Patients or passports? The 'hostile environment' in the NHS.

Throughout the pandemic, the NHS has continued to charge certain patients for their care based on their immigration status and to report patients with outstanding debt to the Home Office. Research has consistently shown that these policies act as a significant barrier to healthcare access for already minoritised communities, and that during the pandemic patients have remained fearful and reluctant to seek care due to charging, including care for 'exempt' conditions such as COVID-19. Charging policies, and associated data sharing, represent only one of the myriad ways in which structural and 'every day' racism operate to impact health; however, they undoubtedly form a part of the picture as to why COVID-19 has disproportionately affected many minoritised communities. © Royal College of Physicians 2021. All rights reserved.