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11.10.16

Home Office keen to support pilot for pregnant women to prove right of care

Pregnant women may have to show ID to prove they are UK or EU nationals before receiving obstetric care under a proposed pilot scheme at St George’s University Hospital NHS FT (SGUH).

Papers from the trust’s latest board meeting say that a pilot is being considered where women will have to show photo ID and a utility bill when checking in to obstetric services.

Under current laws, patients who are not UK or EU citizens or have not been resident in the UK for a certain period of time are supposed to pay for NHS care.

Rebecca Schiller, chief executive of charity Birthrights, a human rights childbirth charity, said: “It is unlawful to deny a labouring woman maternity care whatever her residential status. The current Department of Health overseas visitors guidance makes it clear that, while a woman who isn’t ordinarily resident in the UK may be asked to pay for her maternity care, life-saving services should never be withheld if she cannot afford to pay or can’t pay in advance.

“To demand that women present evidence of their recourse to public funds while in labour is impractical, places an unacceptable burden on overstretched staff and is cruel and inhumane to women at an already stressful time in their lives. Birthrights believes that these plans will act as a disincentive to access maternity care that will put the lives of already vulnerable women and their babies at risk.

“The Birthrights legal team are working with urgency to address this issue. As a first step our lawyers will be writing to the board of St George’s University Foundation Trust to outline why these plans are unlawful and demand that the pilot scheme is dropped.”

The papers say that providing care for non-eligible patients could cost the trust £4-5m a year.

Obstetrics patients are currently supposed to fill in a form, including details of their eligibility, but these sections are frequently being left blank.

The trusts says that this makes it harder to tell whether patients are eligible for care, and by the time they are shown to be non-eligible, they have already been treated.

Non-eligible patients are meant to be invoiced for care at a 150% tariff, but SGUH said around 80% of the bills go unpaid.

Under the proposals, patients who cannot prove eligibility will be automatically referred to the Overseas Patient Team for further investigation.  If the pilot is successful, it will be rolled out across the hospital.

The papers stated: “The Home Office are keen to support this pilot as a way of benchmarking this process nationally.”

SGUH also said it is trying to discuss the issue with Wandsworth CCG to ensure GPs co-operate with the plans when referring women for treatment.

However, it added the discussions “have been slow to get off the ground due principally to some reluctance to fully engage with the issue from SGUH’s perspective”.

The papers include e-mail correspondence between Jo Johnson, head of private and overseas patients at SGUH, and Dr Michael Lane, board member of the CCG and London maternity lead for the Royal College of General Practice.

Johnson said that St George’s is being targeted by non-eligible patients because of its lack of robust processes, and that individuals in Nigeria are offering women paid assistance to have their babies at the hospital.

She added that the government is planning revised guidance which will advocate “routine presentation” of proof of eligibility, and planning to introduce charges for non-eligible patients to use A&E and ambulance services.

She noted: “This is will be a blanket process for every woman referred or self-referred to St George’s for obstetric care. No-one will discriminated against.

“We are also mindful that there will always be exceptions and patients may need to have access to services for clinical, ethical or moral reasons. We would advocate that patients are always treated as individuals and each case is assessed on its own merits.”

Dr Lane stated that there is “no realistic prospect” of the women’s country of origin being included on referral forms. He added that clinical experience shows that some patients have no photo ID and women “from certain cultural backgrounds” will have no utility bills or bank statements in their name because the male head of the household handles such matters.

An NHS Wandsworth CCG spokesperson said: “NHS Wandsworth CCG has a duty to ensure that any new proposals that affect access to services are clinically safe and do not increase health inequalities. We will continue to seek assurance on these proposals in light of our statutory duties.”

Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: “This move by the trust is a concern. I am sure no trust would deny care to women in labour or who are pregnant and arrive at a hospital needing urgent care related to their pregnancy.  To be clear, the law says, and government policy states, that trusts must offer care to women in labour, irrespective of their immigration status in the country.

“On the wider level midwives also have more than enough to do without checking women’s eligibility and determining their immigration status. They are not border guards, they are healthcare professionals there to deliver clinical care to all women. This is not their job and never should be and we must assume that the trust will not require them to do this. Their job is to care for the women who walk through the doors of their maternity unit and it is the responsibility of trusts to care for and treat these women.

“Most importantly this move could also be dangerous because it could deter women from seeking care in a timely fashion. This could potentially have a serious impact on the health of the mother and their baby and the outcome of the pregnancy.

“I would ask the trust to clarify their policy and to give assurances that all pregnant women who need care will receive it, no matter what their immigration status.”

A spokesperson for St George’s said: “This is a proposal and not a plan. Further work would need to be undertaken, including speaking to key stakeholders before we would be in a position to proceed with the pilot.”

The proposals come as the government abandoned plans last week to require companies to list how many foreign workers they employ.

2.30pm UPDATE

The RCM said it had received reassurances from the trust that midwives will not be required to check patients' eligibility.

(Image c. David Jones from the Press Association)

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