Using enforcement agents to recoup migrant NHS debts: an issue for migrants, an issue for us all

Can you imagine a bailiff entering your home and selling your possessions, to pay for essential healthcare services you should never have been charged for? Or a debt collector hounding you to pay a medical bill you simply don’t have the cash to cover?

For most of us, this would be an imaginary scenario. But in the UK today, this is the shocking reality for some migrant users of the NHS, who already form one of our country’s most vulnerable groups.

Migrants Organise recently supported a migrant woman who received several threatening letters from a debt collector who was chasing an outstanding medical bill. The hospital had incorrectly charged the lady, who was suffering from mental health problems and several other medical conditions.

This is by no means a unique case. A news article published yesterday confirmed that hospitals across England are now using external agents to approach migrants regarding unpaid dues. More than half of the 111 hospitals that responded to a Freedom of Information request filed by journalist Natalie Bloomer confirmed that they currently use debt collectors or had done so in the past.

Hospitals are using enforcement agents to chase NHS bills owed by migrants.

Free at the point of use?

Since April, the government has been charging certain migrants for GP and emergency treatment. Non-EU migrants and students are being forced to pay before being allowed access to NHS provision and refugees, asylum seekers, and undocumented migrants are being excluded from many essential medical services.

Charging for medical assistance is contrary to the founding principles of the NHS, which was established to provide free health care for everyone living in the UK, regardless of their ability to pay. But bringing in agents to recover dues represents a new low in a series of actions that are undermining the crucial services upon which all of us depend.

Bullyish, ineffective tactics

Employing debt collectors and bailiffs to follow-up on debt accrued from unpaid medical bills is aggressive and unsafe. Despite regulations introduced by the government in 2014 to cut bailiffs’ powers, their approach is still highly intimidating and humiliating for people, many of whom are already vulnerable. It causes significant stress and risks forcing people into even more difficult situations as they try to dodge contact with enforcement agents.

There is also evidence that people are being incorrectly charged for essential healthcare. The migrant we worked with continued to receive letters from debt collectors, months after a solicitor had proved that the woman was not liable. Other organisations have also seen cases of people being pursued by collection officers when hospitals had no right to charge them in the first place.

Quite apart from the distress caused by using enforcement agents, as well as the errors in application of the charging system, the process is also clearly ineffectual. Many of the migrants being charged have no source of income and simply cannot afford to pay hospital debts or the upfront fees that some hospitals are now demanding. Attempting to fulfil payments can be ruinous for some patients, and can cause others to avoid seeking medical care altogether.

The government claims that charging migrants will save the UK money, but so-called ‘deliberate health tourism’ costs a maximum of £300 million a year – only 0.3% of the overall NHS budget – and generates more profit than loss. The costs that can be recouped by charging people for their medical care are tiny for the NHS – to date, the 59 hospitals that were using debt collectors have only received £659,000 out of the £5.788 million they have been chasing since January 2016. Conversely, the costs of implementing the charging system are vast, with the monies being better off used to actually support those in need.

A problem for migrants, a problem for us all

Charging migrants for healthcare and using aggressive debt collection methods are part of the ‘hostile environment’ the government is deliberately creating to make lives for migrants without status so untenable that they leave ‘voluntarily’ or choose not to enter the UK at all. Racist and divisive, it is extremely harmful to the individuals directly affected.

But it is not only migrants who should be worried. We all suffer from the migrant charging system, as it damages our entire society’s commitment to universal healthcare. Racial profiling is being used to determine who to charge, based on the perception that they look different or have foreign sounding names – a step that will undermine the values that unite us. Furthermore, now that this charging process has started, it will become easier for the government to expand charging to everyone, regardless of nationality.

Public health concerns us all, and calling out the human cost of poor practices, while pushing for equitable and accountable care approaches, is crucial to both our individual and collective wellbeing. We hope that you will join us in our efforts to ensure that healthcare is available on the basis of need, for everyone.

Read our blog post to find out more about the hostile environment the government is creating for migrants and some of the steps we have taken to date to protest against this policy.

By Eleanor Weber-Ballard,

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