Tory measures to stop “health tourism” on the NHS have been linked to the deaths of three pregnant women in a major report that was delayed until after the election.
The women all died after delays in seeking help because they mistakenly believed that they would have to pay for care under the government’s strict charging regime. They sought help in hospitals too late and died as a result of complications.
It is the first time researchers have identified the impact of the government’s controversial charging regime among maternity deaths, and they warned other mothers could be at risk.
Humanitarian organisation Doctors of the World, which runs a patient clinic in London, said the government’s charging regime was “putting the health and the lives of mothers and children at huge risk”.
The Conservative government made rules on recovering money from overseas visitors compulsory in 2018 in an attempt to recoup millions of pounds it claimed was being lost due to so-called health tourism.
All three women identified were eligible for care under the rules and were not health tourists. Undocumented migrants or those illegally resident can face charges.
Their deaths were flagged by the team behind the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries report, or Mbrace.
NHS England was criticised last month for blocking publication of the report during the run-up to the election.
The Mbrace report, by a team at the National Perinatal Epidemiology Unit at the University of Oxford, found there were 209 maternal deaths between 2015-17, with heart disease the single biggest cause. It also found black and minority ethnic women were five times more likely to die than white women.
Researchers examined case notes for all the deaths and identified three cases where women had been reluctant to seek help because they were worried they would have to pay.
Commenting on the death of one woman, who died after collapsing in her third trimester, the report said: “There was a suggestion that this woman and two others whose deaths are considered [in the report] may have been reluctant to access care because of concerns over the costs of care and the impact of their immigration status.”
While maternity cannot be withheld from women if they can’t pay, the report said: “Women may believe they will be asked to pay in advance for planned treatment and this may act as a disincentive to seeking care.”
Marian Knight, professor of maternal and child population health and lead author of the Mbrace report, told The Independent: “These women presented later over concerns they would be charged. They were not health tourists.
“We certainly felt that it was a factor that meant they presented for care later than they might otherwise have done. Being treated earlier might make the difference between life and death.
“It is the first time we have seen this. It’s a risk we need to keep an eye on.”
Anna Miller, policy and advocacy manager for Doctors of the World, said it was seeing women every week “in tears because they are too afraid of huge debt and being reported to the Home Office to get antenatal care”.
She added: “Many are destitute, struggling to meet their basic needs and dependent on food banks and charities.
“The NHS charging rules are undermining the essential role of antenatal care, putting the health and the lives of mothers and children at huge risk.”
Among 103 deaths examined in detail by the Mbrace team, improvements in 29 per cent of cases could have led to a different outcome. In total 209 mothers died during or up to six weeks after pregnancy, with no significant change in deaths since 2011.
The report found maternal suicide is the second largest cause of direct deaths and remains the leading cause of deaths occurring up to a year after pregnancy.
Prof Knight said it was important that both women and staff were aware of the symptoms of heart disease in pregnancy, saying: “Three-quarters of women who died did not know they had heart problems before they got pregnant.”
On the disparity between ethnicity she said work was ongoing to research the causes but added: “It exists and is not getting better.”
She said one of the biggest issues was women falling through the gaps in services and being treated differently because they were pregnant.
She said one example was among women with breast cancer who were not getting investigations to check whether the cancer had spread, for no good reason.
“It’s important to see beyond the pregnancy,” she said, adding: “Maternity is not just caring for healthy women anymore. Women are older and more likely to have health problems and more likely to be obese, which are all factors that give you a higher chance of dying.
“We have to think about that.
“Care really needs to be individualised. There can’t be a one-size-fits-all model.”
A Department of Health and Social Care spokesperson said: “The NHS will never refuse maternity care and we recently invested £1 million to expand a team of NHS experts to help hospitals understand cost-recovery rules and exemptions consistently, making clear that urgent treatment – including all maternity services – should never be withheld.”