Introduction

The Faculty of Sexual & Reproductive Healthcare has stated that there is "no health without sexual and reproductive health".1 While this is an admirable ambition, for many migrants to the UK the introduction of upfront charging for some services and an agreement to share data between the National Health Service (NHS) and the Home Office, the department of the UK government responsible for immigration, security and policing, threaten their ability to access treatment, endangering their health and having potential wider consequences for public health.

The 2014 Immigration Act mandated that patients deemed to be "overseas visitors" must pay for some aspects of NHS care in England. Since October 2017, NHS trusts have been required to withhold treatment from chargeable patients unless payment is received in advance.2 During the same period, NHS Digital, the national information and technology partner organisation to the health and care system, and the Home Office signed an agreement whereby confidential patient information could be shared with the authorities in immigration cases.

Upfront charges can be deferred, but are not waived, for ’immediately necessary' treatment that a patient needs promptly to save their life, to prevent a condition from becoming immediately life-threatening, or to prevent permanent serious health damage from occurring; or for ’urgent care', treatment that is not ’immediately necessary' but which cannot wait until the person can reasonably be expected to leave the UK.2 For non-urgent treatment, various categories of patient and categories of care are also exempted, including sexual health and family planning services. However, in practice both the policies above are likely to have serious ramifications for patients who may need those services. While these issues apply across the NHS, they are salient to highlight in sexual and reproductive healthcare (SRH) because they undermine the exemption from charging in these …