Reply from Health Secretary about the use of the NHS by overseas visitors

In my blog of 11 August, I said I would write to Jeremy Hunt MP about the use of the NHS by overseas visitors. This is his reply, dated 3 September 2015.

Dear John

Thank you for your letter of 11 August about the use of the NHS by overseas visitors.

There is no provision whereby visitors to the UK can automatically be entitled to free NHS hospital treatment. Anyone who is not ordinarily resident in this country is subject to the National Health Service (Charges to Overseas Visitors) Regulations 2015. The Regulations place a legal duty on NHS hospitals to establish whether a person is ordinarily resident, or exempt from charges, or liable to be charged. Where it is established that charges apply, they cannot be waived for any reason.

Where a person claims exemption from charges under provision of the Regulations, the hospital will ask them to provide documentary evidence to support their claim to free treatment. For example, an overseas student claiming he is here for a three year degree course might be asked to provide documentation to confirm he has leave to enter the UK for that purpose and that he is actually attending the course.

A person who is found liable for charges, or who refused to provide the appropriate evidence to confirm their claim to free treatment, will be asked to pay in advance of receiving any treatment. However, when, in a clinical opinion, medical treatment is immediately necessary it will not be withheld and should go ahead without delay. The NHS is essentially a humanitarian service and no-one in need of immediate treatment will ever be left to suffer just because they cannot pay. Treatment that is not immediately necessary, but otherwise urgent in that it cannot wait until the patient returns home, will also be provided without delay, although hospitals will have time to try to obtain payment in advance. Non-urgent treatment should not be given until the patient has paid in full in advance.

In cases where immediately necessary/urgent treatment is given and the patient is without funds to pay, the hospital should provide only such treatment as is clinically required to stabilise the patient to allow them to return to their own country. This decision will be made locally, based on clinical judgement. This will ensure that the hospital does not incur additional expenditure that it cannot recover, which has a knock-on effect on services that can be provided to NHS patients.

Furthermore, a new health surcharge for non-European Economic Area (EEA) temporary migrants, such as students and workers, who come to the UK for more than six months was introduced on 6 April. This is paid alongside their visa fee.

With regard to your concerns about the European Health Insurance Card (EHIC), the Department of Health takes any case of possible misuse of the EHIC seriously and is continuously working to detect and tackle any suspected fraud. We are currently reviewing the EHIC application progress, and began a major piece of work a few months ago to examine and identify any areas for improvement on all of our administrative systems relating to EEA healthcare payments, including the EHIC. We expect to complete this work by the end of the year.

Entitlement to the EHIC, which provides access to any immediate and clinically necessary state-funded medical treatment in all EEA countries and Switzerland, is based on ‘insurability’ under EU law, not on a person’s nationality. Therefore, as healthcare in the UK is based on residency, it is correct that non-UK nationals, and in some cases their family members, will have a right to a UK EHIC if they meet the UK’s insurability criteria and are not covered by another EEA country. Similarly, there will be UK nationals who carry EHICs from another EEA country because they are insured there, and these people are expected to present their EHIC when accessing NHS treatment in the UK.

The UK reimburses other EEA countries for the cost of providing treatment to people we are responsible for under EU law, irrespective of nationality. In the same way, other EEA countries reimburse the UK for the cost of the NHS providing treatment to people they are responsible for under EU law, including UK nationals insured in another EEA country.

Yours ever

Jeremy Hunt


  1. Nick
    October 2, 2015

    Big difference between should charge and does charge.

    Mr Hunt’s reply is deliberately ambiguous on the matter

  2. Narrow Shoulders
    October 2, 2015

    “The NHS is essentially a humanitarian service and no-one in need of immediate treatment will ever be left to suffer just because they cannot pay.

    By whose order? That is not the covenant as I understand it. My taxes go towards providing a service for UK residents (preferably UK citizens but I will accept residents/taxpayers). Why should I pay for the world? It is not as if either the UK or the NHS is flush with spare cash is it?

