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Ethics
Healthcare access for children and families on the move and migrants
  1. Lisa Murphy1,
  2. Jonathan Broad1,
  3. Bryony Hopkinshaw1,
  4. Sarah Boutros2,
  5. Neal Russell3,
  6. Alison Firth4,
  7. Rachael McKeown4,
  8. Alison Steele4
  1. 1Medact, London, UK
  2. 2Institute of child health, University College London Institute of Child Health, London, UK
  3. 3Molecular and Clinical Sciences Research Institute, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
  4. 4Royal College of Paediatrics and Child Health, London, UK
  1. Correspondence to Dr Lisa Murphy; lisaanna.murphy{at}gmail.com

Abstract

Background The United Kingdom (UK) National Health Service (NHS) charging regulations have increasingly restricted migrants’ healthcare access, in the context of a wider national policy shift over the past few years intending to create a ‘hostile environment’ for migrants. With an estimated 144 000 undocumented children living in the UK and increasing public concern that these regulations are negatively impacting migrant health and well-being, as well as contravening international child rights agreements, it has become imperative to understand their implications.

Methods A mixed methods digital survey, covering attitudes towards and understanding of UK healthcare charging, and giving space for relevant case submission, was disseminated through communications channels of the Royal College of Paediatrics and Child Health (RCPCH) to their members. Quantitative data were analysed on Stata, and basic proportions were calculated for each response proportion. Qualitative data were analysed using a framework analysis approach.

Results There were 200 responses, from a range of healthcare professional backgrounds. The majority were not confident in interpreting and applying the charging regulations. One-third (34%) reported examples of the charging regulations impacting patient care, analysis of which elicited seven key themes. Our survey gathered 18 cases of migrants being deterred from accessing healthcare, 11 cases of healthcare being delayed or denied outright, and 12 cases of delay in accessing care leading to worse health outcomes, including two intrauterine deaths.

Discussion Our results describe a range of harms arising from the current NHS charging regulations contributing to delays in or denials of healthcare, due to patients’ fear of charging or immigration enforcement, including potential deportation, and confusion around entitlements. This harm affects individual patients, the migrant community and the NHS – often in multiple simultaneous ways. Many patients eligible for NHS care, such as trafficking victims, are not being identified as such. We found the current charging regulations to be unworkable, and that harm could not be eliminated simply through improved awareness or implementation.

  • paediatric practice
  • ethics
  • children's rights
  • health service

Data availability statement

Data are available upon reasonable request. The corresponding author is happy to release data in an anonymised fashion to any researcher, organisation or similar who wishes to review it.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjpo-2019-000588

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    Data availability statement

    Data are available upon reasonable request. The corresponding author is happy to release data in an anonymised fashion to any researcher, organisation or similar who wishes to review it.

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    Footnotes

    • Correction notice This article has been corrected since it was first published. Provenance and peer review statement has been corrected.

    • Contributors LM, JB, BH, SB and NR developed the initial survey, which was reviewed by AF, AS and RM. AF and RM managed dissemination via Royal College of Paediatrics and Child Health (RCPCH) online channels. LM and JB did the initial analysis and developed the framework for analysis. LM, BH and RM coded the data gathered against the framework. LM and SB performed the further analysis and write up for the qualitative results section. JB and NR performed statistical analysis and made the included figures and tables. SB led on writing the introduction, BH led on writing the discussion, while LM and AS performed full paper editing. AF performed further review with support from RM prior to finalising the paper for submission. LM arranged the materials for submission and liaised with BMJ Paediatrics Open editorial staff. LM is responsible for the overall content as guarantor. This research has been carried out, analysed and authored by five child health professionals and two members of staff of the RCPCH.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None delared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer-reviewed.