In a small victory for those fighting against the creeping demands of the UK government's immigration system, an NHS data service has withdrawn from an agreement in which it provided information on suspected irregular immigrants to the Home Office. The agreement was part of what was the government's "hostile environment" strategy for suspected irregular immigrants, publicly rebranded as a "compliant environment" by Home Secretary Sajid Javid in June 2018.
In recent years, landlords, employers, education staff and health professionals have become increasingly responsible for checking the immigration status of their tenants, employees, students and patients. The hostile environment became more palpable to those it targeted and those compelled to administer it through two consecutive immigration acts in 2014 and 2016.
The latest change in language from "hostile" to "compliant" aimed to detoxify policies that are reaching deeper and deeper into everyday life, drawing ordinary people into the roles of border guards. And against which different civil society groups continue to fight.
One such policy was a memorandum of understanding (MoU), drawn up in November 2016 between the Department of Health, NHS Digital and the Home Office, that allowed the Home Office to request access to non-clinical information of patients. NHS Digital provides national information, data and IT systems for health and care services. Under the agreement, the Home Office could request the name, date of birth, gender, last known address, and contact details of people using NHS primary care services who it suspected were in the UK without permission and who immigration officials had failed to find through other means.
Many medical organisations oppose the sharing of patient information because it is deemed dangerous to individuals and public health.
On November 12 2018, NHS Digital confirmed that the data–sharing agreement – which had already been suspended in May – would be withdrawn. This followed legal proceedings by organisations who argued that it violated patients' right to privacy under the Human Rights Act. They also argued that it didn't pass the considerable public interest test required to breach the doctor-patient relationship, left migrants too scared to access healthcare services they were entitled to and discriminated against non-British patients.
A joint legal effort of Liberty, Migrant Rights Network, Doctors of the World and the National Aids Trust demonstrated how crucial it is for diverse organisations to campaign together against the use of data collected for other purposes by UK border staff.
Data-sharing in other forms
But the Home Office hasn't given up. A spokesperson told the Guardian that it would continue to work on a new MoU with NHS Digital to enable it to: "Make requests for non-medical information about those facing deportation action because they have committed serious crimes." Nor has NHS Digital ruled out signing another data-sharing agreement with the Home Office if, after a consultation, its assessment is that it would be in the public interest to share the data requested from them.
As well as legal challenges, the compliant environment is being challenged through Freedom of Information requests. One request uncovered that an agreement had been in place since 2015 between the Home Office and Department for Education to share the details, including addresses, of up to 1,500 schoolchildren a month. The aim was specifically to "create a hostile environment" in schools in order to locate and deport individuals and families. After widespread protest and campaigning by organisations including Against Borders for Children, in April 2018, the government agreed to end the practice.
Other Freedom of Information requests have revealed the numbers of migrant patients denied treatment because they cannot afford to pay upfront. Since October 2017, all NHS trusts in England must seek payment in advance before they provide non-emergency treatment to failed asylum seekers and those who have overstayed their visa. Meanwhile, politicians are scapegoating migrants again by increasing the Immigration Health Surcharge required of all non-EU citizens who require a visa to live in the UK, from £200 a year to £400 a year from December 2018.
In research on the impact of what my colleagues and I call "everyday bordering", where people are turned into border guards, we heard that if migrants are pushed underground they end up in crisis mode. This can mean that their physical and mental health is threatened and the chances of them being involved in crime increase.
Health campaigners argue that extra charges for migrants – even the perception that people will be charged for free services such as tuberculosis diagnosis and treatment – prove ineffective for the NHS budget. This is because delays in diagnosis threaten the health of those with infectious diseases such as tuberculosis and increase the risk of others being exposed to and contracting them. A maternity advice service also found evidence that NHS charging deters migrant women from accessing maternity care due to fears of being charged and of the Home Office being notified.
These demands of the compliant environment are of concern to all of those living in the UK – not just migrant communities and ethnic minorities. Our research in London and the south-east shows how the outsourcing of border controls to the public and private sectors creates wider hostility. It brings immigration status into multiple everyday encounters, where it would never have been before, and has drawn health workers and schools into administering the government's damaging immigration regime.