Stop charging destitute migrant women and their children for NHS care

by Maternity Action

Stop charging destitute migrant women and their children for NHS care

by Maternity Action
Maternity Action
Case Owner
We are a national charity established in 2008. We conduct research, campaigning and provide legal advice on maternity and employment rights and benefits, and on access to NHS maternity care.
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Maternity Action
Case Owner
We are a national charity established in 2008. We conduct research, campaigning and provide legal advice on maternity and employment rights and benefits, and on access to NHS maternity care.
Pledge now

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Latest: July 16, 2020

We are appealing the High Court's decision

Maternity Action is appealing the court’s decision to refuse permission to proceed with our legal challenge to charging for NHS maternity care.

Our legal team has identified errors of law in the…

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The Hostile Environment embeds the mechanisms of immigration enforcement into the framework of the NHS. People who cannot show that they have the correct immigration status are faced with huge bills of 150% of the cost of treatment for vital care and fear that hospitals will inform the Home Office about them. Almost all treatment is chargeable, including life-saving treatment for cancer and mental health services. Even maternity care including giving birth is chargeable.

These laws and policies are penalising some of the most vulnerable people in our society, especially women who are destitute, survivors of Female Genital Mutilation (FGM), domestic violence and sexual violence and their children. The charging measures are forcing health workers to act as border guards.

The Government says charging stops ‘health tourism’ but this argument doesn’t work because the people worst affected are not health tourists. They are vulnerable people who have been living in the UK for years. They face barriers to the healthcare they need while they are waiting for their immigration case to be resolved - even after they have paid into the NHS via the immigration health surcharge or obtained a waiver.

NHS treatment can be a matter of life or death. We know of women who have avoided maternity services altogether or missed important scans during their pregnancy, at considerable risk to themselves and their babies. 

We know that people have missed important appointments and tests which are needed to determine the course of treatment and prevent their health from deteriorating. We also know of children who have been prevented from accessing treatments they need which can have a fundamental lasting impact on their development.

The Government says that charging saves the NHS money. It doesn’t. Denying vulnerable people treatment now will only risk them deteriorating and ultimately costing the NHS more when they reach a crisis point. The Government knows this; this is why it has exempted destitute asylum seekers and refugees from being charged.

We are not the only ones who are concerned.

Doctors, midwives and nurses alike are speaking out about this. The Royal Colleges of Physicians, Paediatrics and Child Health, Obstetricians and Gynaecologists, and Midwives have all voiced strong objections to NHS charging and its impact on vulnerable patients. The British Medical Association and its members recently voted in support of abolishing these hostile charging measures.

What are we doing?

We have issued a Judicial Review application to challenge the charging measures. The Secretary of State for Health has not conducted a full review of the impact of NHS charging on vulnerable groups. We argue that the charges are discriminatory, disproportionately affect women and children, and are unfair and unjustified and that an urgent and full review needs to be undertaken

We want the Secretary of State for Health to stop charging:

- Destitute Families (who are mostly lone mothers with children) who are waiting for a decision from the Home Office on their immigration application. 

- Pregnant women and women with new born babies for accessing maternity care.

- Victims of FGM, domestic and sexual violence for accessing NHS treatment.



We have already tried to engage the Secretary of State for Health to do this. We have written to him. We have spoken to civil servants in his department. The Secretary of State for Health has refused to agree to our requests. He has also refused our call for a full review of the charging measures and their impact on vulnerable groups. This is even after the Parliamentary Health and Social Care Committee called on him to do so.

How much we are raising and why?

It is likely that the Government will fight this case very hard. We are at risk of having to pay the Government’s legal costs if we lose the case.

We are a small charity with limited resources. We would struggle to afford the Government’s legal costs and continue with the case because it will risk depleting our limited resources which we need to help the many women who come to us for help.

To offer some protection, we are seeking your help to raise a minimum of £10,000 
to protect us in the event we have to pay the Government’s costs (and for court and admin fees). We will pledge this money and ask the Court to cap how much the Government can recover from us.

We already have the support of some phenomenal lawyers in Janet Farrell (Bhatt Murphy Solicitors), Jason Coppel QC (11 KBW) and Shu Shin Luh and Laura Profumo (Garden Court Chambers). All of them who are willing to work ‘at risk’ (that means we don’t have to pay them, but if we win, they will claim their fees from the Government).

Your support will allow us and our legal team to focus all our energies into pushing the Government to answer for the devastating impact of this harmful charging regime in Court.

Please help us to hold them to account!

If our challenge succeeds and we do not require the funds for the case, the money raised will go towards our campaign for free, safe and quality NHS maternity care for all mothers in the UK.

Who are we?

We are a national charity established in 2008. For 10 years we have been doing research, campaigning and lobbying for the fair treatment of pregnant women and new mothers in the workplace, in the benefits systems and in the healthcare system, irrespective of their immigration status.

Our lawyers provide free legal advice to individual women facing charges for NHS maternity care and for women facing discrimination at work and resolving benefits claims. We regularly give evidence to Government consultations and Parliamentary Inquiries. We were one of the Department of Health and Social Care’s ‘Vulnerable groups’ stakeholders on their charging programme.

Our ongoing All Mothers campaign calls for the immediate suspension of NHS maternity care charges for migrant women until a thorough, independent review can assess the impact of NHS charging policy. This campaign was developed from research we conducted on migrant women’s experiences of NHS charging over the last three years, published as What Price Safe Motherhood? and Duty of care.

We work closely with other organisations working on barriers to care for the wider migrant population.

We believe that all mothers in the UK must have access to free, safe and quality maternity care regardless of their immigration status.

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Update 5

Maternity Action

July 16, 2020

We are appealing the High Court's decision

Maternity Action is appealing the court’s decision to refuse permission to proceed with our legal challenge to charging for NHS maternity care.

