What Does No Recourse Mean?

Anonymous Free School Meals Case Studies

Based on a small sample of the free school meals advocacy letters sent from Hackney Migrant Centre from August 2018 – December 2018. 

Consent has been given for all of these case studies to be shared.

1.      Enfield

A single parent of 3 children who had separated from her ex-partner and moved out of the family home. She was unable to work enough hours to make ends meet due to her childcare commitments. As a result, she could not afford suitable accommodation and was staying in a family member’s garage which had not been converted into a living space. Her children had no choice but to stay living with their father despite the fact that he worked night shifts. Although the father provided housing he did not contribute towards the children’s expenses.

Mother travelled back and forth from her accommodation to the father’s to get the children ready for school and bed and to cook most of their meals. She was only able to work when her children were at school. Her income was therefore very small, and the cost of her children’s school meals were causing the family greater financial hardship.

2.     Lambeth

A single parent who was eligible to make an application to regularise her immigration status, but had been unable to afford a solicitor to help her to make it. This single parent was not legally entitled to work or access any state support. 

The parent had a child in primary school, and was unable to afford their school meals or access to an after-school club. The family’s only income was from their church and friends, and was at most £120 each month. School meals were costing £40 a month and after school club was £5 a day. The child could not attend the afterschool club even though they would have really liked to, and paying for their school meals was costing 1/3 of the family’s whole income.

The child being able to eat a hot and filling meal at school each day was incredibly important to the parent which is why they prioritised paying for these meals. But in doing so the family are left with significantly less to meet their other essential needs including food, clothing and travel. Paying for school meals meant sacrificing elsewhere.

When Hackney Migrant Centre helped to write the free school meals advocacy letter they gave the family a one off emergency hardship grant of £20 that day as the family had no food left at home. Free school meals were requested 3 times between July 2017 and January 2019 with no success.

3.     Haringey and Hackney

Family of 5 - 2 parents, 2 children in secondary school and 1 child in primary school. 4 months before HMC sent free school meals advocacy letters to the children’s schools, an application was made to the Home Office for leave to remain for the family. At the time both parents were unable to work and unable to access state support. For this reason the family were relying on the support of friends, charities and food banks and were struggling to make ends meet. 

The secondary school was able to cover the cost of 2 of the children’s meals, the primary school could not do the same.

Both parents now have leave to remain and are looking for work.

4.     Hackney 

Family of 5 – 2 parents and 3 children. 7 months before free school meals advocacy letter was sent the family had submitted an application to the Home Office for leave to remain. This application was refused but they were appealing the outcome. Whilst the appeal was happening both parents were not allowed to work and could not access state support. 

The family were living in social services provided section 17 accommodation as their children had been identified as being ‘in need’. Their only source of income, provided by the council, was less than £25 per week per person. The family had been trying to pay for their child’s school meals but it was exacerbating the family’s hardship. School had not responded to free school meals advocacy letter 2 months after it had been sent.

5.     Hackney

Single parent family with 2 children. Mother was not allowed to work and the family had been relying on the charity of friends. This support was irregular, unreliable, and not enough to meet the family’s essential needs. They were depending on foodbanks, and were all having to skip meals often.

Not long before the free school meals advocacy letter was sent the mother had had a heart attack. Her ongoing health issues meant that she was unable to do any physical activities that could put strain on her heart. She had blacked-out on multiple occasions, and the friend who had been accommodating the family had asked them to leave. The friend was worried that something would happen to the mother and the family would become a burden that she would be unable to care for. For this reason, at the time of the free school meals advocacy letter the family were facing street homelessness. The headteacher invited the mother in to the school and refused to provide free school meals for the children. 

6.     Lewisham

Family of 2 - A single parent with a British child in secondary school. The parent was not allowed to work and could not receive any benefits. At the time that the free school meals advocacy letter was sent to her son’s school, the family were staying with a friend in a small 2 bedroom flat. This flat was very overcrowded with 6 people sharing 2 rooms and 1 bathroom. Mother and teenage son were having to share a single bed. The family had been asked to leave, and they did not know where they will be able to sleep when this happens.

The family were eating whenever their friend cooked. When the friend didn’t cook they had to skip meals unless other friends were able to help. They had been relying on the support of friends for things like clothes and travel, but this support has been very little at £150 a month at the very most.

When friends gave the mother money she used it to top up her son’s lunch prepayment card. When friends couldn’t help he skipped lunch. Son had been struggling to handle his stressful living situation, he was upset and had been behaving differently at school.

2 months after the free school meals advocacy letter detailing the family’s situation was sent the school had still not responded.

