1. The Asylum Process & Entitlement to Care for Women Seeking Asylum Lorna Gledhill Regional Asylum Activism Co-ordinator, Yorkshire and Humberside

2. What is a refugee? "A person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it..“ UN Geneva Convention, 1951

3. Everyone has the right to seek protection and claim asylum in a state outside their country of origin. An asylum seeker in the UK is somebody who has applied for refugee protection from the UK government, but is awaiting a decision on their claim. But what is an asylum seeker?

4. The Asylum Process Arrival in UK Applies for Asylum at Lunar House, Croydon Sent to Initial Accommodation Asylum Support Application Screening Interview Dispersal into Housing Reporting / Waiting Decision from Home Office Leave to Remain! Refusal (Appeal) Refusal (A.R.E) Removal / Vol Return Detained Fast Track Substantive Interview

5. After filing a claim for asylum, individuals can apply for financial and accommodation support from the Home Office: Section 95 : financial support & accommodation for asylum seekers during their claim. = £36.62 in cash for a single adult per week = 50% of income support levels. Section 4: highly conditional financial support & accommodation for refused asylum seekers. = £35.39 on pre-loaded card for a single adult per week = less than 50% of income support levels People seeking asylum are not allowed to work. Financial Support

6. Housing is provided on a no-choice basis to those who are eligible for support. Glasgow: 2,462 L’pool: 1,437 B’ham: 1,113 Cardiff: 966 London: 932 Q2 2014 (Section 95 only) Housing

7. What’s Going Wrong? Poor decision-making means that many reach the end of the process without their protection needs being recognised. People seeking asylum cannot afford to meet their essential living needs and are not allowed to work. People seeking asylum are often deterred from accessing the healthcare they are entitled to. People seeking asylum are routinely made destitute whilst stating their claim for a safe haven from persecution. People seeking asylum can be detained indefinitely and without charge.

8. People seeking safety in the UK can have very complex health problems due to upheaval, family separation and trauma. Yet… 73% of patients seen by Doctors of the World in London were not registered with a GP even though they were eligible. 21% of their patients had been denied access to healthcare in the last 12 months. Why are we concerned about healthcare? The psychological health of refugees and people seeking asylum currently worsens on contact with the UK asylum system.” Royal College of Psychiatrists

9. RefugeesAsylum SeekersRefused Asylum Seekers (not on support) Primary Healthcare Free Secondary Healthcare Free Charged Emergency Healthcare Free Maternity CareFree Charged Current Healthcare Entitlements of Refugees and People Seeking Asylum

10. All people seeking asylum have the right to apply to be fully registered with an NHS general practice. GPs cannot refuse to register an individual due to the patient’s residency status. BUT Primary Care practitioners are increasingly being asked to register and record the immigration status of their patients on the NHS spine. Primary Care crucial gateway Primary Healthcare is a crucial gateway for the health and wellbeing of people seeking asylum.

11. Entitlement to free hospital treatment is based on your legal residence status in the UK. General Exemptions: A&E Family Planning Services Treatment of certain communicable diseases & sexually transmitted diseases Treatment required under the Mental Health Act Treatment of HIV Secondary Care: People Seeking Asylum exempt People seeking asylum are exempt from charges for NHS hospital care.

12. Refused asylum seekers, who are not in receipt of UKBA support, are liable to be charged for secondary care. However: Treatment received whilst ‘charge-exempt’ must be provided for its full course and not be chargeable. General exemptions for specific care still applies. Hospitals are obliged to provide ‘immediately necessary’ or ‘urgent’ treatment irrespective of a patient’s ability to pay. Secondary Care: Refused Asylum Seekers ‘non-urgent’ Only treatment which is ‘non-urgent’ can be withheld pending payment.

13. Maternity Care: Refused Asylum Seekers Maternity Care can never be withheld from someone who is unable to pay for treatment. Refused asylum seeking women CAN be charged for the care they receive. Maternity care is not exempt from charging, but is automatically classed as immediately necessary treatment. Maternity care includes antenatal care, birth and postnatal care and includes HIV treatment during pregnancy.

14. Difficulties registering with GPs Unwelcoming atmospheres in GP surgery Obstructive receptionists/administrative staff Fears of being reported to the authorities Fear of being charged for care Unfamiliarity with the structure of healthcare provision General difficulties in the asylum process Barriers to Healthcare

15. Impact on Health and Wellbeing Increased presentation at Accident and Emergency Lack of engagement in maternity services (as GPs are primary referral route) and late disclosure of FGM Less diagnosis of both communicable and preventable conditions Further barriers to accessing mental health support

16. Immigration Act 2014 Proposals in the Immigration Act and DoH guidelines include: Changing the criteria for access to free care – from ‘ordinarily resident’ to ‘Indefinite Leave to Remain’ Extension of charging principles to emergency care and parts of primary care. Creating incentives and sanctions for secondary care providers to pursue payments.

17. The new healthcare proposals are “impractical, uneconomic and inefficient.” “GPs must not be a new border agency in policing access to the NHS.” Teamed up with Maternity Action to call for a exemption on NHS charging for all pregnant women and children.

18. What are our concerns? Time consuming immigration checks for patients and staff, including in Primary Care Compromised doctor-patient relationships Barriers to healthcare for all Creating obstacles to primary healthcare fundamentally undermines the objectives of providing an efficient and effective healthcare system Exemptions for immediately necessary care will result in people presenting late for care We believe this will put the health and wellbeing of people seeking safety further at risk.

19. What next? Changes to healthcare entitlements will be rolled out over the next 18 months under the Department of Health’s ‘Implementation Strategy.’ We can still kick up a fuss! Lobby decision-makers to call for a widening of exemptions Speak out about the importance of universal access to free healthcare for people seeking asylum Make sure that we empower people seeking asylum with knowledge of their rights and entitlements to healthcare.

20. “Depriving people of healthcare doesn’t make health problems go away.” For further information about campaigns, briefings and opportunities, contact Lorna Gledhill on 07557 982 498 or yandh@regionalasylumactivism.org