A Guide to the New NHS Charges for Foreign Users

A Guide to the New NHS Charges for Foreign Users

As Home Secretary, Theresa May vowed to foster a ‘hostile environment’ for irregular migrants. Her infamous vans, growling around London carrying the threat ‘Go home or face arrest’ were an early indication of what this would mean in practice. Then, In January 2017, the Department of Health and NHS Digital signed an agreement with the Home Office requiring the NHS to share patient information with the Home Office. The new NHS charges for foreigners seem to be the latest manifestation of this xenophobic pledge. For many, the NHS is a national treasure, a symbol of solidarity and compassion. For the Government, the NHS is another territory around which they feel the need to impose violent borders. NHS workers are to become border guards, checking the papers of patients before providing secondary healthcare services. Welcome to the Nationalist Health Service.

The NHS has been charging patients not covered by the NHS for some time, but there are three major changes in the new charging regime which came into force on 21 August 2017 and 23 October 2017.

First, this system requires patients to pay upfront, meaning that many could be refused treatment if they are not able to make the payment. If the treatment is immediately necessary and urgent, then it must be provided regardless of upfront payment, but patients would then owe the NHS money, which could affect their immigration application.

Second, the scope of the charging regime has been extended from just hospitals to NHS-funded secondary healthcare services such as health visiting, school nursing, community midwifery, community mental health services, termination of pregnancy, district nursing, support groups, advocacy services and specialist services for homeless people and asylum-seekers.

Third, providers of NHS-funded care will now have to record a patient’s chargeable status on their health records. This will allow other parts of the NHS to recoup costs from overseas visitors more easily.

What are the problems with the new NHS charging regime?

• NHS staff are simply not trained or equipped to make complex assessments on immigration status to ascertain eligibility for healthcare;
• Patients may be wrongly charged for care, or refused care because they are perceived to be ‘foreign’ and do not have proof of immigration status.
• Patients may be charged for treatments that are meant to be exempt from the charging regime;
• Patients may be subjected to racial profiling in eligibility questioning, amounting to direct race discrimination;
• Vulnerable people, such as survivors of torture, trafficking, domestic violence who are exempt from paying these charges, may not have evidence of their vulnerability or may not wish to disclose this information to health professionals and so may be wrongly charged;
• The new charges may discriminate against children or people with disabilities who do not normally live in the UK, as they may be disproportionately represented among those who need the kind of healthcare services which have become chargeable;
• Questioning of patients about their entitlement to NHS healthcare may create an intimidating, hostile, humiliating or offensive environment, amounting to harassment;
• People in need, who may be eligible for care, may be deterred by the new charges regime, risking a deterioration of their health or indeed risking their life to avoid questioning about their immigration status;
• People in need of secondary healthcare services that are not immediately necessary or urgent may be refused or charged for treatment until their condition gets so bad that treatment can be provided without upfront payment.

For these reasons and more, the new NHS charges regime needs to be challenged.

Please contact the Duncan Lewis Solicitors Public Law Team if you think any of the above problems relate to your experience:

For advice on how these new NHS charges affect you, please see the Question and Answer sheet below.

Q & A Information Sheet on New NHS Charges

The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 set out changes to the existing regime of charges made by NHS and NHS funded bodies to people not ordinarily resident in the UK.

• Secondary healthcare provided by NHS Trusts, Foundation Trusts, local authorities exercising health functions, and even charities providing NHS funded healthcare;
• All health care where the patient is referred to a specialist, mental health services provided by local authorities apart from the services under the ‘still free’ section above;
• Immediately necessary and urgent treatment is chargeable, but must be carried out whether or not the patient can pay up front. If they cannot pay in advance, the patient accrues an NHS debt which may lead to refusal of their immigration application.

• Primary care (incl. GP services);
• A&E until the person is accepted as an in-patient;
• Family planning services;
• Diagnosis and treatment of contagious diseases and Sexually Transmitted Diseases (STDs);
• Treatment of conditions caused by torture;
• Treatment of conditions caused by Female Genital Mutilation (FGM);
• Domestic and Sexual Violence.

• I have an enforceable EU right to free healthcare;
• I have paid the Immigration Health Charge;
• I am a refugee/have been granted humanitarian protection (including dependants);
• I am an asylum-seeker whose claim has not been determined (including dependants);
• I am an asylum-seeker receiving support under Section 95 of the Immigration and Asylum Act 1999 (including dependants);
• I have been refused asylum but am receiving support under Section 4 of the Immigration and Asylum Act 1999 (including dependants);
• I have been refused asylum but am being provided with accommodation under the Care Act 2014 (including dependants);
• I am a ‘looked after’ child;
• I am a victim of modern slavery;
• I am an overseas visitor with exceptional humanitarian reasons;
• I am detained under the Mental Health Act 1983;
• I am in prison/I am in detention.

• Children, or people with disabilities;
• Failed asylum seekers not receiving asylum support or accommodation under the Care Act;
• Visa over-stayers;
• Irregular entrants;
• Visitors with leave to enter for 6 months or less.

*This is an information sheet only. If you have been affected by the new NHS charges, we recommend that you seek legal advice and refer to the relevant NHS regulations. We have included our contact details above.