New research shows how NHS charges deter patients in need

Published 20th October 2017

New Research_brief_KCL_upfront_charging_research_2310 has shown the dire impact that NHS hospital charging has on the most vulnerable members of our communities, as rules come into force that significantly extend both ID checks and charges.

Over a third of Doctors of the World patients affected by NHS hospital charging have been deterred from getting care, including heavily pregnant women and people suffering from cancer, diabetes and kidney failure, according to new studies.

The research, conducted by post-graduate students at Kings College London at our clinic in Bethnal Green, reports NHS patients being charged up to £80,000 for their treatment. This often left vulnerable people with debts they were unable to clear, even years later.

The two studies, conducted in 2015-2017, used interviews with Doctors of the World patients, clinic staff, volunteers, and GPs, along with analysis of patient records. The Independent has covered the studies today.

The research comes as new rules come into force on 23 October that require all hospitals and many community health services to ID and charge some migrants, in a marked expansion of the previous rules.

Doctors of the World is totally against these new rules, which will make it even harder for vulnerable people to get the healthcare they need. Earlier this month we sent a high-profile letter, signed by medical Royal Colleges and a former NHS chief, to Health Secretary Jeremy Hunt to call for the rules to be scrapped.

Amongst the patients surveyed for the research, fears of being given bills they couldn’t pay and being reported to the Home Office were major concerns.

The health risks for mothers and children were particularly stark. UK guidelines recommend that a pregnant woman has her first antenatal appointment at 10 weeks, but almost 2 in 3 of pregnant women in the new research had not had one by that time and 1 in 4 had not been seen at 18 weeks.

In one case, a woman had not accessed antenatal care until 37 weeks into her pregnancy. At least two women who came our clinic were contemplating abortion in order to avoid being sent a bill.

Claire Ferraro, an NHS doctor and Doctors of the World staff member, said: “Abortion is a deeply personal choice. We should not be putting women in a position where they feel that this decision is imposed on them by the high price of pregnancy and birth in today’s NHS.”

The new charging rules mean that all community health organisations in England that receive NHS funding will be legally required to check every patient’s immigration status. If the patient cannot provide ID to prove they are exempt from charges, they will have to pay in full before receiving any treatment.

The regulations are set to affect all community health services including school nursing, community midwifery, community mental health services, abortion services, and specialist services for homeless people and asylum seekers.

The government charging programme is called “Making a Fair Contribution”, but upfront charges are set at 150% of the costs of treatment and therefore go far beyond this aim. Instead, these charges force many destitute people into impossible situations.

Demanding full payment before treatment means that patients cannot set up a manageable plan where they pay in monthly installments – the only way that many of our patients can contribute.

A Doctors of the World research briefing, which summarises the studies’ findings and draws out policy implications and recommendations, can be found Research_brief_KCL_upfront_charging_research_2310.

Links to the original research are here: Ockert-Axelsson_Capstone_Report_v1.1; Jennifer_Quy_KCL_Capstone_v1.1



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