Hospital charging practices caused vulnerable patients to feel “scared” and “uncomfortable” report says

A South London hospital trust has apologised after their charging practices caused patients to feel “uncomfortable, scared or unable to seek timely treatment”.

A report, published on June 25 and compiled by an independent panel, shared details of how patients who were not eligible for free healthcare, many of whom were vulnerable, were treated by Lewisham and Greenwich NHS Trust.

One patient, who had fled from a non-EU country because of domestic abuse, gave birth at the trust in 2018.

During the day of delivery the patient was approached on the ward by a trust staff member who said that the patient would have to pay £6,000. 

As a direct consequence of this, her blood pressure rose sharply, and she had to remain in hospital for three extra days.

Another patient who became pregnant in early 2019 had a payment plan set up for her – even though she told the trust she could not afford it.

The patient was not allowed to work because of her immigration status and in the later stages of pregnancy she became destitute and homeless. 

Official guidance from the Department of Health and Social Care explains that trusts can choose to write off debts where it is clear that a person is destitute.

The organisation that referred her to the panel, Doctors of the World, stated that it was unclear if an assessment of the patient’s income and ability to pay was made.

Lewisham Refugee and Migrant Network and Save Lewisham Hospital Campaign are campaigning to end these charges.

In a joint statement, they said: “We have participated in the panel in order to reduce the harm of the policy. But we remain completely opposed to the legislation that is part of the continuing Hostile Environment and which we believe will continue to harm patients in the future. 

“Organisations such as ourselves and many others will continue to campaign to end these charges once and for all. 

“We recognise that NHS staff have to comply with this discriminatory and harmful legislation, targeted at undocumented and vulnerable people, and we welcome measures the trust has now taken to minimise the damage the policy causes. 

“We are resolved to continue to work with Lewisham and Greenwich NHS Trust, local organisations and patients to ensure that the damage done by this legislation is minimised until the day it is repealed.”

Access to free NHS care is based on being ordinarily resident and with the legal right to remain in the UK. 

Immigration law states that a person must be lawfully settled in the UK and have Indefinite Leave to Remain to be ‘ordinarily resident’.

The inquiry began after an investigation in 2019 revealed that NHS hospitals were using private debt firms to chase treatment costs from ineligible patients for free NHS care and treatment – including the use of bailiffs.

The Save Lewisham Hospital Campaign received information under FOI legislation revealing that many maternity patients were being charged and referred to debt collectors.

Lewisham and Greenwich NHS Trust also shared patient information with Experian to identify patients chargeable for NHS care. 

The trust set up an independent panel in January 2020 to scrutinise the way it handled charging, both at Lewisham University Hospital and at Queen Elizabeth Hospital in Woolwich.

The report included an apology to patients who had suffered as a result of the charging practices.

It said: “The panel’s work has also highlighted to management a number of instances where the Trust’s past approach to implementation of its legal duties to charge patients has not been delivered in the most empathetic or compassionate way.

“The panel has received details of a number of instances when the trust’s approach to patient charging may have resulted in patients feeling uncomfortable, scared or unable to seek timely treatment and/or choosing to go to other hospitals for their care.

“The trust makes an explicit apology for any instances where patients were not treated with compassion, or in a manner consistent with the values of trust.”

The report outlined 39 recommendations to improve the trust’s NHS charging practices – the majority of which were accepted.

These include reviewing and improving their patient literature to clarify the regulations, writing off debt for people facing destitution, and committing to training on the impact of the charging legislation on patients.