Creating accessible services

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Co-financed by the European Fund for the Integration of Third Country Nationals

7. Creating accessible services

7.10 Health services

It is important to make sure that migrants have information about how to access health services, and what their rights are.  The NHS can be complex for people to understand, access and negotiate.  Evidence shows that the main barriers to migrants accessing health services include:

  • lack of information 
  • lack of familiarity with health care systems in the UK 
  • lack of interpretation and translation support
  • confusion around entitlement to services. 

Confusion about the services migrants are entitled to is a particular issue among those with insecure immigration status, who may not wish to approach authorities to ask for help.  Often, it works well for community and voluntary groups to work with the third sector to promote information about access and rights.  Inclusion of health information in welcome packs and online information sites can also be very helpful.

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The NHS has a wide range of guidance on the rights of migrants to access health services.  

The UK introduced an immigration health surcharge in April 2015. This means that people from outwith the European Economic Area who are students, migrant workers or are joining their families, need to pay an annual surcharge of either £150 or £200 a year. 

People who pay this fee are exempt from charges for NHS services for the duration of their visa.  Others may need to pay for NHS healthcare services.

Some NHS services are free to everyone – including emergency treatment, emergency ambulance services, family planning services, treatment for infectious diseases, pandemic influenza, sexually transmitted diseases and involuntary psychiatric treatment.  

Some people, including those who have paid the immigration health surcharge, asylum seekers, refugees, victims of human trafficking and students on a full time course are exempt from charges for other health services.  However, these individuals may need to pay statutory charges for dental or optical services, in line with the criteria applied to everyone when accessing these services.

This letter provides very detailed guidance on people who are exempt from charges for NHS services.  The Chief Executive Letter (CEL) Overseas Visitors’ Liability to Pay Charges for NHS Care and Services CEL 09 (2010)

The way migrants access health services can vary.  It is important to be aware of the different needs and issues affecting migrants.  The World Health Organisation  identifies maternal health, occupational health, mental health, communicable diseases and non-communicable diseases as priority areas for migrants within the European Union.  

It is important to consider the social context and how this links with health.  For example, some migrants can be more vulnerable to exploitation – at work and at home – which can also influence how they use health services.  Some migrants, particularly asylum seekers and refugees, may also be more likely to require mental health services because of the experiences that led them to seek protection in Scotland.  And some migrants may be less likely to approach health services, resulting in more people approaching services at a later stage in their need for support.

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The Scottish Migrant and Ethnic Health Strategy Group has a strategy for finding out more about the health of migrants and people from minority ethnic communities in Scotland.  

Health Boards will have information on their websites about their interpreting and translating policy/process.  

GRAMNet also has guidance on ethical interpreting, in health care settings. 

Everyone who uses the NHS in Scotland has rights and responsibilities.  Find out more in the NHS Patient Rights Charter.

Case study 

Health All Round in Edinburgh is a voluntary organisation which supports people to live longer, healthier lives.  It uses a community development approach to build physical, social and emotional wellbeing while building social capital and reducing inequalities. The organisation proactively aims to involve central and eastern European people in its work, and employs a community development worker to support social and cultural integration of migrants and help address health inequalities associated with this group.  It engages people through holding conversational English coffee mornings, and language cafes which are platforms for discussion on wider health issues.

Video clips

Hear about Edyta’s experience of health services in Scotland: