In the midst of a pandemic, Priti Patel is focusing on what really matters – making life difficult for immigrants

From upping the Immigration Health Surcharge to fudging visa rules, the home secretary’s appetite for the hostile environment shows no signs of abating during the coronavirus crisis

After months of avoidance, today the home secretary finally went before the Home Affairs Select Committee to account for her department’s response to coronavirus. One of the questions on many people’s lips has been why the Home Office has failed to tell foreign doctors and nurses whether their visas will be extended free of charge – a failure that risks undermining the NHS’s work to address the pandemic. In good news for many NHS frontline workers, the home secretary announced the promised visa extension will go beyond NHS workers on a Tier 2 visa to include midwives, social workers and medical radiographers. But the situation for many other workers – such as porters and cleaners, and pharmacists, as well as social care workers – remains unclear.

This fudge is just one of a number of examples of the home secretary’s continued preference for hardline immigration policies over a pragmatic, public health-led approach. Another is her raising of the Immigration Health Surcharge from £400 to £624 during a pandemic. A third is the NHS charging regulations, which restricts access to most hospital services for migrants without a visa and people who have unsuccessfully sought asylum, creating an underclass of people cut out of healthcare. This policy, championed by the Home Office as part of its hostile environment agenda, is cruel at the best of times – during a pandemic, it is dangerous. Although the Health Department has taken steps to exempt Covid-19 testing and treatment from the charging regulations, medical groups and charities supporting refugees and migrants warn this exemption is too narrow and amounts to an exemption on paper only as it does not cover pre-existing conditions, making it meaningless for those most likely to need hospital care with Covid-19. The British Medical Association, Royal College of Physicians and Faculty of Public Health have called on the home secretary to drop the policy in favour of simple, clear rules that make the UK health system truly “available for all” during the pandemic. Yet the home secretary remains steadfast.

When the NHS charging programme was launched, the government’s equality impact assessment warmed it could lead to discrimination against BAME people, but the government concluded this risk was acceptable and pushed ahead. The home secretary’s determination to keep the NHS charging regulations in place during the pandemic is therefore all the more concerning given the increasing evidence that BAME communities are disproportionately impacted by Covid-19.

This prediction has proven correct; racial profiling has been introduced into NHS services as some trusts single out people who do not appear or sound British, or those with non-British sounding names, for healthcare entitlement checks. BAME people are also less likely to pass these checks because they are less likely to have a passport or driving licence to prove their identity and – as in the case of Albert Thompson, a member of the Windrush generation and an NHS cancer patient – a lack of paperwork can result in treatment being withheld.

There is also evidence that the NHS Charging Programme puts some BAME people off seeking NHS treatment altogether. Last year, a GP recounted his frustration and anger when he treated an elderly black British citizen with a deteriorating health condition who had put off seeing a doctor for years because he worried he didn’t have the right papers.

The need for the home secretary to drop of her fierce commitment to maintaining hostile environment measures is clear. A public health approach to healthcare is paramount in the management of this pandemic and our government has to appreciate the importance of keeping all individuals regardless of immigration status healthy to keep society healthy. But we should also remember that prioritising public health and ensuring healthcare for vulnerable populations is important at all times. It is never a good idea to create an underclass of people cut out of health services; this pandemic is an acute reminder that if part of population is made vulnerable by exclusion, we all are.

Dr Durga Sivasathiaseelan is an NHS GP and a clinic coordinator at Doctors of the World UK