“The overseas team have come onto my ward to deliver invoices to a patient’s bedside. I was shocked that they would approach a patient at their most vulnerable. I’ve also heard about pregnant women having their care delayed or booking at the last minute. I dread to think what kind of impact this will be having.”

– Doctor, St George’s Hospital

This letter has been written by healthcare workers and students from St George’s University Hospitals NHS Foundation Trust 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 the letter 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.

Dear Chief Executive Jacqueline Totterdell and Board Members of St George’s University Hospitals NHS Foundation Trust,

We, the undersigned, call on you to stand up for the rights of our patients. We ask that you suspend upfront charging and ID checks in this trust, and properly evaluate the impact of these policies on patients and staff care.

As you are aware, in October 2017 the Government introduced regulations forcing all NHS Trusts to check the residency and immigration status of patients and, if they are found to be ineligible for free care, to charge them upfront for non-urgent treatment.

These regulations are having a devastating impact on patients and healthcare workers, creating an environment in which people are too scared to access the treatment they need. Healthcare workers are forced to be complicit in withholding necessary care, patients face discrimination and racial profiling, and many people have been inaccurately billed for treatment, causing untold harm and distress. The Royal College of Physicians, Royal College of Paediatrics and Child Health, Royal College of Obstetricians and Gynaecologists, and the Faculty of Public Health, representing more than 70,000 doctors, have called for the suspension of upfront charging pending a full review of their impact on individual and public health.

This letter is signed by [no. of signatures] St George’s staff and students. We believe that ID checks and charging in the NHS directly contravene the Trust’s values of being kind, responsible, respectful and excellent.

The policy causes harm to patients. Patients are too afraid to seek the care they need, they present later, in poorer health, and have worse outcomes as a result. Our relationship with our patients relies on trust that we will provide non-judgemental care to all who need it. By allowing healthcare to become synonymous with immigration enforcement the Trust has jeopardised that relationship, letting fear and suspicion take the place of compassion and understanding.

The policy encourages discrimination and racial profiling. The truth of this policy is that many more patients will now experience discrimination when they try to access NHS services, as people are selected for charging based on their appearance, their name, or their accent. This is borne out through countless examples we witness in our daily practice, supported by prominent examples seen in the press. It is not feasible to check the immigration status of every patient accessing services; the NHS does not have the human or time resources to do so. Early reports from the pilot tests show this method of identifying patients for charging is ineffective at identifying chargeable people.

The policy is unworkable. Healthcare staff are required to make life-changing decisions about people’s eligibility for care. The policy does little to define when a patient’s care is deemed urgent or immediately necessary, the charging exemptions are poorly defined, and we should not be expected to determine our patients’ eligibility for treatment, as we are not immigration experts. The policy puts health professionals in an unacceptable position in which our legal duty of care to our patients is in conflict with the demands under the regulations. Further, it is clear that those who are most likely to be charged are the people least likely to be able to pay. This policy pushes people into destitution, increasing health inequities and discouraging them from accessing care in a timely way. We know that preventative care costs less and we know that this policy will encourage people to present later, making it more likely that they will need urgent or emergency care – care that will then be paid for by the Trust at greater expense. This makes no mention of the cost of the protracted suffering and psychological distress these people face.

We call on you to:

  1. Suspend upfront charging in the Trust – Suspend upfront charging for overseas visitors with immediate effect, and undertake and publish a full public health impact assessment of the charging regulations.
  2. Suspend ID checks in the Trust – Suspend the scheme requiring patients to bring 2 forms of ID. Stop using the appointment pre-attendance form to ask patients to provide unnecessary demographic information which can then be passed to the Home Office. These forms act as a deterrent and stop people attending appointments.
  3. Properly evaluate the impact of charging on patient care – Undertake detailed research into the impact of both charging and ID checks on patients’ health and on the Trust’s ability to meet its equality duty, and other legal obligations including professional duties of care staff have towards their patients.
  4. Call on Government to suspend charging in the NHS – Represent the serious concerns of healthcare workers and patients to Government. The impact of charging on patient care and public health must be properly evaluated, nationwide.

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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