New research exposes extent of Hostile Environment in Welsh NHS

Two years after the introduction of Hostile Environment policies in the NHS, new research published today by Docs Not Cops Swansea shows how migrants are being left in thousands of pounds of debt for accessing healthcare that they need – despite their care accounting for only 0.016% of the Welsh NHS budget.(1)

Data from Freedom of Information requests submitted to the seven Welsh Health Boards by the campaign group shows that in the financial year 2017/18:

  • 1,208 patients were identified as ‘overseas visitors’ – people considered not ‘ordinarily resident’ in the UK. This could include people who may have lived in the UK for many years but are unable to prove their eligibility for NHS treatment, such as members of the Windrush generation, as well as survivors of trafficking and domestic workers whose employers have failed to renew their visa.(2)
  • 285 patients were charged a total of almost £1.1m for NHS care due to being designated a ‘overseas visitors’ – an average of £3,787 per patient. Aneurin Bevan University Health Board’s Overseas Visitors Policy states that it charges 150% of the cost of treatment, meaning that patients are being charged more than it costs to provide their care.
  • Over one-third of the charges (£399,426) remain outstanding, suggesting that many patients are unable to afford to pay for the treatment they need. Unpublished guidance from the Welsh Government released in response to the requests states that health boards should seek payment before treatment starts, meaning that some patients may be declining treatment that they need because they can’t afford it or are concerned about getting into debt.

Christine Haigh from Docs Not Cops Swansea said:

“Two years after being introduced in the NHS with devastating consequences, this research shows that the Hostile Environment is alive and well in Wales, denying people access to healthcare or pushing them into debt to get the treatment they need.

The Welsh Government must firmly reject this racist Westminster policy and make it clear that NHS care is available to all in Wales on the basis of need – as its Welsh founder, Aneurin Bevan, always intended it.” (3)

The Docs Not Cops campaign is a UK-wide campaign calling for an end to checks on patients’ immigration status and charging patients for NHS care. There are many examples of patients who have died or suffered harm as a result of the policy, including:

  • Nasar Ullah Khan, who died after being denied treatment for heart failure. (4)
  • Elfreda Spencer died because she could not pay £30,000 upfront for chemotherapy. (5)
  • Kelemua Mulat died following a six-week delay in her breast cancer treatment while the hospital decided if she would have to pay. (6)

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Notes to editors:

  1. The total charged in 2017/18 was £1,079,236 out of a total Welsh NHS budget of £6,563,488,000 (source:
  2. Examples could include survivors of trafficking, those on spousal visas whose relationship has broken down, domestic workers whose employers have failed to renew their visa, and people who came to the UK as children whose parents did not have documentary evidence of their immigration status. It also includes short-term visitors to the UK whose country of origin may have a reciprocal healthcare agreement with the UK enabling them to access care for free or at a reduced cost.
  3. Welsh founder of the NHS, Aneurin Bevan, wrote in 1952: “One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment.” (In Place of Fear (1952) by Aneurin Bevan)
  4. Source: My patient has been denied life-saving treatment because of where he was born
  1. Source: Cancer patient died after NHS demanded £30,000 for treatment
  2. Source: Home Office prevented asylum seeker’s urgent cancer treatment

Healthcare workers blockade NHS England and hold vigils at six Hospitals to protest charging for migrants in the NHS

six people in scrubs with hands tied by rope, 8 holding signs reading "NHS - Our Hands Are Tied By The Hostile Environment"
  • On Wednesday 23rd October doctors, nurses, patients, and community groups will stage a national day of action to protest immigration checks and charging in the NHS.
  • This marks two years since the introduction of upfront charging for care in the NHS, part of the ‘hostile environment’ policies that have been widely criticised by healthcare workers since their introduction into the NHS.
  • Campaign group Docs Not Cops will blockade the offices of NHS England for their role in passing patient data to credit check agencies to check their entitlement to care.
  • In the evening, healthcare workers and local campaign groups are holding vigils at 6 hospitals around the country to stand in solidarity with the people impacted by NHS charging.
  • Since the introduction of the policy in 2017, a number of people have died after being charged for care or denied treatment, as a result of their immigration status. 

