Department of Health reviews NHS charging regulations 

13 March 2018

Local authorities invited to provide evidence of impact on NRPF services

The Department of Health is currently carrying out a review of the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 which were implemented last year and extended charging to non-primary community services, as well as introducing upfront charging for non-urgent treatment. The changes are summarised in our previous news reports and factsheet.

We have submitted a joint response to the review with the Association of Directors of Children's Services (ADCS) based on evidence provided by local authorities. Unfortunately, due to the short timeframe to prepare this, and as the changes have not been in force for that long, we were unable to gather substantial evidence of how the regulations may have impacted on the provision of NRPF services to children, families, young people leaving care or adults with care needs and the individuals concerned.

Key points of the submission:

  • In the absence of a charging exemption for people receiving social services’ support, councils are concerned that the extension of charging to community NHS services and the requirement to pay up front for non-urgent treatment will only exacerbate and increase these problems.
  • ​Where a child requires non-urgent treatment and can only receive this following upfront payment, then it is an inevitable consequence that councils’ safeguarding duties will extend to covering the cost of NHS healthcare. The majority of families supported by social services are single parent households, so this change will affect women and children. The regulations also create a cost-shunt to local government.
  • Concerns still also remain about extending the scope of charging to community based services, where failure to access preventative treatment will lead to an exacerbation of social care needs, resulting in increased demand on staff time and support costs. This particularly impacts on people with disabilities, who are elderly or are pregnant. 
  • Although it is unlikely that safeguarding duties under section 17 of the Children Act 1989 would extend to repayment of an NHS debt already accrued, if a child’s welfare is adversely affected by the repayment of a debt out of subsistence support, then this may result in increased costs to the local authority if support needs to be increased.
Recommendations made: 

  • The charging exemption to be extended to people who are receiving local authority support 
  • Department of Health to continue to work with councils to capture the impact of the Regulations 
  • Further information and clarity is provided about what secondary and community treatments are subject to charging
It is really important that local authorities document the impacts of NHS charging now and also what happens when charging is implemented more routinely within community services. The review is due to be concluded in Spring 2018 so there is still some time to submit additional evidence for consideration and we will continue to collect case studies beyond this time, as it is expected that this issue will remain of high concern for the foreseeable future. We therefore request that local authority practitioners complete ​and return this ​evidence form to us whenever an appropriate case is identified. 

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