Access to Healthcare for migrants, refugees and asylum seekers in England and Scotland

In the UK, access to the NHS for migrants, refugees and asylum seekers differs between England and Scotland. Individuals who are not ordinarily resident in the UK may be required to pay for their healthcare. However, some services and some individuals are exempt from payment. 

In England, the following services in the NHS which are currently free of charge irrespective of country of normal residence (as long as the overseas visitor hasn’t travelled to the UK for the purpose of seeking that treatment): accident and emergency services, services provided for the diagnosis and treatment of a number of communicable diseases, including HIV, TB and Middle East Respiratiry Syndrome, services provided for the diagnosis and treatment of sexually transmitted infections, family planning services, services for the treatment of a physical or mental condition caused by torture, female genital mutilation, domestic violence, or sexual violence, palliative care services and services that are provided a part of the NHS111 telephone advice line. 

Refugees and asylum seekers and their dependents, individuals receiving support under section 95 of the Immigration and Asylum Act 1999, those whose application for asylum was rejected, but they are supported under section 4 of the Immigration and Asylum Act 1990, by a local authority under section 21 of the National Assistance Act 1948 or under Part 1 of the Care Act 2014, victims and suspected victims of modern slavery or human trafficking plus their spouse or civil partner and any children under 18, and prisoners and immigration detainees are all exempt from any charges. 

Current asylum seekers are entitled to register with a general doctor although in practice many face barriers in registering. Free hospital treatment is not generally available to asylum seekers who are not on Section 95 or Section 4 support. Hospital doctors should not refuse treatment that is urgently needed for refused asylum seekers who are not receiving Section 95 or Section 4 support, but the hospital is required to charge for it. The hospital also has discretion to write off the charges. Any course of treatment should be continued if it is under way at the time when asylum is refused. 

In Scotland, however, all asylum seekers are entitled to full free health care, including those refused asylum seekers not on Section 4 support and including the spouse/civil partner and any dependent children of any of these people 

Access to mental health services in both Scotland and England is not guaranteed, and is often lacking and specialised treatment for victims of torture and traumatised asylum seekers is available, but is in short supply. It is provided by a number of independent charities, the largest being Freedom from Torture, the Helen Bamber Foundation, and the Refugee Therapy Centre. Specialist trauma practitioners, including psychiatrists, psychologists and trauma counsellors and therapists, also work in health authorities and trusts around the country, but they are few and access is extremely limited. Language and cultural barriers also hinder appropriate referrals from workers with initial contact, and impede asylum seekers’ own awareness of what is available. Smaller NGOs also specialise in counselling for refugees. 


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