Written evidence from Maternity Action

About Maternity Action

  1. Maternity Action campaigns to better protect the rights of pregnant women, new mothers and their families and promote their health and wellbeing.  We deliver online information and telephone advice on maternity rights in employment, maternity benefits, breastfeeding rights and access to NHS maternity care.

 

  1. Maternity Action delivers the Maternity Care Access Advice Service which is a specialist service to help women get the maternity care they need, to advice women on whether they have to pay for their NHS maternity care and to help women to deal with problems relating to charging.  This service commenced in July 2016.

 

  1. Maternity Action published an article on the impact of charging for NHS maternity care in the British Journal of Midwifery in January 2016 (R. Feldman (2016), ‘Maternity care for undocumented migrant women: the impact of charging for care’ British Journal of Midwifery vol. 24 no.1).

 

  1. The Women’s Health and Equality Consortium has commissioned Maternity Action to undertake a small research project (£10,000) on the impact of NHS charging on health inequalities, focusing on sexual and reproductive health. 

 

Summary

  1. The Government’s programme of charging for NHS maternity care has a negative impact on the health and wellbeing of many pregnant women, new mothers and babies living in the UK.  Evidence on the numbers of women affected and the nature of the impact is not available.  This is an important gap in evidence.  Without this data, it is not possible to conclude that the income generated by the Government’s programme of charging outweighs the undesirable consequences.  Neither is it possible to assess the potential negative impacts of the NAO recommendations for future development of the charging programme.

Response

  1. While commonly described as a measure to address ‘health tourism’, a significant number of women who are currently living in the UK are subject to charging for NHS maternity care.  These include: vulnerable migrant women (e.g. refused asylum seeker not in receipt of Home Office support seeking care in England), women on the pathway to settlement (e.g. women with Fiancee Visas), and women whose babies will be British nationals as a result of having a British father (e.g. woman married to a UK citizen who does not have a ‘Family of a settled person’ visa).

 

  1. Department of Health guidance states that no woman should be refused or face delay in accessing maternity care because of charging issues: 

No woman must ever be denied, or have delayed, maternity services due to charging issues. Although she must be informed if charges apply to her treatment, in doing so she should not be discouraged from receiving the remainder of her maternity treatment. Overseas Visitor Managers (OVMs) and clinicians should be especially careful to inform pregnant patients that further maternity healthcare will not be withheld, regardless of their ability to pay. (Guidance on implementing the Overseas Hospital Visitors Regulations 2015 at 8.6)

  1. Despite this guidance, many pregnant women and new mothers living in the UK face difficulties accessing essential NHS maternity care.

 

  1. The complexity of charging regulations has led to confusion among NHS staff about entitlement to NHS care.  Women are known to have been refused maternity care because staff mistakenly believed they were not entitled.  For example:

‘I am a… citizen with Indefinite Leave to Remain and have recently become pregnant. I live in the UK. I think I am able to seek NHS maternity services— pre and postnatal. Is this correct? I believe it is but medical centre staff are confused and are referring me to private clinics. Are they right?’
(enquiry to Maternity Action)

  1. Research commissioned by the Department of Health suggests that as many as 30% of the people assessed by Trusts were incorrectly classified, resulting in charges being imposed on people who were actually entitled to free care (Creative Research 2013).

 

  1. Women are known to have been deterred from accessing NHS maternity services as they are afraid that they will be refused services, that they will face charges which they cannot pay or that they will be reported to the Home Office. For example:

 

A woman had become pregnant by a British man whom she met in her country of origin, and then came to the UK on a 6-month visitor’s visa; during this time, she developed complications with her pregnancy. Her baby had not moved for several weeks and no heartbeat had been detected. Clinicians told her that it was likely her baby had died, and that she would have to be induced, but the treatment would cost approximately £2500. She refused treatment because she wanted to travel back to her own country in order to apply for a 2-year spouse visa to live with her husband in the UK. A lawyer acting for her directed her to an international relief charity which ran a clinic staffed by volunteer clinicians, but did not know the outcome of her case
(‘Heavily pregnant immigrant carrying dead child wouldn’t seek help as she was afraid she’d have to pay NHS under ‘health tourism’ rules’. Independent 20 March 2014)

 

A woman who had experienced problems with her first baby was found to have high blood pressure during her second pregnancy. Her doctor wanted her to be admitted to hospital but she refused this because she was fearful about being charged for her maternity care (she had been charged for the care she received when she had her first baby). She attended appointments with a midwife during her pregnancy but continued to refuse to go to hospital, despite strong recommendations from the midwife and doctor that she do so. By the end of her pregnancy she was very ill and, when she gave birth, her baby was unwell. The woman’s kidneys failed and she was admitted to the hospital’s intensive care unit. She now requires long-term dialysis.
(Case study provided by a practising midwife at a London hospital)

 

  1. Late commencement of antenatal care and missed antenatal appointments are risks for poor maternal health outcomes.  Antenatal appointments enable midwives to identify and treat health conditions early in pregnancy.  Inadequate antenatal care may prevent screening and routine scans, reversal procedures for FGM, proper planning for labour or timely implementation of multidisciplinary health or social interventions if they are needed.

 

  1. The costs flowing from inadequate antenatal care are significant.  For example:

 

  1. There is no reliable data available on the numbers of women whose access to maternity care has been affected by charging policies.  There is no substantial research into the different ways in which charging impacts on women’s access to care, such as late commencement of care, missed appointments, or giving birth without a midwife or other clinician. 

 

  1. Maternity Action is currently undertaking a small research project on the impact of charging on health inequalities, focusing on sexual and reproductive health.  This project is expected to provide some indication of the barriers to accessing maternity care experienced by women and suggestions for strategies to address these.  It is a modest piece of research and would not be sufficient to enable an estimate to be made of the number of women affected or the ways in which access is affected.

 

  1. In the absence of sound data on the negative impacts of charging on women’s access to maternity care, it is not possible to conclude that the income generated by the Government’s programme of charging outweighs the undesirable consequences. Neither is it possible to assess the potential negative impacts of the NAO recommendations for future development of the charging programme.

 

  1. Maternity Action has consistently raised concerns about the impact of the Government’s charging programme on access to NHS maternity care in our communications with the Department of Health, including consultation responses.

 

  1. Maternity Action recommends that:

 

 

 

 

16 November 2016