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Lewisham and Greenwich NHS Trust report examines the controversial practices used when charging migrants for health care


South-east London NHS Trust used credit check firm to find and pursue patients who could be charged for treatment

Date of Publication:
15 July 2021

Lewisham and Greenwich NHS Trust report examines the controversial practices used when charging migrants for health care

15 July 2021

A report was published last month by the Lewisham and Greenwich NHS Trust following an inquiry by an oversight panel into the practices for charging migrants at University Hospital Lewisham and Queen Elizabeth Hospital in Woolwich, which treat patients in the south-east London boroughs of Lewisham, Greenwich and Bexley.

NHSThe report was publicised at the time by Lewisham Refugee and Migrant Network (LRMN) and the Save Lewisham Hospital Campaign (SLHC) and by local press, and it has recently had some national media coverage.

The 32-page report can be downloaded here.

As explained by LRMN, the report examines the controversial practices used when charging migrants and overseas visitors for health care at the two south-east London hospitals, including the use of credit check firm Experian to find and pursue patients who could be charged for treatment.

LRMN and SLHC said in a joint statement last month: "Since 2013 and up until 2019, the Trust shared patient information with Experian to identify patients chargeable for NHS care. The partnership with the credit check firm was approved by NHS Improvement (part of NHS England), who in January 2019 promoted the partnership to eight trusts to carry out similar checks. Thanks in large part to this partnership, Lewisham and Greenwich NHS Trust referred 1,085 debts worth £5.4m to debt firms (that used bailiffs to collect debts) from 2016 to 2018, which was said to be the highest in England according to an investigation by The Guardian in 2019."

For background, see the Health Service Journal's September 2019 article here.

An Oversight Panel was established by the Lewisham and Greenwich NHS Trust in 2020 to examine the controversy and to find the best way to implement national policies for charging people who are not eligible for free NHS services whilst fulfilling the Trust's values of compassion and respect for patients.

Last month's report by the Panel states: "Over the course of the past eighteen months the Panel has received independent assurances that the Trust's application of the current framework for patient charging is in line with legislative guidance. However, the Panel's work has also highlighted to management a number of instances where the Trust's past approach to implementation of its legal duties to charge patients has not been delivered in the most empathetic or compassionate way. As is demonstrated by some of the case studies shown at Appendix 7 to this report, the Trust's approach may have resulted in patients feeling uncomfortable, scared or unable to seek timely treatment and/or choosing to go to other hospitals for their care."

Lewisham and Greenwich NHS Trust said it sincerely regretted, and apologised for, any instances where patients were not treated with compassion, or in a manner consistent with the values of Trust.

The Trust suspended its contract with Experian in October 2019 and has since formally terminated the contract.

LRMN and SLHC both participated in the Oversight Panel and they recounted how patients affected by the Trust's practices described a lack of empathy and compassion from staff as they pursued debt from new mothers, homeless patients, and even some patients who were eligible for free NHS treatment.

One patient said: "I was charged about £7,000. I was staying in one room accommodation and I couldn't even afford a payment plan to pay back the debt. There were threats that they were going to report me to the Home Office and I received calls every day. This was at the same time that my child was diagnosed with autism."

Another was quoted as saying: "I have a friend who had a tumour in his head and was too afraid to get care - as he couldn't afford the bill and didn't want to be reported to the Home Office and forced into detention. In the end, we had to call an ambulance - things got too terrible."

The report has broader significance beyond Lewisham and Greenwich NHS Trust and it highlights the inherent tension in the practice of charging migrants for health care.

It states: "Putting patients at the heart of the NHS is an often-stated aim of national government and local NHS organisations. All NHS trusts have a legal duty to identify patients who are not eligible for free NHS care and to charge them for that care. At the same time, clinical and non-clinical staff aim to make sure that patients who attend their Trust – or who need to attend for care – can access care and treatment. A tension exists between the legal requirement to charge non eligible patients whilst keeping their health care needs at the centre of the caring relationship. That tension can and does affect patients, clinical staff, and members of the Overseas Visitors Teams. However, all clinical staff have a professional duty to place the best interests of their patients first and foremost. These potentially conflicting obligations can place staff in moral dilemmas if handled inappropriately. It is the responsibility of every NHS Trust to live within legal and financial regulations while recognising the professional responsibilities of their staff."

LRMN and SLHC said the report reflects much of what they know about the NHS charging regulations and how the legislation is putting patients' lives at risk up and down the country.

The organisations said: "The immigration system is extremely complex, making it difficult for many to settle their status and leaving them and their children open to charging despite living and working in the UK for many years. The charging practices are a result of the hostile environment legislation which has had far reaching effects on universal access to NHS healthcare free at the point of need. Once considered a precious right, the right to healthcare is slowly being chipped away. Today, NHS trusts are being forced to become border guards, demanding documentation, raising invoices, denying treatment and sharing patient details with the Home Office, which only spreads fear and distrust in communities and has prevented many from seeking life-saving care."