Undocumented Children in the UK
In 2012, the University of Oxford’s Centre on Migration Policy and Society (COMPAS) estimated that there were approximately 120,000 ‘undocumented children’ living in the UK, 65,000 of whom were actually born here. Under the new legislation these children no longer have a right to access free secondary NHS care, and will be charged 150% of the actual cost, upfront before accessing the care. Trusts will be obliged to withhold care if payment is not made, unless the treatment is judged as ‘urgent or immediately necessary’, which is not defined in the guidance from the department of health. Treatment that is urgent or immediately necessary may be provided but will nevertheless be chargeable under the regulations, again at 150%. There have already been cases where adults and children have been denied treatment for various conditions including leukaemia and other cancers (including a brain tumour in a child) due to these regulations, and it is clear that there will be more cases arising as these regulations continue to be rolled out over the coming months and years.
Charging pregnant women for antenatal care and delivery also has clear negative implications for child health, given the importance of antenatal care and delivery care in preventing complications in newborns such as prematurity, perinatal asphyxia, neonatal sepsis and a range of other outcomes. It is also likely that charging for maternity care, which is by nature preventive, is economically counterproductive and likely to lead to greater costs from complications that would otherwise be prevented. This has already been seen in case studies where women are deterred from seeking antenatal care and develop preventable and expensive complications.
Immigration law and obtaining and maintaining a ‘legal’ status
In addition to restricting the right of ‘undocumented children’ to access health care, changes in immigration law have also meant that the process of obtaining and maintaining a legal status in the UK has become much more difficult for children and their families. For example, fees for citizenship and residency applications have grown, meaning that since 2012, children are more likely to fall into the category of being undocumented, and to therefore be ineligible for free secondary health care.
The additive negative effect of changes in immigration law and entitlement to NHS care
In summary, the likely result of recent changes in both immigration law and entitlement to NHS care mean that there is a large and in all likelihood growing population of children living in the UK who will be denied treatment in the NHS based on their immigration status and ability to pay. This is unprecedented in the history of the NHS.
Apart from the clear implications for the health of the individual children involved, this is likely to lead to worsening public health, including potentially increasing transmission of infectious diseases. Furthermore, this may also lead to further decreasing the visibility of these children to the health service, reducing opportunities for preventive healthcare, and for identifying safeguarding issues which these children are at higher risk of, given the difficult social circumstances of their parents who may be unable to work legally for example.
Contradiction of UN Conventions, UK government aims, and RCPCH recommendations
The charging regulations contradict several conventions to which the UK is a signatory, as well as undermining stated policy aims of the UK Government.
- United Nations Convention on the RIghts of the Child (UNCRC)
- Article 2: Right to non-discrimination
- Article 6: Right to life, survival and development
- Article 9: Right not to be separated from parents (except to protect the child)
- Article 19: Right to be protected from all forms of abuse
- Article 20: Right to special attention
- Article 22: Right to protection while seeking refugee status or when considered a refugee
- Article 24: Right to the highest attainable standard of health care
- Article 27: Right to a standard of living adequate for a child’s physical, mental, spiritual, moral and social development
- International Covenant on Economic, Social and Cultural Rights (ESCR)
- In particular the ‘right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ enshrined in article 12
UK Government policy aims
- Commitment by the UK Government to halve the number of maternal and neonatal deaths by 2020
RCPCH Recommendations and Vision
The regulations also seriously undermine the mission and objectives of the RCPCH and the recommendations of the State of Child Report (2017), and the Vision for 2017.
State of Child Health (2017) Recommendations:
- To reduce child poverty and inequality
- To maximise women’s health before, during and after pregnancy
- To tailor the health system to meet the needs of children and young people, their parents and carers
Vision for 2017 Recommendations:
- Adoption of ‘child health in all policies’ approach
- Preventing avoidable child deaths
- Increasing immunisation uptake
- Improving child mental health and wellbeing
- Delivering care built around the needs of infants, children and young people
- A cross party commitment to a publicly funded, provided, and managed National Health Service, free at the point of use