Hundreds of migrants have declined NHS treatment after being presented with upfront charges over the past two years, amid complaints the government’s “hostile environment” on immigration remains firmly in place.
Data compiled by the Observer under the Freedom of Information Act shows that, since January 2021, 3,545 patients across 68 hospital trusts in England have been told they must pay upfront charges totalling £7.1m. Of those, 905 patients across 58 trusts did not proceed with treatment.
NHS trusts in England have been required to seek advance payment before providing elective care to certain migrants since October 2017. It covers overseas visitors and migrants ruled ineligible for free healthcare, such as failed asylum seekers and those who have overstayed their visa. The policy is not supposed to cover urgent or “immediately necessary” treatment. However, there have been multiple cases of people wrongly denied treatment.
Dr Laura-Jane Smith, a consultant respiratory physician and member of the campaign group Medact, said: “I had a patient we diagnosed as an emergency with lung cancer but they were told they would be charged upfront for treatment and then never returned for a follow-up. This was someone who had been in the country for years but who did not have the right official migration status. A cancer diagnosis is devastating. To then be abandoned by the health service is inhumane.”
In some cases, the consequences are terrible. In 2018, the Guardian reported the case of Elfreda Spencer, who died after being denied chemotherapy for a year, during which her cancer became terminal.
In another case, Simba Mujakachi was refused treatment for a blood-clotting condition under the upfront charging rules before he had a stroke. He is now a member of the campaign group Migrants Organise.
“The hospital told me I had to pay thousands of pounds before I came in for surgery and that having a debt could affect my asylum application, so I didn’t go, even though I knew I needed it,” he said. “I didn’t have that kind of money and I was not allowed to work. And then, just before I turned 30, I had a brain haemorrhage and a stroke that left me disabled.
“The inhumane treatment I have been subject to under the hostile environment over the past 10 years was the cause of my life-changing stroke. I think about what would have happened if I had been able to get the treatment I needed like everyone else.”
Oke, 35, arrived in the UK from Nigeria in 2007. He had lived with pain in his hands and feet since childhood but the symptoms worsened, and in March 2020 he was diagnosed with a rare condition called Fabry disease after having a stroke and kidney failure and contracting Covid.
He needed enzyme replacement therapy (ERT), which is not a cure but may help prevent further organ damage and strokes. But it was not available unless he was able to either regularise his immigration status or pay.
Over three years of increasing pain, Oke involved the medical group Doctors of the World and his MP, Afzal Khan, and then the parliamentary and health service ombudsman. Within a week of the latter contacting the hospital trust, it agreed to provide ERT. “I felt like I was being treated like an animal, not a human being,” said Oke. “It’s been awful, because apart from the physical pain there’s also the mental pain, not knowing what’s going on, what could happen next. It’s been a nightmare.”
Amardeep Kamboz, head of services at Doctors of the World UK, said:
“Access to healthcare to all living in the UK, including secondary care, where we often see the most pressing health issues, should and can be equal, based on need and never dependent on someone’s financial or immigration status.”
A Department of Health and Social Care spokesperson said: “The NHS is a residency-based healthcare system, and entitlement to free hospital care is based on being lawfully and properly settled in the UK. People who are not ordinarily resident here must contribute to the cost of their care unless exempt from charge, such as refugees.
“Payment is only required upfront in non-urgent cases when the care can safely occur after the patient’s departure from the UK. Immediately necessary or urgent care must never be withheld or delayed pending payment, as charges for this care can be recovered afterwards by instalments or written off as unrecoverable if the patient cannot pay.”