NHS Charges for Overseas Visitors. By Thomas Powell. CBP-3051.Jump to full report >>
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 hospital 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, and EU regulations and other international agreements provide reciprocal healthcare that benefits visitors from and to participant countries. 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 note describes the position in England but see section 5 for links relating to other parts of the UK.
This note is intended to help Members of Parliament with questions from constituents and provides an overview rather than a detailed account of the rules. The NHS Choices website provide general guidance for overseas visitors about charges for NHS services and, according to their circumstances, where they may be exempt from charges. The main legislative provisions are contained in regulations and the Department of Health has issued Guidance on implementing the overseas visitor hospital charging regulations 2015 (a Department of Health press release provides further information on the changes introduced on 6 April 2015).
GP services are excluded from the overseas visitor charging regulations, however, the guidance on the implementation of the regulations sets out some information on registering overseas visitors in primary care (see section 4 of this note).
Both NHS hospitals and GPs have a duty to provide free of charge treatment which they consider to be immediately necessary or emergency, regardless of whether that person is an overseas visitor. It should be noted however, that being registered with a GP, or having an NHS number, does not give a person automatic entitlement to access free NHS hospital treatment
The Immigration Act 2014 makes provision for non-EEA temporary migrants (e.g. 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 migrant is then entitled to free NHS services for the duration of the visa. Visitor visa holders cannot pay the surcharge in order to get access to free NHS care. 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. A Home Office press release provides information on the introduction of the requirement to pay the ‘health surcharge’ on 6 April 2015. Further information is provided in the Library briefing on the Immigration Health Surcharge: common casework questions.
The UK Government has consulted on a number of other proposals including measures to improve the system for identifying patients who should be charged. In July 2014 the Government published its Visitor and Migrant NHS Cost Recovery Programme Implementation Plan 2014–16.
In December 2015 the UK Department of Health consulted on proposed changes to further extend charging for overseas visitors and migrants who use the NHS, including exploring changes in:
The Queen’s Speech on 18 May 2016 announced that “Legislation will be introduced to ensure that overseas visitors pay for the health treatment they receive at public expense.” This may include new charges for A&E, diagnostic tests and ambulance services. It is reported that GP services are expected to remain free of charge due to fears that visitors with communicable diseases would fail to seek help if they were ill.