Montserrat’s NHS Medical Quota Under Scrutiny After Cases of Brown and Baker

Montserrat’s system for sending patients overseas for specialist medical care is under renewed scrutiny, as recent cases highlight gaps in the UK’s NHS quota scheme that have left vulnerable residents without adequate support.

During the September 30 sitting of the Legislative Assembly, responses to questions from Opposition Member Donaldson Romeo confirmed that Montserrat’s Ministry of Health allocates roughly EC$1.38 million annually for medical evacuations (medivacs). So far in the 2025–26 fiscal year, 12 patients have received overseas treatment at a total cost of EC$430,975, with outstanding invoices of nearly EC$379,000 still to be paid.

Only four patients have qualified this year under the NHS/Government of Montserrat 10-patient referral quota, which allows BOT citizens to access NHS treatment in the UK free of charge.

Strict Criteria

According to the Ministry of Health, patients referred under the scheme must have a chronic or complex illness that cannot be treated in Montserrat or the region, hold the legal right to reside in the UK for the duration of treatment, and have a family member or friend in the UK to provide housing and subsistence support. The Government of Montserrat does not cover these costs.

Officials confirmed that some patients with urgent needs do not qualify under the scheme, even where treatment is unavailable locally.

Brown and Baker Cases

The quota system has come under increased attention following the case of Cherry Brown, 69, who travelled to the UK in March 2025 on a Montserrat government referral but was later denied free NHS care. Brown, who requires knee replacements and suffers from hypertension, became homeless in Swanley, Kent, before being assisted by local officials.

Another case is that of calypsonian Robert “Shorty” Baker, 63, who is currently in Jamaica after spending more than £8,000 on treatment. Supporters have called for his transfer to the UK for further care.

Romeo has written to the Foreign, Commonwealth and Development Office (FCDO) and Foreign Secretary David Lammy on both cases. In his letter, he said:

“The injustice is stark … tens of millions of pounds (up to some £50 million) have been expended annually since 2021 by the FCDO on housing, welfare and legal aid for some 60 Sri Lankan Tamil asylum seekers … in contrast, the cost of ensuring life-saving medical, housing and welfare support for Ms Brown, Mr Baker, and the small number of similarly situated BOT citizens and residents is minimal.”

He further stated:

“In this instance you have the opportunity, means, legal and moral authority to renounce a blatant double standard and demonstrate through your treatment of Montserrat’s BOT passport holders in desperate need that the life of every citizen, temporary or permanent resident of Montserrat, those who travelled on their own or were medivacked to the UK, other British soil or elsewhere, carries equal value and dignity, and has the right to equal protection.”

A Costly Burden

Government records show that over the past five years, medivac costs have ranged from EC$112,000 to EC$366,000 annually. Patients are required to sign repayment agreements, though only four of the 12 who received assistance this year are currently making repayments, the acting Minister of Health Dwayne Hixon told the house.

Looking Ahead

Montserrat is currently building a new hospital, expected to be completed in late 2026 as part of a £19.4 million Health Transformation Project funded by the UK. Whether it will have the staffing capacity to handle critically ill patients remains to be seen. Until then patients will continue to rely on regional facilities or the NHS quota for specialist treatment abroad.