Our legal team has identified errors of law in the court’s reasoning which found a good basis for an appeal. We made an application to the Court of Appeal on Monday 6 July 2020.

Although we were unable to secure substantive progress on our legal challenge, we are pleased to report that our legal challenge has prompted the Secretary of State for Health and Social Care to carry out a new review into the impact of NHS charging on certain vulnerable groups. The Secretary of State informed us of the existence of this review only shortly before the High Court hearing on 30 June 2020. There has been no other public announcement of this review. We will be working hard to ensure that the review, which has been described as an internal process, hears evidence from organisations working with those affected by charging, and that the review findings are made public.

We were heartened by the comments made by the judge on the importance of our legal challenge. While she did not accept our legal arguments, she made clear that in her view the legal challenge was responsibly brought by Maternity Action in the public interest and raised issues of significance.

In our appeal, we will continue to challenge the adverse impact caused by NHS charging for victims of gender-based violence and destitute families in receipt of ‘Section 17’ support from local authorities, as well as charging for maternity care.

For Maternity Action, protecting the health of pregnant migrant women is a critically important issue which deserves legal scrutiny. This appeal is our last chance to proceed to a full hearing. We don’t yet have a timeframe for the appeal to be considered. It may be completed within three months, or may be longer, depending on the number of cases in the queue.

The High Court judge ruled that Maternity Action is liable for costs for the early stage of the case. The funds you have provided us have allowed us to be able to pay the costs order. We will put the remainder raised toward our appeal. We are asking for our supporters to help us to continue to raise funds necessary to allow us to take this legal challenge to a full hearing. As before, if our challenge succeeds and we do not require the funds for the case, the money raised will go towards our campaign for free, safe and quality NHS maternity care for all mothers in the UK.

Update 4

Maternity Action

July 1, 2020

Court rejects our application for a Judicial Review

Maternity Action today lost our legal challenge to the scheme of charging destitute migrant women for NHS maternity care.  Following an oral hearing this morning, the High Court denied Maternity Action permission to proceed with the judicial review.  We are now deciding whether or not to appeal the decision.

We would like to thank all those who have supported us to bring this case. Your contributions matter so much to us, and to the women who continue to struggle with the unfairness of this Government's charging regime.

Our Director, Ros Bragg, released the following statement.

“For more than ten years, we have been asking the Government to stop putting the health of destitute pregnant women at risk by charging them for essential NHS care, and we will not stop campaigning on this. We know from our research that charging deters vulnerable women from attending for maternity care, putting the lives of women and their babies at risk.  These are women who struggle to afford food and shelter. They are in no position to pay for healthcare.

The pandemic creates new dangers for pregnant women, and particularly for BAME women who are at greater risk of hospitalisation and death.  It is of enormous concern to us that the Government is still resisting our calls for suspension of maternity charging.

The confidential inquiry into maternal deaths, released last year, found that three women who died were affected by NHS charging.  We know from our advice service that there are women with high risk pregnancies who are avoiding maternity care out of fear of incurring a debt they cannot pay.

The Government claims that it is conducting and internal review of the impact of charging on pregnant women, however this only came to light in the week before the court hearing.  Whether the Government is genuinely committed to explore this question remains to be seen.”

The Guardian's coverage of the hearing is available to read here.

Update 3

Maternity Action

June 18, 2020

We've got a new court date!

Our oral permission hearing to renew our application for a Judicial Review of NHS charges for destitute migrant women is scheduled for June 30th at the High Court. We cannot confirm at the moment whether the hearing will be in person or if it will be heard remotely.

The pandemic underscored what we have tried to advance with this legal action: That life-saving care must be accessible to all, especially the most vulnerable. To deter destitute migrant women and their children with maternity care charges they are unable to pay, and with the threat of detention or deportation if they are reported to the Home Office, is to put their lives at greater risk, and to put public health at risk. 


In April, Maternity Action signed a letter with Doctors of the World, various royal medical colleges and national charities to call for the immediate suspension of all NHS charges in the face of mounting casualties from coronavirus. The Government has ignored public health professionals and service organisations on this matter, only introducing charging exemptions for Covid-related symptoms. The NHS Charging Regulations remain in place, and will continue to keep away frightened migrants, including pregnant women who need ante-natal care and birthing support, many of whom belong to Black, Asian and Minority Ethnic groups disproportionately impacted by Covid-19.

With the support of our legal team, we are therefore pursuing our Judicial Review for the Government to suspend maternity care charges for pregnant women and their children so that they can access NHS care without any hindrances. We thank all of you who have supported us throughout this case and hope for your continued support as our oral hearing nears.

Please monitor our latest updates using the #AllMothers hashtag.

Update 2

Maternity Action

March 31, 2020

Oral hearing deferred to late April

Our oral permission hearing scheduled for March 26th at the High Court to renew our application for a Judicial Review of NHS charges for destitute migrant women has been deferred for a month. We thank everyone who has supported this case and we will keep you updated.

The Maternity Action team and our dedicated legal team will pursue this legal action to the best of our ability no matter what the circumstances. #AllMothers

Update 1

Maternity Action

Feb. 11, 2020

Update on our JR

In our last update, we said that we'd issued the Judicial Review application and we were waiting for a decision on permission.  On Friday 23 January, we were told that the High Court refused Maternity Action's application for permission to apply for judicial review.

 

The next step was for us to take advice from our legal team about the merits of renewing the application. Our legal team advised us to renew the application and we asked the High Court for an oral permission hearing.  The hearing date is Thursday 26 March 2020.

 

We are planning an action at the High Court on 26 March, the day of our oral permission hearing.  We will keep you updated as we would love to see those who have supported this case at the hearing along with the Maternity Action team. 

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