Digging in for the future

 Today the Liverpool Women’s Hospital digs the first turf to mark the start of the new, much needed NeoNatal Unit This investment of £15 million is the way  that we want to see Liverpool  Women’s Hospital grow and thrive.

February 2019. Save Liverpool Women’s Hospital is still campaigning for a fully funded Liverpool Women’s Hospital, for the NHS, for all our mothers, sisters, daughters, friends, and lovers, and for the babies. We campaign with the public and with trade unions, women’s organizations and pensioners to challenge the people with the power to make these decisions. The real decision makers are the Government, their friends in the multinational health care companies, and their local appointees. In reality, an ordinary doctor or nurse has little say., and few approve of what’s happening to the NHS.

Despite underfunding, Liverpool Women’s Hospital, and the NHS work wonders. The day to day caring work of NHS staff continues, under pressure, and meanwhile, these battles are fought out in boardrooms, with big companies and international politics. There are very real dangers ahead for staff and patients.

We want LWH to be upgraded on site with full cooperation with all local and regional hospitals. We want bloods, diagnostics and imaging all upgraded. We want parent accommodation for the neonates. We want the hospital to go on caring for Liverpool people. This campaign offers solidarity to people trying to improve working conditions in the hospital.

We want the money from the government as much as the Board does but not for the same purpose

We have consulted a leading obstetrician and a team of health workers in different professions, about our objections. Some of our activists fought and lost to stop the PFI at the Royal., which was as passionately supported by the Board at the Royal as this ” move” is supported at the Liverpool Women’s hospital. Doctors are not trained in health economics, nor are they infallible. The doctors and managers who supported PFI were very fallible about the Royal

The late Sam Semoff campaigner for the NHS and a fierce opponent of PFI

Tectonic plates are moving in the NHS. Different types of privatization are fighting over the NHS, which continues to be underfunded and the staff overworked.

Good health care is an investment that repays the money paid by the country three times over.

Back to basics

The NHS model was designed to provide all the treatments needed, for all the people, and not for profit.  This model is the  most efficient and the most cost-effective, focusing the maximum money on the patient and the least on profit and admin

The UK can well afford a good health service. Funding to western European levels would easily sort the NHS problems.

Bad health care is expensive and wasteful, to the country as a whole, and bad for the individual and bad for their families.

Women fought for decades to establish a health service, and that campaign started in Liverpool. For 70 years, everyone has benefitted from women who persisted.

The current part-privatized NHS model spends money on financial consultants and private profit, money that should go to treating patients.

Liverpool Women’s Hospital is in the midst of (often-chaotic) change in the NHS.

There has been significantly more privatization since the Health and Social Care Act. This gave parcelled up services to private companies to run under the NHS label. Now the model of privatization is changing. Local commissioning is going. CCGs are merging.  Hospitals are being closed or merging.

The internal market is now challenged as wasteful. The model of Foundation Trusts is being criticized.  Instead, the NHS is being divided into 44 Accountable care services. These services must work within a set budget so rationing is required. The treatment might be needed but it will not necessarily be given, and admin rather than doctors will say yes or no to treatment like an insurance company does. This is being brought in, gradually across the country.

How to boil a frog. If you put a frog in boiling water, it jumps out. If you put it in tepid water and heat the water up the frog does not know it is being boiled, it sits and cooks.  So privatization is done on the sly.

 Capital Spend

The NHS needs money for day to day services, (revenue) and capital spend, money to build new hospitals, NHS capital spending was squandered by the PFI scandals that built flawed hospitals and charged way above the cost of the build, and are still raking it in. Liverpool Royal is just the worst of the scandals. The new Royal will now be completed without a PFI! The money will come from the government directly. PFI( and it’s variations with different initials ) is now disgraced, and not available for the move favoured by the management at LWH. (See pages page 177 to 179 of the pre-consultation business case for their earlier

Huge public health hazards like the toxic diesel particulates that accumulate in the placenta, cannot be ignored. The health campus, with major corporations, on the Royal site, is highly questionable for pregnant women and babies.

Our campaign wants to keep a women’s hospital, on site. We think this site is safer and we think a focus on women’s health is essential.

Help Track the Takeover

UNITEDHEALTH IN THE NHS

This is a shared post from POHG research and campaign group. It gives us information and requests our help. Please help if you have the time to do some google research through documents about your local area.

