Handing NHS data to the Home OfficeBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j911 (Published 22 February 2017) Cite this as: BMJ 2017;356:j911
- Anne Gulland, freelance journalist, London, UK
What is the agreement between the NHS and the Home Office?
A memorandum of understanding published in January revealed that NHS Digital must give the Home Office information about patients it believes have committed an immigration offence.1 This includes people who have absconded from immigration control, escaped from detention, or exceeded their permitted length of stay in the UK.
What information will be shared?
NHS Digital will not be asked to share clinical information but will be required to provide a patient’s last known address, date of birth, full name, and date of NHS registration. The memorandum states that the information to be provided “falls at the less intrusive end of the privacy spectrum, making disclosure easier to justify as the public interest threshold is lower.”
What will the Home Office do with the information?
The Home Office will encourage people who have committed an offence to return home by denying them access to benefits. In more serious cases it will arrest, detain, or deport them.
Is this a new agreement?
Yes, the agreement is new but the Home Office has been requesting data from the NHS on migrants since “at least” 2005, according to Kingsley Manning, former chair of the Health and Social Care Information Centre, as NHS Digital was known until last year.2 However, previously the Home Office had to write directly to GPs for a patient’s last known address and, according to charity Doctors of the World, GPs often refused to share this information. Doctors of the World said it refused one such request last year and knows of another GP who has also refused these requests. Now, NHS Digital will hand the information over, bypassing GPs.
How much information is being handed over?
According to the Department of Health the Home Office made 8127 requests for data in the first 11 months of 2016, which led to 5854 people being traced by immigration enforcement. This is a considerable increase from 2014—there were 725 requests for information in the first three months of that year compared with 2244 requests in September and October 2016.3
What has been the reaction?
A letter to the Guardian signed by organisations such as Doctors of the World, the National Aids Trust, and the British HIV Association warned that the agreement “marks the intrusion of a political agenda into how our medical records are kept and safeguarded. It shows that NHS Digital cannot be trusted with our confidential information.”4 Fiona Caldicott, the NHS’s national data guardian, will also look at the practice to ensure that all uses of patient information are “transparent, legal and proportionate.”
How will it affect public health?
Jessica Potter, a clinical research fellow at Queen Mary University of London who is undertaking research on migrants’ access to healthcare in the UK, believes that it will deter many undocumented migrants from seeking healthcare or encourage them to give false names and addresses.
“People often take other people’s names and addresses. That can be dangerous when someone comes into hospital and there’s a record that they have been treated for a particular illness. It will also mean that people will present later and are more likely to present to emergency departments,” she says.
She points to various studies showing the links between the threat of deportation and reluctance to seek healthcare. One study of 268 legal immigrant students in Sweden showed that threat of deportation was the main determinant for avoiding seeking healthcare for treatment of HIV.5 And a review of 66 studies on barriers to healthcare for undocumented migrants found that understanding the healthcare system, shame, and the fear of deportation were the main barriers.6
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.
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