Fear of bills and Home Office keeping pregnant migrants away from NHS
Charities warn women are avoiding ante-natal care Trusts demand payment against official guidelines
Hundreds of pregnant women without legal status in Britain are avoiding seeking NHS ante-natal care because they fear being reported to the Home Office or facing costly medical bills, say charities that work with vulnerable migrants.
The Guardian has seen letters from one NHS trust, sent to women with complex asylum claims, warning them that their ante-natal care will be cancelled if they fail to bring credit cards to pay fees of more than £5,000 for maternity care.
The letters contravene NHS guidelines, which state that maternity care should never be denied.
Doctors of the World, which runs clinics for trafficked women, undocumented migrants and asylum seekers whose claims have been rejected, is dealing with growing numbers of women in the late stages of pregnancy seeking medical help at its east London clinic.
The women say they are too scared to go to the NHS for fear of high bills or being reported to the Home Office.
In January a woman went to the clinic in labour, having had no ante-natal care. “She was very fatigued, she was pale. She had been too frightened to go to hospital because of her immigration status,” said Deman Le Déaut, who runs the women’s and children’s clinic in Bethnal Green.
This was the second woman in four months who had gone to the clinic for the first time at the end of a pregnancy, and who had not accessed mainstream healthcare. “We are seeing a lot of women six months pregnant onwards, not accessing medical care. That is incredibly dangerous,” Le Déaut said.
One patient, from Eritrea, was in the early stages of pregnancy, homeless and living in a bus shelter when she visited the clinic, having been wrongly turned away from a GP because she had no proof of a home address.
A number of women have visited the clinic alarmed by debt-collection letters sent by NHS trusts, which instruct them to attend ante-natal appointments with money to pay deposits of several thousand pounds for maternity care.
“Please ensure you bring your credit/ debit card or cash to this meeting. Please note the trust will not accept part payments or any delay in paying the deposit,” a letter sent by Barking, Havering and Redbridge university hospitals trust said.
“Failure to pay a deposit for treatment may result in your future appointments being cancelled. Overseas visitors who incur costs for treatment and do not pay will be reported by the trust to the Home Office and debt collecting agencies. The Home Office will review all records of bad debt and this could be detrimental to any future applications to visit the UK.”
NHS rules state that it is legitimate to seek payment from those not eligible for free care – those not ordinarily resident in the UK or living here illegally – but emergency treatment cannot be withheld.
A Department of Health (DH) spokesperson said NHS staff should be “especially careful to inform pregnant patients that further maternity healthcare will not be withheld, regardless of their ability to pay”.
The spokesperson said: “Our guidance specifically says that maternity care should never be denied or delayed while a patient’s eligibility is established.”
The Barking, Havering and Redbridge NHS trust said it had recently updated the standard letter to make “it clearer that maternity care would never be withdrawn or appointments cancelled”.
Le Déaut said: “It is bad practice to send these letters demanding credit cards. You are not supposed to threaten pregnant women – documented or undocumented – that you are going to withhold services. These people have no means whatsoever to pay this debt.”
One patient was phoned by a debt collection agency on a weekly basis, which had a negative effect on her mental health, according to staff at the charity.
The charity Maternity Action, which runs a helpline for women, has also noted rising demand for its services. “We regularly hear from women who are very distressed about receiving large bills from the NHS for maternity care. It is pointless sending letters of demand to women who can’t afford to pay for food and housing,” said Ros Bragg, the charity’s director.
The DH spokesperson said that no one should be denied urgent treatment and “vulnerable people, including those seeking asylum, and refugees, are not charged for NHS care they receive”. at the clinic, said: “This is not health tourism by any stretch of the imagination. These are people at the outer reaches of society, [with] cash-in-hand jobs, providing the infrastructure for society but unable to access healthcare. The women I’ve seen tend to be very anxious, nervous.”
Staff said there was growing awareness among patients of a memorandum of understanding, published by the Home Office and NHS Digital, which came into effect on 1 January and sets out how the Home Office can ask the NHS for information on immigration offenders.
“When they hear if you go to the doctors the Home Office might be knocking on your door, they choose to stay away,” Le Déaut said. She said she understood the need to ensure “health tourists” paid.
Binta,(not her real name) a pharmacist from Sudan, arrived in 2010 to visit her husband, a Sudanese doctor with a British passport. While she was trying to organise permanent residency she became pregnant. The Home Office said she needed to go home to apply for a new visa. By then in late pregnancy, she did not feel able to travel. Papers for her appeal did not come immediately, so she found herself ineligible for NHS care. When the GP referred her for a scan she got a £2,669 bill. “I was very frightened. I thought that they would deport us, or I would be sent to jail.”
Her husband, who is now requalified and working as an NHS doctor but was unemployed at the time, said: “They kept re-sending the invoice … we couldn’t afford [it]. It distracted me from that beautiful moment of birth – all the time I was thinking about the money and [if] they were going to take me to court.”
Deman Le Déaut, left, manager of Doctors of the World’s London clinic, says vulnerable women are facing NHS demands for charges they can’t pay, below