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

The Guardian - - NATIONAL - Amelia Gentle­man

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

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