Plans for a digital NHS tag for overseas patients are raising concerns about migrant privacy
Plans to create a new digital label for the records of NHS patients from abroad have raised concerns among doctors, as well as privacy and migrant rights activists.
A new data category called Overseas Visitor Charging would be created in the national NHS records under proposals inherited by the Labor government from its Conservative predecessor.
Sunday was the deadline for responses to an NHS England consultation on the proposals, which could see the Department of Health and Social Care (DHSC) see more information on how often hospitals charge migrants to access services.
However, the plans will also test the Labor government’s approach to sharing migrant NHS data, which has been at the center of controversy under the Tories over 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, trafficking victims and asylum seekers, said: “Large data sharing schemes like this make it very difficult for us to reassure patients that hospitals are safe places and that patient confidentiality is respected.”
“Every day in our clinic we see patients who are too scared to go to NHS services because they fear they will be reported to immigration.”
People with an active asylum claim are always exempt from NHS charges. While trusts have some discretion in charging other users of NHS services, such as migrants, they do not have the option to waive them completely.
Trusts must issue an invoice for costs incurred. If they assess that a person cannot pay, guidelines recommend not pursuing the bill, but the patient remains indebted to the trust. The debt notice is passed to the Home Office, which can then use it as a basis for refusing certain immigration applications.
Other concerns about the proposals were raised by medConfidential – a campaigner for health data privacy – who said the new data would allow DHSC to challenge a doctor and hospital’s decision that a person’s care is free at the point of use .
Sam Smith, co-ordinator at medConfidential, said: “If there’s an error in the government’s databases, you can’t know about it until a big bill arrives. The ‘hostile environment’ of previous Conservative governments still monitors every patient in every hospital.
“The Department of Health in England can decide that patients owe ‘the NHS’ without the patient having any idea this has happened until the next time they apply for a visa or attempt to re-enter the country.”
The British Medical Association (BMA) said its members were “fully aware” of what the doctors’ association described as the “chilling impact of the tariff regime and associated data sharing policies – meaning some of the most vulnerable people in society are forced to avoid seeking health care that they desperately need.”
Dr. John Firth, chairman of the BMA’s international committee, added: “Healthcare enforcement and immigration must be completely separate. Doctors want to provide care to the person in front of them, not act as an extension of the border police.”
A spokesperson for the Department of Health and Social Care said: “It is right that overseas visitors and those not legally based here contribute to their treatment costs as our healthcare system is a residence-based system.”
An earlier scheme using NHS data to track down patients suspected of breaking immigration rules was abandoned after a legal challenge in 2018 by, among others, the Migrant Rights Network (MRN).
Mary Atkinson, MRN campaigns and networks manager, said: “This government now has the opportunity to scrap any plans for further data sharing and restore our NHS to the purpose for which it was founded: providing healthcare for all.
“For too long, communities have lived in fear and been denied access to life-saving care as successive governments have prioritized anti-migrant policies over people’s lives.”
The plans were mentioned in a consultation on proposed changes to the Contract Monitoring Information Standards, a set of rules for reporting costs by hospitals and trusts. Question 22 asks: “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 migrant NHS registrations would need to be linked to a Home Office reference number, raising concerns about potential tracking, privacy rights and the expansion of the ‘hostile environment’.
NHS England was instructed by a senior civil servant writing on behalf of then Health Secretary Steve Barclay to accept and store ‘Home Office reference numbers’ in the files of ‘relevant patients’.