  • In 2014, America’s largest health insurer UnitedHealth saw their President of global expansion installed as Chief Executive of the NHS in England.
  • UnitedHealth has a track record of being fined for fraud against the US government, but these penalties do not ever seem to improve its conduct. UnitedHealth is currently being sued by the US Government in a case ongoing since 2017.  https://www.nytimes.com/2017/05/19/business/dealbook/unitedhealth-sued-medicare-overbilling.html
  • UnitedHealth is right now embedding its subsidiary company Optum as an integral part of NHS GP care nationwide, through its financial control systems and IT systems (including the Scriptswitch software).  This insurance company has sold these Trojan Horse systems into the Clinical Commissioning Groups which control our GP services nowadays.

Case study – NHS Ealing Clinical Commissioning Group (CCG)

UnitedHealth subsidiary Optum has been installed in NHS Ealing CCG’s clinical and financial decision making, with tasks that require its access to patients’ confidential medical records.

One of Ealing CCG’s Joint Vice-Chairs has the following Register of Interests entry, which mentions Optum:  https://www.ealingccg.nhs.uk/media/147147/COI-GB-Members-Register-Aug-18-v3.pdf

Referrals

In 2015 NHS Ealing CCG expensively outsourced its referral management service to Optum; this included a transfer of staff to this UnitedHealth subsidiary. https://www.ealingccg.nhs.uk/media/1304/Paper_7_Referral_Facilitation_Service_-RFS-_Procurement.pdf

This “Referral Facilitation Service” (RFS) covers all GP referrals that come under eight speciality areas:

The RFS contract allows for provisional expansion in the future; e.g. extending to prior approval of all GP referrals to acute hospitals.

Optum, as referral gateway operator for NHS Ealing CCG, now decides which patients referred by their GP (primary care) to hospital (secondary care) will be funded out of the NHS CCG’s budget.

In other words, a UnitedHealth subsidiary now determines whether an Ealing GP patient who needs NHS hospital treatment of the above types is allowed to access it.

GP medical records access for UnitedHealth

The “Referral Facilitation Service” contract gives UnitedHealth access to the medical records of all patients registered with Ealing CCG’s GPs whose referrals it handles.

Might this situation explain why Ealing CCG’s Fair Processing Notice does not reference the data processor for referrals?https://www.ealingccg.nhs.uk/media/124323/eccg-fair-processing-notice-v2-0.pdf

How many NHS contracts like this are in place across the country already, positioning UnitedHealth to access commercially valuable patient data that the patients thought they had shared only with their family doctor?

We can all work together to identify and publicise where UnitedHealth and Optum are gaining footholds within our NHS

If you feed back what you find about all this in your area on to this and the Public Health list, and also share your information and the crowdsourcing request with all of your interested contacts, then soon we’ll all have a much clearer picture of this threat, and the specific contracts, locations and public officials involved.

Please use your access to search engines, libraries, experts and any other resources and contacts you can think of, to uncover and document deals that have been struck by UnitedHealth/Optum, and what roles they are in with your own CCG and neighbouring ones in your part of the country.

Save Liverpool Women’s Hospital

“We want the absolute best for our patients all the time.” Liverpool Women’s Hospital doctors said on the BBC program ‘Hospital’ on 25th January 2019

The staff also stressed the importance of the hospital as a safe space for women.

Some of the great work Liverpool Women’s Hospital does was shown on the programme. Oddly the very real problems were presented, not as a consequence of underfunding, cuts and privatization, overworked staff and faults in the NHS structures, but as a consequence of it being a standalone hospital!

Liverpool Women’s hospital operates in a climate of cuts and shortages, like all the NHS in 2019. The basic maternity tariff is inadequate. There are significant cuts, underfunding and staff shortages across the NHS. There is a shortage of doctors, midwives, nurses, and other key staff groups. The bureaucrats seem to grow in number. Financial consultants, not the medical ones, are making loads of money from the NHS. This arises from Government policy, and only from that. Somehow this did not feature in the programme.

We have to fight for a fully funded NHS, stop the cuts, train more doctors and nurses. We want to Save Liverpool Women’s Hospital. Keep the only women’s hospital in the land!

The move to the Royal has not been funded, at least not this year. If it had been approved earlier it would have been a PFI! We oppose this move, we oppose the PFI! A move to the Royal site, especially in its current chaos, would be wrong in many ways.

We want people also to recognize that particulates from diesel damages babies. Most of the rest of the world has got this message. The move to the Royal presents significant problems in putting the babies into a hazardous situation. That is not the only reason we oppose that move.

