Our advice lines are full of terrified women, scared to go to antenatal appointments in case they are charged, even if they should be exempt.
Soman Noori, a 26-year-old Afghani asylum seeker, gave birth to a baby girl at 30,000 ft while on an evacuation flight from Kabul to Birmingham last month. There was no doctor aboard, so the crew delivered the child in an airline seat.
She was lucky – her care was free.
New research from Maternity Action has found that many other pregnant asylum seekers and vulnerable migrant women are being charged thousands of pounds for NHS maternity care – even though the law says they should be exempt.
Under rules first introduced in 2004 and revised in 2017, NHS Trusts have a legal duty to issue financial charges, including for vital maternity care, to those “not normally resident in the UK”.
There are various exemptions intended to protect the most vulnerable pregnant women and new mothers – including asylum-seekers and those who are destitute.
But our new research report, Breach of Trust, has found that NHS Trusts are routinely failing to apply these legal safeguards correctly. As a result, vulnerable women are being wrongly issued with invoices for thousands of pounds.
Some Trusts are taking an extremely aggressive approach to payment, including using debt collection agencies to pursue unpaid charges
It’s hard to overstate the impact of maternity charging on the health of mothers and their babies. Our advice lines are full of terrified women, scared to go to antenatal appointments in case they are charged, even if they should be exempt.
This makes it much harder for midwives to deliver essential care, which is particularly worrying as this group is at higher risk of health complications.
These are women like Ann, who was undocumented at the time of her daughter’s birth, but now has leave to remain in the UK. She is currently challenging her charges on the grounds of destitution. She said:
“I didn’t attend any antenatal appointments because I didn’t know if I would have to pay.
When I was 28 weeks pregnant, I experienced severe pain and went to hospital. My daughter was born but only lived a few hours.
While the baby was blue in my hands, the lady from the overseas office came and said, “If you sleep on our bed, we’re going to charge you.”
Our report sets out case studies of errors in assessing immigration status which resulted in women entitled to free NHS care being wrongly invoiced; of women being charged when they are covered by an exemption; and of NHS Trusts aggressively chasing payments from women who are clearly destitute and so have no means to pay.
Department of Health & Social Care guidance supports debt write-offs for women who are destitute. However, our report reveals some Trusts are taking an extremely aggressive approach to payment, including using debt collection agencies to pursue unpaid charges.
Maternity Action is urgently seeking changes in the practice of Trusts to reduce the negative impact of charging on migrant women’s access to maternity care.
We’ve worked with the Royal College of Midwives to develop guidance to assist NHS Trusts to comply with the law, and we’d urge MPs to engage with their local Trusts to ensure that all NHS England Trusts adopt this guidance.
We’re also calling for Trusts to immediately undertake an audit of Overseas Visitor Manager files of women charged for maternity care to determine compliance with regulations and guidance, Trust policy and the Trust’s legal obligation to reduce health inequalities; and undertake swift remedial action where shortfalls are identified.
Finally, we’re calling on Trusts to release public reports on progress towards implementation of the guidance.
We must protect those who are exempt from NHS maternity charging – the lives of our most vulnerable mothers and babies depend on it.
Ros Bragg is the director of Maternity Action.
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