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On 23rd October 2017, the Government made it a legal duty for NHS Trusts to charge up-front for treatment for people who are unable to prove their entitlement to free NHS care, and increased the chargeable amount to 150% of the cost of the treatment. This was a significant change in the way the NHS administered charging for care, and has increased the need for hospitals to check IDs and immigration status before providing care.

The impact has been wide ranging, impacting migrants, UK citizens, and groups of people supposed to be exempt from charging as evidenced by the Windrush Scandal, research by the Equality and Human Rights Commission, and the Government’s own review. The policy has faced harsh criticism from the healthcare community with members of the BMA overwhelmingly voting in favour of scrapping the policy and both the Academy of Medical Royal Colleges and the Royal College of Midwives calling for the policy to be suspended pending a formal review of the impact. Last week the charity Maternity Action launched a court case challenging the discriminatory impact of charging migrant women for care.

The Human Cost of Charging 

Since the introduction of the charging policy, there have been many cases of people who have died as a result of delayed treatment or being denied care. In a number of cases, it was found that their treatment had been wrongly denied or charged. 

  • Nasar Ullah Khan – a 38 year-old Pakistani national living in Birmingham – died after being denied a heart transplant as a result of not having indefinite leave to remain, and was presented with £32,000 in care costs. 
  • Elfreda Spencer – a Jamaican-born grandmother living in London – was told she had to pay a £30,000 upfront deposit before her chemotherapy for breast cancer could begin. She waited for a year before being treated, by which time her cancer had become terminal. She died aged 73 in London last year.
  • Kelemua Mulat – a 39 year-old mother of one from Ethiopia – was denied treatment for six weeks for advanced breast cancer while the hospital tried to work out if she was eligible for care. She eventually started treatment, but by that time the cancer had spread. She died one month ago. 
  • Saloum –  a 53 year-old Gambian man forced to flee his home as an outspoken oponent of FGM – collapsed in December 2018, and was found to have terminal brain and lung cancer. He was unable to access free NHS care and was turned away from hospital because he could not pay the £8,397 bill, eventually becoming homeless. He died in April 2019
  • Other stories of people impacted by the charging regulations include Albert Thompson, Esayas Welday, Pauline Pennant, Beatrice, Bhavani Espathi, and Evette White


Campaign group Docs Not Cops [1] has organised a national day of action to mark the two year anniversary of the introduction of upfront charging and highlight their calls for an end to charges for NHS care.

This morning they will stage a blockade at NHS England, to highlight their role in running a pilot scheme in which NHS Trusts were encouraged to share patient data with Experian to check their entitlement to care.

In the evening, vigils will be held at 6 hospitals across the country: Brighton, Birmingham, Bristol, Manchester, and in London at the Royal London and Lewisham Hospitals. The vigils will see thousands of healthcare workers, patients, and community groups come together to stand alongside people who are affected by the Hostile Environment, and share stories of the impact of NHS charging.


Luke Costello, Senior NHS Nurse , said:  

“I started working in the NHS because I believed in its founding principles, that care should be given on the basis of need, not ability to pay – but the charging regulations brought in under the Hostile Environment have completely overturned that. It’s becoming increasingly impossible for me to care for and build trust with my patients when they know I might ask them to pay. The government must put an end to charges for care, and commit to the founding principles of the NHS: that it is a service free to all who need it.” 

A Children’s Doctor who works at the Royal London Hospital, who asked to remain anonymous, said:

“As a children’s doctor, I know that having rapid access to healthcare saves lives. I’m furious that barriers are being put up which prevent my patients and their families seeking and receiving the care they need. If their birth was complicated, or the babies need intensive care, the cost very quickly goes into the hundreds of thousands – and parents only have three months to sort out the paperwork before they’re expected to pay. I’m demonstrating at the Royal London today because it was revealed that 35 children were charged here in 2018/19 for their healthcare.”