Liverpool Women’s Hospital should stay where it is and be improved on site. Already £15 million is being spent on upgrading the neonatal provision. Moving the hospital would be a major mistake.

All of the NHS is at risk. In this situation, we need to defend what we have “What we have we hold!” Other experiences of closures have not been good ones. Other experiences of building at the Royal and building using PFI were catastrophic.

This is the only hospital fully devoted to the needs of women, in the whole of the UK. Women’s health needs much more research and more focussed research. Young women and girls are still crippled by period pain, not all contraception is safe, fertility is problematic for many and women, on average, live with ill health for 18 years.

We need research and dedicated treatment to prevent stillbirths and into birth injuries. We need research and dedicated treatment to deal with post-natal injuries to women

We need to stop  low birth weight and illnesses in babies

We need research into  women’s mental health

For all of this, we need the emphasis and focus on women.

Problems with recruiting Cancer specialists

The programme stressed the shortages of consultants and difficulties in recruiting to the  Liverpool Women’s Hospital. A clear future for the Liverpool Women’s will surely help this.

The problem’s with cancer recruitment are not confined to Liverpool Women’s Hospital. This problem must be addressed nationally and locally. Of course, doctors from different hospitals should cooperate, as the surgeon described. Such cooperation is hindered financially and organisationally by the  Foundation Trust system. This system has to go to be replaced by a system that promotes cooperation and cuts undue bureaucracy.


The Women’s Hospital Building

The hospital is a good building, better than many newer ones
Liverpool Women’s Hospital is 23 years old. It is a good hospital building only a few years older than the first of the flawed PFI hospitals built across the country. The site is set back from the road and landscaped to keep traffic away.

Problems with the Royal site

There is a half finished new hospital, a hospital that will need demolishing and a cramped site in heavy traffic. It would be dangerous to have Liverpool babies born in such a situation.
Traffic fumes, and especially particulates, are very dangerous for babies. “Burning fossil fuels is now “the world’s most significant threat to children’s health”. Their life chances are compromised before they are born. Toxic particles from exhaust fumes pass through the lungs of pregnant women and accumulate in the placenta. The risk of premature birth, and low birth weight, this causes, is described in the British Medical Journal as “something approaching a public health catastrophe”. Guardian

The move to the Royal site is part of a larger project, not one that focuses on the needs of our mothers, sisters, daughters, friends, and lovers nor for the precious babies. The move is part of this planThe Campus can provide 100,000 square metres of space devoted to life sciences. This will provide development space for companies involved in research, pharmaceutical and biomedical industries. The Campus will capitalize on its location with a unique concentration of health, academic and industry life science assets; the famous Liverpool School of Tropical Medicine (extensively supported by Bill Gates), the National Zoonoses Centre, Medical School, Dental School, centre for drug safety science, Wolfson Centre for Personalised Medicine, pharmaceutical and biomedical industry.

The move is also part of the plan to close one of Liverpool’s Hospitals, which is well documented. Liverpool Women’s Hospital should stay where it is and be improved on site. Already £15 million is being spent on upgrading the neonatal provision. Remember Liverpool Women’s Hospital it is less than a mile away from the Liverpool  Royal Hospital site

All of the NHS is at risk. In this situation, we need to defend what we have “What we have we hold!” Other experiences of closures have not been good ones.

This is the only hospital fully devoted to the needs of women, in the whole of the UK. Women’s health needs much more research and more focussed research.

Liverpool Women’s Hospital features on BBC #Hospital

The Liverpool Women’s Hospital is a great hospital where staff, in general, are happy to work. It saves many lives and helps launch thousands more tiny lives each year. In the midst of all the damage being done to the NHS, saving Liverpool Women’s Hospital is crucially important, for all our mothers, sisters, daughters, friends and lovers and for all the babies born there.

Liverpool Women’s Hospital is the subject of a programme #Hospital, which shows some of the outstanding work of the hospital and talks about a major recruitment crisis at Liverpool Women’s Hospital.

The Chief Executive of LWH is reported as saying “Alongside the patient stories featured, you will see some of the other challenges we face as an NHS Foundation Trust, including our desire to protect our services for the long-term future by moving to a new Liverpool Women’s Hospital on the campus of the new Royal Liverpool Hospital site.” 