    1. Lifelogic
      October 2, 2015

      Well is seems they have enough cash for vanity treatments, not bothering to invoice overseas users and quack treatments. But not enough to do may urgent operations competently or promptly.

      Someone I know could very easily have died from a perforated gall bladder, due to delays in a gall bladder removal operation, they ended up going privately, where it was done far more efficiently within three days.

    2. Anonymous
      October 2, 2015

      NS – When the people who pay for it are left to suffer, ie put on long waiting lists whilst in pain or denied cancer treatment, then why shouldn’t those who haven’t paid for it suffer ?

  3. Lifelogic
    October 2, 2015

    The NHS are simply not doing this most of the time, In my experience they almost never to bill chargeable people or even make any effort to even find out. Surely Jeremy must know this full well?

    Once again we see that the EU has developed an absurd system that is hugely open to abuse and is consequently hugely abused. Often with people travelling and registering as resident in the UK but then getting preferential treatment (paid for by the UK taxpayers) back in their own countries.

    Apart from a safety net for the truly desperate why has the state got anything to do with medical treatment at all. It would work far better if the state just got out of the business, stopped distorting the market and lowered taxes so people could pay for their own treatments or take insurance. They could also get rid of insurance premium tax and encourage insurance with tax relief for those not using the NHS.

    1. Lifelogic
      October 2, 2015

      Is the NHS still paying for homeopathy, alternative medicine and other absurdities, plus the vanity treatments all at tax payers expense?

      All cheered on by Prince Charles types one assumes. Perhaps Jeremy could enlighten us?

      1. Rita Webb (Mrs)
        October 2, 2015

        LL you want to see how much the NHS spends on bedwetting, ear wax removal etc. You know the sort of stuff any competent mother could sort out with wasting a doctors time.

    October 2, 2015

    I have never been asked for my ID when going to a hospital. I do not have an ID. If I did have an ID and I was un-angry enough to readily provide it in my native land; and, my name was john Smith, what check is made that I am the john Smith I say I am and not another John Smith? None. Frankly it is pretty well impossible to check and be even 75% sure.

    Amongst our foreign visitors, foreign residents and originally foreign residents,- those foreign residents who have changed their name to an English name ( there are many ) plus ones who have married someone with an English name and so their name is changed plus those foreigners who have changed their name via marriage to another person who was a foreign resident with a foreign name or is a temporary foreign visitor with a foreign name or an English name there are many identical names as with “Smith” plus many , many alternative spellings of originally identically spelled names. And because of the nature of rented accommodation and the ability to move immediately from one address to another plus the small difficulty in checking land registers for owners of houses whose names in turn do not necessarily correspond with all who are resident at an address, it is a quite impossible job… to do what Mr Hunt outlines.

    Yes I have been associated with businesses which had to use all legal means to find people from online data ( which is very inadequate ) and by virtual house by house enquiries in the locality on foot.
    Mr Hunt replied to your letter: “There is no provision whereby visitors to the UK can automatically be entitled to free NHS hospital treatment. ” WRONG

    If you have uncontrolled immigration;uncontrolled borders; an infinite variety and number of accommodation providers ( including foreign owned and foreign landlorded, both resident and not ) and overly busy hospital staff who hail from a multitude of countries with and infinite variety and number of English comprehensions ( and allegiances and values ) then is a problem indeed. Not a problem Mr Hunt with the best will in the world can address.
    But it is a problem for which the UK government is entirely responsible.
    So, what percentage of foreigners who are wholly ineligible for treatment for free…. actually getting it for free? Is it 99% or 98% ?

    1. Vanessa
      October 3, 2015

      You are normally asked for your NHS number which is, I presume, only given if you are a resident of the UK.

  5. A different Simon
    October 2, 2015

    Mr Hunts response sounds much the same as the responses you get and publish from other ministers .

    They are all characterised by a complete indifference to the plight of ordinary Britons . People like Hunt make the rules and the rest of us are expected to like it or lump it .

