The NHS should never have been part of the “hostile environment”

After five years of damage, one of the most egregious parts of Theresa May’s “hostile environment” policy was finally curbed last night.

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The government would have you think that deportations and threats of deportation were the only consequences of its longstanding policies to remove people in the UK illegally.

It has become clear that this is far from the case, and it is only after five years of damage that one of the most egregious parts of Theresa May's “hostile environment” policy was finally curbed last night.

The last few years have seen an explosion in the Home Office using NHS records in a bid to track down and deport people – a shocking breach of what most people assume to be cast-iron medical confidentiality.

The policy, which was explained away by saying the records used only non-clinical data (your name and where you live), as if that technical distinction would make some difference to people as they learn accessing basic healthcare could put themselves and their family at risk.

The use of NHS records to try and aid deportations extended from a policy allowing the Home Office and police access to the documents to try and tackle serious and organised criminal offences – an exception which may seem justifiable to many. Yet this was widened to include immigration offences, including simply the suspicion of being in the UK illegally.

The use of this power ramped up rapidly. Between 2010 and 2014, records were accessed a total of 6,900 times. By 2016, records were accessed 8,100 times in just 11 months, and their use continued to rise.

More perniciously still, the NHS and the Home Office expanded the amount of information immigration officers could access. Once, the officials could only access information on which GP the suspect was registered with – meaning they could ask that GP for address details, a request some (if not many) GPs refused.

This was changed so that the address details were handed over directly to the Home Office by the NHS’s centralised data providers, meaning doctors could become unknowingly involved in the deportation of their patients, simply by entering their address onto their clinic’s systems.

One London GP, speaking to me for BuzzFeed News in 2016 as the system was changed, said she regularly received letters from the Home Office asking for details on her patients – back when GPs still had the power to deny most such requests.

“I think it's very unethical for me to be involved with the Home Office in hunting people down. We rely on people trusting us. People are unaware when they hand their details to their GP that they're shared with NHS Digital,” Dr Miriam Beeks told me.

“I think GPs aren't aware of what NHS Digital is doing – passing information without patients' permission to all sorts of bodies, including the Home Office. We always thought patient confidentiality was paramount.”

This co-opting of ever more bodies of the state to become extensions of immigration agencies has included landlords, employers and others. But the use of NHS health records has always come with dangers that the other areas do not.

If someone was worried that they or a relative – or even someone in their house – were in the country illegally, then they may not have accessed healthcare for themselves or their children, even if it was urgently needed.

That would be inhumane enough, but it’s not only such people who can face consequences, as public health groups have warned for years. For instance, the UK has experienced sustained outbreaks of tuberculosis, which can often concentrate in particular immigrant communities, turning the UK’s mean-spirited immigration policies into a public health disaster. AIDS groups and others spent years similarly trying to raise the alarm of the dangers of giving at-risk groups any extra reasons not to access health care.

By demonising immigration, and by co-opting the health service into the role, the Home Office and the ministers behind its policies – Theresa May and her successors – put the health of all of us at risk. And for years, we as a public stood by and let it happen. It has only been in recent months, thanks to Sarah Wollaston and her health committee that campaigners’ voices have been listened to, and the policy finally changed on Wednesday night.

The ministers making these rules carry much of the blame. But we as a public share some, too: we let this happen. We should know better – and be better – than that.

James Ball is an award-winning freelance journalist who has previously worked at the Guardian and Buzzfeed. He tweets @jamesrbuk