The time money and effort put into the flawed plan to move the hospital less than a mile down the road, has perhaps distracted the board, if we are now to believe that after all recruitment is the problem. This crisis in recruitment has not featured greatly at the board meetings of LWH which our campaigners have attended for the last number of years.

Our campaign sees the move as a serious risk to the service provided by Liverpool Women’s Hospital. The people of the UK and of Liverpool have lost many NHS beds and services, we have had to pay for crazy dangerous projects like Carillion at the Royal PFI, all of which have been “sold” to the public with false gravitas by NHS strategists and politicians. Not many apologies have been forthcoming when they have been proved so very wrong.No apologies for leaving the NHS short of beds, no apologies for the PFI scandal. Why? These projects have made a lot of rich people much richer

The NHS needs more doctors. Britain has fewer doctors per head of population than other advanced countries. There are 2.2 doctors per thousand people.  Cuba has 5.9, per head of population and is significantly less wealthy than the UK.

Doctors themselves need more doctors so they do not have to work ridiculously long hours, and have a better work life balance.

There are now more doctors in training, and if you trust him, Jeremy Hunt claims that more doctors will be trained in future, with new medical schools opening.

There is though a shortage of doctors and many who train either take time out or leave altogether or want to work part-time. Doctors are human and often female. Women need time off to have babies. Men too want paternity leave. Ridiculous working hours and stress make it harder to retain staff.

There is a shortage of doctors at pretty much every stage.

The basic causes of the shortage are

1. The UK has not trained enough doctors and relied on recruiting from abroad. There are many overseas doctors working in the NHS. These medics are most welcome and badly needed.

2. Cuts, privatisation and underfunding are driving significant deterioration of the  work experience for staff

3.Recently, there has been a drop in recruitment from the EU.

There are some recruitment issues specific to the main specialisms, obstetrics, and gynecology, in the Liverpool Women’s hospital. The most commonly mentioned was difficulty in recruiting to rural areas. Being in a rural area is not a problem at Liverpool Women’s Hospital.

There are problems in the mix of different levels of experience required in Obstetrics according to the Royal College of Obstetricians

None of these issues would be changed by the unnecessary move of LWH less than a mile down the road to the New Royal Site, proposed by the Liverpool CCG and the Trust.

To improve recruitment our campaign believes the Trust, the Government and NHS need to do the following

  • Improve staff confidence in the management at the hospital, as shown in annual returns.
  • Return to the ethos of a women’s hospital, appoint more women to senior medical and surgical positions.
  • Nationally recruit more  doctors, train more doctors and retain more doctors
  • Reduce the working week as soon as possible.

Getting the Truth out there

The NHS is a huge, massively successful institution, but one that has been battered and bruised in the storms of privatization, globalization and government policy.

The problems of the NHS, nationally and locally, have not been adequately reported by the mass media, with some honorable exceptions

When the plans for  Wirral walk-in closures was mooted, the local BBC gave the management time on local radio to sell the appalling plans, without any comparable balance from the opposition, although the opposition has been proved valid.

Before the  September 2018  Save Liverpool Women’s Hospital demonstration Radio Merseyside gave management time to oppose our demonstration with no comparable response time from the campaigners.

When the Carillion PFI collapsed, no adequate reporting was made of the long campaign of local opposition to the whole Carillion PFI  project at the Royal Liverpool Hospital.

The Hospital programme on BBC 2 has given some good coverage but has not spoken (to our knowledge) to NHS campaigners in the area, even though campaigners have worked hard over issues like the PFI in Carillion New Royal Hospital, the overall cuts, and to Save Liverpool Women’s Hospital.

In all of these changes, the media have given little coherent coverage. There have been some detailed programmes but the messages from one series are not reflected in the news or subsequent programmes.

The reality of mass privatization, of PFI, and lack of oversite in huge public procurement projects goes largely unreported

The NHS is a mass of contradictions. It saves life, but makes its staff ill from overwork. It is designed as a universal service but refuses life-saving treatment to some, based on dodgy migration status rules.

Recent changes mean that crucial treatments are rationed or refused causing greater cost further down the road, as the patiant needs more expensive care later in life.

The NHS needs a steady stream of investment in its buildings but wastes that money on PFI. It claims to be run by doctors but spends exorbitant amounts on the use of financial and accountancy consultants. It introduced the “Internal Market” and “Foundation Trusts”  proclaiming that competition promotes efficiency but reality shows these experiments as costly, wasteful and at times deadly. The NHS is underfunded but hospitals are described as “overspending” or “in debt”.

