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Migrant women charged up to £14,000 for NHS maternity services in England | Global development

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New mothers are being charged up to £14,000 to give birth in England, according to a report on the experiences of migrant women who have been billed for NHS maternity services.

The report, published on Thursday by the healthcare charity Doctors of the World (DOTW), reveals that more than a third (37.8%) of the mothers surveyed – who include undocumented, refugee and asylum-seeking women – received a bill for maternity care after their babies were delivered, ranging from £296 to £14,000. Of that group, half were charged £7,000 or more.

The charity found that many had been charged incorrectly, as current rules stipulate migrant women should be charged at 150% of the cost of secondary care, but certain groups, including asylum seekers, refugees and those with leave to remain, are exempt under government legislation.

Mental health issues were also reported by more than a third of the 257 women in the survey, which, the charity says, were exacerbated by high maternity-care charges. Others reported being deterred from seeking further medical attention as a result of the charges.

Anna Miller, of DOTW, said: “At our clinic we see women with a range of different immigration status who are charged for NHS maternity services and avoid antenatal care as a result.

“In some cases, these are women without formal status in the UK who are charged under the policy and will end up with large bills they are unable to pay. In other cases, it’s people who are eligible for free NHS maternity care, such as refugees and asylum seekers, who have been charged incorrectly.”

Kemi, 38, received a letter from her local NHS trust less than two weeks after her baby was born by emergency caesarean section, warning her she should pay £4,900 or risk being reported to the Home Office.

“As soon as I got that bill, the landlord made me and my baby leave the house,” Kemi said. “I became so depressed – I didn’t see myself as a human being any more.”

Unable to pay the bill for maternity care and having been evicted from her home, she began using food banks and sleeping rough with her baby.

Kemi arrived in the UK from Nigeria on a student visa and had applied for asylum by the time she gave birth in 2016. It took four years to prove that she did not have to pay the crippling charges, during which time she and her baby were homeless.

“Police cars would go past us and we had to hide, because I was so scared they were looking for me, wanting me to pay that bill,” she said. “I had to cover my baby’s head, and hide, because I didn’t want them to take her away from me.

“I was in so much pain because the wound [from the caesarean section] hadn’t healed properly and my baby was so cold, so malnourished. I had to feed her canned food,” she said.

According to DOTW, the cost of a vaginal delivery is typically between £5,000 and £7,000. Complications, such as instrumental delivery or caesarean section, incur higher costs. A debt of £500 unpaid after three months may be reported to the Home Office and owing a debt to the NHS can be grounds for refusing applications to remain in the UK.

Alongside postnatal debt, DOTW says the charging regulations are having a significant impact on women before they give birth, with some service users deterred from seeking healthcare because of the costs they may face.

The charity’s findings show that, while more than two-thirds (67.6%) of women nationally have had their first antenatal appointment by 10 weeks, only 19% of the women it surveyed had had their first antenatal care appointment by then.

These findings come after a review of ethnic inequalities in maternal healthcare, published by the NHS Race and Health Observatory in February, highlighted a lack of adequate interpreting services and other barriers to communication within maternity services, as well as disrespect, stereotyping and discrimination.

Dr Claire van Nispen tot Pannerden, one of the report’s authors, who has also led a mother and children’s clinic for DOTW, said: “We’re concerned that this is just the tip of the iceberg. We’re receiving more calls from women saying ‘I’ve received this letter, what do I do?’ From very early on in pregnancy, women are being targeted with these warnings.”

She added: “This is part of a much bigger hostile environment. We need to do much better at understanding the barriers these women are facing and we are urging an independent public inquiry and an end to the charging of maternity-care services.”

A government spokesperson said: “All refugees, asylum seekers and victims of modern slavery are exempt from NHS treatment costs. While some migrants or visitors to the UK may be required to contribute, we’ve always been clear that urgent care should never be delayed or withheld over charges, including all maternity services.”

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I have taken a ‘vow of silence’ around my husband – Chicago Tribune

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Dear Amy: I have a marriage question.

I have taken a sort of “vow of silence” around my husband of 40 years.

I am not giving him “the silent treatment.” I respond to questions, provide the occasional benign observation, and try to make statements of support.

He finds a way to contradict virtually anything I say.

