Sr.Barts workers protest banner. Source: Flickr - War on Want Sr.Barts workers protest banner. Source: Flickr - War on Want

Marion Macalpine reports from the recent Hackney Keep Our NHS Public meeting on migrant health and welfare during the lockdown

A well-attended Zoom public meeting was held last night, hosted by Hackney Keep Our NHS Public (KONP) on ‘What is happening to migrants’ health and welfare under lockdown?’, with speakers Rayah Feldman and Mamie Joyce from Hackney Migrant Centre.

Most of us think that NHS treatment is free at the point of use, even though delivery is increasingly through private sector companies. Hackney KONP called this meeting to provide information on who is being charged for NHS care, and what are the implications for those already destitute; also to discuss what we can do to expose and counter the damaging effects of charging. Rayah Feldman who is Chair of Hackney Migrant Centre gave an outline of charging:


  • Charges to migrants are levied at 150% of the normal tariff that is charged internally in the NHS. So for example, while the normal internal charge for maternity (including antenatal care, delivery, and postnatal care) is £4662, the charge to a migrant woman is nearly £7000 while she has to pay £1300 for a termination.

  • Failure to repay £500 or more within 2 months results in being reported to the Home Office and can result in refusal of subsequent immigration applications or to re-enter the UK.

  • Charges must now be levied in advance (with an exception for maternity care).

  • There are some exemptions that now include COVID-19 testing and treatment, as well as other infectious diseases, A&E, survivors of torture, victims of domestic and sexual violence, and Female Genital Mutilation. But many patients may not know before diagnosis if what they have is chargeable or not, so are very often deterred from attending.

  • People can make repayment plans but often they are destitute and hospitals don’t often agree small enough repayment plans.

Who is charged?

  • Migrants who are here legally but who do not have Indefinite Leave to Remain (ILR) have to pay a substantial yearly health charge, which will rise to £624 per annum in October 2020 and has to be paid upfront, plus the cost of their visa. Family members also have to pay the surcharge.

  • People facing this charge include doctors, nurses, and others working in hospitals and for the NHS.

  • It can take 5 to 10 years before applicants get ILR, with renewals necessary every two and a half years. The cost of a visa for two and a half years is £1033 + £1560 for the surcharge, which comes to a huge £2593 for each member of a household.

Effects of charging

  • People are deterred from getting care, leading to a worsening of conditions, avoidance of treatment including COVID because exemptions are not known in advance.

  • Under COVID lockdown people still get letters demanding payment from hospitals and debt collectors. Hospitals often contract with debt collection companies such as CCICM.

  • Charging leads to stigmatisation and racial profiling – white British patients are much less likely to be challenged, also confusion about who is chargeable.

  • Contact tracing – both fear of the Home Office and the hostile environment generally have a negative impact on contact tracing.

  • Anxiety and stress- there is a terrible impact on pregnant women and their babies and families.

What has happened under lockdown

  • Nothing has happened to health care charging except a very little publicised exemption for testing and treatment of COVID 19. Many asylum seekers are still in overcrowded hostels unable to socially distance or self-isolate. People are still getting demands for payment. Maternity cases have not been invoiced but are likely to be when the pressure on hospitals diminishes.

  • Although homeless people are being accommodated in hotels, in many cases they’re not being provided with food. This is true of people who’ve been accommodated through Hackney Council and other local authorities and of people who were in shelters who’ve been moved to hotels.

  • Children from families with No Recourse to Public Funds have become entitled to food vouchers in lieu of Free School Meals to which they were formerly not entitled. However these groups are also subject to a maximum household earnings threshold of £7,400 per annum (an unbelievably low amount) but without any top-up from Universal Credit.

  • At Hackney Migrant Centre there has been an increase in both the number of single people as opposed to families approaching for help.

  • Difficult for people in crowded living conditions to social distance., for example, a pregnant woman with 2 kids in her uncle’s living room.

  • Hackney Migrant Centre has re-organised to an effective system of remote advice on immigration, housing ad health advocacy. They also have Collective care team – to support people with food deliveries, etc. They are also campaigning on health care and free school meals.

Experiences of individuals

Mamie Joyce, health advocate at Hackney Migrants Centre

  • ‘O’ who has lived in the UK for 35+ years was charged over £12,000 for ongoing cancer treatment. Currently he takes medication with significant side effects. Despite this, has received debt collectors’ letters during COVID lockdown. ‘O’ is destitute and relies solely on local community support and family. ‘O’ has said how stressed this makes him and how it can exacerbate his already very fragile condition.

  • Another patient was charged for treatment at over £270 per month. Through Hackney Migrant Centre this was renegotiated to £50 per month. This patient is still paying charges during Covid-19.

Another example from Terry Day

  • A patient at Whipps Cross with advanced TB which had destroyed his hip bone. He was invoiced £52k for the cost of a hip replacement. Pressure helped get the charges waived in this case, but many others are understandably reluctant to have publicity.

What can we do?

  • Campaign for the kind of society we want to live in, rather than these cruel and horrifying regulations

  • Support campaigns against charging Keep Our NHS Public, Patients not passports, Docs not Cops Campaign against charging for follow-up treatment, including different forms of therapy.

  • Expose the use of debt collection companies to harass destitute migrants

  • Donate and use seeking donations to spread information:
          • Hackney Migrant Centre
          • Akwaaba – a social centre for migrants in Stoke Newington, now active in giving support.
          • North East London Migrant Action
          • Join Keep Our NHS Public nationally and contact the local campaign.

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