7.     Lewisham (note: Lewisham council agreed to cover the cost of the 2 older childrens school meals, it was not their school)

HMC wrote free school meals advocacy letters on behalf of a single parent with 3 children who attended 2 different schools. The parent was unable to work or receive benefits and could not afford the cost of regularising their immigration status. The family were regularly skipping meals and could not afford basic essentials such as clothing and travel. At the time of writing to the schools the family were at risk of becoming street homeless.

One of the children’s schools refused because they had many children in the same situation. The school said that their budget was so tight that they could not afford books for their library. Fortunately free school meals were arranged for the other 2 children.

8.     Bromley

Family of 5 - 2 parents and 3 children one of which was a new baby. At the time that the free school meals letter was sent the family were living in council provided section 17 accommodation as the children had been identified as being ‘in need’. The whole family were surviving on £100 each week which was provided by social services as both parents were not allowed to work.

More information about why this is happening:

When a family with NRPF falls on hard times they cannot access the welfare benefits that they need to survive. This leads to the most extreme poverty when families are both in and out of work.

NRPF affects people with the right to live and work in the UK, who pay the same rate of tax. It also affects people who are currently undocumented. 

People become undocumented for many reasons including: being unable to access good legal advice; being unable to afford huge immigration and legal fees; not knowing their rights; being in abusive relationships; unfair decision making from the Home Office.

People struggle to make ends meet whilst in work due to factors including: low wages; zero hours contracts; being unable to afford childcare to work enough hours; the high cost of living.

In the UK, on top of benefits there are also other forms of support that families can access to reduce the harm caused by poverty. These include free school meals, access to a free childcare allowance, and the healthy start vouchers. However, to qualify for this help you must be receiving certain benefits. For those who are denied benefits due to having NRPF, they and their children are also excluded from these other vital forms of support.

Regardless of a child’s status, they are affected when their parents or carers have NRPF. There are many British children who are growing up in unimaginable poverty due to the withholding of welfare support to their parents.

Recommendations:

Local authorities

Assessments should be child-focused, fair, and transparent. They should be conducted by social workers, in line with statutory guidance. Children’s views, wishes, and feelings should be solicited and given due regard in decision-making. In line with Article 3 of the UN Convention on the Rights of the Child, the best interests of children should be the primary concern when staff are making decisions that may affect children.

Local authorities should be sensitive to the vulnerabilities of families approaching them for support and give parents ample opportunities to provide an explanation for inconsistencies or gaps in information. Local authority staff should treat families with dignity and respect.

Immigration and fraud officers should not be part of Child in Need assessments. They act as a deterrent to vulnerable families and therefore put children at greater risk of destitution.

NRPF Network Practice Guidance should be adopted by local authorities to ensure they are carrying out consistent, lawful assessments and making decisions in accordance with best practice.

Starting rates for financial support provided to families with NRPF under section 17 should never be lower than rates provided to destitute asylum-seeking families under section 4 of the Immigration and Asylum Act 1999. Financial support should be provided to the family as a whole and should be sufficient to meet the family’s needs. Information about how rates of financial support have been calculated should be accessible to families and social workers should make sure that families feel confident to raise issues about subsistence.

Local authorities should carry out checks on accommodation provided before families are moved into properties. Accommodation provided should be suitable for families and consideration should be given to the need for privacy, the location of a child’s school and their community, the behavior of other residents, and access to basic facilities. Social workers should make sure that children have adequate privacy, space for homework, and feel safe in the accommodation.

Central Government

The Home Office should not apply the NRPF condition to individuals granted leave to remain on human rights grounds.

Local authorities should be sufficiently funded by central government to meet their duties under section 17.

Central government should consult and provide statutory guidance on the provision of accommodation under section 17.

Changes should be made to The Education Act 1996 to ensure children in families with NRPF are entitled to free school meals.

The government’s 30 hours free childcare scheme should be made available to families with NRPF.

Legal aid should be reinstated for individuals applying for leave to remain on the basis of family or private life.

Immigration application fees for leave to remain on the basis of family or private life should be scrapped.

Project 17

To explore how we can be more effective at seeing and hearing the children and young people we work with.

Identifying further partnerships and funding opportunities to build on this work.

At the time of the incident that led to an extreme change in Annie’s circumstances, she had leave to remain with no recourse to public funds (NRPF). She was living with her now ex-partner, and her 2 children. Her ex-partner is the father of her youngest child.

In early 2018, after taking her children to school, Annie came home to find that she had been locked out by her ex-partner without any warning. She went to the police and was told that as she was not on the tenancy agreement her ex-partner had the right to do this. The police took Annie to her local council’s social services so that emergency accommodation could be arranged for her and her children.

