An elderly woman suffering from two forms of cancer had vital NHS treatment delayed for months because she couldn’t afford a £150,000 upfront charge, the Observer can reveal.

The case highlights not just the impact of the government’s upfront charging regime – introduced in 2017 as part of its “hostile environment” towards immigrants – but also the failure of changes to the guidance given to hospitals that were announced in response to previous controversies.

The patient’s family and doctor both appealed for help to her local MP – the health secretary Matthew Hancock. But even though Hancock was presented with clear signs that his own rules were not being followed, there is no evidence he intervened to ensure that the urgent treatment was provided.

The patient, whom the Observer is not naming at her family’s request, came to Britain from Azerbaijan in June 2018 to visit her adult children.

Later in 2018 she noticed a lump in her right groin, which was diagnosed as a nodal malignant melanoma – an aggressive form of cancer. Subsequent tests showed she also had a separate cancerous growth in her lung.

However, the Home Office rejected her application to extend her six-month visa, and as an undocumented migrant, she became eligible for upfront charging.

Under NHS rules, “urgent or immediately necessary” care should be provided to chargeable patients even if they cannot pay for it upfront. Her local hospital trust, West Suffolk, repeatedly assessed her treatment as urgent or immediately necessary.

But West Suffolk could not provide vital immunotherapy to treat the melanoma, instead referring her to Cambridge University Hospitals (CUH) – which refused to provide it unless she paid £150,000 upfront. This meant that a third hospital trust, Royal Papworth, could not provide the required treatment for her lung cancer.

With CUH only providing palliative care, and amid fears her cancer could worsen, both her family and her doctor at Royal Papworth wrote to Hancock in June this year urging him to intervene.

NHS denied treatment for migrants who can't afford upfront charges Read more

The doctor’s letter to Hancock advised him that “with any delays, there is likely to be a spread of her cancer disease, which means treatment would not be possible”.

But despite this clear evidence that treatment was urgent, the Department for Health simply recommended the case be discussed by the trust. In August, humanitarian organisation Doctors of the World intervened on the patient’s behalf, but it was not until September, when the patient, now 75, won her appeal against the Home Office for leave to remain in the UK, that the upfront charges were dropped and treatment was finally provided.

During these months, the patient only received palliative treatment. Meanwhile, Hancock was telling the parliamentary health select committee and BBC’s Victoria Derbyshire programme that he would look at individual cases where safeguards in the upfront charging regime were not being followed, while defending the overall system.

Since October 2017, NHS hospitals in England have been required to seek payment before providing elective care to overseas visitors and migrants ruled ineligible for free healthcare.

This has led to cases where patients were wrongly denied treatment. A government review concluded that hospitals should “consider fully when a patient can be reasonably expected to leave the UK”.

The official guidance includes case studies where treatment for not just cancer but even bunions is provided because it could not wait until the patient left the UK. In the latter case, the hypothetical patient was an undocumented migrant whose case with the Home Office meant they were unlikely to leave the country within six months.

But even though the Azerbaijani woman had been in the UK since June 2018 and was appealing – ultimately successfully – against the Home Office, Cambridge was insisting as late as September 2019 return home for treatment.

Once immunotherapy was finally provided, it was unsuccessful – the patient’s cancer had become terminal and spread to other parts of her body. It is not certain if this was caused by the delay to treatment. She is currently receiving end of life treatment to try and extend her life and reduce the pain.

CUH and Royal Papworth trusts both indicated they could not comment on individual patient cases. The department for health said it could not comment during the pre-election period.

A Conservative spokesperson said: “British taxpayers fund the NHS, and it is only fair that overseas visitors make a contribution too. Money raised from charging overseas visitors is reinvested back into frontline services NHS, to ensure everyone can get the care they need.

“There are exemptions in place for vulnerable people, and the guidance is clear that urgent treatment will never be withheld.”

Anna Miller, a policy and advocacy manager at Doctors of the World, said: “This is a tragic example of how the charging rules are causing serious harm to patients in desperate need of medical care, and it is not an isolated case. In the last six months Doctors of the World’s caseworkers have supported 18 people who have had treatment withheld.”

“Every child, woman and man in this country should get the medical care they need, or lives are at risk. That is one of the main principles of the NHS, it’s what makes our health system one of the best in the world, and we should be proud of that.”

Dr John Chisholm, chair of the BMA Medical Ethics Committee said: “The BMA has been consistently and highly critical of the existing overseas charging regulations, with the impact on vulnerable groups being a particular concern. We believe the regulations must be suspended pending a full, independent review into their impact on individual and public health and whether they are even fit for purpose.

“A doctor is first and foremost a caregiver, not a border guard, and none of us should ever be expected to determine whether someone is eligible for urgent care based on their background or status in the UK. We are there to treat people on the basis of their medical need.

“The Department of Health and Social Care must also ensure that any new guidance on the present charging system actually reaches and informs the behaviour of hospitals and Overseas Visitors Managers, so that shocking and distressing cases like this do not occur again.”