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NHS: Non-UK Residents

Volume 712: debated on Monday 20 July 2009


My honourable friend the Parliamentary Under-Secretary of State, Department of Health (Ann Keen) has made the following Written Ministerial Statement.

Since the publication of the cross-government immigration enforcement strategy Enforcing the Rules: A Strategy to Ensure and Enforce Compliance with our Immigration Laws, the Department of Health and the Home Office have been working together to review the rules on charging non-UK residents for access to National Health Service services in England.

The House will wish to know that the joint review has concluded and the Government are today able to outline their conclusions.

The National Health Service was founded over 60 years ago. Sixty years on, this Government remain committed to its founding principles: a national health service for the benefit of the people of the United Kingdom, free at the point of delivery and funded by general taxation.

However, it is neither feasible to operate the NHS without proper controls over access, nor fair, in an age of mass global travel and movement, to ask the taxpayer to fund unrestricted access to non-UK/EEA nationals. It is the Government’s responsibility to protect NHS resources from exploitation or inappropriate use.

That is why, in concluding the review, the Government are today announcing measures to support a clearer and fairer system of access to NHS services—a transparent system that will maintain the confidence of the public by preventing inappropriate access.

The Government have decided to maintain the current system of charging non-residents for most secondary care (hospital) services. Treatment in an accident and emergency department and treatment for specified infectious diseases that could create a public health risk will remain free to all. The Government also propose limited extensions to the current range of exemptions from charges for hospital treatment for certain non-residents.

Persons seeking refuge or asylum are already exempted from charges for the duration of their application including the full appeal process. The Government have not been persuaded that this full exemption should be extended to all of those whose application has failed but have not yet left the country. It has however recognised the case for those whose claim has been refused but who are being supported by the UK Border Agency because they would otherwise be destitute, have children and/or because it is impossible to return them home through no fault of their own. It is therefore proposed that an exemption from charges is extended to this group.

The Government also propose to exempt from charges all unaccompanied minors, including those in local authority care, while clarifying the principle that the accompanying parent or guardian of a non-resident minor is responsible for the cost of their NHS treatment. Together with the exemption for victims of human trafficking that was introduced from April this year, these changes reinforce the protection and rights to healthcare of the most vulnerable groups, regardless of their residential status.

While maintaining the principle that other visitors or irregular migrants who are not specifically exempted should be charged for their treatment and that, in non-urgent circumstances, treatment will be withheld if the costs are not paid, the Government remain firmly committed to the requirement that immediately necessary and other urgent treatment should never be denied or delayed from those who require it. We are currently engaging with key stakeholders to ensure that guidance to the NHS in this respect is clear and comprehensive.

The principles of providing immediately necessary treatment must always be applied to any maternity care, to ensure that the health of the mother or baby is not put at any risk. Maternity treatment therefore must never be delayed or denied. However, the Government have not been persuaded that charges should be abolished in relation to non-exempt patients for maternity treatment. There is clear case evidence that a small number of visitors enter the United Kingdom specifically to use NHS maternity services.

In relation to HIV treatment, the Government recognise that clinical evidence on treatment, including its role in prevention, is developing constantly. Moreover, HIV is a major global problem, the control of which creates significant financial as well as human costs. We will therefore undertake further analysis of the latest medical and public health evidence together with consideration of how the current policy on treatment aligns with the Government’s wider international aid strategy for HIV. This analysis will inform a future decision on whether the current treatment policy (that only initial diagnosis and counselling are offered free of charge to non-UK residents or individuals who are not otherwise exempt) should be revised.

The Government also propose that the period of absence for current residents that can be disregarded for the purpose of determining continued eligibility for free NHS hospital treatment in England is extended from three to up to six months. This proposed change reflects the increasing tendency towards longer periods of travel overseas for some people and will protect the rights of British citizens who travel abroad while still residing substantively in the United Kingdom.

The Government acknowledge that general practitioners (GPs) are well placed to take account of the healthcare needs of their local communities. GPs also play a pivotal role in the provision of public health services (in which they are currently at the forefront of our response to the threat of pandemic swine flu). Since the inception of the NHS, GPs have had the responsibility of determining whether a particular individual should become a patient of their practice. This applies to all patients and, while the discretion that we give to GPs is limited—for example, decisions must not be discriminatory—we do not believe that any specific changes are required in respect of foreign nationals. Where an individual is refused registration, a GP is able to offer routine treatment on a private fee paying basis, but must provide any immediately necessary treatment free of charge.

A small minority of visitors deliberately seek to enter the UK, legally or illegally, in order to access NHS services without payment, some returning on a number of occasions for additional treatment while their previous debt remains unpaid. We therefore believe that there is a strong justification for practical working level co-operation between the NHS and UK Border Agency to apply immigration sanctions to those seeking leave to enter or remain when they have substantial uncleared debts to the NHS. It is only fair that these individuals are prevented from returning to the United Kingdom, or extending their stay here, until they have cleared their debt. The Government therefore propose to amend the Immigration Rules to provide that non-EEA nationals will normally be refused permission to enter or remain in the United Kingdom if they have significant debts to the NHS.

The Government are also attracted to the principle of visitors who are not covered by EEA or other reciprocal health agreements being required to have personal health insurance provision, as is already the case in some other countries. We intend initially to seek views on the merits and feasibility of such a scheme, which will inform further work to evaluate possible options.

The proposals apply to England only. The Government will, however, consult with devolved Administrations, particularly with regard to the proposals on health tourism and health insurance where there may be benefits in a United Kingdom-wide approach.

The proposed policy changes in this Statement will be put to public consultation in the autumn and full supporting information will be provided at that time. Subject to a positive consultation outcome, revised regulations will then be laid as required to enable changes to take effect.