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June 02, 2021

NHS inquiry highlights harmful effects of hostile environment on patients

Patients have suffered as a result of the charging practices at Lewisham and Greenwich NHS Trust (LGT), a report released last week has revealed.

The report, published Friday 25th June, concludes an inquiry set up by LGT in November 2019 into its arrangements for charging patients who are ruled ineligible for NHS treatment and care at the Trust by law. The inquiry was set up in response to public outcry from campaigners and local authorities and over the Trust’s practices

Despite the vulnerable status of many patients, the inquiry revealed a lack of compassion and empathy from Trust staff towards their situations, causing significant distress.

In one case study submitted to the inquiry, a patient retold how they screamed and fell to their knees when they received their invoice for £15,480 for life-saving maternity care. At the time, this patient was living in supported accommodation and had no income.

Another patient told the inquiry how their blood pressure rose after hearing they were being charged for their stay in hospital. The news was delivered just hours after giving birth and they were forced to extend their time in the ward as a direct result of the impact of the £6,000 charge on their stress levels.

One patient, interviewed by Lewisham Refugee and Migrant Network, said: “I was charged about £7,000. I was staying in one room accommodation and I couldn’t even afford a payment plan to pay back the debt. There were threats that they were going to report me to the Home Office and I received calls every day. This was at the same time that my child was diagnosed with autism.”

Some also reported being afraid to pursue healthcare after their experiences, suggesting that the Trust’s practices endangered lives, violating the NHS’ core purpose. One patient said: “I have a friend who had a tumour in his head and was too afraid to get care – as he couldn’t afford the bill and didn’t want to be reported to the Home Office and forced into detention. In the end, we had to call an ambulance – things got too terrible.”

The report outlined 39 recommendations to improve the Trust’s NHS charging practices, the majority of which were accepted. These include reviewing and improving their patient literature to clarify the regulations, writing off debt for people facing destitution, and committing to training on the impact of the charging legislation on patients.

In a joint statement, Lewisham Refugee and Migrant Network and Save Lewisham Hospital Campaign said: We have participated in the panel in order to reduce the harm of the policy. But we remain completely opposed to the legislation that is part of the continuing Hostile Environment and which we believe will continue to harm patients in the future. Organisations such as ourselves and many others will continue to campaign to end these charges once and for all.

We recognise that NHS staff have to comply with this discriminatory and harmful legislation, targeted at undocumented and vulnerable people, and we welcome measures the Trust has now taken to minimise the damage the policy causes. We are resolved to continue to work with Lewisham and Greenwich NHS Trust, local organisations and patients to ensure that the damage done by this legislation is minimised until the day it is repealed.”

In the report, the Lewisham and Greenwich NHS Trust said: “The Trust sincerely regrets, and apologises for, any instances where patients were not treated with compassion, or in a manner consistent with the values of Trust.”

Press release ends



For more information, or for comment, please contact Hera Lorandos at and 07949455601 and Tony O’Sullivan at and 07960312725


The inquiry began after an investigation in 2019 revealed that NHS hospitals were using private debt firms to chase treatment costs from ineligible patients for free NHS care and treatment, including the use of bailiffs. The Save Lewisham Hospital Campaign received information under FOI legislation revealing the extent to which maternity patients were being charged and referred to debt collectors; they raised these questions with the Trust early in 2019. Lewisham and Greenwich NHS Trust also shared patient information with Experian to identify patients chargeable for NHS care. In January 2019, NHS Improvement invited 8 other trusts to copy this approach with Experian, ignoring the inherent data abuse. Before this practice ended due to pressure from campaigners, the Trust had referred 1,085 debts worth £5.4m to debt firms CCI and LRC from 2016 to 2018 – the most of any practice in England.

Since 2014, the Government has expanded its NHS charging policy, forcing NHS Trusts to check patient ID and charge up-front for non-urgent treatment and requiring migrants to pay 150% of the cost of their care. Part of its Hostile Environment immigration policies, these changes have rendered hundreds of thousands of people in England ineligible for free NHS care – including destitute families living in England permanently.

Official guidance from the Department of Health and Social Care explains that Trusts can choose to write off debts where it is clear that a person is destitute — however Trusts often don’t use this power, leaving many families with debts they will never be able to pay.

Lewisham Refugee and Migrant Network (LRMN)

LRMN has worked with refugees, asylum seekers and other migrants for about 28 years. We empower refugees, asylum seekers and other migrants with a specialist and holistic service. We advocate for people’s rights, campaign for wider change, meet their basic needs and help them improve their wellbeing.  @lrmnetwork

Save Lewisham Hospital Campaign 

The Save Lewisham Hospital Campaign is non-party political community-based campaign whose aim is to save and protect Lewisham Hospital and to defend the NHS.