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.
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.