I could observe trees swaying gently in the wind, say, “It seems breezy today,” and he would reply, “No, it isn’t. The wind velocity must be such and such degrees for it to be breezy.”

I would like to be able to communicate openly about that issue and other issues in our marriage. I’d like to be able to discuss my hopes and dreams.

I’d like to be able to share silly, fun thoughts and creative ideas.

But if I say almost anything, he replies “No, it isn’t…” or, “No, you don’t…” or “That’s not the right way to look at it.”

So, if I brought up my feeling that my husband often contradicts me, he most certainly would reply “No, I don’t!”

I feel that I live in a world of “NOs.”

It would be self-sabotage to leave the marriage after 40 years.

How can I encourage the same care and security internally?

I would like to break my vow of silence, feeling secure that I won’t immediately be contradicted, but I’m at a loss for how to do that.

– Wife With No Words Left

Dear No Words: If your husband’s contradictory reactions are confined mainly to his interactions with you, then it would seem that his entrenched negativity is expressing hostility toward you.

If he tends to be “Mr. No” with everyone, then I’d say his hostility is directed toward himself. He seems quite unhappy.

Avoidance is a natural response to being continuously shut down, and so actually – you are giving him the “silent treatment,” but it is important for you to recognize that you do have a voice and have a right to use it.

I hope you will try to start a conversation about the effect this is having on you. If you use “I” statements, such as, “I feel sad when you respond to me with such negativity,” he can shoot back, “No, you don’t” – which will bring the whole process into the realm of the absurd, and might catch his attention.

There are many books and resources offering ways to communicate better. Therapy could help you two to make great strides. One book you might read is, “Dealing with the Elephant in the Room: Moving from Tough Conversations to Healthy Communication,” by Mike Bechtle (2017, Revell).

Dear Amy: Since my husband retired, he has stopped taking daily showers.

In fact, if he showers once a week, I am lucky.

He walks five miles every day for exercise and perspires a great deal, but he doesn’t change his shirt.

I have tried humor: “Gee, honey, you’re kind of fragrant.”

I’ve also reassured him that washing many shirts is no problem. I have requested directly that he change his shirt, and even handed him a clean shirt.

We live in an open-plan condo, and I’ve taken to burning candles and incense to improve the air.

Can you think of something more effective?

– Distressed Wife

Dear Distressed: Don’t you wonder why your husband has stopped showering? Have you asked him? Ignoring hygiene is sometimes a sign of depression, but he sounds like someone who is trying hard to take good care of himself.

So why is he neglecting his hygiene – a vital component of his own self-care?

When your body and clothing stink so much that your partner is burning incense to try to mitigate the stench, it starts to smell like a deliberate and hostile gesture.

You’ve been responding to your husband as if he is an unpredictable bull, waving clean shirts in his direction. Ole!

Stop hinting around. You have the right to cohabit with someone who demonstrates the willingness to bathe – for your sake, if not for his own.

Ask Amy

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You might tell him, “Honey, I’m not merely asking you to shower. I’m telling you that it’s a requirement for us to live together.”

Dear Amy: Thank you for running the letter from “A,” who described her challenges after meeting and getting to know her birth family (she had been adopted).

I’m adopted, too, and this dream of meeting my perfect biological family persisted for me – until I met them.

– Grateful for Adoption

Dear Grateful: Dreams sometimes need to be dashed before they can be fulfilled.

(You can email Amy Dickinson at askamy@amydickinson.com or send a letter to Ask Amy, P.O. Box 194, Freeville, NY 13068. You can also follow her on Twitter @askingamy or Facebook.)

©2022 Amy Dickinson.

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Emergency care issues in England contributed to 200 deaths last week, says medical chief | A&E

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More than 200 people who died last week in England are estimated to have been affected by problems with urgent and emergency care, according to the president of the Royal College of Emergency Medicine.

Dr Adrian Boyle, who is also a consultant in emergency medicine, told BBC Radio 4’s Today programme that a failure to address problems discharging patients to social care was a “massive own goal”.

Ambulances had become “wards on wheels” while patients wait to get hospital treatment, Boyle said, adding that those most at risk “are the people that the ambulance can’t go to because it’s stuck outside the emergency department”.

He said there were lots of causes of the approximately 900 excess deaths estimated in England last week “but we think problems with urgent and emergency care are probably contributing to about a quarter of this”.

