Author: Denis Campbell
In 2015, the then prime minister David Cameron hailed the British volunteers, including scores of NHS staff, who worked at the Ebola treatment centre at Kerry Town, near Freetown, the capital of Sierra Leone, as “heroes”. Each received a commemorative medal etched with their name as a mark of appreciation of their efforts.
Now at least 20 doctors, nurses, midwives, dentists and others are handing their medals back. They want to register their disgust and abhorrence at how “hostile environment” immigration policies, introduced by Cameron’s successor, Theresa May, have made access to NHS care difficult and sometimes impossible for many.
The double whammy of eligibility checks and upfront charges for care that hospitals in England have had to enforce since last October represent a significant hardening of a tough approach to migrants’ use of the NHS that began in 2014.
That year, the Immigration Act changed the definition of the concept of “ordinarily resident”, with the result that more people lost their entitlement to free NHS care. From then on, NHS access for nationals from outside the European Economic Area was limited to those with “settled status” – indefinite leave to remain in the UK.
In 2015, using regulations under the same legislation, those deemed ineligible for NHS care had to start paying 150% of the cost of any hospital treatment they received, though people were billed retrospectively, not in advance. In addition, NHS trusts could share with the Home Office the details of anyone who owed the NHS at least £1,000, which could affect their immigration status and ability to enter Britain from abroad. That sum has since been reduced to £500.
The same regulations introduced an annual £200 “immigration health surcharge” payable by any overseas visitor entering Britain on a visa to work, study or visit relatives, and also all members of their family. It is due to double to £400 this autumn.
It applies to countries with which the UK does not have reciprocal arrangements to provide healthcare to their citizens.
Even health professionals from overseas who come to work in the NHS for fixed periods have to pay the £200, as do their partners and children. Healthunions have denounced the surcharge as a deterrent to foreign staff to come to work in the overstretched NHS.
But separate new regulations last year have proved the most contentious yet. They mean hospitals in England have to ascertain a patient’s immigration status upon arrival and, if they are not eligible for NHS care, they must pay for any treatment in advance – at 150% of the true cost – or else be denied it.
The charging regime applies to most forms of care patients receive in hospital but does not extend to care in A&E, at a GP surgery or at an NHS clinic which provides public health services, such as sexual health care.
NHS staff, and groups such as Medact, Docs Not Cops and Doctors of the World, have opposed upfront charges which, they claim, are deterring sick people in fragile, vulnerable circumstances, such as those who are destitute after being denied asylum, from accessing NHS care they need, either because they cannot afford to pay or because they are scared they will be hit with a bill.
There is particular concern about pregnant women not attending antenatal care which could prove vital for their own, or their baby’s, health.
And there is unease that patients who are seriously unwell are often not receiving care they need, despite their condition meaning that their treatment is “urgent or immediately necessary” which, under the regulations, means the upfront charges should not apply. That inconsistency was illustrated by the case of Albert Thompson.
Regardless of the fact the Windrush generation Londoner was unable to prove his entitlement to NHS care, the advanced nature of his prostate cancer meant radiotherapy was “urgent or immediately necessary”. Nevertheless, the Royal Marsden cancer hospital in London refused to treat him unless he paid £54,000 first.
“Ife Abimbola” (not her real name) is the human face of the charges faced by those deemed ineligible to receive NHS care. She has been billed £14,447 by the Homerton hospital in Hackney, east London, for giving birth to her son and daughter there in 2015 and 2016.
“I got a letter from the Homerton last October telling me to pay the £14,447, even though no one at the time I had my children there told me I would have to pay. I was crying when I received the letter. I didn’t know what to do. I have no money. My only income is the £280 a month I get from Hackney council,” she says.
The 42-year-old came to Britain from Lagos, in Nigeria, in 2007, overstayed her six-month visitor’s visa and hopes to be allowed to stay, though has been refused asylum several times. She is destitute, lives in a council flat, is unable to work and gets clothes for her children from a charity.
“After receiving the bill, I told my doctor that I would never open another letter with ‘NHS’ on it ever again because it was too scary, in case there was another bill inside.
“I cry all the time because of the bill and I can’t sleep at night for thinking about it. They shouldn’t just suddenly hit people with a bill for thousands of pounds. The bills, the charges, are killing women. My blood pressure is now so high that I take tablets for it. I’m a single mum with two kids. Do they want me to die?”
Abimbola is open to paying the £14,447 back in small amounts, but doing that depends on being able to work, which depends on her being granted asylum. It is unclear if her claim will be successful.