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Making Children Pay for Their Healthcare Poses Significant Risks

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Government proposals will deny vulnerable children access to vital healthcare

Last month Public Health England (PHE) published figures showing that cases of measles in England had fallen to 24 in the final quarter of 2013. The numbers of confirmed measles cases in England hit the highest levels since 1995 during the first quarter of 2013, when over 600 confirmed cases were reported: children aged 10 to 16 year olds were the most affected. The increase prompted PHE, NHS England and the Department of Health to announce a national catch-up programme in April 2013 to improve MMR vaccination uptake in teenagers.

Around that same time, the government published its plans to limit access to vital health services to children, young people and families on the basis of their immigration status and introduce a system of charging for primary and A&E services through the Immigration Bill. These proposals - currently being debated in parliament - mean that services such as vaccinations for children and emergency treatment may now become out of reach to many children and young people in our communities.

Changes to the exisitng charging system
The government already charges migrants for secondary health care like a hospital stay for example, but the new proposals will mean that individuals could now also be charged for primary care and A&E services. Whilst children and families will still have free access to a GP consultation, any treatment needed as a result of that appointment could now become chargeable, including prescriptions, immunisations and ante-natal services.

Worryingly there will be no exemptions for children and young people. This is despite the government recognising in its response to the public consultation that vulnerable children might be denied treatment as a result of this charging and that there is widespread support for exempting all children from charging. These provisions also run contrary to the government's obligations under international and domestic legislation: under the UN Convention on the Rights of the Child (UNCRC) every child has a right to receive the highest attainable standard of health regardless of their status.

These proposals will affect primarily undocumented migrant children - those who don't have a legal status to stay in the UK. The University of Oxford estimates that there are an estimated 120,000 undocumented children living in the UK, the majority of who were born here while others have grown up in the UK. This is the only 'home' they know and will have no lasting links or support networks in their parents' country of origin. Many of these children will already be at risk of homelessness, destitution, exploitation and social exclusion. They could now be further excluded from key public services.

A threat to children's health and safety
There is overwhelming evidence of the benefits of early intervention programmes, particularly for the most disadvantaged children and families. Early diagnosis reduces unnecessary complications, improving children's health and well-being. Experience from abroad shows that charging for healthcare increases barriers faced by children and their families because parents fear being unable to pay hospital bills causing them to delay seeking treatment when their child was unwell.

Public health put at risk
The government's proposals highlight an exemption for infectious diseases but it is unclear if this means that all children will still be part of vaccination programmes. If children don't get vaccinations, this could pose serious health risks to other children and wider society, and undermines the government's own commitments to reduce the incidence of childhood infections. Restrictions on healthcare access for migrants in Northern Ireland recently caused an outbreak of measles and subsequent hospitalisation.

Increasing family debt as well as costs to government
Some of the destitute children and young people we have worked with through our projects at The Children's Society have already faced difficulties as a result of being forced to pay for hospital treatment. By introducing charging for primary and emergency care, more children and families are likely to be deterred from accessing vital services, incur greater levels of debt or be forced into exploitative situations in order to obtain funds.

Even with a charging regime, the government itself acknowledges that chasing vulnerable migrants for healthcare debts is costly and fruitless when most have no means to pay. Many also argue that the new NHS registration system needed to implement this charging regime is unlikely to be cost effective because of such high operating costs and increased bureaucracy.

Furthermore, increasing barriers for vulnerable children and families to accessing care is likely to increase health inequalities which are estimated to already cost the NHS more than £5.5 billion per year.

We are calling on the government to rethink its proposals to ensure that all children and young people have access to free healthcare while they are in the UK when they need it, regardless of where they're from or who their parents are.