Protecting medical impartiality – health data and immigration enforcement

As of 1 January, 2017, there is now an agreement between the Home Office, Department of Health (DH) and NHS Digital, to formalise information-sharing for the purposes of enforcing UK immigration law. That means immigration enforcement agencies will be allowed to access ‘non-clinical’ personal details of parents and children whose immigration status may be in question via their health data. The justification for this agreement is that there is a determining ‘public interest in sharing this non-clinical information’ in enforcing immigration policy.

The RCPCH position

The RCPCH objects to this measure for a number of reasons, including:

  • Using health data to identify families of irregular immigration status may deter such families from accessing health services in the UK. This is a breach of human rights commitment to ensure universal access to care, regardless of status, and undermines public health measures through undetected and untreated conditions.
  • It risks co-opting the health system – and by extension health professionals – to the enforcement of a non-health political agenda, therefore undermining the fundamental premise of medical impartiality. Health professionals must not be placed under any obligation other than to the optimum care for the patient in front of them.

We are also concerned that:

  • Prior to the current agreement, information requests were made by the Home Office and processed through local NHS service providers; under the current arrangement, information will be sourced directly through NHS Digital back office, bypassing local providers.
  • A ‘Privacy Impact Assessment’ was not carried out in relation to this agreement, as it was not considered necessary. It is claimed that for each information request, NHS Digital carries out a public interest test. But because this test is incapable of capturing the public interest value of ensuring  all at-risk parents and children access appropriate public health interventions and health care, and the public risk of excluding such people from the health system.
  • Although DH recognise that any ‘data sharing protocol must not unlawfully discriminate, or create barriers to advance equality of opportunity’, the very fact there is data-sharing agreement may deter some individuals or families from seeking or effectively accessing care.
  • According to correspondence from the Health Select Committee, both Public Health England and the National Data Guardian have expressed concern that this agreement may affect public perceptions of trust in the confidentiality of the health system, and thus ‘create a real barrier to engagement’.
  • According to the agreement, ‘the Home Office and NHS Digital will expect the other to have taken every reasonable measure to comply with the appropriate data security and information governance standards’. Given recent events concerning international cyber- attacks, and the problems associated with the initiative launched by NHS England and the Health and Social Care Information Centre (HSCIC, now NHS Digital), it should be incumbent on the UK Government to demonstrate fully its capacity to comply with data protection and governance requirements prior to this agreement.

What can RCPCH members do?

  • Contact RCPCH to register your view of this agreement
  • Sign up to a petition to oppose this agreement
  • Refer to the Safe surgeries toolkit (Médecins du Monde)
  • Contact the National Data Guardian (chair: Dame Fiona Caldicott), to raise your concerns
  • Submit a Freedom of Information (FoI) request to NHS Digital to request transparent details of the process of enactment of this agreement (e.g. number of requests made by the Home Office to NHS Digital; number of responses authorised by NHS Digital; number of challenges to Home Office requests (if any); evidence of ‘public interest test’ applied to Home Office requests by NHS Digital and outcomes of such tests).