Britain’s Home Office tried to coordinate the delivery of news that a vulnerable man’s application to remain in the country had been refused with a doctor, social workers, and a police safeguarding team.
Campaigners are now warning of a “blurring of boundaries” between immigration enforcement and health professionals.
Home Office documents seen by VICE World News show that the immigration agency had real concerns that the news could have a “detrimental impact” on the vulnerable couple, a Pakistani man and his British wife.
Sarah, who lives in the north of England, has not seen her husband Asif in almost two years. She only spoke on the condition that their real names would not be used.
Despite them being in a relationship for almost a decade, Asif’s application for an in-country spouse visa was refused and he was deported to Pakistan in early 2019.
Before his deportation Asif was also Sarah’s carer; she suffers from PTSD, severe depression and agoraphobia. He was also the carer for her elderly parents.
The couple are now applying to get Asif permission to return to the UK. Files obtained by the couple as part of their legal efforts contain copies of correspondence to health professionals from the Home Office as well as internal conversations about the case.
These documents show that the decision to refuse Asif’s application to remain in the UK had been made over a year before it was issued. This is because the Home Office spent 15 months trying to navigate “safeguarding concerns”, noting that both Sarah and Asif were “vulnerable” and that he had said he considered killing himself. The Home Office itself acknowledged that the news that Asif would be forced to leave the country him could have a “detrimental impact” on his and Sarah’s mental health.
Over those 15 months, the Home Office tried, and failed, to coordinate with a GP and other health professionals as it planned to deliver news of Asif’s deportation to the couple.
One email between Home Office officials asks: “Please contact the applicant’s partner’s GP and [advise] we will be serving an adverse decision and are concerned this will have a negative effect on her mental health and therefore would like them to agree to providing support when this decision is made.”
But the email warned, “Please remind them not to disclose we are looking to make an adverse decision in advance of us serving the decision.”
The Home Office also tried to get the police involved, with one email suggesting, “We could call 101 to see if a safeguarding visit could be arranged to coincide with the service of any decision.”
Internally, the Home Office expressed frustration at the lack of engagement from GPs and social workers, noting late into the process that it was “extremely difficult to try and get the decision served for the applicant”.
The Home Office acknowledged that the couple’s vulnerability meant that it had a “duty of care” towards them. Home Office staff hoped that getting health
Health and migrant charities have warned about the potential damaging effect of health professionals appearing to coordinate with immigration authorities in the delivery of bad news such as immigration refusals.
“It's all part of the trend of the blurring of boundaries between the health service and the Home Office”, said Anna Miller, head of policy and advocacy at Doctors of the World. “The Home Office is extremely interested in having unfettered access to NHS data and NHS resources to carry out immigration enforcement work.”
“It's ironic that the Home Office decided a person is simultaneously not deriving or vulnerable enough to be granted status, but also too vulnerable to be told about the decision without a clinician present,” she added.
Sarah said she changed GPs after she found out that, on the request of the Home Office, her GP had withheld the news of the pending refusal decision from her. “I lost all trust I had in [my GP]”, she said. “It kind of hurt that when they first contacted her about it, she never came to me about it.”
James Skinner, former NHS nurse and Access to Healthcare Campaigner at Medact said: "As healthcare workers we rely on building a bond of trust with patients. By asking GPs to be the face of bad news, the Home Office is showing a total disregard for the deterrent impact it will have on migrant communities already targeted by the Hostile Environment in the NHS, and understandably suspicious of this collusion between health services and immigration enforcement."
Asif’s precarious immigration status meant he was unable to register with a GP when he lived in England. This, in turn, frustrated Home Office efforts to deliver the news through local health services.
While everyone can technically register with a GP in the UK, regardless of immigration status and without documentation, charities have warned that there are often significant barriers.
Asif and Sarah say these barriers to healthcare had a profound impact, including preventing them getting NHS help with IVF. The couple, who had been together for almost a decade, were desperate to have children but due to earlier complications this was not possible without medical help. Now, even if Asif successfully returns to the UK, she will be ineligible due to her age.
Additionally, the Home Office conduct raises data protection concerns. Immigration status and health issues are recognised as especially sensitive categories of information that should be carefully guarded, according to Privacy International.
The fact that Asif was not a patient of either the GP nor the social services to whom the Home Office shared this information with seems like a “flagrant departure” from data protection principles by the immigration agency, Laura Lazaro Cabrera, the organisation’s legal officer, said.
“In the absence of a person's explicit consent, sensitive data can be processed in only a handful of circumstances. It is difficult to see how the circumstances of this case meet any of these conditions,” she said.
The Home Office declined to answer a question about whether such disclosures were in line with its policies.
While the Home Office declined to answer any questions about the policy and procedure of engaging health authorities in this way, it is not isolated. A case was raised in the media and at a parliamentary committee in 2018, where a GP said he had been sent a deportation notice to give to his client, who had mental health concerns. At the time the Home Office said it did not recognise the description of the letter. British Medical Association leaders at the time said the letter was “unacceptable”.
Officials have themselves recognised that immigration enforcement measures can “even exacerbate vulnerabilities in some instances, for example preventing individuals with mental health issues from accessing health care,” according to a report by the UK’s chief inspector of borders and immigration.
The impact of Asif’s forced departure has been immense, Sarah told VICE World News. Without her husband she has been unable to leave the house due to her agoraphobia and, because Asif helped manage her medication, she has had to go through withdrawal from her anxiety medication. The stress of his pending removal meant she attempted to take her own life in 2018.
“The hostile environment is just that, hostile, it really is”, Sarah said. “I’m a British citizen, from birth, I’m affected by it, even though it’s not designed to affect me.”
“They don't realise the damage they cause.”
Sarah believes that the fact that it took over a year for the Home Office to deliver the news shows that it knew how vulnerable they were, and that its actions were self-preservation. “They've basically done everything they could so if anything did happen… if I did take my own life, they had no responsibility,” she said.
Mary Atkinson, Families Together campaign officer at the Joint Council for the Welfare of Immigrants (JCWI) said that the “callousness and carelessness” shown by the Home Office was shocking, but routine.
“Time and time again, we see them handing down decisions that they know will cause harm”, she said. “If you’ve been told that somebody is vulnerable, and needs their family with them, the logical and humane thing to do would surely be to let them stay with their loved ones. Instead, the Home Office presses ahead with removing vulnerable people from their families, and tries to get other people to clear up the mess that’s left behind.”
Support from groups like Reunite Families, affected families who campaign for those separated by UK immigration rules, and the JCWI, had been “invaluable”.
“The day my husband left, she spoke with me until the early hours of the morning”, Sarah said, of support from someone in Reunite Families who had previously been through similar situations. “All the following day. For about two days solid, until I heard from him again, once he got back to Pakistan.”
The Home Office declined to answer a series of detailed questions about this policy and practice. It also said it does not routinely comment on individual cases.
In a statement, a spokesperson said: “All applications are considered sensitively, appropriately and on their individual merits and decisions are communicated through the proper channels to the applicant directly or to a nominated representative. We would only contact a medical professional in very specific and legitimate circumstances.”
“We are determined to fix the broken asylum system to make it firm and fair. We will stop abuse of the system while ensuring it is compassionate towards those who need our help”, the spokesperson added, echoing a speech by Home Secretary Priti Patel at the Conservative Party conference in October. The Conservatives have been in government since 2010.