World Health Day, organised by the World Health Organisation, is a global awareness day celebrated on 7^th April each year to draw attention to a subject of importance to global health. This year the theme is universal health coverage.

In England, we can boast one of the most accessible healthcare systems in the world, providing free health care to over 50 million people. In 2017, The Commonwealth Fund ranked the NHS the third most accessible healthcare service out of a list of developed countries[i]. However, one group in the England do not benefit from the accessibility of the NHS: undocumented migrants[ii]. Migrants are currently charged for most healthcare provided in hospitals (known as ‘secondary care’). Recently, the Government has extended charges into community services and now requires migrants to pay upfront before accessing any chargeable treatment or care.

Why is this important for HIV? Migrants are disproportionately affected by HIV. In 2016, 55% of people newly diagnosed with HIV were born abroad; this figure has remained relatively stable over the last decade[iii]. HIV treatment itself is exempt from charges, but if undocumented migrants cannot access other vitally important elements of healthcare then the positive impact from HIV treatment services will be compromised. People living with HIV are far more likely than the general population to suffer from other illnesses, some serious, where unaffordable charges apply.

Even though HIV treatment is free for everyone, it is highly likely that migrants will be deterred from accessing hospital care altogether because of extortionate costs – meaning opportunities to test people for infectious diseases will be lost. As late diagnosis is the most important predictor of morbidity and premature mortality amongst people living with HIV, charging presents a significant barrier to improving HIV outcomes[iv].

The charging regime is confusing and complex for NHS staff to implement and many people entitled to free care might struggle to prove their eligibility; patients are already being wrongly denied treatment. The recent case of Albert Thompson – a man who has lived in the UK for 44 years but is being denied cancer treatment until he can pay £54,000 upfront – has brought attention to the devastating consequences that can arise from the charging regime.

These policies are pushing already-marginalised communities away from the vital services they need and further exacerbating the entrenched health inequalities that migrants experience. And charging is just one of a number of policies that make up the Government’s draconian ‘hostile environment.’ Coupled with the data-sharing agreement that allows addresses of migrants to be shared between the NHS and the Home Office, the Government is allowing migrants to be left without care despite their acute healthcare needs.

The charging regime is designed to deter migrants from accessing healthcare, and in this endeavour, it is succeeding cruelly. It is also designed to recover costs for a cash-strapped NHS, and in this endeavour, it is failing miserably. Undocumented migrants are often destitute, with little or no ability to pay for their healthcare. Little money is therefore received – but does that matter? Healthcare for migrants amounts to less than 0.5% of the NHS budget[v]. When you consider administrative costs of the charging regime and the much higher costs of treating migrants who are seriously ill because they were deterred from accessing earlier and cheaper healthcare[vi], only one conclusion is possible; the game is not worth the candle.

This is why on World Health Day we must hold our Government to account for failing to meet the healthcare needs of migrants and call on the Government to withdraw all regulations charging migrants for use of the NHS. The NHS might be one of the most accessible healthcare services in the world, but for migrants the NHS seems focused on denying access, not enabling it.