The Commissioning mode and outsourcing have been expensive and inefficient. For example, great services like local sexual health services have been privatized to an untried service. It is not all roses in the NHS, and along with the cuts. there can from time to time be real neglect, and desperate mistakes.

There are very good, careful journalists, but somehow the account of the NHS given in the mass media does not match the crisis.

When the NHS gets good coverage as with the seventieth birthday of the NHS, stories.emerge in the press that counter the picture.

The national NHS and individual Hospitals spend a lot of money on press, media and public relations. Liverpool Women’s Hospital paid for full page adds to counter our campaign demonstration. They have established links with the media press. Hospitals employ professional companies for some projects.

The mega  corporations using the NHS to make profit have major involvement in the ownership and control of the media.

Campaigners have to keep working for good press and media coverage and keep using social media which is more open to us.

Teresa May should bring better gifts

Today Sunday 6th January, is the Feast of Kings or the Epiphany, traditionally celebrating when rich kings brought gifts for the new-born child. Far richer  men and women are coming to Liverpool tomorrow to announce the next ten-year national spending round on the NHS. There is little to celebrate in it, indeed it is conscious cruelty and rudeness. The great wealth of this country, massively more than biblical kings, could and should, give so much more. The money cited represents less than half of what is needed.

The national management of the NHS, and government since the health and social care act, have done great harm.

The policy of reducing beds has been disastrous.

Decisions on the level of funding have been catastrophic.

Decisions on the numbers of doctors trained, recruited and retained have been way short of what’s necessary.

Abolishing bursaries for midwives and nurses was dreadful and will damage health care for years.

Using PFI to build hospitals wasted vast sums of money, transferring public wealth to private hands for no eventual benefit to the NHS. Liverpool’s Royal is just one of the many problems it caused.

Spending huge sums of money on major public projects like building  multimillion hospitals but not over seeing them or supervising them well is a wicked waste of money.

Paying staff poorly and over working them is bad for staff, bad for patients, very bad management, and bad value for money.

Employing big accountancy firms has not been value for money for the NHS but has given money we pay in tax to make them richer still.

Rationing care by restricting treatments and delaying operations  is causing pain suffering and in the  long-term greater cost to the NHS.

Giving  private companies vast numbers of contracts to provide care is wasteful and ineffective again siphoning off the money we pay to private profit.

Parceling up the NHS into packages small enough to be commodities in a free trade deal with Trump et al is an absolute betrayal.

Health care spending pays back three times in benefit to the economy and far more in terms of health and happiness. The amounts announced today are half of what is needed spent.

The NHS is our inheritance from the generation that defeated Hitler, it has been a continuous 70 year long investment in public well-being. This huge public wealth is being taken from us.

Liverpool has suffered badly from this NHS regime. There has to be change, reverting to a publicly provided universal and comprehensive health care system.

midwives cleaners etc

Patients Not Passports Workshop in Liverpool

Introductory comments and information from Greg Dropkin

I’ll make some general points about the charges imposed on certain migrants for using the NHS. This stands at the border between two very big issues: immigration control and the hostile environment created deliberately by the government, and the attack on the underlying principles of the National Health Service. The idea of the NHS was to offer comprehensive healthcare for everyone in Britain, that is to say universal and comprehensive healthcare, publicly provided, publicly accountable, publicly funded through general taxation, and free at the point of use. Each principle is under assault, and the migrant charges are part of the attack.

 

Healthcare is no longer universal if certain people can no longer access it in reality, and it is no longer free if certain people are forced to pay for it. Listen carefully to what the last Health Secretary, Jeremy Hunt, had to say in 2017 in introducing the Govt response to the consultation on extending charges still further.

 

“Our NHS is the envy of the world and we have no problem with overseas visitors using it – as long as they make a fair contribution, just as the British taxpayer does.” And then, in the Overarching Principles, the gov’t stated “Whilst overseas visitors can access its services, in order for the NHS to be financially sustainable it is vital they make a fair contribution towards the cost of those services. It is therefore our intention to make sure that only people living here and contributing financially to this country will get access to free NHS care.”

 

That might sound reasonable, until you think about it. If only people living here and contributing financially to this country will get access to free NHS care, what about the 12 million people in Britain under 16 years old, none of whom are contributing financially? What about the chronically ill, or the Long Term Unemployed?

