Populations on the move: accessing healthcare in a ‘hostile environment’

Chair/discussant: Kate O'Donnell

Symposium Summary

Aims

In 2012 Theresa May, then Home Secretary, announced that she was going to make the UK a ‘hostile environment’ for some groups of migrants. This symposium will use data from the UK and Europe to ask: What constitutes the ‘hostile environment’? How does it interact with healthcare delivery? What strategies of care has it shaped? How might it affect ‘candidacy’ in relation to healthcare access? Is it solely a UK phenomenon? 

Content

To open, the session will introduce the ‘hostile environment’ and its ostensive technologies. Presenters working in primary care and public health will then use empirical data to discuss the ways in which technologies of the ‘hostile environment’ influence how care is sought, negotiated and delivered in a primary care setting.  Using data from a clinic providing care to those excluded from mainstream health services, the first presentation will highlight access barriers faced by some migrant populations seeking care and the complexity inherent in providing it. The second presentation uses the notion of ‘candidacy’ to explore ways in which the ‘hostile environment’ plays out within narratives of healthcare access amongst migrant patients and healthcare workers. The final presentation provides a European perspective on the gaps in health provision that exist but were bridged through legislative or practice change, in the hope to provide some inspiration as well as pragmatic examples for the UK context.

Format

Introduction followed by three presentations (12 minutes each) and discussion at the end of the symposium.

Discussion

The session will end with an interactive panel.  We will use Twitter to collect questions throughout the presentations and get the audience to vote for the topics they most want addressed.

Rationale

This symposium will provide perspectives from both healthcare workers and patients.  Further, both formalised healthcare settings such as General Practices and care provided outside of the mainstream are covered.  In doing so, these researchers, doctors and activists bring together a broad picture of the milieu migrants currently find themselves experiencing when accessing healthcare in the UK and Europe.

Audience

Those interested in migration health, healthcare access and health service provision.

Presentation 1 - Complex care and the hostile environment

Peter Gough, Doctors of the World

Abstract

Doctors of the World UK, is an international humanitarian organisation providing medical care to vulnerable populations. In the UK, we run a volunteer-led primary care clinic and advocacy programme. In 2016 we saw 1,924 patients, including refugees, asylum seekers, undocumented migrants, victims of trafficking and homeless people. The clinic focuses on holistic care, with social assessment a priority. On average 6 years has elapsed before our service-users first attempt to access healthcare. This talk will use on-the-ground experience, case studies and data from UK and Europe to highlight the challenges of providing holistic care in the ‘hostile environment’.

Presentation 2 - Negotiating candidacy in a hostile environment

Jessica Potter, Queen Mary University London

Abstract

Through a critical interpretive synthesis of literature on healthcare access, Mary Dixon-Woods and colleagues constructed the notion of ‘candidacy’ to describe “the ways in which people's eligibility for medical attention and intervention is jointly negotiated between individuals and health services”.  Using data gathered as part of a wider research project exploring healthcare access amongst migrants with TB in a UK context, this presentation will draw on narrative interviews with patients and healthcare workers to explore how the hostile environment acts as an ‘operating condition’ influencing negotiations of candidacy throughout patients’ attempts to have their healthcare needs fulfilled. 

Presentation 3 - Law and practice: healthcare provision for undocumented migrants across Europe

Eve Geddie, PICUM

Abstract

The Platform for International Cooperation on Undocumented Migrants (PICUM) was founded in 2001 as an initiative of grassroots organisations. Now representing an extensive network of organisations across primarily European countries PICUM will present evidence of the gap between international human rights law and policies and practices existing at a national level.  Using specific examples, methods of working at a more local level to remove national borders from healthcare and minimising access barriers for undocumented migrants will be presented.  These ‘beacons of light’ can teach us ways to improve health for these excluded individuals, as well as the wider population.