Boyle spoke after hearing one woman describe her mother waiting for an ambulance overnight in agony with a broken hip. Ambulance workers have voted to strike over pay and conditions, saying they are “on their knees” and facing unsafe staffing levels.

He said he had not seen such waits since the 1990s but concerted effort then had succeeded in reversing the problem. “Going back 20 years, we were able as a country to turn this round.” Boyle said.

His comments came as the NHS launched 42 “winter war rooms” across England, designed to use data to respond to pressures on the health system.

When asked about the project, Boyle said it was too early to tell if it was a good idea, adding: “You can paralyse yourself with analysis, it really is actually more simple and about building increased capacity.”

He said the problem was best solved by focusing on hospital discharge and social care. “Fixing this starts at the back door of the hospital and being able to use our beds properly,” he said.

“At the moment, there are 13,000 people waiting in hospitals, about 10% of the bed base, who are waiting to be discharged either to home, with a little bit more support, or to a care facility. And that’s just a massive own goal. We just need to reform the interface between acute hospitals and social care.”

The idea of the 42 NHS “traffic control centres” will be to get patients into beds more quickly and manage demand by crunching information on issues such as A&E waiting times, staffing levels, ambulance response times and bed occupancy. Staff will be able to divert ambulances away from full hospitals to ones with capacity.

Prof Stephen Powis, the NHS national medical director for England, said: “These locally delivered control centres are just one part of our wide-ranging preparations for winter but will play a vital role in the sharing and use of vital information to drive smarter decision-making by local NHS teams

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Readers sound off on Trump’s campaign, nuclear power and airborne warfare – New York Daily News

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Opelika, Ala.: Re “Still full of Donsense” (Nov. 17): Former President Donald Trump announced his 2024 run for the White House. This wasn’t revelatory to anyone who has stayed abreast of Trump’s public career. He’s an inveterate and insatiable attention craver, and his official announcement guarantees he’ll get just that until November 2024. He’s always wanted the world as his audience and lusted for attention that few men in history ever receive. Furthermore, he embodies the adage that all publicity is good publicity.

Trump has long proved he’s the king of mendacities. He’s the punchline to “when is Trump lying?” — when he opens his mouth. Thus, it was expected that Trump, encrusted with lies, would launch his 2024 presidential bid. He announced his candidacy while submerged and swamped in legal jeopardy. Of course, the legal issues were incited by his political foes. Oh boy. He faces a federal indictment threat because classified documents were found at Mar-a-Lago. Trump’s rationale was that he declassified the documents after he vacated the White House.

The Trump Organization is on trial in Manhattan for criminal tax fraud. Allen Weisselberg, the organization’s chief financial officer, pleaded guilty to tax fraud charges in August. A case over journalist E. Jean Carroll’s rape allegation is also looming. Trump’s bluster and bravado notwithstanding, he’s sweating about the probes concerning the 2020 election and the Jan. 6 Capitol riot.

All this toxic waste flows from what Peter Wehner described as Trump’s full-spectrum corruption. Marc D. Greenwood

Larchmont, N.Y.: Donald Trump’s excuse for meeting with the white supremacist Nick Fuentes is that he didn’t know who he was and that Kanye/Yeezy/Ye brought him to dinner as his plus-1. The bigger question is why the hell would Trump invite Kanye/Yeezy/Ye to his house for dinner in the first place? Was he looking for a cheap pair of Adidas? Steve Michaud

Staten Island: To Voicer Raquel Hanon: I hope you were kidding or being sarcastic in your statement about Donald Trump. Were you sleeping through the insurrection? Did you not hear him say that he could stand in the middle of Fifth Ave. and shoot someone and, even worse, he could sexually abuse women at no cost to him? He is a criminal who should be put away. He is an egomaniac and manipulator and should be prosecuted and held responsible for everything that he did. If you or any other everyday person did what he did, including hiding taxes, you would already be sitting in a jail cell. So wake up and smell the coffee. He divided this country. He should never be president again. Natalie Johnson

Saratoga Spring, N.Y.: To Voicer Eugene Rodriguez: You are spot-on about how destructive a conservative GOP House majority will be for the next two years. Your list of disasters omitted one more: After they have destroyed all the progress we have made, they will blame the Democrats for everything they have done. When will we ever learn? Bob English

