{"id":3089,"date":"2016-10-12T12:45:32","date_gmt":"2016-10-12T11:45:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3089"},"modified":"2016-10-12T12:45:32","modified_gmt":"2016-10-12T11:45:32","slug":"natal-nativism","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/10\/12\/natal-nativism\/","title":{"rendered":"Natal Nativism"},"content":{"rendered":"

Scene: the boardroom of a large NHS Trust, somewhere in England.<\/em><\/p>\n

“And so that brings us neatly to the last item on the agenda: passport checks for pregnant women who want a checkup.\u00a0 The thing is, you see, that it turns out that we’ve been providing obstetric care\u00a0to some women who aren’t actually UK citizens.\u00a0 And, clearly, that has to stop.”
\n“To stop?”
\n“Well, maybe not stop.\u00a0 But you know what I mean.\u00a0 We can’t go providing treatment to anyone who comes knocking at the door!\u00a0 Why, we’d have a queue from here to Timbuktu, not to mention the cost!”
\n“Oh, quite.\u00a0 No, I quite agree that we can’t be the world’s supplier of healthcare.”
\n“No.\u00a0 So that’s settled, then.\u00a0 No more obstetric services to women who can’t demonstrate their eligibility.”
\n“Hmmmm.”
\n“You don’t look convinced.\u00a0 What’s the problem?\u00a0 These women aren’t eligible.”
\n“Well, no.\u00a0 But… well, look.\u00a0 Remember when Dr Smith retired, and when Dr Jones got that transfer to work in the Inner Hebrides?”
\n“All too well. \u00a0Two great losses to the Trust.\u00a0 What’s your point?”
\n“Well, I seem to remember that we pooled together to buy them nice leaving presents.”
\n“We did.\u00a0 It was the least we could do.”
\n“I agree.\u00a0 But, you see, the thing is, they weren’t actually entitled<\/em> to them.\u00a0 If you see what I mean.”
\n“I’m not sure I follow.”
\n“No.\u00a0 Well, you see, the thing is, we bought them those presents, and gave them to them, because it’s the decent thing to do.\u00a0 There’s no rule that says that we have to buy them.\u00a0 They wouldn’t have been wronged if we hadn’t.”
\n“Yeeeeeeessssss…\u00a0 I mean, no.\u00a0 But yes.”
\n“But we gave them the presents anyway.\u00a0 Because the rules set out what’s minimially decent.\u00a0 Not an upper limit.”
\n“Yeeeeeesssss…”
\n“Well, you see, I was just wondering: might the same apply in other contexts?\u00a0 Allowing for the obvious differences, of course.”
\n“You’re losing me again.”
\n“I thought I might be.\u00a0 Well, you see, it’s like this.\u00a0 We’ve been providing treatment to pregnant women without paying attention to whether they’re entitled by the strict letter of the law.\u00a0 And that law specifies who is entitled to treatment. \u00a0But that doesn’t necessarily impose any exclusions. \u00a0You see, I wonder if by getting bogged down in the rules, we might… um…”
\n“Might what?”
\n“Well, you see, the thing is…”
\n“Go on…”
\n“Look: we might end up looking like utter shits.”<\/p>\n

Wholly fictional, this, of course.\u00a0 No such conversation took place.\u00a0 On the other hand, as reported by the Beeb<\/a><\/span>, here’s a document from St George’s University NHS Trust<\/a><\/span>.\u00a0 Skip to p80:<\/p>\n

\n
\n
\n

Obstetrics<\/span><\/p>\n

The Overseas Patient Team and the Division are involved in devising a pilot study to ascertain what processes might be introduced to identify non-eligible women before receiving care.<\/p>\n

The current practice is that patients are booked in and asked to complete a booking-in form. This form asks for proof of eligibility including passport details etc. However, these forms are routinely returned to the administration staff without these eligibility details completed and administration staff do not follow up on the missing information. The form is then kept until the woman has had her baby and then sent down in batches to the Overseas Patient Team for checking. This means that most, if not all, patients have to be sent a letter asking them to bring in documentation to prove eligibility. If they do not respond to the letter they are sent an invoice for their treatment at 150% as it is assumed they are not entitled.<\/p>\n

