Extracts from the Implementation Plan 2014–16

The programme is subdivided into four main phases of work, these are:

  •  Phase 1: Improving the existing systems
  •  Phase 2: Aiding better identification of chargeable patients
  •  Phase 3: Implementing the migrant health surcharge. The introduction of the health surcharge is being managed by the Home Office.
  •  Phase 4: Extending charging

Who will be charged?

Non-EEA temporary migrants (including students and workers)

Will be expected to pay a health surcharge as part of the visa process, unless they are exempted. This will mean they are entitled to use the NHS, as an ordinarily resident patient would, whilst they have valid leave to remain (usually between 6 months to 5 years).

Non-EEA visitors

Those in England for less than 6 months continue to be chargeable (unless covered by a country specific reciprocal agreement or other exemption) but will be more likely to be identified and charged.

Expatriates

Under current rules, expatriates are normally chargeable for NHS care (or should use EHIC/S2 mechanisms if residing in another EEA country) on the grounds that they are not ordinarily resident in the UK. However, the Government is considering whether to exempt from charges expatriates who have made significant National Insurance contributions in the past.  No final decision on this has been taken.

Vulnerable groups who are not currently exempt

We are considering strengthening exemptions, or other ways of ensuring necessary treatment is provided, for victims of domestic violence, human trafficking and vulnerable children.

People who are here illegally

Will continue to be chargeable, as they are now.

What services are currently free for everyone but will be chargeable for visitors?

NHS hospitals

Will be considering introducing charges for A&E care, outside EHIC collection (without compromising rapid access to emergency care for those in immediate or urgent need).

NHS services outside NHS hospitals

Will be considering extending charges to the majority of NHS services including community services, dentistry, optics and pharmacy. Extending current charges to treatment provided by all commissioned providers of NHS services.

Services exempt from charging

GP and nurse consultations in primary care

Will remain free, ensuring everyone will continue to have access to prevent risks to public health such as HIV, tuberculosis (TB) and sexually transmitted infections.

A note on immediately necessary and urgent treatment

NHS providers have a statutory obligation to make and recover charges from patients who are deemed chargeable under legislation. However, providers also have human rights obligations, meaning that treatment which is considered by clinicians to be immediately necessary (which includes all maternity treatment) must never be withheld from chargeable patients, even if they have not paid in advance. Failure to provide immediately necessary treatment may be unlawful under the Human Rights
Act 1998.

Treatment which is not immediately necessary, but is nevertheless classed as urgent by clinicians, since it cannot wait until the overseas visitor can return home, should also be provided, even if payment or a deposit has not been secured. Providers are
nonetheless strongly encouraged to obtain a deposit ahead of treatment deemed urgent if circumstances allow. However, if that proves unsuccessful, the treatment should not be delayed or withheld for the purposes of securing payment.

Non-urgent treatment should not be provided unless the estimated full charge is received in advance of treatment.

Treatment is not made free of charge by virtue of being provided on an immediately necessary or urgent basis. Charges found to apply cannot be waived and should be applied. Providers should take a pragmatic approach as to the most appropriate time
to discuss financial arrangements with the patient.

The Department’s Guidance on Implementing the Overseas Visitor Hospital Charging Regulations includes assistance to providers on what constitutes immediately necessary, urgent and non-urgent treatment and how this must be determined by
clinicians only.

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