These Ill & Pregnant Women In The UK Can't Access Healthcare

Photo: Mark Sherratt.
Jeremy was already six months pregnant by the time she first saw a doctor. Born in the Philippines, the 38-year-old had been living in the UK for almost 10 years when she conceived her son, Ethan, but she had never registered with a GP surgery.

When she did try and see a doctor, she was repeatedly turned away; surgery after surgery said she didn’t have the right documents.

“We were so desperate,” Jeremy said, “We felt hopeless because I hadn’t had a proper check-up and we kept getting turned away.” In the end she was only able to access antenatal care with the help of a charity, Doctors of the World (DOTW), a non-profit who run a drop-in clinic for migrants struggling to access services.

Most people in the UK take easily accessible, free healthcare for granted, but thousands of migrants like Jeremy face numerous barriers to accessing treatment. In England, most undocumented migrants and refused asylum seekers are ineligible for free secondary healthcare. This includes antenatal treatment, meaning that pregnant women often have a particularly hard time.

Fear that NHS doctors and hospitals may share information about their undocumented patients with immigration authorities, misinformation regarding entitlement to healthcare, gatekeeping behaviour by GP surgery staff who are unaware of the rules, and the threat of a bill for up to £6,000 just for having a baby mean some migrant women never access services at all, and many others only seek treatment at the last minute.

The current situation is bad – Doctors of the World saw 1,604 people in 2015 – but it could be about to get much worse. Following a "successful" trial by one NHS trust, the Department of Health has said it is considering introducing passport checks for people seeking non-emergency treatment at all UK hospitals.

Some hospitals have already said they will trial a version of the scheme out of choice, with expectant mothers at St George’s in Tooting soon to be asked to provide papers showing they are eligible for free NHS care when they arrive for scans. Those unable to do so are to be referred to the Home Office (who are reportedly very supportive of the scheme) and could face deportation, according to The Guardian.

Charities like DOTW argue that creating additional barriers to accessing treatment, and placing the burden of proof of entitlement to healthcare onto patients is irresponsible.

Doctors are caregivers, not border guards,” said Leigh Daynes, executive director of DOTW UK, in a statement. “Protecting the NHS from alleged misuse must not compromise a doctor’s duty to treat the patient in front of them.

“From the amount of sick and vulnerable people we see turned away from GP surgeries every day, we know there’s already confusion about identity checks among frontline healthcare staff and proposed new rules will only add to that.”

Doctors are caregivers, not border guards

Anna Miller, a project leader at DOTW, said that, at the moment, most people attending their drop-in clinics are undocumented migrants or refused asylum seekers.

People in these categories tend to live in constant fear of being detained or deported, which can make visiting hospitals difficult: “The NHS is a state healthcare system,” Miller said. “There’s often anxiety about making yourself known to the state.”

Jeremy agreed this was a big part of the problem for her. She was scared that if she went to a hospital, things would escalate and she would be forced to go back to the Philippines and separated from her husband.

“We had planned to build a family together,” she said, “I was scared that would be destroyed if I was sent home.”

Sarah, 57, also a migrant living in the UK, said “paranoia” about seeing healthcare providers is so pervasive it often does not go away, even after acquiring leave to remain in the country.

Sarah contracted HIV after being gang-raped in South Africa, where she was born. When she came to the UK she told hospital staff that she was HIV positive, but was denied treatment.

At one hospital she said she was told to go away because she was costing the facility too much money. “The doctor kept telling me he wasn’t going to treat me, that I had overstayed my welcome and that I should go back to South Africa,” she said.

Other, slightly more helpful staff advised her to register with a GP – but the poor treatment she had already received from medical professionals, combined with worries about being billed, and fear of being reported to the Home Office, stopped her.

For 18 months she did not take any medication for her condition, and was convinced that she was going to die.

“People tell a lot of stories, [they say the] GP will call immigration on you,” she said. “You become paranoid. Your mental state just goes and you don’t trust anyone.”

She said many of her friends feel the same way. “They’ve been here more than 20 years, some of them, and they still don’t have GPs. Because they don’t feel safe to go register with a GP.”
Photo: Mark Sherratt.
Soon after arriving in the UK, Sarah became suicidal. She was referred to a specialist psychiatric hospital, but because of her immigration status as an "overstayer" she was told she could not be helped and was discharged without medication or any psychological treatment. She had no permanent housing and was also struggling to come to terms with her sexuality.

When she was finally referred to DOTW, she said it was the first time she had been treated like a human being. The charity helped her register with a GP, who she still sees today. But by that point, Sarah said, her mental health had been permanently damaged.

Miller said DOTW is increasingly seeing patients receiving “really sizeable bills” – sometimes amounting to 150% of the actual cost to the NHS of their treatment.

In real terms, she said, this means women are looking at bills in the region of £6,000 for an uncomplicated delivery. Even in cases where the baby has died during the birth or shortly afterwards, DOTW has encountered women who have been invoiced for thousands of pounds.

“We also often see hospitals threatening to report migrants to the Home Office if they don’t pay their bills in two months,” Miller said, adding that it is especially difficult to settle a bill that big in such a short time if – as is the case for most undocumented migrants and failed asylum seekers – you do not have a legal right to work in the UK.

Because of the repercussions, Miller said, the current protocol is a clear violation of the Department of Health’s own rules. “NHS guidance says that patients should not be denied, deterred or delayed in accessing antenatal care,” she said. “The way that hospitals are writing to pregnant women and issuing them invoices in advance and threatening to tell the Home Office is definitely deterring them from accessing services. And it’s prioritising the recovery of costs over antenatal care and patients’ ability to pay.”

Miller said introducing passport checks could start to affect other groups of people, too. “There’s a fairly substantial cost involved in having proof of ID, and they’re [also] asking for proof of address,” she explained. “British people in lower socio-economic circumstances are less likely to have these documents, so it's going to put in place barriers to these people accessing healthcare.”

In addition to endangering homeless people, the new policy could also disproportionately affect Black and minority ethnic (BME) women – both documented migrants and Brits – and result in racial profiling, Miller said. “We’re concerned that because it's a lot of work for hospitals, they’re going to target people who don’t look or don’t sound British” she told Refinery29.

“It’s British people as well who will be impacted by this, and it’s always more vulnerable people who will be affected the most.”

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