“As a doctor I find it appalling that my employer could encourage me to provide substandard care for a patient because of their nationality. Recently I saw ‘cost recovery staff’ document in a very sick young female’s notes that staff should “refrain from providing non-urgent treatment because she is chargeable for her care and has not yet paid a deposit”. Patients will suffer. Either through direct clinical neglect, or (more likely) through delayed presentation to health services due to fear of financial ruin or being reported to authorities.”

– Junior Doctor, Royal Liverpool University Hospital

The following statement is written by healthcare workers Royal Liverpool University Hospital in response to the introduction of ID checks and upfront charging in our workplace. Every day we see the devastating impacts of this policy.

Please sign this statement to let the Trust know that it is our duty to advocate for our patients, to provide non-judgemental care, and ensure Trust policy improves care for our patients rather than causing harm.

“I don’t want to work for a trust that supports this. I represent the trust I work for but I don’t represent this.”

– Junior Doctor, Royal Liverpool University Hospital

“To my mind, the practical, public health case against up-front charging is overwhelming, and has been captured in position papers on migrants and TB from the International Union Against TB and Lung Disease over many years. It is one of the driving arguments for the provision, globally, of Universal Health Coverage (UHC). It is disappointing that the NHS, the global pioneer of UHC, is taking this direction in the very year that UHC is to be a topic of a UN High Level Meeting….
…I have laid out the public health argument for the specific case of TB, but the same principles hold true for other high consequence infectious diseases. In addition, I strongly object on grounds of ethics, morality, and equity; all strong underpinning values of the NHS.”

– Consultant, RLU

“I had a patient invited to screening by the NHS- they were found to have cancer. The initial assessment generated a request for CT [scan] for an incidental finding. At this point they were told their type of visa meant they would not be able to access NHS treatment for their cancer, and they’ve been sent a bill for all the previous outpatient appointments and MRI/CT scans. They only accepted [investigation] because as a hospital we invited them to come for results of screening – this seems wholly unfair and distressing way to manage someone from overseas. I totally support a change of policy at the Royal to a more pragmatic and humane one”

– Consultant, RLUH

Mission Statement

Under the terms of the Immigration Act (2014), NHS Hospitals are obliged to identify migrant patients and charge them up to 150% of the usual costs of their care. In October 2017 a requirement was introduced for charging to occur before treatment is received.

We are a group of staff at the Royal Liverpool University Hospital united by concerns regarding the Government’s policy of charging migrants for healthcare. We believe that the policy conflicts with our duty towards patients, and, by turning clerical and clinical members of staff into an extension of the UK border force, undermines trust and distracts from our role as health care professionals. Furthermore, we believe the policy targets a vulnerable population, threatens public health, and is likely to lead to increased morbidity and mortality. Although there is emerging evidence of harm, the true economic, public health and personal healthcare effects of this policy have not yet been properly evaluated.

Our group’s mission is to campaign for healthcare charging of migrants to be suspended, and for Sections 38 and 39 of the Immigration Act (2014) to be repealed. Until this occurs, we are calling on the Royal Liverpool University Hospital to make a public statement acknowledging the concerns of its staff and supporting the Royal Colleges’ call to suspend charging, and to take immediate interim measures to reduce harm to vulnerable individuals.

Implementing Migrant Charging at RLUH: Suggested measures

1. Public statement:

Make a public statement acknowledging the concerns of its staff and supporting the Royal Colleges’ call to suspend charging

2. Emergency treatment:

Don’t approach patients while they are receiving emergency or immediately necessary treatment

Don’t charge for treatment received in Clinical Decision Unit – treatment received on the CDU should be regarded as being provided within Accident and Emergency and is therefore exempt

In all cases of an NHS service being withheld, the Trust should:
– be able to provide evidence that the classification of care as “non-urgent” was made by a clinician
– provide evidence that the patient’s return date is based on fact and is well-informed (e.g. booked on to a flight; date agreed between patient and clinician)
– provide written assurance that if the date on the form has been passed and patient remains in the UK, that the patient is entitled to be reassessed by the clinician

3. Sharing patient data: anonymity and data protection:

Stop using Pre-attendance form – this is unnecessary and the Trust is not legally required to do so. No PAF or similar form should be issued before first attendance (e.g. by post before outpatient appointment) – to mitigate barriers to patient contact, and to enable clinical assessments of urgency to take place

Any request for information must be shown to comply with Caldicott principles and with GMC guidance on confidentiality.

Don’t ask for identification in the Genitourinary Medicine (GUM) clinic – patients are entitled to anonymous treatment here, and treatment for sexually transmitted infection is exempt from charging. Remove posters about charging from the GUM Department

Remove threatening posters from all other clinical areas, and replace them with posters that provide reassurance that patients will not be turned away, and that reiterate the Trust’s public position

Do not share any patient’s debt details with the Home Office

4. Incorrect application of charging regulations:

Develop a dedicated complaints mechanism for patients or their advocates to challenge decisions to withhold care. Ensure that any posters displayed in the hospital are accompanied by a signpost to the complaints procedure, and by a copy of the Trust’s public statement opposing charging regulations

5. Exercising discretion in applying charges:

Investigate patients’ ability to pay, and consider introducing waivers or repayment schemes for patients who may struggle to manage their debt.

Do not pursue family members or next of kin for repayment following a patient’s death

Remove recovery of migrant healthcare charges from the Trust business plan

James Skinner

Access to Healthcare Campaigner at Medact
James runs Medact's work campaigning against the discriminatory and damaging NHS migrant healthcare charging regulations.

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