9. Submissions on Behalf of the Migrant Primary Care Access Group by Ms Naik KC
Ms Naik: My Lady, I don’t know if you can see me. I don’t think you can in fact.
Lady Hallett: I did ask that the computer should be lower or … anyway, I can see you now. Can you see me?
Ms Naik: Yes, I can, my Lady, thank you very much. I’m very grateful.
My Lady, I am instructed, with my learned junior Ms Moodie and a team of solicitors from the Public Interest Law Centre, by the Migrant Primary Care Access Group, which is quite a difficult acronym, so I am going to ask in shorthand to refer to them as the Migrant Care Group, if that assists.
The four organisations, as my Lady is aware, are Doctors of the World, the Joint Council for the Welfare of Immigrants, the Kanlungan Filipino Consortium and Medact. They’re concerned as to the barriers and inequalities to the Covid-19 vaccine uptake, including the impact it’s had on this exceptionally vulnerable group with multiple protected characteristics but, by reason of their immigration status, including those with uncertain or no immigration status.
This, as my Lady is aware from the submissions we have made in writing, is the reason why we sought to distinguish ourselves from the other core participants in this module and we’re very grateful for the consideration of those further submissions and therefore our inclusion here.
We further note, as we do, that we’ve used the term “migrant” or “migrant community” but obviously we highlight at the outset that the individuals we represent are – and the four organisations who represent their interests, have wide, diverse characteristics depending on their individual circumstances and their immigration status, and also that immigration status is not static and indeed may have changed during the course of the Covid pandemic.
We just have hopefully five areas to address you on in short:
One is just a summary of the Migrant Care Group’s key areas of interest.
A specific issue arising from the agenda as to the status of the Secretary of State for the Home Department, who is not currently a core participant in this module, although she was, we understand, in Module 1.
The issue around Rule 9 requests that arises in respect of that and as to the way in which those might be conducted.
The key lines of enquiry, just an observation on the wording of those. And also what we might be able to contribute to that with our particular clients.
Finally, the scope, just a proposal on the expansion of the scope of Module 4 in relation to immigration, detention and accommodation.
So if I might just first summarise, really, as my Lady is aware, that the Migrant Care Group will provide evidence on the impact of the government’s vaccine delivery for wider migrant community, with particular focus on successive policies and legislation and the practices that created very significant barriers for this cohort and the impact of that.
We hope to provide evidence of the support that our particular clients were able to provide to overcome barriers to inequalities to those migrant communities, and the four organisations that we represent all shouldered significant public health responsibilities during the pandemic which should, we say, have been provided by the state to combat at least a decade of austerity, continuing anti-migrant rhetoric, and hostile environment policies that we say catastrophically prevented vaccine uptake for migrants, both documented and undocumented.
Furthermore, the majority of the people represented by in this group are from Black, Brown and minoritised communities, and they face additional institutional structural racism when seeking to access healthcare, actually both primary and secondary, including trying to access the vaccine, and also the consequences for those who then sadly fell ill or worse.
For today, and having heard Counsel to the Inquiry, Mr Wald KC, we have some just brief observations in relation to some of the points that he raised, and we noted that when you granted core participant status to this group that – I think my Lady noted in your ruling of 17 July that the understanding and perspectives of those with uncertain immigration status and how this might have affected access to the vaccines was something you were concerned to address.
We say, and Counsel to the Inquiry observed, that the development of the vaccine was intended to prevent serious illness amongst the most vulnerable, and we say this must include all persons within the UK, regardless of their status, and that again is something that we say the Inquiry should focus on.
Mr Wald was also, and we’re very grateful to hear it, concerned to address that Module 4, the scope of it are to address the barriers to vaccine uptake, including adequacy of the government planning for and response to inequalities relevant to the vaccine uptake amongst certain groups and those from particular ethnic groups. Whilst again we welcome that, as we said, in writing and we observed in Mr Wald’s written submissions, we say that ethnicity is not an adequate or sufficiently specific definition to identify or address all the specific barriers to take-up or accessibility based on immigration status, and again we say it includes but isn’t limited to uncertain status or lack of it.
So, to put it bluntly, we say that anyone in the UK, even those who might otherwise have been facing removal from the UK, who have no current immigration status, as well as those who did, all need to be addressed and all their concerns need to be addressed in the context of the government’s developing, shaping and delivering of the vaccine roll-out and delivery.
Mr Wald rightly said that the central issue would examine whether these were sufficiently tailored to meet those with particular needs, and from those particular backgrounds and communities, and what we say is that at the heart of our submissions will be the right to respect for human dignity that, regardless of immigration status, paraphrasing Baroness Hale in Limbuela, that:
“… The fundamental values of a decent society, which respects the dignity of each individual human being, no matter how unpopular or unworthy she may be.”
I’m sure that’s something that the Inquiry will have at the heart of their concerns. Read that together with the definition of structural racism that we heard from Ms Banton, those two concerns are matters which are entirely apt to the issues that the migrants in this – these core participants face and need to be addressed in the context of the Inquiry’s further dealings.
Just coming back on the point from Ms Banton in relation to the request for an expert, we of course wholly support that, and it may well be that some of those issues that are sought to be addressed in the context of structural racism in that, for those core participants of FEHMO, may well address the specific position of migrant communities, and we certainly hope that that is the case and that we wouldn’t need to therefore replicate it.
One important thing we want to talk about and one of the key submissions that we will be making is that in order to examine the impact for the Migrant Care Group, that the Inquiry will have to examine the impact and the breadth of the government’s hostile environment policy, and we know that was introduced by Theresa May when she was Home Secretary in 2012. It was later renamed the compliant environment by Sajid Javid, as the later Home Secretary, partly I think as a result of the Windrush scandal.
