Correspondence to Dr Bryony Hopkinshaw;b.hopkinshaw@nhs.net Charging families for healthcare because of their immigration status is causing harm to the health of children in the UK, and has wide-reaching impacts on entire families, including fear of accessing healthcare, exacerbation of poverty and deepening of health and social inequalities.1 2 Growing evidence of this has prompted the UK’s Royal College of Paediatrics and Child Health (RCPCH) to publish a position statement officially opposing charging for healthcare in the UK’s National Health Service (NHS).1 In this article, we describe who is affected by NHS charging, the widespread harm that it causes to child health, and why we have chosen to speak out as a professional body on this issue. Unless they meet a specific exemption, all of these children are deemed ‘chargeable’ for NHS secondary care.8 The number of families subject to healthcare charging in the UK is likely to be increasing rapidly.9 Children and young people who are nationals of other European countries may have unwittingly lost legal residency in the UK as a result of Britain’s exit from the European Union.9 This particularly affects young people in state care and recent care-leavers, who are reliant on Local Authorities to apply for the EU Settlement Scheme on their behalf in order to maintain legal residency once leaving care. A devastating example of someone being too scared to access care despite being eligible for free treatment, was seen in April 2020 when an adult died at home of COVID-19 due to fears of charging and immigration control, despite the fact that treatment of COVID-19 is exempt from charging.17 Similarly, a mother and her baby had potentially avoidable health consequences after avoiding antenatal care due to fear of charging, despite being a victim of trafficking and therefore exempt.2 The dangers of spreading fear and distrust are one of the key reasons why we oppose healthcare charging for all patients, not just for children and young people. At the RCPCH, we have written guidance for health professionals to provide them with the knowledge and tools to advocate for families impacted by charging,8 and host a tool where professionals can report on the impacts of charging on child health.31 We continue to support our members in advocating for the right of all children to access healthcare, and encourage other professional bodies to join us in our position against this legislation.
Why charging patients in the UK for going to hospital is wrong and bad for child health