Social services were incredibly hostile. Annie was shouted at and told to ‘go back home’ (meaning country of origin) and section 17 support was refused. The reason given was because Annie had ‘no recourse to public funds’ (NPRF) - NRPF is a condition whereby a person is unable to access many welfare benefits. Annie was told that she was lucky to have been accommodated by her ex-partner and advised to look for work - which Annie had already been doing extensively.

Annie’s children’s school agreed to look after her children until 6pm so that she could try to arrange somewhere for the family to sleep that night. At 6pm she still hadn’t found anywhere and had to pick up her children. They walked around their town centre in the rain until a friend agreed to accommodate them later that evening. None of the family were in sufficiently warm clothing and Annie has been locked out without a buggy so had to carry her youngest child. Annie’s youngest child was very ill due to a respiratory condition.

The friend who accommodated the family only agreed to allow them to stay if they left the house early in the morning when she went to work. This meant that Annie sat in a church all day with her youngest child whilst her friend was at work. Annie found a pram that someone had thrown away to use. At this time she could only afford biscuits and juice to sustain her children.

After 2 days a different friend who lived in a different local authority agreed to accommodate the family. This friend was living in a 2 bedroom flat with her partner and 4 children. When Annie moved in the number of people in this flat increased to 9.

Throughout this time the social services team were still refusing to accommodate the family, but were going to Annie’s eldest child’s school to interview her without warning. Both mother and child found this confusing and distressing. Social services contacted both fathers of Annie’s children, and suggested that she leave her children with the ex-partner who had locked them out a few days earlier. Annie was shocked as this was both not possible, and not in the best interests of her children.

Social services visited the second accommodation that Annie was staying at on 3 occasions without warning. They pressurized Annie’s friend to accommodate the family for 48 days. Annie was repeatedly advised to make a Change of Conditions application, but no support was offered to help the family make this application, or to accommodate them whilst it was being made. The family who were hosting were made so uncomfortable by their treatment by social services that they wanted Annie and her family to leave as soon as possible,

Haringey Migrant Support Centre (HMSC) had been supporting Annie throughout this time. Their solicitor approached the different local authority of where Annie had moved to for section 17 support.  This social services team was very helpful and accommodated the family. Annie would not have known that she could ask the second council for support without the help offered by HMSC. This second and supportive social services team also referred the family to an early intervention officer due to their concern about her eldest child witnessing domestic violence.

HMSC also referred Annie to The Unity Project for help to make the Change of Conditions application to remove the NRPF condition from her visa, and arranged a clothing donation and access to food banks for the family.

Annie suffers from extreme back pain and the cost of childcare were barriers to her finding employment that she was able to maintain. If Annie’s application for recourse to public funds was refused and she was denied access to section 17 support she may have found herself with no other option than to try to return her abusive ex-partner.

Because of her precarious housing situation her eldest child had to live with her ex-partner. Grace could not be parted from her baby as her ex-partner would not have been able to care for a baby, and Grace was still breastfeeding. Grace was providing most of the childcare for her eldest child. She also helped with cooking, cleaning, shopping and taking her child out for leisure activities. This was because Grace’s ex-partner has a mental health condition that made it hard for him to do these things.

At the time of making her application for recourse to public funds Grace had an income of less than £900 a month. £580 of this was from her *statutory maternity pay, and the remaining amount was all the child support that her ex-partner could afford to help with. On this income, and with only £250 of savings, Grace was completely unable to secure and maintain rented accommodation and meet the other essential needs of her family.

Unfortunately Grace’s change of conditions application was refused almost a month after it was submitted. These were the reasons given:

‘We acknowledge your claim that you are homeless and currently living with various friends. However, this does not demonstrate that you do not have adequate accommodation or any means of obtaining it because you have not provided any evidence of having approached the local authority or homeless charities for assistance.

You have stated that you are unable to meet your essential living needs. However the breakdown of your monthly income and expenditure that you have provided indicates that you are able to meet your essential living needs through your current income. We note that your expenditure includes road tax, but you have advised us that you no longer pay this. Deducting this from your expenditure breakdown indicates that you are able to meet your essential living needs through your current income’.

Grace could not demonstrate the conditions of her living arrangements as she had no secure accommodation to evidence.

Grace was not aware of any homeless charities that she could approach or that her local authority could help.

Grace’s income and expenditure breakdown clearly showed that she had no way of affording to pay for adequate accommodation, which is an essential living need.

The cost of Grace’s road tax was £19.25. She paid this the month prior to submitting the change of conditions application which is why it was included in her breakdown.