    Jeremy Hunt gives an example of overseas students being entitled to free healthcare .

    This is blatant example of British citizens subsidising universities and colleges . Instead how about :-
    – making private travel/health insurance cover a prerequisite for entering the country for everyone
    – scrapping the convention of free healthcare for students and making the educational establishment responsible for paying the cost of treatment and seeking reimbursement .

  6. Old Albion
    October 2, 2015

    So all the illegals coming in from Calais. All the bogus asylum seekers now migrating through Europe. All the economic migrants from all over the world who arrive in England will be expected to pay for their treatment upon arrival…….yeh right!

  7. Iain Moore
    October 2, 2015

    How bad things have got can be seen by Jeremy Hunt using the example of foreign students being required ( what an imposition) to prove they are in a three year university course.

    Why should foreign university students be getting free medical treatment, ever? Is this part of the university marketing strategy…’Come and study in the UK and have free health care thrown in!’ As this seems to be the case, then the NHS should establish a value for the cost of this service we are giving foreign university students, and charge the universities accordingly.

    Universities for all their claim to be a successful industry are in receipt of a lot of hidden subsides from the state, like the free healthcare for foreign students, as well as offering a way to circumvent immigration controls.

    1. Denis Cooper
      October 2, 2015

      It’s not just “Come and study in the UK and have free health care thrown in”, it’s also “And be allowed to stay on in the UK after your course.”.

  8. alan jutson
    October 2, 2015

    Thank you for posting this reply John.

    So it looks like each Hospital has got to up their game in A&E departments nationwide, to ensure people are either entitled or not to free treatment.

    On the few occasions either myself or my family have had need to go to A&E we have never ever been asked for proof of residency, neither have any of us heard anyone else being questioned.

    Me thinks if doctors and health workers are complaining about the size of budgets, then first of all they should be ensuring that only those entitled to free treatment actually qualify to get it. All others should be treated as we are when in foreign lands and be covered with our own medical insurance or reciprocal arrangements.

    Perhaps there should be a record kept of how much each health authority has billed out and collected on an annual basis.

    1. Anonymous
      October 2, 2015

      The criteria should be changed from ‘immediately necessary’ to ‘immediately life threatening’ when it comes to giving free treatment.

      The message must go out that people have to be insured if they come here. I wouldn’t dream of entering a non EU country without health cover.

    2. waramess
      October 2, 2015

      Now, this neatly hits the bulls eye.
      How many on this site have ever been asked for proof of eligibility for NHS treatment?

    3. Iain Moore
      October 2, 2015

      Asking Doctors to protect the NHS from fraudulent access will probably illicit a reply that it is against their medical ethics, of course when they are working in a private capacity, they’ll get the money up front from you before your allowed across their threshold.

  9. lojolondon
    October 2, 2015

    Great, that covers it in theory. Now all we have to do is state that in the case of a foreign national abusing the system, the NHS individual responsible for delivering the unpaid service will be personally responsible for paying / recovering the funds. Simples.

  10. The Prangwizard
    October 2, 2015

    To take the student example first – I see he only ‘might’ be asked for proof. I take it there is thus no obligation or requirement for hospitals to ask. Thus what will likely happen is that the soft option will be taken, and he will not be asked. If he his and objects, he will be probably be ‘waived through’ so as to keep the peace. Mustn’t appear ‘racist’ either must we?

    As for ‘urgent/immediately necessary’, the same soft line will probably be taken. There will be in both cases a fear of causing ‘offence’ or ‘distress’, and the scammers will take advantage. I dare say the loosest definitions will be used. Thus fine words are circumvented and the abuse of the system goes on.

    I think we can take all this for granted especially given the political stance taken in many hospitals – they will no doubt use the ‘humanitarian’ policy as justification for all manner of rule bending, and also out of cowardice.

