homelessness and asylum


sensing a rejection, spoke more forcefully, ‘I must see doctor now!’ The receptionist, conscious of the practice’s zero tolerance policy towards aggression, thrust a multi- lingual leaflet into the woman’s hands and closed the window. The woman could not read, and turned away in tears.


Do these scenarios resonate for you? Maybe your last encounter with a homeless person was during your A&E attachment, or in general practice. What about ‘immigrants’ who have limited or no English? Street homeless people and asylum seekers are among the more visible of the ‘marginalised’ or ‘socially excluded’ groups. But there are many others whose access to proper primary health care is jeopardised by the negative reaction of care providers.


laws and loopholes


Under UK law, both the Race Relations Act 1976 (amended in 2000) and the Disability Discrimination Act 1995 (amended in 2006) govern how we provide healthcare. While the less well known but highly relevant ‘right to health’ (found in article 12 of the International Covenant on Economic, Social and Cultural Rights, ratified by


16


the UK Government in 1968) 1 adds a moral, if not a legal, dimension.


Under the NHS, healthcare should be available to all UK citizens at the point of need, regardless of the nature of the health problem, race, religion, occupation, sexual orientation, or any other label. That term ‘citizen’ highlights one of the issues – there are rules determining entitlement to NHS care for non-citizens, whether European Community (EC) citizens, non-EC visitors, asylum seekers, or so-called ‘failed’ asylum seekers. 2


But neither a street homeless person who is a UK citizen, nor an asylum seeker whose case is under consideration by the UK Border Agency (UKBA), fall into the category of those who are not entitled to NHS care. 2


So


why do these scenarios seem so familiar?


problems and prejudices


Consider the reasons why this hypothetical practice raised barriers to our homeless man:


 He had no fixed address


 He posed a threat to the waiting room environment


 She could not understand the receptionist


 She could not read the literature, even in her


own language


 She would need an interpreter, which would


mean a longer consultation, and additional cost to the Primary Care Trust (PCT) or the practice itself


 She might have one or more ‘difficult’ conditions such


nucleus christmas ‘08


and he might upset other patients


 He had a ‘difficult’ disease (alcohol dependence)


 He might increase the workload of the nurses


 He would probably not contribute to the practice’s


score in the Qualities and Outcomes Framework (a points-based system for payment to NHS GPs, largely focussed on chronic disease management)


We could add that he was not the sort of patient they wanted to include on their list. And what about the woman with limited English? She failed to get help, despite the receptionist trying to follow procedures. The practice was not bending over backwards to help her, rather the reverse; there was a negative attitude at all levels:


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44