After Grace’s Change of Conditions application was refused she approached social services for support before making another application to remove the NRPF condition. 5 months after making her first application for recourse to public funds Grace’s second application was successful. The process of applying for recourse to public funds was incredibly distressing for Grace at a time when she was the sole carer of a new baby and had been separated from her other child.

Footnote:

Please tell us whether you think children are able to access a sufficient quantity of food to prevent them going hungry?

No. I have met many families with no recourse to public funds (NRPF) whose children are skipping meals, and/or have diets with limited fresh produce and no variety. There are children whose access to food is entirely dependent on the charity of friends or organisations. This charity is often insufficient and unreliable.

Please tell us what you think helps and/or hinders children from accessing a sufficient quantity of food

When families have no recourse to public funds (NRPF), due to the parents' or carers' immigration status, they cannot receive state support regardless of their need. This leaves families, both in and out of work, in extreme poverty. Poverty hinders accessing a sufficient quantity of food.

Schools do not receive funding to provide free school meals to children from families with NRPF from their local authority. In my experience, many schools do not have the money available from their own budgets to cover this cost for children to be able to eat for free. Therefore, many children without adequate access to food at home, are also being refused access to a reliable and filling meal each day at school.

Schools do want to help, but when they are in areas with many migrant families with NRPF, the demand can be too high and their budgets too small to help. Schools not having adequate funding hinders accessing a sufficient quantity of food.

Please use this space to tell us whether children are able to access enough healthy food to meet their nutritional needs

No. The children who I have met that are living in exceptional poverty, have limited diets whose regularity depends on the charity of friends. I have spoken to parents that can only afford to send their child to school with a bread and jam sandwich or a packet of crisps each day. I have spoken to families whose children have to skip meals.

When families cannot access housing because they have no recourse to public funds (NRPF) they are often forced to sofa surf. This means that they are living in temporary and unreliable accommodation with friends, families and sometimes strangers. Often, they sleep in living rooms and on sofas, and have to keep moving to stay out of the host family's way. When a family does not have their own space, the use of the household's kitchen becomes very difficult. Families often cannot store food or cook freely. Their meals will depend on if the friend wants to, or can afford to feed them. If the friend does not or cannot, they are forced to buy fast food from an already tiny budget, further exasperating their destitution. Fresh produce often needs a fridge and has a shorter shelf life. For families with little storage space and without access to a kitchen, fresh produce is impractical and expensive.

I have met many many families in this position, and this is a far too common experience for families with NRPF.

Please tell us what you think helps/hinders children from receiving enough healthy food to meet their nutritional needs

When a family has no recourse to public funds (NRPF) they cannot access state support regardless of how destitute they are.  This impoverishes families; it forces them to survive on tiny amounts of money and live in completely unsuitable conditions.

NRPF can therefore lead to food poverty. It means that in many cases there is not enough food, let alone a healthy variety of food.

When a family has NRPF they are not allowed to access free school meals for their children. This means that the children who are the least likely to be able to eat enough at home, also cannot rely on a filling and varied meal at school.

Please tell us if you are aware of children who are accessing food in socially unacceptable ways? Please include any ways of obtaining food that may cause embarrassment/shame for children and their families or that are not culturally appropriate

It is socially unacceptable that people are left with no other option than to ask friends to help them to feed their children.

It is socially unacceptable that children are racking up debt each time they eat a meal at school that they need but their family can't afford.

I have met a parent who had accrued £1000 of debt to her child's school because she was unable to pay for their school meals; that child was then punished by not being allowed to attend his end of secondary school prom. It is socially unacceptable to stigmatise children and parents in this way.

School should be a space where children can learn and play together as equals. If a child is from a family that is struggling financially, they must be able to eat the same meals as their friends at school. It is socially unacceptable for this to place a family further into destitution.

Please tell us about any policies or programmes that you think have helped to alleviate children's food poverty

I do not know of any government policies that have helped to alleviate children's food poverty for families with no recourse to public funds (NRPF).

Hackney council has recently pledged to raise the amount of subsistence that they give to all families receiving Section 17 support who have children in year 3 and above to cover their school meals - all children in years 1 and 2 already receive free school meals in England.

I have written to schools who have agreed to use money from their own budgets to cover the cost of a child's school meals when their family has NRPF. Although this makes a significantly positive impact on the welfare of a child, this is not a long-term solution.

When a school pays for a child's meals it has to take money from its budget that was meant for other things; many schools cannot afford to do this. It also means that the school cannot receive the pupil premium for these children.

The pupil premium is extra funding given to schools to allow them to support children from disadvantaged backgrounds.

