The Impact on Midwives of NHS charging for maternity care
12th September, 2019
A report has been published describing the impact on the relationship between midwives and their patients as a result of the NHS charging overseas visitors for maternity care where they are not entitled to free NHS treatment. The 53 page report by Maternity Action uses research conducted with midwives across the UK working with migrant families, providing first-hand accounts of how charging for maternity care affects their practice.
The report describes its findings as ‘sobering reading’. It argues that the policy to charge for maternity care affects some of the most vulnerable people in society, and that attempts to recover money from women who have used maternity services is ‘driving a wedge’ between midwives and the women needing their care.
With a foreword written by Gill Walton, Chief Executive of the Royal College of Midwives (RCM) the report is critical of the inclusion of midwifery services in the NHS ‘Cost Recovery’ policy, arguing that it is detrimental to the care of vulnerable migrant women and prevents midwives supporting a woman to access the care she needs.
The report identifies a number of issues of concern. The requirements of the charging regulations are considered to impact upon the professional standards of midwives, hindering them from being an advocate for the women in their care and impacting on their capacity to give optimal care to women in pregnancy and beyond. Midwives were concerned that women were deterred from attending essential appointments for fear of being charged, as well as being caused stress by being pursued for bills they couldn’t afford to pay, and consequently declining further treatment. The result highlights potential negative effects on the physical and mental health of the patient.
Midwives themselves faced additional workload to understand how the regulations worked in practice and inform the women that they would be charged or how to gain exemptions. They reported inadequate or non-existent training in this requirement, and a concern about the ethical and moral implications of charging for maternity care and being required to make reports to the Home Office.
The RMC is unequivocal that access to maternity care should never be denied on the basis of ability to pay. This is particularly so given the inequalities faced by minority ethnic and migrant women, as indicated by a series of studies. Midwives identified what they perceive as a conflict in that they have a professional responsibility to address health inequalities, whilst at the same time charging regulations contribute to inequalities in access to care.
The report concludes that charging impacts negatively on both midwives, and on pregnant women, disproportionately affecting those women who are most in need of support, and exacerbating inequalities in the system.
Whilst the report concludes with a recommendation that there is an immediate cessation of charging for maternity care, it accepts that this is unlikely. A further 15 recommendations aim to improve the current system should charging remain. The full report can be accessed at here.
Please note that this briefing is designed to be informative, not advisory and represents our understanding of English law and practice as at the date indicated. We would always recommend that you should seek specific guidance on any particular legal issue.
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