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Exempt maternity care from NHS charging

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Maternity Action, Royal College of Midwives, duty of care, report, research, midwives, NHS charges, pregancy, vulnerable women, Home Office sanctionsWomen affected by NHS charges “are some of the most vulnerable people in our society”.

Maternity Action has published the findings of its new research that examined the impact that the National Health Service’s charging policy was is having on midwives.

The research, the first of its kind to investigate the impact of NHS charging policy on midwives, found that midwives were concerned that the policy of charging for NHS care was undermining trust and creating a climate of fear amongst vulnerable pregnant women.

Women who are charged for their maternity care include destitute women in the asylum system, and women who have escaped sexual exploitation and domestic abuse.

Charging for NHS care became a legal requirement in 2015 – and then upfront charging came into force in 2017.

Charges for standard maternity care start at £7,000.

‘Duty of Care: The impact on midwives of NHS charging for maternity care’ also highlights concerns previously voiced by the Royal College of Midwives that some women were seeking maternity care only when late on in their pregnancy, missing important tests and treatments, or avoiding antenatal care altogether for fear of charges and Home Office sanctions.

And the report has concluded that there is an irreconcilable conflict between midwives’ duty of care as set out in professional midwifery standards and in relation to NHS principles and values and the measures required by Trusts to identify chargeable women.

In Maternity Action’s view this conflict can only be resolved by ending charging for NHS maternity care. This is therefore the first recommendation the report makes.

The other recommendations should be read as interim measures pending the full suspension of charging; measures which may help to mitigate the negative effects of charging on both midwives and the women they look after:

Immediately suspend charging;

Amend immigration rules to stop debts affecting future immigration applications;

Improve data collection on charging practices and maternal outcomes;

Ensure Trusts take all measures possible to safeguard maternal and newborn health in administering cost recovery;

Develop policy and practice guidelines on charging procedures to mitigate damage done to women;

Ensure all communications and actions treat women respectfully;

Do not assess chargeability by way of information collected as part of routine clinical care;

Do not share any clinical information with the Home Office;

Notify women that they are chargeable in good time, with an opportunity for face-to-face discussion;

Set up transparent criteria for establishing inability to pay;

Provide an invoice that clearly states which payment level they have been charged for;

Invest in more community midwifery services that conduct outreach with recent migrants and women with little or no English;

Be mindful of the obligations contained within the Nursing and Midwifery Council (NMC) and General Medical Council (GMC) codes of practice;

Be mindful of the ways in which charging for NHS maternity care undermines efforts to optimise care for disadvantaged migrant women.

Commenting on the report, Gill Walton, Chief Executive and General Secretary of the Royal College of Midwives (RCM), said: “The RCM is committed to supporting our members to deliver safe high quality care and cost recovery is a barrier to this.

“We believe that maternity care should be exempt from NHS charging altogether to protect and promote maternal and new-born health.

“This is why the RCM is calling for the charging regime to be suspended until the government can prove this policy is not doing any harm and jeopardising our shared ambition to make England the safest place in the world to have a baby.

“Women affected by these charges are some of the most vulnerable people in our society.

“Research has shown us that charging for maternity care reduces the likelihood of vulnerable migrant women receiving care.

“These women are at greater risk of poor maternal health outcomes, including maternal deaths, and premature birth.

“Midwives should not act as gatekeepers to the maternity services.

“They owe a duty of care to all pregnant women who seek care from them and they should provide care to all pregnant women irrespective of ability to pay.

“The recommendations from this report, if implemented, will absolutely improve the situation for vulnerable migrant women and the midwives who care for them, and begin to right the wrongs of Cost Recovery.

“The RCM hopes that NHS Trusts, commissioners and most of all, the government, listen to the voices of midwives in this report and do the right thing.”

To read the full report, click here.

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