Published: 07 March 2023
Version: 1.0 Feb 2023Print this document
- What are the health impacts of having ‘No Recourse to Public Funds’?
Many migrants in the UK are subject to the condition of ‘No Recourse to Public Funds’ (NRPF). This arises from a person being subject to immigration control, as described by Section 115 of the Immigration and Asylum Act 1999. Being subject to NRPF may result in economic hardship and hence individuals being unable to meet their basic needs – as such, NRPF represents a risk to public health. A person who has NRPF has no entitlement to most welfare support paid by the state, including income support, housing benefits, and a range of allowances and tax credits. Being subject to NRPF also means a person has no access to homelessness support or entitlement to be allocated social housing. It is estimated that almost 1.4m people in the UK are subject to the NRPF condition.
NRPF applies to most migrants in the UK until they obtain indefinite leave to remain or are granted British citizenship (people granted refugee status also do have recourse to public funds). Most visas require a migrant to live and work in the UK for five years before an application for indefinite leave to remain can be made. People who have had 10 years of continuous lawful residence in the UK are also eligible to apply for indefinite leave to remain.
People with NRPF are a heterogeneous group, from diverse backgrounds, who experience a variety of economic and social situations. Many people with NRPF are working, some in well-paid roles, albeit without the safety net of welfare support. Others are in low-paid work or not working, and may be supporting families without being in receipt of welfare support. Individuals and families with NRPF lack a state-sponsored safety net should difficulties arise in their economic or practical circumstances, as seen for example during the COVID-19 pandemic or other economic shocks. Consequences may include experiencing cycles of unstable housing, mounting debt, and poverty. These may result in significant negative health impacts, particularly among the most vulnerable individuals, including children. The responses of local authorities (LAs) to people subject to the condition of NRPF are likely to impact upon health outcomes – and also on health inequalities, given that impacts may be experienced differently by different population subgroups.
People with NRPF are eligible to receive assistance from their LA via a range of services including education and social care. LAs have duties under legislation including the Care Act 2014, the Children Act 1989 (Scotland: the Children Act 1995; Northern Ireland: The Children Order 1995), and the Human Rights Act 1998. No additional funding is received by LAs for any costs associated with supporting people with NRPF. LAs differ in the extent to which they exercise their powers to support people with NRPF. Differences are observed in access to support, and responses vary across regions. Level of support provided, and response to entitlements, appear to be linked to geography and suggest potentially inappropriate application of the law and/or inconsistency in interpretation of legislation.
Data collection and recording of issues related to NRPF is problematic. The risk of stigmatising people subject to NRPF needs to be balanced against building an accurate picture of the impact of NRPF. There is limited research conducted in the UK that has investigated the health impacts of living with NRPF. A small body of published research is available, primarily in the field of social work, reporting on specific issues, such as domestic and gender-based violence. More research is needed to understand the health impacts and consequences of being subject to NRPF, particularly among children and families. Interventions intended to mitigate negative health impacts are also needed.
The Public Health Research (PHR) Programme wishes to commission research on the health impact that LA actions (the exercising of available powers) have on people subject to NRPF. The actions studied can be either the operationalising of powers, or initiatives aimed at mitigating any health harms of having NRPF. The impact of NRPF disproportionately affects women, ethnic minorities, people on low income, and people with disabilities; there are evidence gaps regarding vulnerable males and impact of NRPF. The PHR Programme is predominantly interested in interventions operating at a population level rather than at an individual level, and that address health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways, and encourages researchers to explore such disparities in their study design.
The PHR Programme recognises that this call is broad in its nature but would like researchers to be targeted in their chosen research area. Examples include:
- Evaluations of different LA actions to support people subject to NRPF.
- Evaluations of interventions aimed at supporting the health of single adults who have NRPF, particularly vulnerable men.
- Explorations of interventions aimed at families, particularly lone parents with NRPF.
- Research into interventions seeking to mitigate the impact on children of being born to a person who has NRPF.
- Evaluation of interventions that aim to guide people in ‘navigating the system’ when they have NRPF.
- Research into the impact that the nature of the relationship between LAs and the third/voluntary sector has on outcomes for families with NRPF.
- Evaluation of interventions designed to address health impacts on people with NRPF who are not (yet) in crisis or who do not (yet) have acute needs.
- Explorations of the health impact of potential practice variations under Section 17 of the Children Act 1989 (or equivalent) between LAs in supporting individuals and families with NRPF.
There is limited research on the health impacts of having NRPF, as well as a lack of longitudinal research exploring the temporal aspects of being subject to the NRPF condition for long periods of time. Because of this, the Programme is willing to consider epidemiological research or expanded development of an intervention. Please contact the programme to discuss before applying.
A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of health outcomes, target population group, as well as the rationale for their methodological approach. Researchers are encouraged to consider additional outcome measures including those relating to the broader determinants of health and health inequalities, which should be specified and justified. Researchers will also need to specify key outcomes and how these will be measured in the short, medium and long term.
Understanding the value of public health interventions – whether outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Researchers are strongly encouraged to ensure that service users, including people with lived experience from the target audience, are involved in the design and planning of the intervention and/or as potential, suitably rewarded, members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences and they might do this through involving them as costed/rewarded members of the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences, and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practice, and ensure their proposed research is complementary.
For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information. These can be found by clicking on the relevant commissioned call on the main funding opportunities page. This also includes closing dates and details about how to apply.