How have overseas charges impacted the health and wellbeing of children and young people?

Since 2017, changes to NHS charging regulations have placed requirements on NHS trusts to identify patients not ‘ordinarily resident’ in the UK who should be charged for receiving secondary and community care. This policy has, sadly, placed vulnerable groups at risk of worsened health outcomes as they choose to delay or deter seeking treatment.

There are estimated to be 144,000 undocumented children currently in the UK and at risk of falling between the gaps if they fall ill.

To better understand how children and families are impacted by overseas charges, we undertook a survey of our members in 2019. Responses from over 200 child health professionals revealed a worrying picture. Over a third of respondents knew personally of patients that had been adversely impacted by these regulations. 

The resounding impression from staff was that parents likely to be impacted by overseas charging are scared. They are worried that attending any health care service with their child will result in one or all of the following: charged with payments they cannot afford or referral to the Home Office for deportation. 

The result of this fear is that patients either don’t attend or they delay when they attend. We know that early intervention is key, and that delayed presentation to health services can see health problems exacerbated, making them more difficult to treat, and potentially lead to longer-term health problems. Our survey results shed light on the deeply concerning consequences of this. 

Born with a severe and life-limiting condition which could have been detected antenatally if she had received antenatal care at the right time in the pregnancy.

Survey respondent

Our findings revealed a lack of understanding and confidence amongst healthcare staff in interpreting and applying charging regulations. Certain groups are exempt from upfront charging, like asylum seekers and refugees.  Only 14% of respondents said that they would feel confident identifying patients who should be exempt from charges. And for patients deemed to be eligible, there was a lack of understanding about when charging should be applied, upfront or retrospectively? These results are unsurprising, given that only 12% of respondents have received training on this topic. Recognising this, the RCPCH has been involved in the development of guidance for paediatricians on how to support potentially chargeable patients. We will publish this in the coming months. 

What patient groups are exempt from charging?

  • Asylum seekers
  • Refugees
  • Victims of trafficking (recognised by the National Referral Mechanism)
  • Looked After Children
  • Those with some infectious diseases and notifiable infections
  • Those with conditions which arise as a result of violence (e.g. domestic abuse, sexual torture, female genital mutilation)

Interpretation and application of these regulations is placing a burden on us as clinicians; our primary focus should ultimately be providing high-quality clinical care. Many of us currently spend time advocating for the needs of individual patients to receive care without unfair payment. The RCPCH is calling for a reversal of all overseas charging regulations to protect our most vulnerable patients. Even if children and pregnant women were exempt, charging of other adults within their families would potentially have adverse health outcomes for both parents and children. 

I feel exorbitant charging for immigrant children and the undue delay getting things done [procuring equipment, getting consultations] for such children would create a bad reputation. As a doctor, I feel stressed and immoral handling this.

Survey respondent

We are pleased to see that overseas charges have been suspended for the treatment of any patients with COVID-19. Spread of coronavirus has demonstrated that we are all at risk of becoming ill and we should all be confident to access healthcare as and when we need it.

Read more from the findings of our survey within this recently published in this BMJ Paediatrics Open article, ‘Healthcare access for children and families on the move and migrants’.

The RCPCH will continue to host an online evidence submission for cases where the charging regulations have impacted patient care or outcomes and encourage health professionals to contribute.