Fayetteville, N.Y.: The Daily News argues that nuclear should be part of New York’s future energy mix (”Power, heat and light,” editorial, Nov. 28). You called Indian Point’s shutdown a “setback,” claimed renewables are ramping up at “a snail’s pace” and predicted that without nuclear energy, we’re in for a “bleak era of green blackouts.” Evidence doesn’t support this. Renewables and energy efficiency totaling more than twice Indian Point’s power are coming online in New York within three years. By 2030, they will have replaced Indian Point five times over. Most blackouts occur from distribution bottlenecks, not lack of power. Wind and solar plus storage improve reliability via microgrids, while nuclear does nothing for grid resilience. Nuclear generation cannot rapidly adjust to match wind and solar’s variable outputs. Nuclear power plants require steady offsite power that increases reliance on fossil fuels. Nuclear disproportionately impacts vulnerable communities. It is a poor decarbonization strategy and New York shouldn’t invest in it. Hilary-Anne Coppola

Bayside: The mayor is going on vacation to Qatar? Who is paying for this? Is he bringing a high-priced security detail? Is he the mayor of New York City or a tourist? Problems are everywhere in the Big Apple and all this guy wants to do is party. Why did I vote for him? No hope and no change from the prior idiot who ran the city into the ground. Bring back Mike Bloomberg. Timothy Collins

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Brooklyn: So the mayor is now going to Greece for a conference while crime is off the hook here. Who pays for that trip? This photo-op mayor knows how to waste money. How much did he waste on the shelters on Randalls Island? Yet his top priority is to move 250,000 city retirees to a new Medicare Advantage plan, which is all about denying care. I guess he needs the money to give another friend a top-paying city job. What a joke. Andrew Cioffi

Fresh Meadows: Your editorial “A surgical intervention” (Nov. 26) supports changing Law 12-126 to impose a Medicare Advantage plan on city retirees to save NYC money. While acknowledging recent reports showing deficiencies in Advantage plans, you ask retirees to depend on “binding assurances that it [NYC] will use its institutional weight to keep private providers in line.” Well, we depended on NYC’s assurances that we would have our current insurance when we retired and look how far that got us! Also, there are better ways to save the city money than on the backs of its retirees. The city could self-insure its retirees and hire an outside party to administer the plan. It could closely monitor overcharges by hospitals and doctors, etc. Instead, it chooses to reward insurance companies rather than its retirees. Mayor Adams expressed sympathy for retirees as a candidate, calling the proposed change a “bait-and-switch.” As mayor, he has evidently made new friends. Robert Cowen

Brooklyn: Don’t blame the sky, the beautiful sky / for the horror that lurks below / Where sticks and stones and bombs and drones / are coming from, only heaven knows / The sun shines over all of us / coming from the heavens above / shining on a world still fighting / between the worlds of hate and love / Don’t blame the sky for the horror / dropping down from the clouds / The beautiful blue sky blankets us all / but can’t stop the maddening crowds / If only people could see / that with hate, you always fall / Don’t blame the sky, sometimes it cries / for a world that doesn’t care at all. Janis Feldman

Kew Gardens: New York City has always had affordable housing. What do people think housing projects are? In the ‘50s, I lived in the beautiful, well-kept Williamsburg Houses in Brooklyn, next to wonderful, caring neighbors. It was affordable. I graduated high school, went to work and moved out of the projects and into my own apartment. My parents stayed and lived very happily until they moved to Puerto Rico. Stories about living in housing projects have changed a lot. Enough said. Gladys Garcia de Birkenhead

Rockaway: New York media is essentially ignoring Stacey Pheffer Amato’s ongoing attempts to steal the rightfully won Assembly seat from Thomas Sullivan in the Rockaways. Will establishment politicians stop at nothing to retain power? Scott O’Keefe

Croton-on-Hudson, N.Y.: Remember when mail-in votes were called absentee (or military) ballots and there were only a few thousand of them? Also, the election results came in that night. Hmm, the good old days. Pete McKenna

Astoria: Did we just forget about the border? How many illegal aliens did we let in unvaccinated, along with criminals and the mentally ill with everyone else so far? Nothing is ever said about fixing this problem. Our country is suffering because of this. What is it costing us? Wake up! Anthony Gigantiello

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