HEALTH
major issue for the Government. Though without any firm numbers or availability of a rigorous study, the Government introduced new regulations in April 2004 in order to combat ‘health tourism’, where migrants are said to come to the UK to access health care (BBC, 30 December 2003). The regulations targeted: failed asylum seekers and others with no legal right to be in the country; overseas visitors; heavily pregnant women who live overseas coming to the UK just to give birth (even if their partner lives here) and business travellers to the UK and their dependants. These groups were to pay for treatment in NHS hospitals. As from 1 April 2004 failed asylum seekers and others with no legal right to be in the country were no longer to be treated; dependants of permanent residents in the UK were only entitled to free treatment if they were themselves permanently resident in this country; and business travellers and their dependants who fell ill while in the UK were not entitled to free treatment (Kelly et al, 2005). Access to secondary care was limited except for Accident and Emergency (A&E), infectious diseases such as TB, sexually transmitted diseases except HIV/AIDS, compulsory psychiatric treatment for those detained under the Mental Health Act and treatment deemed ‘immediately necessary in the opinion of the clinician’. However, although patients are charged, they must be given treatment (Médecins du Monde, 2008). The Médecins du Monde study of 883 users of a health care project for migrants in London questioned the extent of health tourism (also see National Aids Trust 2008 for HIV/AIDS) and found that most of those they treated had been living in the UK for an average of three years and that, for many, the major problem was accessing GPs. The recent case of R (A) v West Middlesex University Hospital Health Trust 2008] EWHC 855 (Admin) was in relation to a rejected asylum seeker, but it has a wider application for lawfully present and ordinarily resident migrants. It established that current Department of Health guidance allowing hospitals to refuse all but ‘immediately necessary treatment’ to some migrants unless payment was forthcoming was unlawful. 8.4
Gender
The main issue raised in relation to gender and health care is access to antenatal care and maternity services. Despite the restrictions, all women are entitled to antenatal care, which falls under the category of ‘immediately necessary’. In the Médecins du Monde project, the largest single number of visits (118 in 2006–7, or 22 per cent) was for reasons of pregnancy, childbirth and family planning (Médecins du Monde, 2008). Many women had turned to the clinic to get help to access such care as well as terminations. Although the project was able to register their patients with GPs, many were refused access to free terminations. Thus exceptions to the 2004 regulations are not always applied in practice. 107