 

Of course, children will become part of the future workforce and if they manage to get a job, they will pay income tax. But so will migrants, who already pay taxes every time they go to a shop, who want to work and who are, on average, healthier than the rest of the population.

 

Why is the NHS in financial difficulties? Is it health tourism – i.e. people who come here just to use the NHS and then go home? No, that costs £70m per year, around 0.06% of the NHS budget. Could it be PFI, which costs £2bn per year? Staff shortages £3.7bn. Private contactors £8.7bn. Or government cuts to the NHS budget, £22bn per year? Blaming migrants diverts attention from the real causes of the funding crisis in the NHS. But there is more to the agenda.

 

In order to try to recover costs from certain people, hospitals and community services have to set up a complex system to check everyone’s entitlement to free NHS care, train staff to use it, allocate computers etc. In future that system can be aimed at anyone the government wishes to charge for any aspect of their health care. It is the thin end of the wedge to destroy the principle of free NHS care.

 

Then there is privatisation. Currently, care of the dying is exempt from charging migrants, but only if it is provided by a Community Interest Company or charity. In other words, this specific care need is being moved out of the NHS for certain people. In 2011, the govt floated the idea of requiring health insurance in order to get a visa. As we know, the long term aim of the various NHS reorganisations is to move to a health insurance system.

 

Attacking migrants access to the NHS puts clinical staff in a conflicting position. They are trained to deliver care on the basis of clinical need, not immigration status. Except for urgent and immediately necessary treatment, certain migrants must now pay upfront charges at 150% of the NHS tariff, before they are treated. Urgent treatment is billed afterwards. Migrants from outside Europe will be reported to the Home Office after two months if they owe the NHS over £500. When patient data is passed to the Home Office, it undermines the trust between patient and doctor.

 

People who are frightened of being charged or reported to the Home Office may delay or avoid seeking treatment. They are then at risk of getting more ill and ending up in A&E. Even with an infectious disease like TB, whose treatment is free for everyone, the stresses faced by migrants in the hostile environment including poor housing, mean they are at greater risk of developing the disease, and then at greater risk of delaying treatment, which is then a public health risk for the whole community. The NHS needs to trace people with infectious diseases to know who they’ve been in contact with, but fear of being charged or reported makes that even harder. In other words, in public health terms the policy is crazy.

 

There is an excellent overview in a recent article by Ed Jones, which I urge you to read along with a national leaflet from KONP, explaining the charges and busting the myths about migrants and the NHS. For example, about 20% of NHS workers were born outside the UK – so much for the myth that the NHS is a national, not an international service.

 

To sum it up, migrants are not causing the crisis in the NHS. The charging regime is inherently racist, no matter what Equality Impact Assessments the gov’t issues. We should oppose charging anyone in Britain for using the NHS, and we should defend all of its fundamental principles.

 

Rayah Feldman is here now. She is a social researcher in London who has studied both HIV and maternity, including several reports for Maternity Action, including the very recent “What Price Safe Motherhood?” She will explain in detail the real situation facing undocumented migrant women during and after pregnancy, as a result of the charges.

 

Report on Charging Women for Maternity Care in UK 2021

Talk at Liverpool.

PNPnew

This talk is based on a recent report for Maternity Action ‘What Price Safe Motherhood?: Charging for NHS Maternity Care in England and its Impact on Migrant Women’

Maternity care charging is a limited part of NHS charging but it’s significant because maternity care is usually regarded as special, so charging for it with no concession to its special status in relation to women’s and children’s rights  makes the UK govt’s approach to it particularly problematic – and worth questioning.

NHS charging is a very significant part of bringing the border into everyday life.  This is often called the ‘hostile environment’ – a shorthand for hostile environment for undocumented migrants, but actually creating a nightmare for all migrants as shown by the Windrush scandal.

Today I want to focus on what charging for mat care means in practice for the individuals it affects – and if time to explore a bit more its implications.  In the workshops we can discuss ways of campaigning about charging and where mat. care might sit in such a campaign.

I will focus on 3 aspects of charging for maternity care in England as there are some differences in rest of UK

  1. Who is charged
  2. Charging procedures and practices
  3. Impact on women affected

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  1. Who is charged

People with visitor visas, UDMs, expats. – people not ‘ordinarily resident’ in the UK.    All other migrants who do not have ILR have to pay an Immigration Health Surcharge of £200 per year (doubling in December).  This is paid in full in applying for a visa, so it’s £500 per person for 2½ years (£1000 in December) on top of visa charges of £1033.

