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Doctors of the World UK highlights impact of NHS patient charging policy on vulnerable migrants


Medical charity says HNS charging is a threat to patient and public health

Date of Publication:
15 October 2020

Doctors of the World UK highlights impact of NHS patient charging policy on vulnerable migrants

15 October 2020

The medical charity Doctors of the World UK (DOTW) yesterday published a new report on the impact that NHS charging has on migrants in vulnerable circumstances.

LogoThe 20-page report is here.

DOTW runs permanent and mobile clinics in London and provides medical care, information and practical support to excluded people such as destitute migrants

The report explains: "In June 2018, DOTW launched the Hospital Access Project to provide specialist casework support and legal advice to people refused NHS hospital care or non-primary care related NHS services in the community due to their immigration status in the UK and as a result of the NHS Charging Regulations (2015 and 2017). This report presents the findings of an audit of service user data collected by caseworkers delivering DOTW's Hospital Access Project between July 2018 and July 2020. The study population is 27 individuals who have been assessed by an NHS service as not 'ordinarily resident' in the UK and have been refused access to services. It includes those who have had services withheld pending payment upfront."

The report's key findings are as follows:

• 44.4% (12/27) of service users had a refused asylum claim and 37% (10/27) had an outstanding human rights or asylum application, or appeal.

• In total, 44.4% (12/27) of service users could not be removed from the UK due to an outstanding legal case, for example an outstanding human rights application or appeal, an outstanding asylum claim or appeal, or an outstanding judicial review, which meant they could not be removed from the UK until their case had been closed.

• 96.3% (26/27) of service users were destitute, which meant they did not have adequate accommodation or any means of obtaining it or could not meet their other essential living needs.

• The average delay in receiving treatment was 37.3 weeks. 51.9% (14/27) of service users experienced a delay of over six months (26 weeks) and the longest delay was 4.1 years (224 weeks).

• 59.3% (16/27) of service users required an 'urgent' or 'immediately necessary' NHS service, with an average delay in receiving treatment of 36 weeks. The longest delay for treatment for a life-threatening or serious health condition was 2.5 years.

• In 22.2% (6/27) of cases requiring 'urgent' or 'immediately necessary' treatment, the NHS trust did not follow the guidance and apply a charging exemption and the service user was wrongly charged for their treatment.

Anna Miller, the author of the report and DOTW's Head of Policy and Advocacy, said: "The report lays bare the true impact of the NHS patient charging policy on patients. Put simply, those who cannot afford to pay have to go without treatment, however desperately they need it.

"It shows that all the safeguards put in place to ensure urgent medical care is provided regardless of a person's ability to pay aren't working, and patients suffer for months, sometimes years, on end, alone."

Miller added: "At best, the NHS charging policy is problematic, unworkable in practice, and a poor use of NHS resources. At worst, it is reckless and a threat to patient and public health, and the UK's commitments to achieve universal healthcare coverage."

The British Medical Association's Chair of Council, Dr Chaand Nagpaul, told the Guardian: "It is alarming and disturbing that this report highlights the scale of delays and obstruction to urgent care facing migrants who are seeking asylum in our nation, including those who are entitled to free NHS care. Safeguards must be in place to protect people in vulnerable situations from inhumane delays to treatment, as well as ensuring that those who need immediate treatment aren't deterred from seeking it."

Responding to the report, a Government spokesperson told the Guardian: "Urgent treatment should never be withheld. Services such as NHS 111, primary care and A&E continue to be free of charge to all patients – including those from overseas.

"Many migrants to the UK are entitled to free NHS care because they are ordinarily resident here or exempt from charge. This includes vulnerable people like refugees, asylum seekers and victims of modern slavery."