We hear their stories: thinking differently about access to healthcare at Christmas time

By Gabrielle Bourke, Policy Advisor on 20 December 2018 Maternity Services RCM Annual Conference

This time of year is a good time to take stock, think about what we've achieved, what's still to do, and what's driving us. I've been reflecting on hearing midwives Memuna Sowe, Faye Macrory and Hilary Alba talk about their work with vulnerable women using maternity services, on Day 2 of the RCM Conference in Manchester back in October. Their passion and commitment was palpable, and the questions from the floor showed how many RCM members feel the same way about helping those women who need us the most. I hope those of you who were there felt inspired too.

That session of conference popped into my head when reading the latest report from The Equality and Human Rights Commission, and Doctors of the World, on the lived experience of access to healthcare for people seeking, and refused, asylum. It's easy to fall into clichés when talking about maternity services at Christmas time, but the nativity story is, amongst other things, about a family negotiating bureaucracy, on the move, with a few special characters visiting to make the birth special (and brighten up that stable with some bling). The report outlines how hard it is for our most vulnerable people to access healthcare, and also the amazing work of NHS staff and others who are doing their best to make it right.

The ECHR and DOW researchers interviewed asylum seekers and refused asylum seekers across the UK. They were experiencing many different physical and mental health conditions, including pregnancy. Many had experienced trauma before their arrival in the UK, and had been dispersed around the UK many times. The themes of this study echo those in Maternity Action's recent report into NHS maternity care charges for pregnant women.

In their own words, those interviewed felt that sometimes, they were not treated as humans with equal rights to others. They lived in fear – of being reported, of having to pay for healthcare when they were already destitute, and of being judged and subject to discriminatory attitudes. Language barriers and lack of information made it hard for them to access everything they and their children needed.

I thought of Memuma, Faye and Hilary when the report talks about asylum seekers’ appreciating the graciousness of staff, taking a holistic approach to their needs, seeing them as people with aspirations which are real and achievable, no less than anyone else’s. Asylum seekers’ own perseverance and resilience too is important to recognise; as midwives and MSWs we see every day the power of women. As Memuma told our RCM conference, ‘You have these definitions, but the true definition is when you meet these women and hear their stories’.  It’s clear too that staff working in the NHS, local authorities and other public bodies too are crying out for better information and more training. The confusion and fear is shared amongst professionals as well as those seeking asylum.

This evidence has led the EHRC, and now too the Royal College of Physicians, Royal College of Paediatrics and Child Health (RCPCH), Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Public Health (FPH), to take a stand with us and say the NHS charging regime is damaging to public health, and it needs to be suspended. The EHRC too agree with us that maternity care should be exempt from NHS charging altogether, to protect and promote maternal and newborn health. Pregnant refused asylum seekers need to get more support too – better housing and maintenance – not just in the last weeks of pregnancy, when intervention can be too late.

This report builds on an already overwhelming evidence base we have about how damaging NHS charging and the approach to refused asylum seekers’ healthcare is. As the Faculty of Public Health says, “The [NHS] charging regulations present substantial implementation challenges for health care providers, risk the disengagement of migrants from all services, may lead to poor health outcomes and are not supported by good financial or ethical justifications.” Sadly, the Government this week announced they were making no changes to the policy, and refused to publish the basis for that decision. It is a bizarre stance from a government that only last summer pledged to make England the safest place in the world to have a baby. This Christmas, I’m left asking: Safe for whom?