Access To Treatment For Visitors

THT CASE STUDIES

  • February 2000: a woman from an East African country who was not entitled to free NHS treatment told THT that she had been diagnosed at a London hospital where a midwife had unofficially given her some “medicines” but was unable to offer ongoing treatment. It was unclear what the offered “medicines” were. The woman did not re-present and it is not known if she went to another hospital in hopes of treatment, or if she returned to her country of origin.
  • Mid-2000: a woman from a Central African country presented to a South Coast A&E department very unwell with TB. The woman was a student who had been in the country for less than 12 months. She was given emergency treatment and TB treatment. However, she was then also given a bill for £2000 for her treatment (which should have been free according to most interpretations of current guidelines). Rather than argue, once able to discharge herself she moved her care with the support of THT to another clinic out of area who were more willing to treat her for free. Without intervention, she might well have returned to the community with an easily communicable disease (TB) not fully treated – a situation which can lead to drug-resistant TB.
  • January 2002: A man from Southern Africa with HIV and TB presented at a central England hospital and was admitted as an emergency. After two days it was found that he was not entitled to free NHS treatment and he left even though he was significantly unwell with both conditions. THT discovered this when a worker tried to visit him and found him already gone. It appeared that although he was entitled to free TB treatment, the information that he would be charged for the HIV treatment, which he would be given simultaneously, meant that he was unable to continue at the hospital. THT recontacted him in the community and persuaded him to return to a different hospital, which was willing to treat both conditions freely.
  • November 2001: a woman from Southern Africa presented at a central England hospital pregnant and was diagnosed with HIV. She was questioned by more than one person from the finance or accounts department about her entitlement to care and found to be a student, resident in the UK for less than 12 months. She was then (incorrectly) told she would be charged £10 for her HIV test. She was also told that she could not receive any treatment to prevent mother-to-baby transmission of HIV unless she paid full cost for it. She subsequently contacted THT staff who, having checked the position with the hospital, supported her in going to another hospital out of area who were prepared to interpret the regulations more generously and consider preventive antenatal treatment as emergency treatment.
  • November 2000: a woman long-stay visitor from Southern Africa presented at a South East England hospital and was found to be pregnant. She was subsequently diagnosed with HIV through routine antenatal care, whereupon she was investigated, told that she was not entitled to free NHS care, billed for previous services and asked to provide a deposit for future care. She felt unable to return to the hospital even for her antenatal care and, in a state of confusion and distress, contacted an HIV support organisation. She was advised to re-seek care elsewhere rather than avoid all health services, and was subsequently accepted for free care including preventive treatment for mother to baby HIV transmission at another hospital. Unfortunately this meant she had to travel considerable distances to receive treatment, but she did eventually have an HIV negative baby, quite possibly thanks to the intervention of the support organisation and the attitude of the second hospital.
  • A woman who was married to a man recently seconded to the UK by a multinational company presented at a London hospital and was diagnosed as both pregnant and significantly ill with HIV. The hospital was unable to offer her free treatment according to its interpretation of the guidelines, but did so in a sensitive manner and tried to work with her to obtain payment from her husband¨s employers. However, this caused severe difficulties with confidentiality and his employment. The company insurance did not (as almost all do not) cover HIV and the hospital had to work intensively with the family to avoid disclosure of her status, which could have prevented payment for her routine antenatal costs by the company. The husband was also concerned not to raise questions with the company about his own potential HIV status, which could have impacted informally on his future employment. The hospital supported the family in managing the further HIV treatment costs, which they had to pay themselves. Had the hospital not been extremely sensitive and worked closely with the family and THT, this could have been a potentially very difficult situation.
  • September 2001: THT was contacted about the three year old son of a man from central Africa who was applying for exceptional leave to remain under Article Three. The man had already been diagnosed with HIV and the child was subsequently also diagnosed with HIV at a Central England hospital. Although the child was significantly ill, the hospital told the father that it would not provide NHS treatment until his application to remain had been processed and agreed. The social worker involved contacted THT and was advised that this was not the normal interpretation of the guidelines, under which Article Three applicants are treated like asylum applicants for the purposes of health services. However, since the hospital in question was intransigent and time was of the essence in treating the increasingly unwell child, the social worker referred the child to another hospital further away which was willing to treat him. The father and son are thus forced to regularly travel a considerable distance, with travel costs presenting an ongoing problem, until either the father¨s status is resolved or the local hospital has the guidelines clarified to its satisfaction.
  • Late 2001: THT was contacted by a health promotion service north of London about an asylum seeker with HIV dispersed to their locality. She had recently given birth to twins and was being advised not to breastfeed in order to avoid transmission of HIV. However, as an asylum seeker she was not entitled to baby milk vouchers and was unable to afford the cost of formula at the supermarkets which the voucher system forced her to shop at (milk powder often being for sale in baby clinics at wholesale prices, but for cash only). To avoid breastfeeding (and the potential subsequent personal and clinical costs of a child with HIV) the local health promotion unit found the cost of her milk powder as a one-off stopgap solution.
  • April 2002: THT was supporting an asylum seeker from Southern Africa who was based on one side of London in secure and suitable accommodation. He was significantly unwell with HIV and being treated on an intensive but outpatient basis by a nearby clinic with a reputation for excellence. Because of NASS¨s policy of “clustering” asylum seekers, he was moved inappropriately to insecure bed and breakfast accommodation on the other side of London, without cooking facilities and with other asylum seekers from his country of origin, who he did not want to know his diagnosis. He is now regularly forced to make a difficult journey of more than an hour each way, involving several changes of public transport, in order to attend the clinic that understands his medical history and complex needs. This move was undertaken by NASS despite letters from both the local authority and the attending clinician supporting his need to remain where he had been originally settled.

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Published: May 2, 2003
Last edited: January 5, 2011