Issues with this process include that women have already completed their treatment pathway and incurred significant costs prior to being identified as non-eligible, that large numbers of non-eligible patients are identified by default leading to increasing verbal and physical abuse and complaints, and that blanket invoicing incurred at a cost of \u00a325 per invoice, generates additional costs only for the invoices, in most cases, never to be paid.<\/p><\/blockquote>\n

Hmmm.\u00a0 Women who aren’t entitled to NHS care, in London.\u00a0 Something tells me that a good portion of them will be here illegally or semi-legally.\u00a0 Which is to say that they’re vulnerable, and probably pretty much on the breadline as it is, and yet the policy is to charge them not for the cost of their care, but for the cost of their care times one and a half<\/em>, and to charge them \u00a325 a pop for a letter… and then the Trust waxes indignant when that money isn’t paid.<\/p>\n

You don’t say?<\/p>\n

The pilot recommends a new way of working at the booking in process. Administration staff would be trained to check documentation (photo ID and current utility bill) which the women will be asked to present on booking. This will be advertised widely throughout primary care in preparation. […]<\/p>\n

Anyone who was not able to prove eligibility would automatically be referred to the Overseas Patient Team for further investigation allowing real time management and identification of no [sic<\/em>] eligible women.<\/p>\n

The Home Office are keen to support this pilot as a way of benchmarking this process nationally.\u00a0 […]\u00a0 If this pilot study is successful the aim would be to roll it out across the hospital to safeguard all \u2018front door\u2019 access.<\/p><\/blockquote>\n

Ugh.\u00a0 Vile.\u00a0 Why did noone stick up their hand and say that this makes the trust look pretty shitty?<\/p>\n

All this for the sake of what is estimated on p79 as \u00a34-5m annually.\u00a0 Not chicken-feed, for sure.\u00a0 But… really<\/em>?\u00a0 It’s not much.\u00a0 The UK is a rich country (still).\u00a0 London is a rich city. \u00a0It’s highly unlikely to be the case that pregnant women who weren’t already in London are coming to London for the sake of a bit of obstetric care; so the idea that there’s an incentive doesn’t seem self-evidently convincing. \u00a0What is clear is that we have a group of people, members of which have other people actually inside their bodies; and those people and the people inside them presumably have needs and interests.<\/p>\n

So, even leaving aside the possible costs of providing emergency care that might have been avoided if non-emergency care were available; even leaving that… really<\/em>?<\/p>\n<\/div>\n<\/div>\n<\/div>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Scene: the boardroom of a large NHS Trust, somewhere in England. “And so that brings us neatly to the last item on the agenda: passport checks for pregnant women who want a checkup.\u00a0 The thing is, you see, that it turns out that we’ve been providing obstetric care\u00a0to some women who aren’t actually UK citizens.\u00a0 […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,963,2148,475,403,2022,1544,407],"tags":[],"class_list":["post-3089","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-curios","category-law","category-politics","category-rant","category-reproduction","category-the-nhs","category-wtf"],"yoast_head":"\nNatal Nativism - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/10\/12\/natal-nativism\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Natal Nativism - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Scene: the boardroom of a large NHS Trust, somewhere in England. “And so that brings us neatly to the last item on the agenda: passport checks for pregnant women who want a checkup.\u00a0 The thing is, you see, that it turns out that we’ve been providing obstetric care\u00a0to some women who aren’t actually UK citizens.\u00a0 [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/10\/12\/natal-nativism\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2016-10-12T11:45:32+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2016\\\/10\\\/12\\\/natal-nativism\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2016\\\/10\\\/12\\\/natal-nativism\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Natal Nativism\",\"datePublished\":\"2016-10-12T11:45:32+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2016\\\/10\\\/12\\\/natal-nativism\\\/\"},\"wordCount\":1057,\"commentCount\":2,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"clinical ethics\",\"Curios\",\"Law\",\"Politics\",\"Rant\",\"Reproduction\",\"The NHS\",\"WTF?\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2016\\\/10\\\/12\\\/natal-nativism\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2016\\\/10\\\/12\\\/natal-nativism\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2016\\\/10\\\/12\\\/natal-nativism\\\/\",\"name\":\"Natal Nativism - 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