The Parliamentary Under-Secretary of State for Health (Anne Milton)
I am today publishing the Government’s response to the public consultation on access to the national health service by foreign nationals that was issued by the previous Administration before the election.
The NHS is built on the principle that it provides a comprehensive service, based on clinical need, not the ability to pay. However, it is not free of charge to all comers. Legislation dating back to 1977 permits persons who are not ordinarily resident in the United Kingdom to be charged for NHS services and subsequent regulations, first introduced in 1982, impose a charging regime in respect of hospital treatment.
The charging regime provides for some categories of non-residents to be exempt from charges, and international agreements provide reciprocal healthcare that benefits visitors from and to participant countries. It also takes full account of humanitarian obligations in the provision of healthcare, in particular ensuring that the emergency medical needs of any person are treated irrespective of their status or ability to pay.
The consultation was based on a limited review of access and charging policy. After considering the responses we received the Government have decided to take forward their main proposals, specifically to lay the new consolidated charging regulations including the specific changes that were consulted on:
extend the time UK residents can spend abroad without losing automatic entitlement to free hospital treatment from three months to six months;
allow failed asylum seekers who are on UK Border Agency support schemes for families or because there is a barrier to their immediate return, to continue to receive free hospital treatment (but retain charges for those other failed asylum seekers who refuse to return home); and
guarantee the provision of free hospital treatment for unaccompanied children while under local authority care.
In addition, we are taking this opportunity to introduce a limited term exemption for Olympic and Paralympic games competitors and officials in line with a commitment made in our successful 2005 bid, and to amend the trigger for exempting charges for pandemic flu treatment to protect public health.
We also support the Home Office’s plan to introduce proportionate immigration sanctions on overseas visitors who refuse to pay appropriate charges for treatment provided. The Department will therefore introduce measures to enable data-sharing with the Home Office to support this while guaranteeing necessary data privacy standards.
However, it is increasingly clear that the overall charging regime is neither balanced nor efficient. Overall entitlement to free healthcare, through residency or other qualifying exemptions is often more generous to visitors and short-term residents than is reciprocated for UK citizens seeking treatment in many other countries. Charging regulations only cover hospital treatment, so visitors may receive free primary care and other non-hospital based healthcare services. Although hospitals have a statutory duty to enforce the regulations, effective enforcement by hospitals appears to vary considerably.
For these reasons we believe that a further fundamental review of the current policy is needed. The review will include:
qualifying residency criteria for free treatment;
the full range of other current criteria that exempt particular services or visitors from charges for their treatment;
whether visitors should be charged for GP services and other NHS services outside of hospitals;
establishing more effective and efficient processes across the NHS to screen for eligibility and to make and recover charges; and
whether to introduce a requirement for health insurance tied to visas.
Access for European Union residents is determined by separate EU regulations. The review will not consider changes to these regulations.
The review will respect the NHS’s core values and its obligations to provide urgent treatment, as well as the need to protect public health and observe international agreements. Denying necessary access to any person or group is not an option. We will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. It will be informed by exploring equivalent policies in other health economies and we will seek views and input from NHS managers and other interested parties. The scope of options is deliberately wide-ranging and we do not want to rule individual changes in or out pending this further evaluation. The proposals will be the subject of a full public consultation on completion of the review.
The Government’s response to the consultation has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the printed Paper Office.