'It’s designed to help disadvantaged pupils of all abilities perform better, and close the gap between them and their peers...

In the 2018 to 2019 financial year, schools will receive the following funding for each pupil registered as eligible for free school meals (FSM) at any point in the last 6 years:

£1,320 for pupils in reception to year 6

£935 for pupils in year 7 to year 11'

(https://www.gov.uk/guidance/pupil-premium-information-for-schools-and-alternative-provision-settings).

Students are identified as needing pupil premium support if they receive free school meals. Children with NRPF cannot apply for free school meals because their parents aren't allowed to receive benefits regardless of how much they may need them. This means that often the poorest children in our society not only cannot access food at home and in school, but are also denied any extra support that the pupil premium offers as well.

Please tell us of any policies or programmes which you think should be introduced to help alleviate children’s food poverty

I think schools should be adequately funded to be able to give free school meals to all children who need them. This must be regardless of their parents’ immigration status.

Any policy introduced must allow children from families with no recourse to public funds (NRPF) to access free school meals if they need them. This must also result in schools receiving the pupil premium for those children. This will allow children to access any extra support that they need, including being able to go to breakfast and after school clubs.

Whatever measure is put in place must be carefully considered. It must be sensitive, supportive and understanding. It cannot result in reporting to the Home Office. This is essential to safeguard the welfare of children.

http://www.leedsbeckett.ac.uk/childrensfoodinquiry/

Further submissions submitted by email to [email protected] on 30/11/2018:

To whom it may concern,

I am Hackney Migrant Centre's school meals advocate. My role has been to help families with no recourse to public funds (NRPF) request that their children's schools support them with free school meals.

The families that I work with are experiencing extreme poverty but are unable to access benefits. As free school meals funding is calculated according to whether a child's parents are in receipt of benefits, there is a huge number of children who are excluded from this vital provision. My role has been to ask schools to use their own budgets to support these children. Schools are often unable to do this. More information about the impact of denying free school meals to families with NRPF can be found here: https://www.childrenslegalcentre.com/free-school-meals-dfe/

I would like to submit further evidence to your inquiry. I have attached a small selection of advocacy letters and refusals from schools. These documents demonstrate the need for free school meals for families with NRPF, and that when schools refuse to help it is because they do not have the funding to provide this support.

I have already answered the online questionnaire on 28/11/2018. I would like to make clear that when I referred to NRPF, I am referring to families with NRPF as a condition on their visas, and also undocumented migrant families.

I would also like to say that although Hackney council's commitment to fund school meals for children in Section 17 accommodation will make a significant difference to those families, there are still many families with NRPF who are living in poverty and who are not receiving section 17 support. This point is illustrated clearly by the fact that of the 41 children that I have written free school meals advocacy letters for, only 9 had been receiving Section 17 support.

Most of the women (interviewed for report) had no entitlement to any kind of benefit or financial support during their pregnancies because of their irregular immigration status, and so were often very poor, and even destitute. 

Refusal of care 

In spite of clear guidelines that all maternity care must be treated as immediately necessary and not be withheld if a woman is unable to pay, one woman was informed in writing half way through her pregnancy that her future appointments would be cancelled if she failed to pay the bill. Maternity Action’s advice service has reported several similar cases where both hospitals and GP practices have incorrectly refused treatment or GP registration because of a woman’s lack of immigration status. 

The impact of charging on women

All the women interviewed described their initial reactions to receiving bills for their maternity care in terms of shock and bewilderment, especially as most of them had been unaware they had to pay, and none were in a position to do so.

Three women said that had they known earlier that they would be charged they would have had an abortion though in the event, did not do so. However, for most women, the invoices, accompanied by letters and phone calls requesting money and threatening to report them to the Home Office, or even telling them that they would never be able to regularise their stay, induced very high levels of anxiety and fear, affecting their physical as well as mental health. Some women spoke constantly of their fears of what might happen because they could not pay the bills they had received. Whether or not women were billed during or after their pregnancy, the demands for payment affected their willingness to see a midwife or doctor when they were not well, or even for routine appointments after they had given birth.

The following experiences were the ones taken from the report where the mothers were most likely to have had NRPF.

Ayesha 

Ayesha came to the UK in 2011 from West Africa to an arranged marriage. She had not met her future husband but he was ‘nice and caring’ when she spoke to him on the phone. They stayed together for about 4 months but she fled from him because he turned out to be violent and abusive. At that time she could not speak English and knew nothing about the UK. She survived by helping out different women she met in her mosque who offered her shelter in return for help with housework and childcare. When she became pregnant a family took her in for a longer period but made it clear she would not be able to continue to stay once she had her child. She was afraid to go back to her country because she had run away from her husband, and she was also worried that her family would force her daughter to have FGM. She applied for asylum just before she was due to give birth. 