But that hostile environment and the effect of those persons affected by this policy is going to be a key part of understanding the vaccine roll-out, the barriers to uptake and, indeed, the drivers of mistrust. Not forgetting that when Theresa May introduced those policies, she said:
“The aim is to create, here in Britain, a really hostile environment for illegal immigrants.”
The consequence of that, which was a range of measures aimed at identifying, reducing the numbers of migrants in the UK, those that she asserted had no right to remain, then led to a series of measures under Immigration Acts which restricted people’s access to various things, including driving and bank accounts and renting property, but in particular, of course, we’re concerned with free healthcare.
That meant, because the measures involve data sharing between government departments, that that led to a fear amongst persons who were unwilling, because of a fear of reprisals, to seek medical attention, to register with GPs, and therefore, in the context of the pandemic and the vaccine roll-out, would therefore not have been able to be easily identified as being eligible for vaccinations, being identified as clinically vulnerable for early vaccine, even to book an appointment through the national bookings system, because it required the individuals to trust and attend and share key personal information with medical staff and institutions, and the risk of that being shared with the Home Office was a real and great one.
So we say we’ve seen the impacts of those kind of policies in the Windrush scandal, but it doesn’t end there, and that leads me then to the point that we make, the third point, which is that Secretary of State for the Home Department isn’t a core participant, as I mentioned at the outset. She was in Module 1, and we raised in our written submissions that it is of some grave concern to us that she is not. Why she is not, we’re not aware, but we understand she hasn’t chosen to apply in this module, although had done in the previous one.
To contextualise the importance of that, the Public Accounts Committee in 2020 report on immigration enforcement found that the committee wasn’t convinced that the department was sufficiently prepared to properly safeguard the existing, as they say, legal immigration population in the UK whilst also implementing the new immigration system and managing its response to the Covid pandemic.
So once they’ve raised those concerns and put them on paper in September 2020, about the Home Office’s response to the pandemic, we are concerned that they are not a core participant, and we note, as I understand it, that your Ladyship could invite the Home Secretary to apply to participate as a core participant in this module.
We would ask that your Ladyship give some consideration to that. I’ve understood from Mr Wald that there is no – I don’t understand there is any particular reason why they haven’t been, but I may have misunderstood that.
In any event, even if they’re not a core participant, then it affects the nature and degree of disclosure that we can expect from the Inquiry and also the Rule 9 procedure.
We’ve heard from Mr Wald again that there’s no limitation on the evidence being procured from the Secretary of State, but we say that core participant status would obviously submit and impose a far greater and more far-reaching obligation on the Secretary of State as to the impact of her policies and whether she reviewed the impact of the hostile environment policies in the context of the provision of the Covid-19 response and in particular the vaccine roll-out.
So we do say, although we recognise that Mr Wald has said Rule 9 requests will be given careful consideration, if that’s to be the procurement of – the way that the evidence is going to be procured, we do say that we would, first of all, invite the Inquiry and my Lady to consider whether in fact the Secretary of State can have core participant status – or should have core participant status, I should say.
We also echo the concerns in the context of the Rule 9 process that the instructions are not currently disclosed to our clients, and therefore – if we were going through the Rule 9 process, and therefore we’re not in a position to comment on the breadth and detail from our clients’ frontline expertise and experience. We submit that the Inquiry would be properly and fully assisted by that, if that process were to be amended.
I understand there has been an earlier ruling, I haven’t seen that as yet, but we do –
Lady Hallett: More than one.
Ms Naik: My Lady, I understand.
In this regard, when a core – we say that a significant government department is not currently a participant, and if they’re not going to become a participant, then the nature and degree of the evidence that should be procured from them would be, we hope, assisted by some input from our clients. But we’ll perhaps leave that for the moment, depending on the outcome of the first point we make.
The fourth point, in relation to key lines of enquiry, and again we’re very welcome to hear from Mr Wald about the drivers of mistrust that he set out in his written and oral submissions today in relation to public messaging, and the drivers of hesitancy and uptake, he observes – well, we’ve made the observations about the hostile environment, but he particularly observes that the groups identified were – the potential audience groups were based on residency, ethnicity and socio-economic circumstances and health concerns. That’s in his note to the Inquiry from August this year.
We say again that fails to quite capture the fundamental difference between – and access to vaccines based on immigration status and identifying the potential audience on ethnicity alone doesn’t go far enough and is an insufficient basis on which to identify persons, relevant persons, and the full spectrum – otherwise the full spectrum of migrant voices may be omitted through that process.
So we invite the Inquiry to specifically include in the target audience for the KLOEs non-British nationals, and specifically to hear evidence from documented and undocumented migrants as to the fear of authority and contacting the authorities and, crucially, why that includes persons who do have immigration status. Our clients can provide that, so we do invite the Inquiry to receive that evidence in due course.
The final point relates to the scope of Module 4, and as far as we’re aware, and I’m sure I’ll be corrected if I’m wrong, that it doesn’t currently specifically address migrants of the immigration detention state and migrants living in remote Home Office accommodation sites such as, sort of, Napier Barracks, Penally, those kinds of sites where there are other restrictions in place on those who are accommodated there. Again, an expansive approach and consistent with the terms of the Inquiry and particularly about the public health response across the whole of the UK we say should include those persons in immigration detention.
So, again, as far as we’re aware, there is no other core participant within Module 4 who will address that circumstance.
So those are the points, my Lady, that we wish to raise. I do emphasise particularly that we’re interested to hear the point about where the Secretary of State for the Home Department lies in terms of participation, but we also finally then thank you for allowing this core participant to participate specifically in the Inquiry.
Thank you.
Lady Hallett: Thank you very much indeed. Thank you.
I think you’re in a similarly difficult position to see, Mr Willers, aren’t you?
Mr Willers KC.