A destitute asylum seeker who was billed more than £10,000 for having a baby could afford to pay just a penny a month, leading to calls for an urgent review of NHS maternity charging for migrants.
Kim, 34, whose name has been changed to protect her identity, was invoiced and then contacted by a debt collection agency after having an emergency caesarean section.
Asylum seekers, who receive around £7 a day per person for food, clothing, communication and toiletries, with small “healthy food” top-ups for mothers of young children, are exempt from charges under the NHS cost recovery programme. The scheme was first introduced by a Conservative government 10 years ago this month, targeting overseas visitors and migrants.
However, many women entitled to free NHS maternity care are being wrongly charged, pregnancy charity Maternity Action said.
Kim’s case was complicated by changes in her migration status. She first claimed asylum in the UK in 2017 after a crackdown on government critics in Zimbabwe, her country of birth, but was refused.
In 2021 she became pregnant and made a fresh asylum application, having struggled to do so earlier, she said, because of the pandemic.
After the birth of her daughter in March 2022, when she had an active asylum claim and should have been exempt, Kim was invoiced for maternity care by Leeds teaching hospitals NHS trust (LTHT) for £10,703.23.
The trust later told a debt collection agency that she owed an additional £3,450 relating to previous inpatient care for mobility problems that occurred after her first asylum application had been refused.
Kim, supported by the early parenthood charity National Childbirth Trust (NCT), wrote to LTHT saying: “I am forbidden by law from working and do not have a bank account.
“I would like to propose repayment of £0.01p a month. I am embarrassed that I cannot offer greater contribution … even this will be a stretch. A requirement to pay more than this will put me under significant pressure to obtain money unlawfully.”
LTHT has now apologised to Kim “for any distress caused”, confirming they “cancelled” the invoices once they received “updated information demonstrating her eligibility”.
The trust’s chief medical officer, Magnus Harrison, added: “Where a patient has accrued charges for NHS treatment and their eligibility later changes, previous charges still apply. If a patient is deemed destitute or at risk of imminent destitution then the trust may choose not to pursue the debt for the time being.”
It is recommended in the UK that pregnant women have an initial antenatal appointment before 10 weeks, but fear of charges meant Kim did not seek antenatal care until four months, encouraged by NCT.
“The danger is that incorrect implementation of the rules deters women from seeking appropriate antenatal and postnatal care,” Judith Dennis, Maternity Action’s head of policy, said. “This has serious implications for maternity safety (and) the health of women and babies.”
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Anna Miller, Doctors of the World’s head of policy, said charging migrants meant babies whose parents had been here for years were “born into debt”, with no evidence of the cost-effectiveness of a policy that led to “people avoiding treatment” until crisis.
Describing the impact of being charged, Kim said: “I really felt depressed … where am I going to get this money? I was still a new mum, breastfeeding as well … you’re trying to heal from a caesarean and then there’s a bill, there’s a small child as well.”
Kim remains in asylum accommodation, where residents have complained of mould and cockroaches, awaiting a decision on her claim and attending college, hoping to study nursing.
The NCT is calling for the impact of maternity charging to be examined and for access to interpreters and “secure housing” for pregnant women who are migrants.
The NCT head of programmes, Helen Lloyd, said: “The threat of NHS charging creates a hostile environment for pregnant women with unclear immigration status.”
A Home Office spokesperson said: “Asylum accommodation is required to meet strict standards, and regular inspections are conducted to ensure these are maintained.
“The NHS is a residency based system and it is only right that those who are not lawfully settled here, or exempt from charge, should contribute to the cost of their care.”
