‘Charging overseas patients for maternity care could risk lives’, warns health committee chair

The chair of an influential council health committee has warned that the policy of charging overseas visitors could “put women and babies’ lives at risk”.

Cllr Ben Hayhurst (Lab, Hackney Central) was speaking following the recent disclosure that invoices for maternity care were sent to 739 women by Barts Health NHS trust in 2018/19.

Barts has since clarified that a “large number” of patients invoiced for treatment were able to prove they were eligible to receive it free of charge, with the Trust receiving payments from 162 people from a revised cohort of 449 maternity patients, with 287 left outstanding.

Cllr Hayhurst said: “I have written previously to the Secretary of State about our concern with respect to overseas charging.

“It puts women and babies’ lives at risk if women are deterred from seeking much-needed medical help or afraid of their details being passed to the Home Office.

“It remains wholly unclear if in fact the overseas charging scheme costs more to administer than is ever brought in, making the whole thing counter-productive.”

Barts says it has now amended its standard billing procedure, with patients to first receive an advisory ‘notice to charge’ rather than an invoice, and has underlined that none of the 739 patients cited were denied maternity care.

When quizzed by the LDRS on whether Cllr Hayhurst’s latter point on counter-productivity was correct, the Trust said it did not hold such information, as the responsibilities of its Paying Patients Department include both overseas and private patients with staffing “flexed according to demand”, meaning the information could not be separated out.

Barts has also stressed that it does not report patients to the Home Office, though it does “ask the Home Office for information about the immigration status of some patients to help establish their eligibility for free treatment”.

Dr Jackie Applebee, a GP in Tower Hamlets, said: “Charging overseas visitors for NHS care is barbaric in that it deters the most vulnerable in society from seeking the medical care that they need in a timely fashion through fear of destitution and deportation.

“Charging also goes against the founding principles of the NHS which were of a comprehensive health service, publicly provided, publicly funded through taxation and free at the point of delivery to all.

“Nye Bevan never intended the overseas visitor to pay and indeed a large proportion of NHS staff, many of whom work in the most lowly paid jobs, are from overseas. The NHS would not survive without them and we owe them a debt of gratitude.”

The Trust has said that it is “happy” to supply figures on overseas visitor numbers and eligibility for free NHS treatment at its next public board meeting, with a view towards publishing annual statistics on the topic, saying that its door is “always open” to campaigners.

It has also put out an information leaflet for new arrivals setting out what details are shared with the Home Office, specifically a person’s name, gender, date of birth, nationality, address, and treatment dates, with no medical information disclosed.

Three maternal deaths in 2019 were women who “may have been reluctant to access care because of concerns over the costs of care and the impact of their immigration status”, according to a report titled ‘Mothers and Babies: Reducing Risk Through Audits and Confidential Studies across the UK’.

The study observes that while no woman can be refused maternity treatment, this may not be commonly known.

A spokesperson for Barts said: “Those who need care that is clinically deemed urgent or immediately necessary – such as maternity care – will always be treated promptly even if a patient indicates that they cannot afford to pay. We do not turn any patients away.

“Nevertheless, the treatment is not free just because it is provided on this basis. Any patient booking into an emergency department or maternity unit is asked where they have lived in the last 12 months. If there is any question about residency status, the case is referred to the Overseas Visitors Team.

“These staff do their best to help and support patients to understand our mutual obligations around payment. In some cases, they may check an individual’s immigration status with the Home Office in order to assess their entitlement to free NHS care. This gives prompt reassurance and clarity to the patient.

“We recognise that charging is a sensitive issue for many people and are committed to being transparent, fair and equitable to patients and staff in fulfilling our statutory obligations.”

A Department of Health and Social Care spokesperson said: “The NHS is funded by taxpayers and it is only right that those that do not live here on a lawful, settled basis contribute to the cost of their care.

“However, we are clear that urgent treatment – including all maternity services – should never be withheld and we are supporting Trusts to ensure these rules are fully understood.”