Helena 

When Helena became pregnant she discovered that her partner was already married with a family and they separated. She was not eligible for any maternity pay or benefits and had to leave her rented room in shared accommodation as she was not allowed to have a baby there. She would have become homeless had not a friend in another city offered her a place to stay.

“I am afraid that if I go to the hospital they will charge me and I’m so afraid what’s gonna happen to me if I say that I don’t have money to pay for that. If they will detain me, or if … after I have delivered the baby if I’m gonna stay at the hospital or in a detention centre or something like that.”

Beatrice 

Beatrice had overstayed her student visa. When she became pregnant she was living with a man who refused to accept paternity of her child and threw her out. She then moved in with another man who turned out to be violent and abusive but she did not leave him because she had no other income and nowhere to go. Her father had been supporting her from her home country but disowned her because of the pregnancy. She was afraid to approach any authorities because “I was scared of being deported.” She told her story to some “church people” who eventually paid a deposit for a room and she managed to leave her violent partner three weeks before her due date. 

Mariam 

Mariam was a refused asylum seeker from West Africa who came to London after leaving asylum accommodation when her claim was refused. She came from a conservative background and had herself experienced FGM. The relationship in which she became pregnant was her first sexual relationship but her partner abandoned her as soon as she told him she was pregnant and she later discovered that he was in another relationship and already had two children. When Mariam became 29 pregnant she was living with a friend who was working but who then left the country, leaving Mariam unable to pay rent for the room and dependant on the kindness of other tenants. She later moved from place to place during much of the rest of her pregnancy. 

She was also desperately unhappy, unable to eat and crying all the time, and had thought of killing herself during her pregnancy. At the time of her interview her child was almost two but she had still not told her mother that she had a child because of the stigma that would attach to her. Hospital charges of nearly £3000 were yet another blow, as Mariam believed that this debt would prevent her from making any successful immigration claim. 

‘I lost 13kg (while I was pregnant) because I was sick. I couldn’t eat, and I have no one... I am on my own. It’s very hard… I was one week in hospital, on my own, no one visited me, no one helped me. Even the social (worker) was saying, this girl has been here one week today, but no one has come. Can you imagine? …. I was sharing (a room) with one lady, she’s the one who knows how I cried, all those nights, crying. ‘Stop crying’ she said. I cried night and day, night and day. She always told me, “Listen, if you don’t stop it, they will take your child away.” If you cry here, they say you don’t want the baby, or that you may hurt the baby. The midwife used to come in and say, “Do you think to hurt your baby, or something?” I say, “No. It’s not about that. What’s happened already has happened, there’s nothing I can do about that. It’s just sad. It’s still sad when you have a child that none of your family can know about.”’

Julia 

Julia was charged for her third pregnancy and then billed for the earlier ones as well. When asked about how charging affected her, she said: 

‘When they told me (about charging) I was so panicked. I was so afraid they were going to stop attending to my children, especially P (with asthma) because she needs the help. And G. (the last child with kidney disease). I was so afraid because I didn’t know anything about it….If I can’t afford the money and they won’t attend to my children what was I going to do? I was afraid to lose my children.’

Julia’s anxiety about her children also affected her own health, raising her blood pressure, until her solicitor assured her that her children would not be removed from her care, and she then calmed down. So far she has not been charged for her children’s medical care.

Isabella 

Isabella and her partner were able to pay their bill over the period of year but nevertheless she felt that the bills she received affected her whole family. 

‘I don’t think my whole family needs to be treated like that. It is not just a bill to me, or not even the bill, the harassment I had to endure all those months because I couldn’t pay. So I was very stressed, and that affected the way I look after my children, it affected how confident I was to be able to have a different role in society, like work or study and other things, I basically stopped for a year or so, so I could pay this debt. I felt like I was in debt with the whole country! Maybe it was a big deal for me, and it won’t be for other people but I was there, pretty much 10 hours a day with two small children while my husband was working extra hours a day to be able to pay this bill. Because we didn’t prepare for that.’

“I don’t go to the GP at all, I never go to the GP. And at the moment I have been diagnosed with a degenerative illness and I struggle to make my appointments. It really left me completely, not angry, but I can’t trust a place like that. Sometimes I think I prefer to be sick… I don’t want to go there. My husband thinks I am crazy, but you never know. Maybe in two months’ time they are going to send me another bill for something that I didn’t even have any idea about.”

