Image: NHS maternity unit. Credit: Andrew Matthews/PA Images, all rights reserved.
The Royal College of Physicians have today joined with other Royal Colleges to call on the government to suspend NHS upfront charging of overseas visitors. The medical leaders say in a statement issued today that the government policy, introduced in 2015 and 2017 regulations, is a "concerning barrier to care" that is "likely to lead to poorer patient outcomes and contribute to already low morale in our profession." The Colleges raise concerns about the impact on public and individual health, and point particularly to the "detrimental impact" on expectant and new mothers and "cases of children having been denied treatment for various life-threatening conditions".
The evidence from fellow health professionals has been mounting since the introduction of the regulations and the message is clear: Upfront charging damages the health of migrants and British citizens alike. From children having their cancer treatment delayed and women suffering preventable birth complications, to the Windrush scandal which saw British citizens of commonwealth descent denied an array of health services, the human cost of these policies is unacceptable.
The call from the Royal College of Physicians, supported by the Royal College of Paediatrics and Child Health, the Royal College of Obstetrics and Gynaecology and the Faculty of Public Health to halt the charges pending a full review, is the latest example of the professional dismay at the unwillingness of the government to engage in evidence-based policy. Working as a junior doctor in London, I experience first-hand the harm caused to patients who have their health care denied and delayed. As I sit comforting the women denied psychological support on the verge of breakdown after years of domestic abuse, I am constantly amazed at the pointless brutality of a system which denies the vulnerable care: as a clinician, and a human, I feel her suffering.
The UCL-Lancet commission on migration and health that was released this month highlights the economic fallout of pursuing exclusionary health policies for migrants. It evidences the net economic benefit of migration for host countries, and debunks common myths of migrants being a ‘drain’ on local services. Indeed, on average migrants experience superior life expectancy than the national average of their host countries. The commission also links poor maternal health outcomes among migrants to barriers created to prevent them from accessing services - a statistic that Britain regrettably contributes to.
Patients in a South London hospital have been asked for a deposit before giving birth - as if not having the down payment will stop them going into labour. It does however, as one woman tells me, stop her from attending her antenatal appointments.
Analysis of charging of non-EEA patients have demonstrated the unequal impact on women of reproductive age, with numerous reports documenting individual pregnant women’s struggles. The Equality and Human Rights Commission (EHRC) last week released research which again demonstrated women who have been through the asylum system are not accessing antenatal care due to fears of charging.
These retrograde policies, of trying to scare patients into not attending hospital appointments under the guise of cost saving, are Theresa May’s hostile environment in action. Women have to choose between the cost of giving birth and the cost of an abortion, financially penalised for an activity which inextricably involves members of both sex. These patterns of out of pocket health care costs impacting women are echoed around the globe, with the World Bank reporting that only 17% of the poorest households have adequate maternal health care compared to 74% of the wealthiest.
Why has upfront charging been implemented despite there being no clear economic benefit, and an array of documented patient harm? These policies are politically motivated; an attempt to win votes based on anti-immigration rhetoric, backed by a right wing press that stokes racial tensions.
It is not only migrant women’s health that is suffering under the current UK government. Recent analysis of life expectancy data in England has shown the alarming increase in health inequalities in the UK. Whilst life expectancy continues to grow for the wealthiest in society, women in the two most deprived deciles have seen a decrease in life expectancy since 2011 (a year after the conservative coalition government came to power). These gender based inequalities are unsurprising, given how austerity has disproportionately impacted the lives of women. As the UN special report on extreme poverty demonstrated, spending cuts have hit women hard, exacerbating domestic violence, whilst the policy of universal credit places women at risk of economic abuse. With pro-nationalist groups who proudly declare themselves “anti-feminist” (Bolsonaro’s Social Liberty Party in Brazil, Vox in Spain) gaining power around the world, we must remain as vigilant as ever in the fight against gender inequities.
The dangerous wave of nationalism that is sweeping across Europe will only serve to drive inequalities deeper. Italy last week revoked the work permits of many migrants, overnight forcing them into an undocumented status. The MSF ship Aquarius has had to stop sailing, after failing to find a flag to sail under, abandoning thousands to drown in the Mediterranean. This just three years after the body of 3-year old Alan Kurdi, a Syrian child fleeing conflict, washed up on a beach in Greece provoking international outrage. It appears to be a sad case of out of sight, out of mind.
The release of these statements should act as a call to action for the medical community and a wake-up call to the government, that their harmful practices will not be tolerated in the NHS. I am proud to be part of a medical community that will stand up in the face of adversity for what we know to be right.