Your officials say they will “forever feel guilt and responsibility” and that “it will take a long time for us to process” the tragedy of Mohammed Majeedi, the 5 year old Afghan refugee who fell to his death from accommodation provided by the Home Office ^1,2. His death is one of many in asylum accommodation³. Every one of these events should provoke reflection and action to prevent further avoidable harm.

More than 60,000 migrants have waited over six months without a decision from your department about their leave to remain in the UK⁴. The Home Office have a duty to provide housing and subsistence while they are waiting, and not to implement policies and practices which cause avoidable medical harm.

As clinicians, we are all too aware of failures of duty of care and consequent harm our professions have not prevented. We understand the anguish that such failures create for everyone involved. But the purpose of “processing” must be to ensure that no further refugees are avoidably harmed⁵.

Current practices of the Home Office and its accommodation providers create unnecessary medical harms and risks to asylum seekers, the public health, and NHS services. These go beyond the obvious physical and environmental dangers of specific hotels and other properties, as found by your own inspectors⁶ and include more directly clinical matters.

Some of us have conducted examinations of numerous asylum seekers housed in “contingent accommodation”. Most had been moved from one site to another, often repeatedly, without explanation or reasonable notice. Nor, where they had been able to register with and access NHS services, were their GP practices informed to permit continuity of care.

We can provide documentary evidence of numerous cases where the resulting discontinuities of care were harmful and/or hazardous to these patients. This list includes avoidable and dangerous disruption of access to essential prescriptions including medicines for which abrupt cessation can be life threatening. We have also seen several interruption of crucial investigations and treatment (see for example, ref 7). The process of unheralded transfer clearly poses public health risks to the control of Covid spread, particularly where the person has difficulty registering with a new GP and does not speak English or is unaware of NHS norms. This is all preventable.

The Williams report⁸ on the Windrush scandal found that “ignorance and institutional thoughtlessness”, a “culture of disbelief and carelessness” and “lack of empathy for individuals” were central to the damage inflicted on victims. In response, you told Parliament that “my ambition is for a fair, humane, compassionate and outward-looking Home Office.” ⁹

As part of the “processing” needed to prevent repetitions of the tragedy in Sheffield and the wider harms of Windrush and the hostile environment, we urge you to implement the following humane and compassionate safeguards which would also make it less difficult for health care professionals to do our jobs.

1. No one accommodated at public expense should be transferred from one location to another without sufficient notice to them and their responsible clinicians to make necessary, medically safe, arrangements.
2. Clinical concerns about the medical impact of transfer raised by residents, staff or clinicians should prompt a review of transfer decisions.
3. Onsite contractors should be notified simultaneously with the resident and be required – subject to patient consent – to:
   1. speak with intended transferees, using professional interpreting as needed
   2. ascertain whether the person is currently or was previously registered with a GP,
   3. if so, assist them to inform that practice of their incipient move
   4. ensure that the resident has at least a two week supply of prescribed medication and their NHS number
   5. provide advice about how to register and use the NHS in the appropriate language. See for example https://forrestmls.org/nhs-leaflet/
4. Transfers should not occur until the above conditions are met. Compliance should be subject to appropriate incentives and monitoring, and that data published.
5. On arrival in new accommodation, residents should be given locations of community health services local to them and assistance with registration, including, where required, interpreting. To facilitate prompt registration and access to care, they should be provided with proof of address and an HC2 certificate.
6. Where death or other critical incidents occur in asylum accommodation, these should always be investigated and the findings published.

Yours sincerely,

The undersigned

References

1. Six o’clock news BBC Radio 4, at 1810h on 24/08/2021
2. Afghan boy, 5, fell from Sheffield hotel onto car park roof, inquest told — The Guardian, 25 August 2021
3. More than 50 died in Home Office asylum seeker accommodation in past five years — The Guardian, 25 July 2021
4. Living in Limbo: A decade of delays in the UK asylum system — The Refugee Council, July 2021
5. Revealed: shocking death toll of asylum seekers in Home Office accommodation — The Guardian, 15 December 2020
6. An inspection of the use of contingency asylum accommodation – key findings from site visits to Penally Camp and Napier Barracks
7. Windrush Lessons Learned Review by Wendy Williams — Published 19 July 2018, Updated 31 March 2020
8. Health consequences of current arrangements for accommodation of migrants in army barracks: a preliminary survey — As submitted to the Home Affairs Select Committee of the British House of Commons on 16/02/2021
9. Priti Patel promises ‘compassionate’ Home Office after Windrush scandal — The Guardian, 21 July 2020