Mei 

Mei was a refused asylum seeker who moved to Home Office accommodation on section 4 support during her first pregnancy. A year after she gave birth she received bills for her maternity care. She went to the Red Cross for help and they asked the hospital to waive the charge and referred her to a debt advice service. The hospital agreed a small reduction in the bill from the date that the application for section 4 support was submitted. It also offered a six month suspension of ‘recovery action’ for payment. When we interviewed her Mei was still in section 4 accommodation and had had another child and had not been charged for maternity care for the maternity care for her second child. The debt recovery suspension for the first pregnancy was still operative at the time of the interview but the debt had not been cancelled.

Mariam 

Mariam (see Chapter 2) applied for section 4 support to which she should have been entitled. 

An applicant for s4 support must show that they are destitute or are likely to become destitute within 14 days. A person is “destitute” if they do not have adequate accommodation or do not have enough money to meet essential living expenses for themselves and any dependants.(2) Section 4 recipients receive accommodation and a prepayment card useable in certain shops. 

However, due to an error by the adviser making the application, it was submitted as a section 95 4 application for which Mariam was not eligible. 

Only people still awaiting the outcome of an asylum claim or appeal are eligible for Section 95 support.

So her application was refused, with the result that she was denied accommodation and financial support from the Home Office in the last weeks of her pregnancy. But, without being a recipient of section 4 support, Mariam was also not exempt from charges for that part of her maternity care that it could have covered. After she gave birth, she received further advice from a migrant support charity and was granted the section 4 support to which she should have been entitled earlier. At the time of her interview her maternity care charges had not been cancelled.

Advice case A - The role of advocacy in clarifying patients’ immigration status 

A, a non-EEA national who had overstayed her visa, contacted the Maternity Action advice service when she was 37 weeks pregnant. She was at risk of violence from her husband and his family if she returned to her home country and had not sought maternity care as she was afraid she would be deported. Following intervention from Maternity Action’s solicitor she was accepted by a GP and a hospital. She was also referred to an immigration adviser who helped her to claim asylum and she was granted refugee status a year later. 

Julia 

Julia has had three children in the UK since 2008 and was never billed. After her last child was born in 2017 she separated from the children’s father and became homeless. She sought accommodation and financial support (section 17 support) from her local social services when her baby was about five months old. An official from the Home Office was present at her social services assessment. She was contacted the following day by the hospital where she had given birth and told that the Home Office had contacted them and told them that she owed money for her maternity care, and soon after she received a bill for about £6000. The following week she received a bill for about £13000 that included her two previous births. Julia had not been billed for any of her three periods of maternity care. 

Mary 

Mary was homeless and sleeping in a church for a year before she and her son, then aged 5, obtained accommodation from social services. She received a standing order mandate from a debt agency to make repayments for her maternity care bill of nearly £6000. She also received a 14 page form to set up a personal budget plan to repay her debt. 

Beatrice 

Beatrice found herself pregnant and giving birth with no immigration status, and no family member or close friend to support her. 

“It’s just me alone with my child. And they’re telling me you have to pay, when my child was four months. I almost went mad. I almost went crazy. It’s my first child. I’ve got no experience. And so the guy’s calling me, you have to pay, you have to do this, when you start working, they take £100 every month. … And I’m like, so you don’t know what I’m going through! … And I told him, stop calling me! There’s no way I’m going to get the money. It’s not just that I’m alone with a child. The Home office is on my back [Crying] I can’t deal with it. It’s just crazy actually. It’s just really crazy….because I’m still trying to get over the nightmare that this is happening and I have to deal with it all alone… 

...When they were calling me and saying I have to pay, I have to do this, there was a point I felt like just dying. And my son was crying, I’m like, shut up! You know what I mean? I just screamed at him like, shut up! It’s just… It does have an impact (on the child) because I shouted at him when I wasn’t meant to. Because he was just a baby then, he was a crying baby. So the whole thing was just too much for me.”

Leah 

Leah had previously heard about charging but she had no idea how much it would cost. It was not her most immediate problem as her circumstances were desperate. She was abandoned by her partner when she became pregnant and had nowhere to live and no money, so that a vague notion of having to pay for her care loomed less large than the immediate reality of destitution. The actual implications of charging seemed only to have hit her when the midwife told her to bring over £2000 to her next appointment when she was 32 weeks pregnant, at which point she said she just cried. 

The midwife told her to contact social services but they said they couldn’t help her.

As a healthy pregnant woman without another child and no current immigration application, social services had no obligation to support Leah.

