Health Centre confusion

Angry responses have continued to pour in concerning the decision by the Imperial College Health Centre to stop treating Imperial postgraduates who live outside of the Centre’s catchment area. The Health Centre only receives money from the NHS to register patients living within this area but additional funding received from the College has traditionally allowed it to treat out of area students. These students do not officially ‘register’ at the Health Centre but rather ‘join’. This allows them to use all of the Health Centre’s provisions apart from the out-of-hours service, but they are still encouraged to register with a local GP.

Despite the College recently increasing the money that it pays to the Health Centre a loss of some NHS funding due to a decrease in the number of registered patients led to the decision to restrict access to services. While Imperial postgraduates are no longer able to join the Health Centre out-of-area Imperial undergraduates and both undergraduates and postgraduates from the Royal College of Music are still able to do so. Undergraduates living in the new Hall of Residence in Acton will, in fact, have to join rather than register since the Hall’s W3 postcode is outside the Health Centre’s catchment area.

In a statement given to Felix about the changes affecting Imperial postgraduates, Dr Sarah Freedman of the Imperial College Health Centre said: “Last summer we flagged up with the College the fact that there was likely to be insufficient funding from them, for the continued provision of all the services for students, which are not funded by the NHS. These include all services provided to students, who are not entitled to register under the NHS because of where they live, but also a variety of other services, such as certification to tutors, for students who are registered. It became clear late in 2012, that the anticipated shortfall was a reality. The College informed us, that they were unable to make up the shortfall as there were no additional funds available and so advised us to cut services. We were really disappointed by this news as we understood that this would negatively impact student welfare.

“After lengthy deliberation, we made the decision to stop seeing unregistered postgraduate students … This was not a decision we wanted to make, but we felt we had no other option, as it is not possible to run a service without sufficient funding.

“I appreciate that some postgraduates were receiving repeat medication and ongoing monitoring here. However we have always advised all those who use our service, but are not eligible to register with us under the NHS, that they should be fully registered with a local NHS GP. Those that followed this advice should not have had significant problems with the transition, although I accept that their health provision may have become much less specialised and convenient. This is surely an argument for the College to provide adequate funding for their care here in future.”

This explanation, however, was disputed by Professor Denis Wright, Imperial College London Dean of Students, who said: “The funding gap arose due to a fall in student registrations in the Health Centre, which in return reduced the capitation fees the Health Centre (which is an NHS practice) receives from the NHS. We could not secure additional College funds at that time as these are set annually through the planning round but did instigate a campaign though Wardens in Halls to increase registrations. This has worked to some degree, although registrations are still below the 2011/12 level. We did not advise the Health Centre to make cuts in services and regret that the Health Centre did so for non-registered PG students.“

The Health Centre has not allowed Union officials to view the agreement it has with College concerning how it should use College funds. In a statement given to Felix, Becky Lane, Deputy President (Welfare), said: “The Health Centre are blocking me from seeing the Memorandum of Understanding between the Health Centre and the College, despite the fact that the College are happy for me to see it. A freedom of information request would be futile due to commercial sensitivity. It does beg the question of what the Health Centre have to hide and what the agreement is based on the College subsidy.”

Postgraduates were initially informed of the decision, which came in force on 1 March, by a notice on the Health Centre website. All postgraduates were subsequently informed of the changes by an email from the Union – which prompted some 200 replies from students expressing their dissatisfaction at the changes. On 30 April, the Union Council unanimously passed a paper resolving “to work with College staff to lobby the Health Centre to change their policy on seeing Postgraduates outside the registration area”.

Speaking to Felix, Helen Pennington, Graduate Students Association Academic and Welfare Officer for Life Sciences, said: “One of the main concerns raised by a postgraduate (who wishes to remain anonymous) was that any students receiving mental healthcare who were outside the catchment area may have had their care/counselling stopped. I imagine that this would be distressing, especially because there is something of a stigma in the UK about mental illness.

“It should also be noted that there is a difference between undergraduate masters (for example physics 4th year) and postgraduate masters (for example any biology masters). These students will usually be in the same age-range, and often doing the same kinds of courses, but are treated differently under College policy. This does notseem entirely fair.”

Responding to these concerns – and the case, raised at the Union Council, of a student “experiencing an anaphylactic episode” being turned away from the Health Centre and advised to call an ambulance instead – Dr Freedman said: “We felt that [Postgraduate’s] maturity better enabled them to manage their health care needs, without the support of the Health Centre, than the Undergraduate population.

“Those with mental health problems who were receiving talking therapies at the Health Centre were encouraged to complete their treatment course here. Those who were on the waiting list prior to treatment starting were advised to access treatment via their local registered GP. So it was not correct to say that patients had their treatment stopped. Once again we feel sympathy for those students affected but reiterate that we cannot run a comprehensive service for all students without adequate funding.

“In general terms though, our policy would be to see anyone with medical emergencies, whatever their registration status. However, our obligation to patients not eligible to use the Health Centre is to provide advice in an emergency and sometimes that advice may be ‘to call an ambulance’.”

[UPDATE: 28/06/2013 - An agreement has been reached with the College's NHS Health Centre over the College subvention for 2013/14. Postgraduate students who are not registered will be able to use the services from 1 August onwards]