Our study did not include expats but our advice service has had requests from women who were deemed not to be ordinarily resident because they worked abroad, or had been living abroad for some time.  So we interviewed women on visitor visas and women who had overstayed earlier visas.

NB We interviewed 16 women – average length of residence –  over 6 years before their last pregnancy.

  • 2 women on visitor visas but both had British partners and were waiting to obtain spouse visas – so just in terms of the assumptions that a visitor is a tourist – this was not the case.
  • 2 women were EU cits/ dependants – wrongly charged
  • Some had come on student or visitor visas and become overstayers, and some were refused asylum seekers, some were very likely trafficked – one certainly was. Some who had overstayed their visas were trying to make further applications for leave, but this is difficult because not eligible for legal aid, and because of UD status had no money.

All those in this situation were very poor, and among the single women, often destitute as the following example shows.

Ayesha

Ayesha came to the UK for an arranged marriage. She had not met her future husband but he was ‘nice and caring’ when she spoke to him on the phone. They stayed together for about 4 months but she fled from him because he turned out to be violent and abusive. At that time she could not speak English and knew nothing about the UK. She survived by helping out different women she met in her mosque who offered her shelter in return for help with housework and childcare. When she became pregnant a family took her in for a longer period but made it clear she would not be able to continue to stay once she had her child. She was afraid to go back to her home country because she had run away from her husband, and she was also worried that her family would force her daughter to have FGM. She applied for asylum just before she was due to give birth.

She became pregnant while sofa surfing (often a euphemism for sex in exchange for accommodation). She did not stay with the father of her child. Ayesha’s story is a good example of how a woman’s immigration status can be dependent on their relationship. It also shows how irregular immigration status for women can give rise to a precarious personal situation in which women can be very vulnerable to abusive behavious by men.

In our study, only 5 of 16 participants continued to be in a relationship with the father of their last baby.

5 women were abandoned when they told their partner they were pregnant

3  – no information about partner (may have also been abandoned or may have been a brief relationship)

3 – separated from abusive partners during or after child was born.

Summary

  • Women were charged who had lived here several years, sometimes had other children born here, or had British partners, or were incorrectly charged.
  • Undocumented women without partners are particularly vulnerable to destitution and exploitation by men.
  • Immigration statuses are fluid and changeable. Ayesha came as a visitor, became an overstayer, then claimed asylum

 

  1. b) Charging procedures

We did expect the women we interviewed to be very poor and living in difficult circumstances.  But we also learnt from the study how harsh the charging regime is.

The charging rules

  • Charges to migrants are levied at 150% of tariff charged to CCGs. So current maternity charges are £6993.63 for full package including antenatal  care, delivery, and postnatal care. £1353 for termination. (Maternity care to CCG is £4662.42).
  • Failure to repay £500 or more within 2 months results in being reported to the HO and can result in refusal of subsequent immigration applications  or to re-enter the UK.
  • Maternity care is considered Immediately Necessary – this means must not be delayed or refused if a woman cannot pay.  But charges must now be levied in advance.

 

Charging practice

When operating the charging rules it is very important to consider the position of vulnerable overseas visitors, including those unlawfully resident in our communities, both those who are exempt from charge and those who are chargeable.

“Overseas Visitor Managers (OVMs), and other NHS staff are strongly encouraged to speak to their safeguarding leads if, in the course of their work, they are concerned aboutthe welfare of any patient. It can also be helpful for OVMs to build constructive relationships with local agencies which support people in various types of need, or to seek advice and information from relevant national agencies and organisations.” (DH Charging Guidance p53)

  • Some women asked for information and were not given it.
  • 2 women were wrongly charged and needed legal help to cancel charges.
  • Some women were billed for previous births which took place years ago after they were billed for the most recent birth. This is now very common.  Home Office officials are now often embedded with social services when they are asked for support by undocumented migrants. The Home Office then inform hospitals that someone had given birth there and was chargeable.
  • Most women were not told anything about charging prior to receiving a letter or invoice.
  • Subsequently they were harrassed with letters and phone calls, often from debt collection agencies. If English wasn’t their first language they could often not understand what people were saying on the phone.

The following are extracts from letters demanding payment which women had received:

Example 1

FINAL DEMAND FOR PAYMENT

Dear Sir/Madam

We wish to notify you that if this account is not settled within 7 days of this letter it will be referred to a debt collection agency and you may face litigation.

