- 09 September 2019
- 3 min read
Midwives say overseas pregnant women ‘must not be charged for NHS care’
Midwives say telling women about the charges makes them feel like they work for the Home Office rather than the NHS.
Gatekeepers of NHS care
Midwives say they refuse to be “gatekeepers” of NHS care as they called on the Government to scrap charges for overseas pregnant women.
In a new report from Maternity Action, backed by the Royal College of Midwives (RCM), health workers said the charges acted as a barrier to providing quality care, with one midwife saying they felt as if they were “working for the Home Office”.
Midwives said some women delay accessing help or fail to have scans over fears they will be charged or detained.
Rules on overseas visitors means they must be charged for NHS care, with pregnancy charges starting at around £7,000, the report said.
Health of patients at risk
It argues the professional duty of midwives and the health of patients are at risk of being compromised by the NHS charging policy.
The costs particularly harm undocumented migrant women, who already have a higher risk of maternal death and adverse pregnancy outcomes, it said.
A group of 15 midwives were interviewed as part of the study, with one saying: “I am not here to enforce immigration rules, I am not here to enforce people’s entitlement, I have a duty of care as a midwife and I need to fulfil that duty of care.
“Part of my duty of care as a midwife is to gain the trust of people who are giving me medical history, who are entrusting me to guide them through the booking process which is the first step they are taking in pregnancy care.
“I need them to trust me and to trust the service.”
The report said some overseas women already face a range of issues, including poverty and destitution, domestic abuse, poor and inadequate housing and a poor command of English.
“Midwives were especially worried about the health impact of late booking by women who were charged,” the report said.
“Persuading women to attend for care regardless of their fears of charging involved significant extra work.”
A specialist midwife who had worked with migrant women for over a decade said her job was “becoming about charging”.
"You feel like you're working for the Home Office"
A community midwife said: “As a midwife, it’s an awful, awful feeling. You feel like you are working for the Home Office.”
Maternity Action and the RCM are now calling on the Government to immediately suspend charging for NHS maternity care.
They also want to stop debt from maternity care affecting future immigration applications.
The British Medical Association (BMA) has also said the charges deter patients and that medics come under pressure to try to impose the costs.
Freedom of Information (FOI) responses to the Daily Mail from 91 NHS trusts last month showed they are owed around £150 million in unpaid bills from overseas patients.
Rosalind Bragg, director of Maternity Action, said of the new report: “The NHS charging regime is failing both patients and the professionals who care for them.
“We are calling for the immediate suspension of NHS charging policy pending a full and independent review of its impact.”
Gill Walton, chief executive of the RCM, said: “The RCM is committed to supporting our members to deliver safe high quality care and cost recovery is a barrier to this.
“We believe that maternity care should be exempt from NHS charging altogether to protect and promote maternal and newborn health.
“The recommendations from this report, if implemented, will absolutely improve the situation for vulnerable migrant women and the midwives who care for them, and begin to right the wrongs of cost recovery.”
A Department of Health and Social Care spokesman said: “We take the provision of maternity services very seriously – and we will never refuse maternity care, regardless of whether someone can pay.
“Every taxpayer supports the health service and so it is only right that overseas visitors contribute towards their treatment costs but exemptions are in place to protect vulnerable people who receive care free of charge.
“We want clinicians to be able to concentrate on delivering the best healthcare and midwives and doctors are not responsible for checking if a patient is eligible for free care or for recovering those costs.”