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The plight of failed asylum seekers in the United Kingdom is a matter of serious humanitarian concern. The BMA's medical ethics department receives regular inquiries about the rights of extremely ill individuals to vital health services where legal entitlement is in doubt. We did not respond immediately to Hall's thoughtful comments (previous letter), but this is not the same as silence. The BMA is a membership organisation, and its overall policy is decided at its annual representative meeting (ARM). This year, for example, we understand a motion is being taken to the ARM calling on the BMA to lobby the government to ensure the provision of appropriate health services for failed asylum seekers. If the motion is passed then we have a mandate to lobby directly. In the absence of such a mandate, our job is to interpret so far as possible existing policy and apply it to emergent circumstances.
Hall is right, the BMA does have a record of promoting human rights in health, and it is out of this background that we have shaped our policy. The medical ethics department has, for example, published guidance on rights of access to health care.1 Largely as a result of Hall's vigilance, we have clarified that general practitioners have the discretion to register failed asylum seekers for routine primary care, although they are not obliged to do so.
In secondary care failed asylum seekers, who are not “ordinarily resident” in the UK, are entitled to free care only when it is “immediately necessary.” Despite these legal restrictions, the BMA has met with representatives of the Department of Health and the Home Office and established that what constitutes “immediately necessary” is a matter of medical judgment and, therefore, medical discretion. The government also undertook to set up a working party, with BMA representation, to look at broader questions of access to health care among migrants without entitlement, but despite our efforts, the group has yet to convene.
Competing interests: JS is the BMA's lead on health and human rights.