Aliya Yule – an organiser at Migrants Organise, who are co-hosting the vigils, said:

“The introduction of charging for migrants has meant that many people are scared to seek the care they need. They are fearful of healthcare providers reporting them to the Home Office and landing them with extortionate bills, rather than helping them when they are unwell. Everybody who cares for the NHS should be worried, as this is the start of a charging regime which will accelerate privatisation for everybody – this is why communities are fighting together against the policy and the Government’s attempt to divide our us by blaming migrants.”

James Skinner, Access to Healthcare campaigner at the charity Medact, who are also c-hosting the vigils, said: 

“Our research has shown that not a single NHS Trust in the country in monitoring the impact of NHS charging policy. It’s inconceivable that the Department of Health and Social Care can force healthcare workers and NHS Hospitals to start charging people up-front without assessing how it will affect patient care, and when all the evidence we do have clearly demonstrates devastating harm.”


Aliya Yule, Migrants Organise – 07960 163915 – 


[1] Docs Not Cops is a group of NHS staff and patients that work to combat racism in the NHS. They believe no one should be afraid to access the healthcare they need, either because they can’t pay or might be punished, and that NHS workers should not be forced to police the people they treat.

I’m a Nurse – Not a Border Guard! #InternationalNursesDay

International Nurses Day is celebrated around the world every May 12. This year the International Council of Nurses have chosen “Nurses A Voice to Lead – Health is a Human right” as their theme.
We agree with them that “healthcare should be accessible to all”.
But – as part of their Hostile Environment policy this Government have been making it more and more difficult for people to access the NHS services they need.
Join our “I’m a Nurse Not a Border Guard” twitterstorm on Saturday 12th May 12noon-2pm and tell @Jeremy_Hunt why #ThisNurse believes in #PatientsNotPassports! Full details below.
12/05/18 International Nurses Day - I'm a Nurse Not a Border Guard - Send Jeremy Hunt a selfie for #InternationalNursesDay telling him why #ThisNurse believes in #PatientsNotPassports
It is now mandatory for NHS trusts to check people’s immigration status before providing secondary care and for them to charge upfront for treatment in many cases. The Immigration Health Surcharge prices people out of visa applications – and is going to be increased even further.
Already these policies are leading to discrimination and racial profiling, to people being too scared to access the care they need, and are turning healthcare workers into border guards. This week the government announced it would suspend data-sharing between NHS Digital and the Home Office in most cases – but we need to keep pushing to ensure no one will have to fear immigration enforcement when seeking medical care
As Nurses we must stand up for our patients and advocate for their right to free, universal, non-judgemental healthcare.
Join us in celebrating International Nurses day by telling Jeremy Hunt it’s time to end prohibitive healthcare charges for migrants, scrap ID checks in hospitals and community care, and time to kick the Hostile Environment out of the NHS.
Tweet a selfie of you and your colleagues (ideally in uniform – but you don’t have to identify yourself) holding a sign saying:
“We treat patients not passports.
I’m a Nurse not a border guard ”
Send it at midday and make sure you @Jeremy_Hunt. Here are some sample tweets to get you started:

1. “We’re nurses not border guards! @Jeremy_Hunt time to kick the hostile environment out the of the NHS! We’re joining @DocsNotCops to say #PatientsNotPassports

 2. “I’m a nurse not a border guard!
#ThisNurse is telling @Jeremy_Hunt that we want to treat #PatientsNotPassports. End the Hostile Environment!”
3. “Health is a human right and we’re nurses not border guards.
For #InternationalNursesDay, I’m telling @Jeremy_Hunt to end NHS charges for migrants – #PatientsNotPassports!”
(not on twitter? Why not take part on Facebook – share our I’m a Nurse Not a Board Guard Facebook event and invite your friends – mention us @Docs Not Cops)
Read an article by a nurse member of Docs Not Cops in IndyVoices: “The NHS has stopped sharing data with the Home Office – now it must halt passport checks on patients
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