The future of charging temporary migrants and visitors for access to NHS services

Jeremy Hunt, the Secretary of State for Health, has recently published the Government's response to the recent consultation on proposed changes to the way temporary migrants and visitors access the NHS in England. The proposed changes will apply in England only, though devolved Administrations may wish to replicate some or all of the proposed changes.

In parallel to the consultation the Government commissioned independent research to provide an estimate:

  • of visitor and migrant health care costs in particular the costs of provision for those who should be charged; and
  • for 'health tourism' where visitors have an explicit intention of obtaining extensive health care without due payment.

The outcomes of both the consultation and the research indicate there is a compelling case for introducing new and more robust and consistent administrative processes and systems.

One of the key proposals is that non-EEA temporary migrants should in future contribute to the costs of their health care by means of an immigration surcharge to collect this contribution with minimal operational impact or burden on the NHS.

Extension of exemptions

For ex-pats the news is good as many who should be charged for treatment provided when visiting the UK are likely to be made exempt following the same principles that apply to UK pensions and other state benefits.

The Department of Health will also be giving further thought as to whether to extend exemptions for victims of domestic and other violence and victims of human trafficking and in the mean time will be seeking the views of relevant agencies and advisers.

The Department of Health does not intend to extend the exemptions to maternity and children generally because of the risk of abuse by visitors either seeking maternity care for themselves or care for their children with existing serious illnesses and it is feared that such an exemption could act as a draw to illegal migrant families.

However the Department is open to proposals on how best to cover other vulnerable children who might otherwise be unable to access treatment.

Extending services where charges apply

The consultation also proposed extending the scope of NHS services for which charges should apply for non-exempt visitors. Charges currently can only be made for most secondary care in hospitals.

Free access to GP consultations will be retained but GPs will be expected to participate actively in the administration of the new system for identifying and recording chargeable patients.

The Government is also committed to charging visitors for treatment in hospital A&Es but there will be a delay before this is introduced so that the systems needed to support the effective administration of such charges can be improved. The priority being be to secure the safe and efficient delivery of A&E services ensuring immediately necessary treatment is not refused and to avoid any unintended charging of legitimate residents.

Apart for GP consultations other services and treatment that are part of primary care including community-based health care prescriptions and dental services (that are already subject to charges for many residents) will be chargeable services.

Improving the existing charging and recovery process

The response underlines how significant improvements are needed in the NHS' charging and recovery process.
The consultation paper - Sustaining services ensuring fairness; Government response to the consultation on migrant access and financial contribution to NHS provision in England is available at:

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