manager at the Joint Council for the Welfare of Immigrants, said: “This government now has a chance to scrap any plans for further data-sharing and restore our NHS to the purpose for which it was created – providing healthcare for all.
“For too long, communities have lived in fear, unable to access life-saving care because successive governments have prioritised anti-migrant policies over people’s lives.”
The plans were referred to in a consultation on proposed changes to the contract monitoring information standards, a set of rules governing the reporting of costs from hospitals and trusts. Question 22 states: “We propose to add a new data element called Overseas Visitor Charging Category to all four data sets ... Would the addition of this data element pose a problem?
The Guardian has previously reported on concerns raised in 2023 when it emerged that NHS records of migrants are to have a Home Office reference number attached to them, prompting concerns about potential tracking, privacy rights and the expansion of the “hostile environment”.
NHS England was directed by a senior civil servant writing on behalf of the then health secretary, Steve Barclay, to accept and store “Home Office reference numbers” in the records of “relevant patients”.
