Public Health England (PHE) has warned that the sharing of personal information by NHS commissioners and healthcare providers risks undermining public confidence in the NHS and could have “unintended serious consequences” for patients.
In a series of letters published by the Health Select Committee, PHE and the National Data Guardian (NDG) voice concern over a recent memorandum of understanding that allows the Home Office to request non-clinical details from NHS Digital about patients, saying it “creates a real barrier to engagement” with health services among migrant populations.
It comes after it was revealed in January that the Home Office had obtained the personal data of thousands of NHS patients as part of a Government crackdown on illegal immigration. A previously undisclosed agreement between the two bodies makes it possible for the Home Office to request non-clinical details from NHS Digital including names, dates of birth and the individual's last known address.
According to the Department of Health, the Home Office made 8,127 requests for data in the first 11 months of 2016, which led to 5,854 people being traced by immigration enforcement teams. More recent measures that came in at the start of April require hospitals to check whether patients are eligible for free care on the NHS before providing most kinds of care.
Doctors of the World UK, a health charity that runs clinics for undocumented migrants, victims of trafficking and asylum seekers, has said more than one in 10 of the charity's patients have refrained from going to a doctor or hospital because they feared arrest.
A review by PHE, sent in response to a letter from the chair of the Health Select Committee expressing concerns over the situation, warns patients’ concerns that this information could be shared with law or immigration enforcement agencies, such as the Home Office, risk “creating a real barrier to their engagement” and could have “serious consequences”.
It adds that assurances about “explicit confidentiality” has been the foundation of the public health system in the UK since the creation of the NHS, and is the basis on which patients share information with healthcare providers.
The review states: “Patients provide information to healthcare providers with explicit assurances about confidentiality and this is the basis for unfettered sharing of demographic and personal health data by patients with health systems; this has been the foundation of the public health system in the UK since the creation of the NHS.
“If patients have concerns that their personal information, even simple identifiers, could be shared with law enforcement or immigration enforcement agencies for the purposes of pursuing them for actual or alleged breaches of law or immigration rules, then this risks creating a real barrier to their engagement.
“In particular this may impact upon asylum seekers, refugees and undocumented migrants or migrant groups legally in the UK who may be distrustful of sharing personal information for fear that it could be accessed by migration enforcement to locate them or their friends and family.”
PHE adds that ensuring access to healthcare for migrants and asylum seekers is not only important for the individual, but also for public health reasons and the control of diseases, pointing out the fact that in the case of contagious illnesses a lack of diagnosis increases the risk of transmission to others.
In response to the same letter from the Health Select Committee, the NDG, which advises and challenges the health and care system to help ensure peoples’ confidential information is safeguarded, warns in a review that being as “open as possible with the public” about how their data could be used was “essential to the healthcare system being seen as trustworthy”.
The review states: “It is vital that people trust the health and care system to safeguard their data appropriately. Being as open as possible with the public about the circumstances under which data about them may be released is essential to the health and care system being seen as trustworthy.
“Given the importance of this matter, we would encourage the Department of Health to commission PHE to start this research as a matter of urgency."
A letter from the Department of Health meanwhile denies such claims, saying it had found "no evidence that this policy would deter migrants from seeking treatment," adding that it had weighed up privacy considerations and the "competing public interest in upholding the Government’s immigration agenda".
"DH is committed to upholding public trust in data sharing and wider patient perceptions of the confidentiality of patient data. On that basis, DH considered the nature of the data requested by the HO and the public interest case for sharing it, by weighing up privacy considerations and the competing public interest in upholding the Government’s immigration agenda.
"The importance of maintaining effective immigration controls is well recognised in Parliament, by the courts, and internationally. Effective immigration control is clearly in the public interest - and this interest extends to the power of government to remove, or prevent entry to, those individuals who might pose a danger to the public and who seek to abuse immigration laws. "
The warnings support recent calls by doctors across the UK that data sharing between health providers and the Home Office should be scrapped. Earlier this month, Doctors of the World launched a campaign against the policy, warning that it requires them to act as “border guards” for the Home Office’s immigration enforcement and is subsequently frightening vulnerable migrants away from accessing healthcare.
In light of the reviews, Nick Harvey, spokesperson for Doctors of the World UK, told The Independent: “When the country's official health and data organisations voice serious concerns about something as important as sharing patient's personal information, it's time to sit up and listen. This data sharing deal is having a real impact not just on individuals but also on public health and public trust in the health system.
”The Department of Health insists there's no evidence that using patient's information to aid immigration enforcement deters people from accessing healthcare services, but we see just the opposite. At our London clinics we see many patients who are terrified of going to the doctor because they fear arrest, including heavily pregnant women and people with serious illnesses like cancer."