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The NHS is built on the principle that it provides a comprehensive health service, based on clinical need, not ability to pay. However, regulations impose a charging regime in respect of NHS treatment for persons who are not ordinarily resident in the UK. The charging regime provides for some categories of non-residents to be exempt from charges, international agreements (including transitional arrangements with the EU) provide reciprocal healthcare that benefits visitors from and to participant countries. Under the overseas visitor charging regulations, charges only apply to secondary (hospital) care and community care services. However, certain secondary and community care services provided by the NHS are specifically excluded from the charging requirement in the regulations.

The principle that NHS services are free at the point of use, unless charges are explicitly allowed for by statute, applies throughout the UK but decisions about specific charges are devolved and these may differ in the different countries of the UK. This briefing describes the position in England – see section 6 for links to information relating to other parts of the UK.

This briefing is intended to provide background information for Members of Parliament with questions about NHS overseas visitor charges. It provides an overview rather than a detailed account of the rules. The NHS website provides general guidance for overseas visitors about charges for NHS services and where, based on their individual circumstances, they may be exempt from charges. As noted above, the main legislative provisions are contained in regulations, and the Department of Health and Social Care (DHSC) has issued Guidance on implementing the overseas visitor charging regulations (updated February 2020).

Under the terms of the Withdrawal Agreement, there is a transition period which lasts until 31 December 2020 during which reciprocal healthcare rights under EU Regulations continue to apply in the UK.  From 1 January 2021, EEA/Swiss visitors may not be covered for healthcare as they are now and may become chargeable. The UK Government has said it wants to continue discussing the future of reciprocal healthcare arrangements with the EU as part of the future relationship discussions.

GP services are excluded from the overseas visitor charging regulations, although, the DHSC guidance does sets out some information on registering overseas visitors in primary care (see section 5 of this briefing for further information on GP services). It should be noted that being registered with a GP, or having an NHS number, does not give a person automatic entitlement to access free NHS hospital treatment.

Hospitals, community healthcare services, and GPs, also have a duty to provide free of charge treatment which they consider to be an emergency or immediately necessary, regardless of whether that person is chargeable as an overseas visitor. Services provided in an A&E department are currently exempt from charge. The DHSC charging guidance also makes clear that no woman must ever be denied, or have delayed, maternity services due to charging issues.

The Immigration Act 2014 makes provision for non-EEA temporary migrants (for example, workers, students or family members, who do not have indefinite leave to remain) to pay an obligatory ‘health surcharge’ in addition to the visa application fee. The payer is then entitled to free NHS services for the duration of the visa (with certain limited exceptions). The Act also adopts a revised definition of qualifying residence, with non-EEA migrants required to be current residents with indefinite leave to remain to qualify for free NHS treatment on the basis of ordinary residence. Further information is provided in the Library briefing, The Immigration Health Surcharge.

The UK Government has introduced a number of measures to improve the system for identifying patients who should be charged, and consulted on a number of other proposals to amend and extend the scope of charging regulations. In 2014 the Government published a Visitor and Migrant NHS Cost Recovery Programme Implementation Plan and the NHS visitor and migrant cost recovery programme webpage provides current information and resources for NHS organisations and frontline staff.

In December 2015 the Department of Health consulted on proposed changes to further extend charging for overseas visitors and migrants who use the NHS, and amendments to the regulations introduced in 2017 included several of these proposed changes.  These amendments extended the scope of the charging regulations to community healthcare services and NHS funded healthcare services provided by non-NHS bodies to the list of chargeable services. All organisations that provide eligible NHS services, not just NHS bodies, are now responsible for charging patients. Under the 2017 regulations providers of chargeable services are also required to recover an estimate of treatment costs upfront (except where this would delay or prevent the provision of urgently necessary treatment). Other proposed changes, such as the introduction of charges for A&E and ambulance services are awaiting further Government decisions. GP consultations are expected to remain free of charge, in part due to concerns that overseas visitors with serious illnesses or communicable diseases would not seek help if charges were introduced for primary medical care.

There have been calls from a number of national bodies representing doctors, and organisations campaigning on migrant rights, for NHS overseas visitor charges to be suspended or abolished, amid criticism that they are unfair and harmful to both individual and public health. There are also concerns that some vulnerable patients have been charged incorrectly or had their treatment delayed, with a number of individual cases highlighted in the media. Similar calls have been made to abolish the Immigration Surcharge or remove the obligation to pay from certain groups, such as NHS staff.

Covid-19 has been added to Schedule 1 of the overseas visitor charging regulations, meaning there can be no charge made to an otherwise chargeable person for the diagnosis or treatment of this disease.

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