Minister attacked for refusing to act on evidence that overseas patients are dying because of upfront NHS charges

Stephen Hammond under fire after rejecting pleas for full review of impact of fees introduced as part of ‘hostile environment’

Rob Merrick
Deputy Political Editor
Sunday 07 July 2019 19:30 BST
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Cancer patients, pregnant women and children are among people denied vital treatment by the fees, critics say
Cancer patients, pregnant women and children are among people denied vital treatment by the fees, critics say

A minister has sparked anger after refusing to act on new evidence that overseas patients are being harmed – and even dying – because of upfront NHS charges introduced as part of the “hostile environment”.

Doctors, MPs and campaign groups have condemned the policy, warning cancer patients, pregnant women and children are among those denied vital treatment because of the fees.

In one case, a man with cancer and unable to leave the country was refused care and subsequently died – while a second woman died after not seeking help for a rare eye cancer because the NHS would not treat her.

Now health minister Stephen Hammond is under attack after rejecting pleas from MPs to recognise the mounting evidence of harm.

In an evidence session – likened to an episode of Yes Minister – Mr Hammond first argued a government review had taken place, before backtracking after being corrected by his top civil servant.

To the disbelief of MPs, he then argued that they, or local NHS leaders, should carry out any such inquiry, denying it was the responsibility of the Department of Health and Social Care (DHSC).

Dr Paul Williams, a Labour member of the Commons Health Committee, accused Mr Hammond of passing the buck, telling The Independent: “Faced with overwhelming evidence of the harm caused, the minister should have said he would review this.

“The policy was part of creating the hostile environment for vulnerable migrants, affecting people with cancer, or pregnant women.

“Those affected are not rich tourists, taking advantage of our NHS, they are members of the community – the people cleaning your office, or serving you in a bar.”

Dr Williams said he sensed “internal pressure” on the minister, adding: “It felt as though the civil servant was not giving him permission – the whole thing felt like an episode of Yes Minister.”

The policy, introduced as guidance in 2017, then made compulsory last year, charges patients from outside the EU 50 per cent more than cost to the NHS, which means up to £15,000 for certain operations.

Hospitals were ordered to demand utility bills, bank statements or payslips from patients, in order to prove their entitlement to free healthcare.

It has also been condemned by the British Medical Association. Dr John Chisholm, chairman of its Medical Ethics Committee, said: “The role of doctors – and all of their healthcare colleagues – must be to treat and care for patients, not to act as border guards, policing patients’ access to and payment for treatment.”

Lucy Jones, director of programmes at the group Doctors of the World, told the committee: “We have seen children denied surgery and a destitute woman being chased for debts incurred during a pregnancy as a result of sexual violence, and subsequent miscarriage.”

And the organisation Maternity Action said: “One woman had a miscarriage and swiftly received a bill for her care, which she could not pay. She did not attend for follow-up care because of the charges.”

Among other recent cases highlighted are:

* A man who had lived in the UK for nine years deemed ineligible for a heart transplant needed to save his life. His family were sent bills for the treatment he received, including after his death.

* A man who moved to the UK from The Gambia 10 years ago denied palliative chemotherapy after being diagnosed with two brain tumours and lung cancer and subsequently died.

* An English-born 60-year-old, who had lived abroad for 20 years was “left distraught” after being told “immediately before an operation it would cost her £6,000”.

* An asylum seeker initially given chemotherapy for leukaemia at a London hospital, before being told he had to leave and would not receive any more treatment.

Giving evidence to the committee, Mr Hammond first claimed his department had reviewed the “potential effect” of the charges, before being corrected by Chris Wormald, his permanent secretary.

The MPs were then told the review had merely been into the “narrow question” of turning what had been guidelines to hospitals into a legal requirement.

When Dr Williams said a patient with kidney cancer denied an operation unless he paid upfront was clearly at risk of “significant harm”, Mr Hammond replied: “The point at issue is actually how the regulations were being applied.”

Asked to order a full review, the minister replied: “I cannot commit to it this afternoon, and it would be inappropriate to do so.”

And, defending the stance, Mr Hammond added: “There is no question of our being resistant as regards harm being done.

“We looked at a particular change to the amendments. It showed that the amendments themselves were not causing harm, but some of the application was. We are constantly in contact with NHS providers about cases.”

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