Part 1 NHS Hospital Charging
The Hostile Environment
Most people come to HMC for help with housing and immigration. These needs are closely intertwined, as without immigration status, many of our visitors are not entitled to work or claim benefits and find themselves destitute. This is the result of the creation of a Hostile Environment for migrants, proudly named as such by Theresa May when she was Home Secretary, but in practice, stretching back far longer, and spreading its tentacles to restrict migrants’ rights ever more widely.
NHS Charging
One of the most shocking elements in the Hostile Environment is the eye-watering charges for NHS hospital treatment levied on people with visitor visas or those whose visa has expired. Asylum seekers awaiting a decision are not chargeable but people whose asylum claim has been refused are chargeable unless they are receiving Home Office support. Unless treatment is considered “immediately necessary” or urgent”
Rules and exemptions are very complex with some conditions, especially infectious diseases, exempt from charges. People who have experienced torture, sexual or domestic violence might also be exempt from some hospital charges.
The high costs and complex rules deter many migrants from seeking any healthcare, even GP treatment which is free to everyone, because they are afraid of incurring debts.
The role of advocacy
It is important to get advice if someone has a debt to a hospital as failure to pay a charge to the NHS or to enter into an agreed repayment plan can result in the Home Office refusing an immigration application. For some years until the Covid pandemic our volunteer health advocate Mamie helped visitors with NHS debts to get many charges written off. One visitor with cancer had his fee of £84,000 cancelled and many women had charges of £6,000 to over £10,000 for maternity care.
However, we did not resume health advocacy until 2023 when Jacqueline was faced with impossible charges while living in homeless persons’ shelters.
A true story from HMC
Jacqueline initially came to HMC in 2020 for help with immigration problems. During the pandemic her situation worsened and she became homeless and destitute. Our housing adviser helped her get temporary accommodation but she was placed in very unsafe and unsanitary conditions. During this time she began to have serious medical problems and was twice hospitalised. She was advised that she needed surgery, but her treatment was delayed because possible new underlying causes were found. However, she was afraid the delays were because she couldn’t pay as she was now being asked about her immigration status by the Overseas Team at the hospital and this added extra stress to her already difficult situation. While awaiting her surgery Jacqueline received a bill for nearly £1500 at a London hospital.
At this point we restarted health advocacy at HMC. I began a long correspondence with Jacqueline’s hospital, asking them to write off her debt. Eventually, the hospital agreed to “review the charges” in 6 months’ time to await the outcome of her immigration application. By this time Jacqueline had had her operation but the charges were over £5000.
While still in hostel accommodation and with her immigration case still not resolved, a year later Jacqueline needed further hospital treatment and received another payment demand, bring her bill to more than £6600. Her re-payment has not been written off, but is still under review.
Without health advocacy Jacqueline would still be being besieged by payment demands, probably from debt agencies contracted to the hospital who have no concern for patient welfare.
How we can help
Like Jacqueline, most, if not all of our visitors would be unable to pay hospital charges like these. Since health advocacy re-started at HMC in February 2023 about 20 of our visitors have requested help with hospital charging. In some cases the person was wrongly charged in terms of the government’s own rules. For example a child was charged even though her family are asylum seekers and so not chargeable. With our intervention the charge was cancelled. We have referred several women who were charged for maternity care to Maternity Action, a charity with a specialist advice service for women with no recourse to public funds and others who are especially vulnerable who have been charged for maternity care.
We also collaborate with Patients Not Passports (PNP), a national network which campaigns against all immigration controls in the NHS. The local Hackney PNP group supports advocacy at HMC and works to ensure migrants know their rights to NHS care. In my next blog I will talk about how we help migrants access free community health services to which they are entitled.
– Author: Rayah (HMC Volunteer Health Advocate)