Patients Not Passports: The fight for the future of our NHS

As the coronavirus dominates the health headlines, James Skinner and Aedín O’Cuill explain how the hostile environment has infected the NHS

In June 2019, just a few days prior to his 30th birthday, Simba Mujakachi developed the worst headache of his life. He woke up two weeks later in intensive care, surrounded by machines, nurses, and his concerned family. Simba had suffered a life-changing stroke which paralysed the left side of his body and affected his ability to speak. During the surgery needed to save his life, the doctors said he only had a 30% chance of survival.

Eventually he moved from intensive care to a rehabilitation ward, and it was here that he was presented with a £93,000 bill for his life-saving operation and stay in the ICU. Why did someone Simba’s age suffer such a significant stroke? And how is it possible that our NHS is charging people for life-saving treatment?

The NHS is a service founded on the principle that healthcare is a human right and should be free to all, regardless of ability to pay. Over the last few years successive governments have introduced policies designed to undermine these principles and fundamentally alter the NHS for the worse. The NHS is now forced to charge people upfront, before treatment, if they are unable to produce the correct documentation. This means that NHS staff are increasingly pressured to act as border guards, having to carry out immigration checks on the patients they are supposed to be treating. Behind the ID checks and upfront charging is a complex web of data-sharing arrangements through which NHS Trusts share patient information with the Home Office which is then used to identify and deport people.

Simba has a blood clotting condition that puts him at a much higher risk of stroke than the general population. Despite knowing this he was unable to access regular care via the NHS because he could not afford it. Prior to having the stroke, he had not seen his specialist team for months. Simba has lived in the UK since he was 14 but the Home Office has repeatedly refused his application for asylum. As a ‘refused asylum seeker’, Simba is not allowed to work or to access vital public services like the NHS. As a direct result of these restrictions, Simba is now living with the devastating impacts of his stroke as well as a debt to the NHS of over £100,000 that he will never be able to pay.

Simba’s story is devastating, but he is not alone. He one of a growing number of people who have been denied the healthcare they need, made destitute by huge hospitals bills or, in the worst cases, died as a result of not being able to afford treatment. This includes Nasar Khan, Elfreda Spencer, Albert Thompson, Kelemua Mulat, Esayas Welday, Pauline Pennant, Beatrice, Saloum, Bhavani Espathi, and countless others whose names we do not know.

Every day, in hospital wards up and down the country, doctors, nurses and administrative staff are asked to make impossible decisions about whether or not to treat ill patients. Given the harm to patients and the threat to the NHS’s values they represent, it is no wonder that these policies have been met with outrage and mass resistance. Campaigns opposing charging are emerging in cities and towns across the county, in Birmingham, Brighton, Bristol, Hastings, Leeds, Leicester, Liverpool, London, Manchester, Newcastle, Oxford, and Sheffield. Medact, Migrants Organise, and Docs Not Cops are working to support these campaigns and, alongside groups like Keep Our NHS Public, are building a nationwide movement of NHS staff, patients, and healthcare institutions opposed to NHS charging.

These campaigns are growing rapidly, now supported by the Patients Not Passports toolkit that contains the basic principles for how to advocate for patients, and how to get started campaigning wherever you are. The toolkit is accompanied by Medact’s briefing on charging, Patients Not Passports: Challenging healthcare charging in the NHS. It explains where NHS charging came from, deconstructs the racialised myths the Government have used to justify it, and provides a comprehensive evidence base to support opposition to the policy.

You can start taking action to support the campaign right now:

  1. Join us in calling for NHS charging to be scrapped and use our tool to write to the Department of Health
  2. Support the Justice for Simba campaign, sign the petition and donate to his fundraiser
  3. Organise – people across the country are organising locally to call on Trusts to resist the charges. We can support you step by step to start a campaign where you are. For more information email or There might already be a campaign where you are.

The campaign is open to all, and all will be needed in order to succeed. These are some ways you can get involved.

Follow @MigrantsOrg, @Medact and @DocsNotCops on Twitter to stay in touch.

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