 Leah had no idea what to do next as she would not be able to stay in the shelter after the baby was born. Leah was interviewed when she was about 34 weeks pregnant. She said: 

“I feel lost right now. Right now I’m still confused I don’t have any documents. Then, with the charging (I feel) bad… If I hadn’t been 33 weeks (pregnant) I could have aborted it.”

Anna 

Anna’s fears almost drove her to avoid her antenatal care altogether. She was charged in midpregnancy, and was very worried about where she would find nearly £7000. She became very afraid to see the midwife at the hospital, despite suffering from constant headaches and other symptoms. She was even afraid to collect her maternity exemption certificate. 

“I just filled in the form but I’m scared to collect it I just filled it out and I’ve got it at home.” She only went to her further antenatal appointments after being persuaded by a friend that she should go for the sake of the baby. 

“Whenever I’m going to the midwife I’m really scared to go. I’m not happy about going there now. I’m always scared. I don’t know what’s going to happen whenever I have an appointment with the midwife. I don’t know what I’m going to hear from them. Maybe they will stop me from getting care. In the hospital I was so scared.” 

Eventually the hospital did persuade her to come and have a scan but she was never again comfortable at the hospital. She eventually had her baby by C-section.

Natasha 

Natasha felt that the overseas charging office was sympathetic to her situation, but even so, as a result of the bills she faced, she did not return for follow up care. She was afraid to go back for a check-up or to find out what had caused this miscarriage and possibly a previous one. 

“My baby was buried and I couldn’t even go. I was just so scared that I was going to go and they were going to come and detain me. 

I went to see my GP, I was still bleeding then. And then there was something still remaining so they had to take me to the theatre to do a D&C. And from then I haven’t had any examination to see anything, to see if it is all OK. At times my period is so painful, I feel cramps when I sit down, when I get up I can hardly walk sometimes. But the clots, a lot of clots…. I am scared to go to the hospital because I don’t know how I will be able to pay on top of this bill. So I haven’t had any exams just to see if it is OK. 

Even to just to hear what caused the death of my baby, that is what I would really like to know. Just tell me what happened, so I know what caused the death, instead I am just thinking ‘’was I stressed?’’, ‘’was I not eating well?’’ was it a time, that I was going on the stairs and I slipped? I don’t know what caused it. Or was it a medical problem? I don’t know.”

Olivia 

Olivia refused to attend further antenatal appointments after she received her first bill. But her blood pressure increased and she couldn’t eat or sleep, and became very depressed an upset. Eventually she was admitted to hospital a day before her due date with very high blood pressure. 

At the time of the interview she said she was suffering a lot of pain all over her body and was unable to sleep, but “I can’t go to the hospital to get it checked because I am scared of getting more bills. I don’t have the money. My life is at risk at the moment but I just have to keep praying to God to help me.”

Many of the individuals affected by charging are in the process of applying for leave to remain in the UK, but are subsequently left saddled with burdensome debts. The complexity of the rules about entitlement also mean that many people, particularly those from minority ethnic backgrounds, are caught up in the effects of charging even when they are fully entitled to free NHS services. 

Beatrice

‘Beatrice came to the UK from West Africa to study in 2012. Her family and boyfriend disowned her when she fell pregnant. Then along with a difficult pregnancy, she suffered a series of setbacks. She thought that as she had a maternity card, maternity care would be free, but on the day her baby was born, she was sent a bill for thousands of pounds (£6000), a bill she had no way of paying.’

‘It was just me alone with my child and they’re telling me I have to pay... I almost went crazy’.

Helena

‘Helena came to the UK with a family she’d been a live-in nanny for in the Middle East. They mistreated her badly, withholding her passport, so she fled. She got another job and became pregnant, but was left by the father. Her landlord then threw her out when he knew she was having a baby. 

All these worries came on top of a very bad pregnancy. And despite having made a claim for asylum, on the grounds of modern slavery, she was billed for antenatal care, and told of more charges to come. So, at 34 weeks, she stopped going to her maternity care appointments.’

‘I was afraid that if I went to the hospital they’d charge me... I didn’t have any money to pay’

‘Ante-natal: £1528

Delivery: £2935

Post-natal: £372′

Josephine

Josephine a Spanish national, was working as a cleaner when she become pregnant. Despite having all the right papers, she was sent a bill for thousands of pounds after the birth. She was hounded for payment until an advisor write a letter on her behalf, saying that as an EU citizen, she didn't have to pay. She’s heard nothing more, but she doesn’t know where she stands.

Josephine has ongoing health problems, but won’t look for care as she no longer trusts the NHS. She feels isolated and alone with her bad health.’

‘They told me I had a big debt from them... They said I had to pay £4000′.