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Migrant Access to the NHS

Volume 573: debated on Monday 6 January 2014

On 30 December 2013, I published a response to the recent consultation on proposed changes to the way temporary migrants and visitors access the NHS in England. The response sets out initial decisions and next steps, taking account of feedback received during the consultation as well as the results of independent research on visitor and migrant use of the NHS that we commissioned in parallel with the consultation and which we published on 22 October1.

The independent research was commissioned to provide, for the first time, a reliable 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. This research provides a compelling case for new and more robust and consistent administrative processes and systems to be introduced.

The consultation was launched on 3 July at the same time as a linked consultation, “Migrant Access to Health Services in the UK” from the Home Office. Both consultations put forward the proposal that non-EEA temporary migrants should in future contribute to the costs of their health care. The Immigration Bill includes a provision to introduce the immigration health surcharge on a UK-wide basis to allow people to make this contribution with minimal operational impact or burden on the NHS.

The consultation also sought views on whether any changes should be made to the categories of non-residents who should be exempted from charges. A proposal to provide more generous exemptions to ex-pats, many of whom should be charged for treatment provided when returning on visits, received broad support. The response proposes to confirm the principle that exemptions should be consistent with criteria applied to UK pensions and other state benefits, but further work is required to confirm specific qualifying criteria and financial impact.

The open review of current exemptions generated requests for a number of new or extended exemptions for maternity, victims of domestic and other violence as well as victims of human trafficking and children. The response commits my Department to give further thought to the exemptions for victims of domestic and other violence and of human trafficking, seeking the views of relevant agencies and advisers as appropriate.

We do not intend to establish an exemption for children or for pregnant women. In both cases we believe there is significant risk of abuse by visitors either seeking maternity care for themselves or care for their children with existing serious illnesses, and may act as a draw to illegal migrant families. We will listen to arguments about how best to cover other vulnerable children who might otherwise be unable to access treatment. All of these potential changes will be subject to further final cabinet approval following further evaluation.

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. In primary care, we will retain free access to GP consultations. We expect GP practices to participate actively in the administration of the new system for identifying and recording chargeable patients.

The response signals our commitment to charge visitors for treatment in hospital A&Es, but this will not be introduced until improved systems can support its effective administration, including the safe and efficient delivery of A&E services, avoiding unintended charging of legitimate residents and ensuring immediately necessary treatment is not refused. It also confirms the intention to extend charging to 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). Officials will work with the NHS to determine how appropriate and cost-effective non-resident charging should be defined and administered.

Finally, the response reinforces the need to make significant improvements in how the NHS manages and administers the charging and recovery process. Sir Keith Pearson, the independent NHS advisor to the visitor and migrant NHS cost recovery programme, and the director of cost recovery are working in partnership with external NHS experts and stakeholders to design and roll out proportionate, cost-effective and operationally successful implementation.

All of these proposals apply to the NHS in England only, although my officials will continue to engage with devolved Administrations who may wish to replicate some or all of the proposed changes.

“Sustaining services, ensuring fairness; Government response to the consultation on migrant access and financial contribution to NHS provision in England” and the supporting equality analysis has been placed in the Library. Copies of the response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office.

It is also available at: