Health charges for visitors and migrants - England

Summary

The Immigration Act 2014 and recently updated regulations on charging overseas visitors for NHS care have led to changes in the way overseas visitors and migrants are charged for NHS care. Although mainly an administrative issue, there are key points that need to be understood by clinicians to ensure that patients are treated appropriately and their information is safeguarded.

Key points

Since 6 April 2015, non-EEA citizens staying in the UK for six months to five years will be required to pay an immigration health surcharge to entitle them to access NHS secondary care. The charge will be paid when applying for a visa and will be £150-200 per year.

Find out more about how these charges will apply

The National Health Service (Charges to Overseas Visitors) Regulations 2015, which only apply in England, reflect this change and generally set out the new rules to be followed for the charging of overseas visitors and migrants who access secondary NHS care.

Click here for guidance on implementation of the new regulations

Current situation regarding charges

Who is entitled to NHS secondary care?

• British citizens/residents of EEA/Switzerland who are ordinarily resident in the UK
• Nationals of other countries who have indefinite leave to remain in the UK
• Nationals of other countries who have paid the health immigration surcharge
• Nationals of non-EEA countries with a reciprocal
  health agreement with the UK
• Refugees and asylum seekers
• Victims of human trafficking.

Who should be charged for care provided by NHS trusts?

• Non-EEA/Swiss nationals visiting the UK for less than six months
• Those who are in the UK without permission, such as those who have overstayed their visa
• Various other groups who fall into a number of specific categories.

Under what circumstances is treatment free to all, regardless of immigration status?

Those requiring certain treatment, including:

• treatment for accidents and emergencies as an outpatient in a hospital’s accident and emergency department
• compulsory psychiatric treatment
• compulsory treatment under a court order (in England and Scotland)
• treatment for certain communicable diseases, such as tuberculosis, cholera, food poisoning, malaria, meningitis and pandemic influenza. In England and Scotland, HIV treatment is free. In Wales and Northern Ireland, testing for the HIV virus and counselling following a test are both free of charge, but any necessary subsequent treatment and medicines may have to be paid for.
• family planning services
• treatment provided to victims of violence including torture, female genital mutilation, domestic violence and sexual violence (in England).

Those requiring immediately necessary or urgent treatment

• The treatment should be provided even if payment or a deposit has not been taken. Failure to provide life-saving treatment may be unlawful under the Human Rights Act 1998.
• Those accessing primary care.

Issues for clinicians

Primary care

There has been no change to the regulations for access to primary care, and GPs can accept any person on to their list regardless of immigration status. Those in the UK for less than three months can also be seen as temporary residents. No GP charges can be made for patients registered as NHS patients. Additional training may be required by practice staff involved in the registration of patients to ensure that patients entitled to access NHS primary care (eg, those without official documentation) are not denied it inappropriately in light of publicity surrounding these changes. Those involved in patient registration will need to understand that the entitlement to primary care remains unchanged despite the changes affecting secondary care.

Referral to secondary care

The guidance suggests that GPs should inform patients of any possible charges when making a referral to secondary care, although the possibility of payment should not influence the GP’s clinical decision regarding the need for secondary care. The guidance also suggests that the referral letter should highlight, where possible, the fact that the patient may not be entitled to free secondary care. It is important to be aware that the GP has no role in deciding the eligibility of a patient to free secondary care, and may not fully understand all the possible exemptions. Information about the patient’s immigration status should only be included in the referral letter with the explicit consent of the patient, in order to avoid breaching patient confidentiality.

Secondary care

Only a clinician can decide whether care is immediately necessary, urgent or non urgent. MPS members will therefore be involved in providing a view on whether treatment should be provided for a patient not entitled to free care. The guidance above provides some clarification of how those terms should be used and defined.

If a clinician is aware of a failure to treat a patient on the basis of inability to pay, when the treatment is immediately necessary or urgent, she/he should take steps to highlight their concerns to ensure that the patient receives appropriate treatment.

Clinicians will also have a role in confirming whether a patient is receiving treatment for a condition which is exempt from charges, eg, TB, and in determining whether a patient is a victim of certain types of abuse such as torture, which could make them eligible for free treatment.

Sharing of data

A recent High Court case has confirmed that the NHS is not required to obtain consent from a patient before sharing non-clinical data with the Home Office for the purposes of determining the patient’s immigration status. However, the NHS should notify the patient that their data is being shared, and how this data may or will be used. No clinical data should be shared in this way.

References

• Immigration Act 2014
• The National Health Service (Charges to Overseas Visitors) Regulations 2015
• R (on the application of W, X, Y and Z) v Secretary of State for Health [2014] EWHC 1532 (Admin)