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Where professional interpreters are denied or no action is taken to remove barriers to informational services, there could be a legal case to answer. Legislation, including the Race Relations (Amendment) Act 2000 the Human Rights Act 1998 and the Equality Act 2010, clearly states that service providers must ensure:

• Public access to information and services
• Provision of language support
• Information about how the actions of services impact on different groups

However, it is important to stress that legislation alone will not ensure an accessible service.

Black African mothers, most of whom were recent migrants, were more than five times more likely to die than white mothers; more than half of the migrant women who died had major problems accessing maternity care.

Evidence shows that some of the most vulnerable migrants are restricted in their access to healthcare with serious outcomes.

Late booking for, or no access to antenatal care and lack of access to interpreter or translation services were some of the factors associated with mortality (Lewis 2007).

Political concerns over health tourism negatively affect the delivery of, and access to, health care for migrants.

However the Labour government admitted in the 2007 House of Lords/House of Commons Joint Committee on Human Rights that there was no evidence to suggest reports of the scale and cost of health tourism were true.

In fact, not addressing barriers to accessing health costs the system more. Poor access to basic health care leads to patients finally presenting themselves to medical services in much later stages of illness, which then require more expensive, and often, less effective treatments.

Primary care is freely available to all, regardless of immigration status - including those  not ordinarily resident or undocumented migrants.

A GP has the discretion to register any new patient, regardless of immigration status and provided they do not discriminate.

As immigration status does not affect eligibility to primary care, GPs have no need to establish immigration status before allocating places.

Not having proof of address etc. should not be classed as a reason to refuse registration (HPA, 2011)

A recent report on the health needs of migrants in the south east asked healthcare service providers “Which services are most accessed by migrants in your area?”

The results present migrants in general as accessing A&E the most.

However, when the results are broken down into further categories they show that refugees and asylum seekers actually access the GP more than A&E. Those accessing A&E were in fact most likely to be irregular migrants,  followed by economic migrants.

• Limited or incomplete monitoring of access gives us faulty information about communities that are already vulnerable.
• Good monitoring happens in conjunction with community engagement to explain its function and understand its implications, cultural competency training for staff, established pathways for feeding information into service planning and feedback mechanisms to the community.

Ethnic matching, although useful as part of a program to improve access, cannot guarantee the desired effect in all settings; conversations need to continue with the community to assess impact and suitability.

For example, the analysis of one service set up in this way showed that access did not improve and, in some cases, worsened. It may be assumed that the problems arose when a male doctor was provided to female patients.

However, conversations with Asian women revealed that they had concerns about being seen by Asian male doctors because of social status and confidentiality worries, rather than gender issues (Chapple, 2001).

We need to understand decision-making patterns. Conversations with community representatives and relevant organisations are essential to understand the decision processes which isolate groups and have access to and understanding of how services can be improved.