Making a difference

A recent report published by the Global Health Advocacy Project shows medical students making an impact on behalf of vulnerable people in the United Kingdom (see www.wherestheconsultation.org). The project, part of the national student group Medsin, led an investigation into government plans to deny primary health care to vulnerable migrants, including failed asylum seekers, and uncovered information that had been gathered but not released four years ago.

In 2004 the Department of Health began consulting key stakeholders about the idea of withdrawing free health care from failed asylum seekers and undocumented migrants. The results of the consultation were never published. When Tom Yates, a medical student from Cambridge, and his colleagues at Medsin realised this, they set out to discover what the government didn’t want to publish.

The results of their inquiries, Where’s the Consultation, were published in August, including many of the responses to the original consultation.

Concerns

Ninety seven per cent of stakeholders consulted raised at least one concern about the proposals, with 82% raising three or more. The objections to the proposals fell into four broad categories.

A large majority of the agencies surveyed thought that it contravened a doctor’s ethical duty to his patients to offer treatment based on immigration status. Many were concerned that there would be logistical problems associated with billing patients who were clearly unable to pay.

Another cost effectiveness matter raised was that good primary care helps to prevent expensive emergency admissions. These proposals threaten to allow health problems to develop until they became emergent, placing a new time consuming and expensive burden on acute medical services.

A public health imperative was also identified because if vulnerable migrants were not being offered primary health care, it would be much more difficult to identify and treat communicable diseases. The proposals might, therefore, lead to the increased spread of dangerous infectious diseases, such as tuberculosis.

Students should comment

Susan Wright, from the medical non-governmental organisation Médecins Du Monde, explains that medical students may often think that they can’t make a difference to important debates: “If you’re training as a medical professional, there’s an idea that you should stay on the sidelines, but students shouldn’t feel like that, they shouldn’t feel that they can’t comment.”

She was impressed by how the report managed to deal with the substantive issue and the procedural one: “The central questions are very important but also, when you consult the public, you can’t say you’re going to release the information on some occasions and not on others. The authors have grounded their report and questions in their own expertise and future specialties, as well as dealing with political questions that affect everyone. We’re interested in this because we’re doctors but also because we’re people.”

In response to the project’s initial Freedom of Information request, the Department of Health released only the names of the organisations involved. Discovering what they had said in the original consultation was painstaking work. It involved tracking down each organisation and asking them to find their original response, or in some cases to remember what they had said.

Threat to health

Yates explained why he and his colleagues chose to take on such a large piece of work: “We picked this issue because it’s the biggest threat to health and human rights in the UK in the past 10 years. Other people weren’t campaigning on it.” He is keen to see further work in medical student advocacy because he thinks that “there’s a lot of opportunity for students to make a difference.”

Abi Smith, deputy chairwoman of the BMA’s International Students Committee, was impressed by what the students achieved: “I’d encourage fellow students and young doctors to take every opportunity to input into activities such as this to strengthen the voice of the young medical community and enable an increasing number of reports to be produced to lobby for improved health both within the UK and globally.”

Competing interests: CH is chairman of Student Action for Refugees at St George’s, University of London.

Provenance and peer review: Commissioned; not externally peer reviewed.

See the BMJ article, “Free for all?” (2008;337:a1111, doi:10.1136/bmj.a1111).

What do you think? Send a response at student.bmj.com.

   

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