    1. Iain Gill
      October 2, 2015

      The main reason the NHS likes to know if you are a student is nothing to do with getting paid. They write “student” in big letters on the back of your card at outpatients so that they can release your operation appointment in the first week of the summer holiday when they know they majority of students will be out of town. In this way they can show you as a “no show” and they have met their targets without actually doing any work. If you don’t believe me ask any postgrad student in student residences while the undergrads are on their summer break about the mass of incoming post from the NHS in the first week of the holidays. You see being a successful NHS manager is all about understanding how you are measured, and making sure you manipulate that, without necessarily doing any good for the patients.

  11. ian wragg
    October 2, 2015

    I had reason to be in hospital recently albeit a paying patient. I was amazed at the number of foreigners on the wards and A & E is apparently swamped each day by people who don’t have a GP ( my nurse tells me).
    I lived and worked overseas for about 30n years and if I needed medical attention my company paid.
    All documentation was in the local language and we had to pay for translation.

  12. James Winfield
    October 2, 2015

    I love immigration but are the NHS actually charging those who they should be? What kind of audit trail do we have?

    1. Lifelogic
      October 2, 2015

      They seem very rarely to charge anyone.

  13. forthurst
    October 2, 2015

    From a government website:

    “What treatment does the EHIC cover? The EHIC entitles you to state- provided medical treatment at reduced cost or occassionally [sic] free. Make sure you have your EHIC with you at all times in case you become ill or have an accident.”

    Oh dear! Does this mean that foreign hospitals are likely to demand and record evidence of entitlement or of insurance cover or require payment if presented with a patient without a national insurance document? Meanwhile, the NHS may require to see a folder of assorted documents or more likely, nothing at all, especially if the patient arrives on a stretcher. The government needs to smarten up its administrative skills rather than relying wholely on its letter writing abilities.

  14. Qubus
    October 2, 2015

    It is not only the foreign students themselves who receive free NHS treatment; a large proportion of them are married and bring over their spouses and children; the wives, who as you can imagine are almost all of childbearing age, then proceed to have further children here and put an additional burden on the NHS. I might also add that these foreign students seem to visit their GPs at the drop of a hat.

  15. Anonymous
    October 2, 2015

    The BBC would have it that the only reasons for the NHS crisis are cuts and old people.

    Ian Wragg’s experience is similar to my own. The last time I visited A&E there was an Eastern European lad with a broken foot bragging to his supervisor that the NHS was going to fix his teeth at a cost of £21k, which he could never afford back home. He was working as a food packer (I doubt he was paying tax at all.)

    I infered from it that a Brit living in his country would not get reciprocal treatment – certainly not to the same value as the chap was being offered here.

    Visit A&E or GP surgeries in London and SE areas or the midlands and you will see the same as Ian and I have.

    Of non EHIC holders. Treatment is restricted to immediately life threatening conditions (even then payment should be demanded afterwards) rather than the vague ‘immediately necessary.’ In any case. EHICs and EU passports are issued like confetti nowadays – so much huff and puff from Mr Hunt.

    When our own people are being put on waiting lists (in pain) and denied cancer treatments it is the Government’s duty to see that they are reprioritised over all others.

  16. margaret
    October 2, 2015

    GP services where many travel around the UK and regularly change GP’s arrive and demand free services , get free prescriptions, demand over the counter preparations on script, want to be treated for simple colds , where the Brits traditionally take paracetamol and hot lemon, then phone their contacts over all parts of the UK if they cannot get their own way and make official complaints about the service in some other respect. We are treated like servants to their whims.
    Our locality is clamping down on many of the preparations which can be bought over the counter, but this will be a ready scenario for loss of patients and good will. Remember this will affect GP business. GP’s need a certain number of patients before they can get staff.

  17. majorfrustration
    October 2, 2015

    By the tone of Hunt’s reply – which does seem to be a template used by other Government Depts – and in the style of, lessons will be learnt, and we are taking this matter seriously- it is quite clear that whilst there are rules the problem is too big for the Government to tackle. Just suck it up tax payers

  18. JoeSoap
    October 2, 2015

    This reply is quite defensive in its nature, which indicates that problems are being skirted around or covered up. A more robust response would have detailed cases and consequences of non-residents having paid or being sent away. My guess is this never happens.

