A/HRC/41/54/Add.4 36. NHS England will provide a range of support to local healthcare systems to help them meet their LTP health inequalities commitments. This includes: • The development of a Menu of Evidence Based Interventions: NHS England is currently working with a range of stakeholders to develop the menu including Public Health England, Local Government Association, and Health and Wellbeing Alliance partners (which includes Friends, Family and Travellers who represent the Gypsy, Roma and Traveller communities). The approach, content and evidence outlined in the menu will look to ensure that local healthcare systems effectively outline their key priorities with a focus on how they will narrow health inequalities over the next 5 years, with specific targets on specific groups including Gypsy, Roma and Traveller people living in the most deprived areas, BAME groups and other protected groups. • Development of Primary Care Networks (PCNs): NHS England is developing health inequalities learning resources which support the PCNs to address health inequalities. Part of this work will be linked to the menu of evidence-based interventions and through joint working with Public Health England and the development of its Health Inequalities Joint Strategic Framework. • Embedding health inequalities in Vaccinations and Immunisation programmes: NHS England is working with the national programme to ensure screening and vaccination programmes are designed to support a narrowing of health inequalities and to ensure the focus on inclusion health groups such as Gypsy, Roma and Traveller communities is embedded in all the work areas. 37. The NHS Long Term Plan sets out actions that maternity services will take to help drive down health inequalities. NHS England will implement an enhanced and targeted continuity of carer model to help improve outcomes for the most vulnerable mothers and babies. By 2024, 75% of women from BAME communities and a similar percentage of women from the most deprived groups will receive continuity of care from their midwife throughout pregnancy, labour and the postnatal period. This will help reduce pre-term births, hospital admissions, the need for intervention during labour, and women’s experience of care. Women from the most deprived communities are 12 times more likely to smoke during pregnancy than women from more affluent areas. In addition to the enhanced midwife model, the NHS will offer all women who smoke during their pregnancy, specialist smoking cessation support to help them quit. 38. Para 30 - The NHS is a comprehensive public health service, free at the point of delivery for those who are ordinarily resident in the UK and operated on a devolved basis by the four UK nations. Overseas visitors who are visiting rather than residing in the UK and those without lawful status have been subject to NHS treatment charges for accessing secondary care services since 1982 and it is right that the UK has appropriate arrangements in place to protect such an important national tax-payer funded resource. 39. The report does not mention the important safeguards inherent in the NHS charging regime which protect the vulnerable. It suggests that women with refugee status have been deterred from seeking maternity care for fear of immigration enforcement action, but UK law is clear that refugees have lawful immigration status in the UK and enjoy the same access right to the NHS as other lawful UK residents. UK law and policy are also equally clear that medical treatment which is urgent or immediately necessary, including maternity services for expectant mothers, should never be withheld irrespective of the patient’s chargeable status. There are no restrictions on who can access GP or accident and emergency services. 40. In administering the charging regime, NHS staff are not involved in immigration enforcement but are operating in accordance with NHS legislation. A recent Department of Health and Social Care review into the impact of regulation changes made in 2017 (including the requirement to obtain payment in advance of non-urgent treatment) did not find significant evidence that changes to the regulations have themselves led to overseas visitors being deterred from treatment. However, Government is doing more to ensure the Charging Regulations are applied properly and fairly and have already updated guidance to emphasize that the longer a chargeable overseas visitor is likely to remain in the UK, the more of their needs are expected to be classed as urgent and provided regardless of advance payment. 8