Hostile healthcare? Initial insights into the landscape of charging policies in the NHS in Wales

Abstract

The NHS is now firmly positioned as a site of immigration control. As the Hostile Environment filters further into the NHS the principle of universality is increasingly disputed. As such, paradoxically, harm is reproduced through an institution which is intended to provide care. Despite the increasing breadth of recognition of the implications of charging migrants within the NHS in England, insights into specific practices within Wales are limited. Therefore, this research starts to address this paucity by providing initial insights into the extent of NHS charging within Wales. The results from multiple freedom of information (FOI) requests sent to all seven health boards in Wales (carried out between January 2019 and August 2023) suggest that NHS treatment charging is common at scale across all health boards providing secondary care in Wales. In some instances, patients are being charged 150% of the cost of their treatment, and a significant number of patients are being incorrectly charged for care. It also appears that many patients have difficulty paying these charges, with significant outstanding invoices and many health boards resorting to using debt-collection agencies and/or payment plans in an attempt to elicit payment, and patients’ details being shared with the UK Home Office as a result. Considering the harms which are produced through NHS charging regulations, campaigners and advocates including Patients Not Passports Wales call for charging regulations to be withdrawn from the NHS in Wales and across the UK.