    No figures are given such as non-residents treated, income from them etc., so one presumes there are no records kept of this.

    It doesn’t list “exceptions” apart from University students, and I guess there are many.

    I have never been asked for my passport or proof that I am resident when visiting A and E so I guess nobody is.

  19. Gina Dean
    October 2, 2015

    My friend who lives in Spain had to go into hospital. She was expected to provide someone to translate for her treatment. To have family come in during the day to see to her. The Spanish women in the next bed paid to have someone to help her while she was in hospital. So why do we give others everything on a plate. At the NHS expense.
    its wrong something has to give, treatment will eventually be basic only. No more frills, yiu want the boob job, tattoos removed you pay.

  20. DaveM
    October 2, 2015


    Watching the news, it’s quite apparent that the tv channels are trying to blame the govt for

    1. Not stepping in to save the Redcar steel plant, and

    2. The high energy costs which have made said plant uncompetitive.

    Maybe one of Lord Lawson’s first jobs could be to point out that the govt can’t step in due to EU law, and that it’s actually EU policy making energy costs so high.

  21. Bob
    October 2, 2015

    Women from the third world come to the UK in the late stages of pregnancy to obtain:
    1) Free access to NHS maternity services
    2) Automatic British citizenship (EU passport)

    This goes on every day and we allow it.

  22. yosarion
    October 2, 2015

    Anyone that has watched a panorama type program over the last thirty years will know the problem, its the Consultants and the junior Doctors who are interviewed in the program, who say it is not their job to vet people and on whether they can afford to pay when they rock up at A & E.
    The fact that their politics lies well to the left in most cases has nothing to do with it.

  23. Ex-expat Colin
    October 3, 2015

    Farage was talking about heavy cost AIDS traffic…with cost stats. Is that false then?

  24. Iain Gill
    October 3, 2015

    Osborne is busy handing power over the NHS to the regions so why bother with a sec of state anyway?

  25. WorriedofWilmslow
    October 3, 2015

    Why not allow private sector providers into A&E to check credentials at time of patient entry and collect all monies due with a share of the money recovered given to the providers?

    We’d quickly discover what the truth of the matter is and resolve the issue one way or the other.

  26. Lindsay McDougall
    October 3, 2015

    “Non-urgent should not be given until the [foreign] patient has paid in full in advance.”

    But it doesn’t always work out like that, does it? When Nigel Farage complained about foreigners arriving for free HIV treatment at £25,000 a pop, he was criticised for his callous tone, not for his accuracy.

    And I have heard an American woman, in the waiting room of the X-ray department in one of your Berkshire NHS hospitals, say how grateful she was for all the free treatment she had received – and wasn’t it wonderful. As I recollect it, she had suffered a fracture of the lower leg.

    I have two observations to make. Firstly, that the staff at the reception desks of NHS departments are neither trained nor temperamentally disposed to demand payment up front. It would have to be done earlier in the process.

    Secondly, and much more importantly, this is yet another episode in the attempted destruction of Nation States and their rights, of blood and belonging, by the bleeding heart liberal intellectual elite. There is going to be World Government, (don’t you see?) and the world is one great labour market and nothing else.

  27. Vanessa
    October 3, 2015

    This is a classic example of government ministers not having a clue about the financing of Britain’s services which are paid for by the British Taxpayer.
    One of the BoE Committee member’s made a speech mentioning the idea of abolishing cash (our currency) once interest rates go negative. Once we have to pay the banks to hold our money safe, a lot of us would take our money out in cash – look at Greece. To stop this they would outlaw cash. Remember Cyprus when the EU took 10% off savings accounts to pay for their bail-out? Well, it will happen here. This government has DOUBLED the debt over five years and it is still going up. To service and pay the interest on this debt is pernicious they will look for ANY WAY they can to take money from us all. Beware ! The NHS is small fry when you look at our debt which is about 800PERCENT of GDP.

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