NHS records of migrants are to have a Home Office reference number attached to them, prompting concerns about potential tracking, privacy rights and the expansion of the “hostile environment”.
A previous scheme using NHS data to track down patients believed to be breaching immigration rules was abandoned after a legal challenge from health and civil liberties organisations warning of a breach of patient confidentiality, discrimination against non-British patients and a risk of deterring people from seeking medical help.
But concerns are being voiced about a new development after NHS England was directed by a senior civil servant writing on behalf of the health secretary, Steve Barclay, to accept and store “Home Office reference numbers” in the records of “relevant patients”.
Under the new direction, the Home Office reference numbers, which have no value to the NHS, would be attached to the personal demographics service (PDS), the electronic database of patient demographic data, such as name, address, date of birth and NHS number.
The NHS gets notification of migrants who pay the immigration health surcharge – a fee paid by many but not all visa applicants seeking to stay in the UK for more than six months in order to access NHS services – but the reference number is now being added in a way that would allow the Home Office to track records.
Home Office documents state that the move relates to the collection of charges for overseas visitors using the NHS, which does not apply to groups such as people with settled status or on so-called skilled worker visas.
The Home Office also rejects the idea that the reference number will be used for immigration enforcement.
Nevertheless, concerns were voiced by organisations including the Migrants’ Rights Network (MRN), whose legal challenge forced the scrapping of a tracking scheme in 2018.
“The introduction of a Home Office reference number to NHS records for migrants signals the growing trend to ignore and abuse patient privacy and data rights for migrants.
“This new process feels and sounds discriminatory, and will likely be used as an immigration enforcement tool to further harm migrants, and deter them from accessing vital healthcare. The NHS should not be doing the Home Office’s bidding by storing this information, and should be firstly thinking of patient confidentiality and their privacy.”
The development has also sparked unease among healthcare unions.
Dr Jan Wise, the BMA’s medical ethics committee chair, said: “The BMA was instrumental in having the dangerous memorandum of understanding between the Home Office, DHSC and NHS England scrapped in 2018 and has spoken out more generally about the inappropriate use of health records by the government. We will be examining this new development closely to ensure that it is not an attempt to recreate a similar system via the back door.”
“Having the shadow of the Home Office looming over every health consultation will erode trust in the NHS. And these are people who’ve paid thousands of pounds to access services, on top of tax.
“The pandemic underlined the importance of retaining confidence in medical services and public health advice. But use of this data is ripe for abuse and mistakes, and risks undermining the work of the NHS.”
The development applies to records held by NHS England, which leads the health service in England and is separate to other devolved jurisdictions of the UK.
A Home Office spokesperson said: “The Home Office shares data with the NHS to ensure individuals can access healthcare free of charge where they are entitled to treatment. The use of a reference number is an established part of these data-sharing arrangements and there is no new reference number being introduced. To suggest otherwise is wrong.”
Home Office sources said its unique reference number, known as the UID2, is used in the digital checking service, which enables the NHS to accurately identify the correct Home Office record when determining if an individual should be charged for healthcare.
The legal order to the NHS England chief executive, Amanda Pritchard, was issued on 9 June and then noted at a board meeting in July.
Sam Smith at medConfidential, a data privacy campaign group, expressed concerns about the process by which the NHS was instructed to start storing the reference numbers.
“The NHS was told to implement a political decision requested by the Home Office, but chose to do so before the NHS England board met to approve the direction,” he said. “The choice to move at a speed makes a mockery of NHS data governance that is supposed to be independent and offer scrutiny.”
NHS trusts have discretion on how to identify patients and where they are from, according to the NHS.