Immigration health charge

Access to treatment Migration NHS Funding

This updated briefing:

  • comments on the decision, announced by the Department of Health in February 2015, to defer proposals to extend the overall NHS charging regime;
  • comments on the introduction of the new Immigration health charge or surcharge;
  • gives detailed consideration to the National Health Service (Charges to Overseas Visitors) Regulations 2015 due to come into force on 6th April 2015;
  • provides an overview of the charging regime for NHS hospital services currently in place and notes some key changes associated with the National Health Service (Charges to Overseas Visitors) Regulations 2015.

The Department of Health decision to extend the charging regime beyond hospitals on hold

The Department of Health announced that a decision has been taken to deprioritise extending and amending charging in primary care in order to focus on making the existing charging regime work better and introduce the new immigration health charge. However, we understand that the current Government still intends to look at extending charging beyond the current rules.  If implemented, the extended charging regime, could in due course lead to:

  • the introduction of charges for A&E care, outside EHIC collection in NHS hospital settings (supposedly without compromising rapid access to emergency care for those in immediate or urgent need); and
  • the extension of charges, in NHS services outside NHS hospitals, to the majority of NHS services including community services, dentistry, optics and pharmacy and extending current charges to treatment provided by all commissioned providers of NHS services.

Subject to the outcome of the general election in May 2015, consultations with various stakeholders and interested parties will take place before a final decision is taken as to whether to extend charging into primary care and A&E; these consultations will not take place before the autumn of 2015. However we should not be complacent and the recent assessment by the Migrants Rights Network strikes an important cautionary note.

The new Immigration health charge or surcharge

The Immigration Act 2014 gives the Secretary of State the power to issue an order to require certain migrants (those seeking leave to enter, remain or entry clearance) to pay an immigration health charge. (Regulation 10, The National Health Service (Charges to Overseas Visitors) Regulations 2015)  Whilst previously it had been thought that the rate might be £150 for international students and £200 for other categories, it would now appear that the charge may be considerably higher, possibly £600 per person. However, the actual rate will need to be confirmed in statutory regulations. The statutory regulations containing this order are due to be laid before Parliament and are meant to come into force in April 2015.

The National Health Service (Charges to Overseas Visitors) Regulations 2015

According to guidance on the DH’s website on the changes:

  • Overseas visitors who need healthcare while in England will soon be charged differently for using the NHS as part of efforts to recoup £500 million a year by 2017 to 2018.
  • From April [2015], the way the NHS charges these visitors is being changed so that it does not lose out on income from migrants, visitors and former residents of the UK who have left, who should all pay for their care while in the country.
  • Within the UK, free NHS treatment is provided on the basis of someone being ‘ordinarily resident’. It important to note that changes in the Immigration Act 2014 redefine and provide a more restrictive definition of ‘Ordinary residence’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK.
  • The changes which come into effect from April 2015 will affect visitors and former UK residents differently, depending on where they now live.
  • Treatment in A&E departments and at GP surgeries will remain free for all.

The regulations are divided into 5 parts and 4 schedules. 5 of the regulations (3-7) focus on making and recovering charges. NHS bodies are required to recover charges from individuals unless the NHS body has determined that the individual is exempt (regulation 5). The rate of charge will depend on whether the individual comes from a country that is a member of the European Economic Area (EEA). For those who come from outside the EEA the charge will be set at 150% of the NHS national tariff for any care they receive.  ‘People who live outside the EEA, including former UK residents, should now make sure they are covered by personal health insurance, unless an exemption applies to them. Anyone who does not have insurance will be charged at 150% of the NHS national tariff for any care they receive.’

The National Health Service (Charges to Overseas Visitors) Regulations 2015

The DH’s Implementation Plan, published in July 2014, stated that where vulnerable groups are not currently exempt, the DH  would consider ‘strengthening exemptions, or other ways of ensuring necessary treatment is provided, for victims of domestic violence, human trafficking and vulnerable children.’ The plan also stated that ‘the Government committed to ensuring that any new system takes into account international law and our humanitarian obligations… vulnerable groups such as asylum seekers, refugees, humanitarian protection cases, victims of human trafficking and children in Local Authority care will continue to have free access to the NHS and will not be subject to the surcharge.’ The exemptions are overviewed in appendix 1 (5). Broadly speaking the scope and range of these exemptions are very welcome. However, it is unclear:

  1. how all those who are exempt will be identified;
  2. how practical or realistic it will be to recover the £500 million a year by 2017 to 2018 planned by the DH;
  3. how any financial shortfalls will affect hospitals and their budgets;
  4. what actions will be taken to ensure that racial profiling will not determine who will be asked for their papers/ documentation to prove their immigration status;
  5. how the complex range of exemptions will be operationalized by NHS staff and made clear to would be service-users.

This note was first published, with more detail, by the Race Equality Foundation.  If you would like to receive further updates from Leander Neckles, please sign up to the Race Equality Foundation’s monthly e-bulletin.