Kelly Muir reflects on the barriers for people with no recourse to public funds when accessing the right to health.

Human rights belong to all of us. They are the basic rights we all have regardless of who we are, where we live or what we do. But the right to health, which is the right to the enjoyment of the highest attainable standard of physical and mental health, is more easily realised for some people than others.

Some groups or individuals can experience barriers in relation to the right to health. This is especially true for people who are socially excluded. These barriers can be related to the individual, for example having difficulty understanding and navigating the public services, not being able to speak the language. Or to the service, for example services may not be well equipped to deal with the complexity of issues socially excluded people experience or they may think they don’t have the resources to appropriately support them.  

For people subject to the immigration condition of No Recourse to Public Funds (NRPF), accessing health services can be complicated, confusing and often not at the top of their priority list. NRPF is a condition attached to limited-time visas such as work, family and study visas and also applies to those who are seeking asylum or undocumented migrants. It restricts access to many public funds such as Universal Credit and Child Benefit and a range of support services such as homelessness assistance, local authority social housing and access to refuges that rely on public funds to operate.

Restricted access to this public safety net, which many of us rely on when uncertainty and crises arise, means that people subject to NRPF are at increased risk of poverty and destitution. And although many NHS services are provided free of charge in Scotland regardless of nationality or immigration status, the restrictions around NRPF can impact people’s health and how they access health services, creating health inequalities and leading to poorer health outcomes.

Some of the impacts that the NRPF condition can have on people’s health include

  • Reluctance to access NHS services due to uncertainty over their rights and entitlements to treatment, difficulty registering with GP services, not knowing whether they need to pay for treatment or not or fear that their information may be passed to the Home Office.
  • Struggling to make or remember to attend appointments because of worries around asylum and immigration applications or accommodation needs.
  • Not having enough money to travel to appointments and facing language barriers.
  • Vulnerabilities to various forms of exploitation such as sexual, domestic and labour exploitation to secure accommodation or to meet other basic needs.

As these examples show, the right to health for people subject to NRPF is much more than easy access to services. It is the needs that aren’t being met which mean that people are not fully realising their right to health. And this is true for most, if not all, excluded and marginalised groups and individuals.  

The ALLIANCE report ‘Investigating knowledge and understanding of the right to health’, notes that systemic issues are the biggest barrier to the right to health and that the social determinants of health (e.g. housing, education, employment opportunities, family income), as well as stigma and discrimination, have an overarching impact on health.  For the right to health to be enjoyed by everyone, public services need to meet the needs of the whole population and this means that specific attention must be given to specific groups and individuals, including people subject to NRPF.  Because, as the report says, “If everyone doesn’t have a right to health, then it is not a right”.

This opinion forms part of a specially commissioned series by the Health and Social Care Academy which reflects on learning and insights from the report ‘Investigating knowledge and understanding of the right to health’. This work aligns with the ‘Be HumanAmbition which set out the conditions for long term, meaningful and sustainable change in health and care.

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