Furthermore, under immigration rules 320, 321, 321A and 322, a person with outstanding debts of over £1,000 for NHS treatment which are not paid within three months of invoicing, may be denied a further immigration application to enter / remain in the UK. If full settlement is not made, information relating to this debt will be provided to the UK Border Agency and may be used by them to apply the above immigration rules.

NB  The demand about repayment of £1000 was out of date and inaccurate.  The letter threatens litigation and provides no invitation to talk to hospital)

Example 2

One woman was told that as she had not paid

“the required deposit an invoice will be sent to the address you have given us. Please be aware that failure to pay this invoice may result in future appointments being cancelled.”

NB The letter made no reference to the fact that maternity care is designated as Immediately Necessary.

  1. c)   Impact of charging on women
  • Deterrence from attending care – women refused to attend further antenatal appointments. Natasha, on leaflet, would not go back for a checkup to find out why she had a miscarriage.  One woman with high blood pressure went to hospital just before delivery after refusing to go to more antenatal appointments. One woman – the only one who paid in full, refused to go to NHS for anything. Even those who did go were scared.

“Whenever I’m going to the midwife I’m really scared to go. I’m not happy about going there now. I’m always scared. I don’t know what’s going to happen whenever I have an appointment with the midwife. I don’t know what I’m going to hear from them. Maybe they will stop me from getting care. In the hospital I was so scared.”

  • Mental health– charging has a really bad effect on women’s mental health, increasing their stress and impacting  on the family as a whole.

“When they were calling me and saying I have to pay, I have to do this, there was a point I felt like just dying. And my son was crying, I’m like, shut up! You know what I mean? I just screamed at him like, shut up! It’s just… It does have an impact (on the child) because I shouted at him when I wasn’t meant to. Because he was just a baby then, he was a crying baby. So the whole thing was just too much for me.”

 

  1. d) Conclusion
  • This isn’t about recouping money for the NHS Of the 16 women interviewed, only 1 paid in full.  1 has 45 year repayment plan! 1 not charged because she claimed asylum. None of the others will be able to pay.
  • It is well known and acknowledged by the government that mental health, poverty, homelessness, and being a migrant adversely affects pregnancy outcomes. So why are they not excluding maternity care from charging?  In my view it’s racism in immigration policy combined with misogyny and hostility to family formation and reproduction among foreigners. e.g. Anwar Ditta case and the Primary Purpose rule in the 1980s and 90s.
  • Also the approach to maternity deeply misogynistic. It sees women having babies in the UK only as maternity tourism, and refuses to see women as students, spouses, workers etc.
  • The implementation of the charging policy is decentralised and not monitored and so is not consitent. There are no audits of the health impact of charging on women or its impact on deterring them from care.
  • Failure to properly examine immigration status of chargeable people let alone their social and financial circumstances as advised by guidance gives rise to mistakes and undoubtedly to racial profiling e.g. in our study two Latin American women  with EU rights were charged.
  • Charging has an insidious impact on NHS.  Divisions between entitled and unentitled become normalised, for example banners in hospitals saying “NHS Hospital Treatment is Not Free for Everyone”   “The NHS is a Residency based provider and is not free for everyone.

 

Credit for images to Maternity Action and “noahs birth” by Kala Bernier is licensed underCC BY 2.0

 

Emily Thornberry Speaks at demonstration to Save Liverpool Women’s Hospital in September 2018

Last September, Emily Thornberry MP spoke at the end of our great demonstration to save Liverpool Women’s Hospital.

 

Emily is a senior  Labour MP who speaks on foreign affairs for Labour  in Parliament. She is the shadow foreign secretary. Last time we had our friend  Diane Abbot M.P,  speaking for the campaign so we have had good support from Labour’s women’s team.We were delighted to have her with us that day, and delighted to have Labour’s health spokesperson  John Ashworth M.P. with us too.

It should now be clear that Labour is committed to saving this hospital. The battle though is not yet won. Plans to open consultation on the unacceptable  plan to move to the Royal are still in place. PFI is probably dead, but the money makers and privatisers can still try to find another ripoff scheme.

The video  has been made for us by Hazuan Hashim. It is lovely and important record of a great step in our ongoing campaign. We still haven’t won but we have made great strides and the hospital is still here.

Our fight and that of other hospitals, walk in centres and services goes on.The NHS has been stripped to the bone and only the good will and hard work of the staff keeps it going

The local and national campaigns for the NHS needs your help..