Further restrictions on NHS healthcare for overseas visitors

18 August 2017

More healthcare will be chargeable and upfront payment required

The National Health Service (Overseas Visitors) Charging (Amendment) Regulations 2017 have been laid before parliament and will increase the types of NHS secondary healthcare that some migrants must pay for, as well as requiring people to pay for all non-urgent treatment up front. Draft guidance​ has also been published by the Department of Health.

The changes are being implemented following the government’s response earlier this year to the consultation which was carried out in 2015. The regulations will automatically become law without a Parliamentary debate if the House of Commons and House of Lords do not raise an objection. The regulations contain changes which are due to come into force on 21 August 2017 and 23 October 2017.

The key changes are summarised here and our factsheet​ detailing NHS healthcare for people with NRPF will be updated when the changes come in, on 21 August and again on 23 October.

Who needs to pay for NHS treatment?

British Citizens and EEA nationals, and non-EEA nationals who have indefinite leave to remain or another form of settled status, will not have to pay for chargeable healthcare when they are ordinarily resident in the UK.

Non-EEA nationals who do not have settled status in the UK, and any EEA nationals, British Citizens and people with ILR who are not ordinarily resident, will be ‘overseas visitors’ and charged for secondary healthcare, unless an exemption applies or they are receiving an exempt treatment.

As of 21 August 2017, where a person is identified as being an overseas visitor, NHS foundation trusts and NHS trusts must record this against the person’s patient record and specify whether or not the person is exempt from charging.

On 21 August 2017 there will also be some changes to the groups that are not required to pay for chargeable NHS healthcare:

  • Dependants of asylum seekers and refugees, and refused asylum seekers supported by the Home Office or local authority under the Care Act, who do not fit under the exemptions in their own right will be exempt from secondary healthcare charging.
  • People working on UK registered ships will no longer be exempt from charges. Instead the owner of the ship will be liable for the cost of a ship worker’s treatment.

Apart from these changes, the groups that are exempt from charging will stay the same. This means that people who will still be required to pay for certain types of health care include visa overstayers, people who otherwise have no immigration permission, people on visitor visas and refused asylum seekers who are not getting housing from the Home Office or local authority under the Care Act.

Changes to the types of NHS treatment that must be paid for

Currently, the only healthcare that an overseas visitor might have to pay for is secondary healthcare provided by an NHS hospital, including services provided by hospital staff in the community. However, this will change so that eventually, all secondary care provided in hospitals and the community will need to be paid for by overseas visitors who are not exempt from charging. This is being implemented in two stages:

  • As of 21 August 2017, any secondary healthcare services provided by an NHS trust, NHS foundation trust or local authority exercising public health functions can be charged for, unless the treatment is exempt from charging. Most hospitals are managed by NHS foundation trusts. NHS trusts may be responsible for providing mental health or drug and alcohol services within the community.
  • The regulations will subsequently be amended on 23 October 2017 to require any organisation providing NHS-funded secondary healthcare to charge overseas visitors for treatment, including charities that are fully funded by the NHS to deliver a service. However, palliative care provided by a charity or community interest company, such as a hospice, will not be subject to the new rules, so will still be free of charge.

Additionally, people who are exempt from charging because they have paid the Immigration Health Charge as part of their application for leave to remain, or fall under the transitional measures and have leave granted before the health charge was implemented, will not be entitled to free assisted conception services, including IVF, from 21 August 2017, unless they have already started a course of treatment.

Accident and Emergency services and primary care services, such as those provided by a GP, will continue to remain free to everyone, regardless of immigration status.

New requirement to pay for non-urgent treatment up front

Currently, it is up to the hospital to decide whether to require full payment up front before starting a course of non-urgent treatment, so it may be possible for a person to start a course of treatment and then be invoiced for this afterwards. Treatment which a clinician decides is urgent or immediately necessary must be provided regardless of whether advance payment has been received. All aspects of maternity care are considered to be ‘immediately necessary’.

As of 23 October 2017, any organisation providing NHS funded secondary healthcare will be required by law to secure full payment up front for the total estimated cost of non-urgent treatment from an overseas visitor who is not exempt from charging.  Where securing advance payment would prevent or delay the provision of immediately necessary or urgent treatment (including maternity services), then the treatment must be provided regardless of whether the overseas visitor has paid up front.

Impact of changes on people supported by local authorities

Although the Department of Health announced its intentions to bring in some of these measures in February 2017, the changes have been introduced with very little time for organisations that will be new to implementing healthcare charging to prepare for these.

There still remains no exemption from secondary healthcare charges for people who are supported by social services because they are destitute and, due to their immigration status, have no access to mainstream benefits or social housing. Two-thirds of households supported by social services include an adult who has no current immigration status and faces being charged for hospital treatment and other types of healthcare, such as mental health services. We have reported that the charging regime and lack of exemption for this group has already caused problems for the individuals concerned and local authorities, so the requirement to pay up front for all non-urgent treatment, including for preventative services, will lead to many people supported by social services being unable to access treatment, leading to exacerbated needs and increasing demand on local authority staff resources. Additionally, where more people are unable to access preventative services in the community, this is only likely to result in increasing demand for the intervention of social services as health needs remain unmet.

These concerns have been put forward to previous Immigration Ministers and we will continue to gather evidence of how the new changes impact on people receiving social services’ support and local authorities.​ 

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