NHS trusts are wrongly hounding vulnerable migrant women for payment of bills of thousands of pounds for maternity care, according to a report.
While some women who have been trafficked, persecuted in their home countries or subjected to domestic violence in the UK have found themselves saddled with bills of several thousand pounds that they are unable to pay, others are avoiding accessing maternity care at all, putting themselves and their babies at risk, because they fear the financial cost.
The report, Breach of Trust: incorrect implementation of the overseas charging regulations by NHS trusts in England, from the charity Maternity Action, is calling on the government to suspend maternity charging for migrants, after finding multiple examples of trusts wrongly billing extremely vulnerable migrant women for their maternity care. The Royal College of Midwives has joined the charity in condemning the NHS charging policy for this group of migrant women.
While “hostile environment” rules say that migrant women must be charged at 150% of the rate charged to NHS clinical commissioning groups that purchase maternity care from hospital trusts, there are exceptions for certain vulnerable groups such as trafficked women, asylum seekers and women who are destitute. However, different NHS trusts interpret the guidance in different ways, with some taking a harsher approach than others.
One woman who was hospitalised when she was heavily pregnant after a serious domestic violence attack by her partner was told by the NHS trust that billed her for maternity care that she did not qualify for a charging exemption as a victim of domestic violence because the attack was a “one-off”.
Another woman, Ann, was told she would be billed for her maternity care hours after the death of her baby, who was born at 28 weeks, five years ago. She is challenging bills of more than £9,000 relating to the baby who died and the birth of a second child from two different London hospitals.
“I didn’t attend any antenatal appointments because at the time I was undocumented and I didn’t know if I would have to pay,” she said. “When I was 28 weeks pregnant I experienced severe pain and went to hospital. My daughter was born and only lived a few hours.
“While I was still recovering in hospital, I was told I would be charged for the birth and that every night I stayed in hospital would be an extra charge. I got the bill before I could even bury my daughter. The debt is lingering and my life is like a rollercoaster. I often can’t afford to eat and don’t know how my child and I will survive. I wish someone would come to my aid.”
The report raises concerns about the aggressive way some NHS trusts go about recouping the money. “We are finding the language used in communications to patients are overtly hostile and not in the spirit of patient-centred care which the NHS strives to achieve,” it states.
Ros Bragg, the director of Maternity Action, said: “We’ve found multiple examples of women being charged when they should be exempt and of NHS trusts aggressively chasing payments of women who are clearly destitute and have no means to pay.
“It’s hard to overstate the impact of maternity charging on the health of mothers and their babies. Our advice lines are full of terrified women, scared to go to antenatal appointments in case they are charged, even if they’re supposed to be exempt.”
Clare Livingstone, a professional policy adviser at the Royal College of Midwives, said: “Charging these women is not only wrong, it is dangerous. There must be no barriers that prevent or makes these women fearful of coming to our maternity services for the care they need.
“Midwives should not be pressured into reporting women’s immigration status. Their job and their focus must be on giving these women the safest and best possible care.”
Dr Edward Morris, the president of the Royal College of Obstetricians and Gynaecologists, said: “Under no circumstances should migrant women be charged by the NHS to access maternity care. These women are already extremely vulnerable. Often they will have complex clinical and social needs and they are already at higher risk of poorer maternal and neonatal outcomes.”
A Department of Health and Social Care spokesperson said: “Our health service is taxpaye- funded and everyone plays a part in supporting it. It is right that overseas visitors help contribute towards treatment costs. We recognise any healthcare costs can create challenges and there are important exemptions for certain types of care, as well as vulnerable groups like asylum seekers and victims of modern slavery.
“The law is also clear that immediately necessary treatment – including all maternity services – must never be delayed or withheld, regardless of whether someone can pay.”