A pregnant woman whose baby is probably dead is scared off from obtaining essential maternity care because she can't afford to pay the £2,500 in charges. This doesn't fit with our image of the care provided by the NHS but, as this article in The Independent demonstrates, it is the reality for many vulnerable migrants living in the UK. Plans to extend charging for NHS care, given effect in the Immigration Bill, will worsen the situation and make life particularly difficult for pregnant women.
Systematic arrangements for charging migrants for NHS care have been in place since 2004. Those who are chargeable include some of the most vulnerable women living in the UK. Many are living in destitution and have no capacity to pay the thousands of pounds of charges for NHS maternity care.
In theory, migrant women who are chargeable should be given maternity care whether or not they can pay in advance. In practice, women are being wrongly refused care because they cannot pay or are asked to pay when they are entitled to free care. The Government's recent research on charging practices found that up to 30% of the people assessed by the NHS were incorrectly classified, resulting in charges being imposed on people entitled to free care.
On top of this, many women are frightened of incurring debts they cannot pay and which will affect their rights to stay in the UK. The Home Office very rarely considers an immigration application for anyone with an NHS debt over £1000. This leaves vulnerable pregnant women to decide between scuppering any chances of regularising their immigration status or somehow managing to have a baby without maternity care.
This approach makes no financial sense. Antenatal care can prevent or manage a whole range of conditions which would otherwise require much more expensive interventions from the NHS. An untreated urinary tract infection, for example, can result in a serious kidney disease and premature birth, adding over £50,000 to the cost of care.
The Government has announced plans to extend charging to more NHS services and to a wider group of migrants. Accident and Emergency services, primary care and pharmaceuticals will be charged for. The many thousands of migrants who have a current visa but don't yet have indefinite leave to remain will be asked to pay a migrant health levy or face up-front charges for care. These changes will force many more migrant women to deal with the complexities of the charging system. Vulnerable women will find it much harder to obtain emergency care and essential pharmaceuticals, in addition to the current problems obtaining maternity services.
Many European countries accept the vulnerability and health risk of pregnant women and exempt maternity care from charging, even for women with irregular migration status. By contrast, the UK plans to continue charging for maternity care, stating that even destitute women will be asked to pay.
The reason given for such an aggressive approach is the fear of women travelling to the UK specifically to obtain NHS maternity care without paying. There has been tabloid coverage of claims of women flying in from Africa to give birth in Guy's and St Thomas' Hospital without paying for their care. There is, however, no evidence of any kind to substantiate this. The hospital in question rejects these claims. Government 'research' in this area offers no hard data, relying on mere estimates and assumptions.
It is for these reasons that Maternity Action and the Royal College of Midwives are supporting an amendment to the Immigration Bill to exempt pregnant women from charging for NHS care. The amendment will protect access to care for vulnerable migrant women living in the UK, while still retaining charges for any woman who might travel to the UK specifically to obtain health care. We believe that high quality NHS maternity care should be available to all women, even migrants.