Children being denied cancer treatment due to their immigration status, doctors warn

Report also warns of intrauterine deaths in pregnant women who are too afraid to access antenatal care

Children are being denied cancer treatment due to their immigration status, according to new research, which has prompted calls from doctors for the government to revoke NHS charging regulations.

The report, published by charity Medact and researchers from the Royal College of Paediatrics and Child Health (RCPCH), found children were having treatments delayed or denied due to the policy requiring hospital staff to demand proof of entitlement to free healthcare.

Pregnant women and families have also been deterred from accessing care due to fear of charging and associated data sharing with the Home Office, with sometimes fatal consequences – including a number of intrauterine deaths in women who were afraid to access antenatal care.

The current NHS charging policy, introduced in 2018 as part of the government’s “hostile environment”, charges non-EU patients 50 per cent more than it costs the NHS to treat them and requires hospital staff to demand proof of entitlement to free healthcare.

There are an estimated 681,000 undocumented people living in the UK, of whom around 144,000 are children – whose status generally depends on that of their parents. The majority of these individuals cannot access employment, rent, mainstream welfare benefits or free NHS healthcare.

The research, based on survey responses from more than 200 doctors and other healthcare professionals, identifies 15 cases of children with cancer or other serious conditions being delayed or denied care due to charging policies.

In one case, a clinician described how a child with a cancer diagnosis was given emergency chemotherapy, but then later denied further treatment due to his immigration status. They said the chemo was eventually resumed after a “substantial” delay.

In another case, a boy who presented with leukaemia and required intensive care treatment and chemotherapy had his treatment delayed because the hospital was unwilling to start it until deposit funds had been provided.

The report also highlight cases of children presenting in a critical condition to A&E, even if accessing care earlier in their illness would not have been chargeable, due to their parents’ fear of accessing the NHS.

Many healthcare professionals who took part in the survey said they felt the charging regulations were having an undue burden on the health system, with one noting that it was “costly to the NHS as people often need emergency treatment and hospital treatment for a condition that was treatable earlier on”.

Respondents also said having to check patients’ immigration status before treating them went against their own values and the principles of the NHS, with some saying they would go beyond their usual duties to advocate on patients’ behalf against inappropriate charging.

They reported frustration that administrative staff would act independently of clinicians, such as by visiting patients on wards to assess eligibility or collect payment for care. Two respondents cited cases of bills being brought to families on clinical wards, causing confusion and distress about whether a child was able to continue receiving care.

Researchers also heard numerous cases of eligible patients being inappropriately billed or threatened with billing, with one respondent saying: “We know that twice as many people that were technically under these regulations got sent bills than were actually required to pay them.”

The study was conducted before the coronavirus outbreak, but researchers said it was highly likely that the deterrent effect of NHS charging would continue to be felt by migrants during the pandemic, as seen in the case of Elvis, a Filipino man who died at home after showing Covid-19 symptoms but was too afraid to access the NHS.

The report concluded that NHS charging regulations were “unworkable” and were having a detrimental impact on the wider health system, as well as conflicting with its staff’s professional and ethical responsibilities.

The findings appear to contradict a statement from the Department of Health and Social Care in December 2018 stating that their internal evidence collection of the impact of NHS charging regulations, which was kept confidential, did not find any evidence of harm.

The RCPCH and Medact, along with other migrant health charities, are now calling on ministers to urgently suspend the charging regulations and commission a transparent independent review of their impact.

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Claire van Nispen tot Pannerden, women’s and children’s project lead at Doctors of the World UK, said the system “clearly compromises the health and safety of migrant children”.

She added: “They are part of society and often cannot return to where they came from; also, many children of migrant parents are born in the UK. We believe every human being has the right to access healthcare and should not be facing barriers in doing so. This is the case even more so for those dependent on others: the children.”

A Department of Health and Social Care spokesperson said: “It is only right those who are not entitled to use the NHS contribute to the cost of their care. However, the health of children is paramount and we are clear urgent treatment for both children and adults should never be withheld, and are supporting Trusts to ensure these rules are fully understood.

“During this unprecedented period, we have also made important changes to the charging regulations meaning no one will be charged for their Covid-19 treatment.”