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Background
The National Health Service provides healthcare free of charge for people who are ordinarily resident in the United Kingdom. When a person who is not ordinarily resident in the UK (an “overseas visitor”) needs NHS treatment they will be subject to the National Health Service (Charges to Overseas Visitors) Regulations 2011 (the “Charging Regulations”) and may incur a charge for treatment.
In accordance with the Charging Regulations the Trust has a legal obligation to make and recover charges for NHS treatment in relation to any person who is not ordinarily resident in the United Kingdom. This is not optional and no one in the Trust has the authority to waive these charges.
Our Approach
Ashford and St. Peter’s Hospitals NHS Foundation Trust is committed to implementing the Hospital Charging Regulations consistently across the Trust, using a robust and common sense approach.
Under Charging regulation 7, where a person has resided lawfully in the UK for one year immediately prior to treatment, that person is exempt from charges. Therefore, for pragmatic reasons, baseline questions should be focused around this regulation rather than ordinary residence, so that the minority of patients who have not resided in the UK lawfully for the previous year can be quickly identified and followed up with a more detailed interview.
For the purposes of this policy therefore, overseas visitors are defined as those patients presenting to the Trust who have not been lawfully resident in the UK for the preceding 12 months. Anyone who has lived lawfully in the UK for at least 12 months immediately preceding treatment is not covered by this policy.
The Trust also has human rights obligations, meaning that treatment which is considered by clinicians to be immediately necessary must never be withheld from chargeable overseas visitors pending payment, although the charges will still apply. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998.
Treatment which is not immediately necessary, but is nevertheless classed as urgent treatment by clinicians (in that it cannot wait until the overseas visitor can be reasonably expected to return home) should also be provided, although deposits should be sought in the period ahead of treatment. However, urgent treatment should not be withheld or delayed for the purposes of securing payment.
The Law
The statutory provisions which enable overseas visitors to be charged for NHS treatment are found in section 175 of the National Health Service Act 2006 (“the 2006 Act”). Section 175 allows the Secretary of State for Health to make regulations for making and recovery of charges in relation to any person who is not ordinarily resident in Great Britain for any NHS services provided to them. They also give him powers to calculate such charges on an appropriate commercial basis. These powers are devolved to the relevant NHS bodies in England.
The National Health Service (Charges to Overseas Visitors) Regulations 2011 (the “Charging Regulations”) place a legal obligation on a relevant NHS body to make and recover charges for NHS treatment provided by that relevant NHS body. The Trust therefore has a legal obligation to ensure that patients who are not ordinarily resident in the UK are indentified, that their liability for charges is assessed in accordance with the Charging Regulations, that those liable to pay are charged in accordance with the Charging Regulations and that those charges are recovered.
Free Services
There are certain services which are free of charge to everyone regardless of the status of the patient.
These include:
- Accident and emergency services;
- Family planning services;
- Certain diseases where treatment is necessary to protect the wider public health;
- Treatment for sexually transmitted diseases including HIV;
- Treatment given to people detained or liable to be detained under the provisions of the Mental Health Act 1983 or other applicable legislation;
- Any other treatment which is imposed by, or included in, an order of the Court;
- Services provided in the community by staff employed by or on behalf of the Trust.
Care of Overseas Visitors
The Charging Regulations place a legal obligation on the Trust to make and recover charges for NHS treatment.
- The Trust must also ensure that treatment which is immediately necessary is provided to any patient even if they have not paid in advance. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998.
- Urgent treatment should also be provided to any patient, even if deposits have not been secured.
- Non-urgent treatment should not be provided unless the estimated full charge is received in advance of treatment.
Immediately necessary treatment
Immediately necessary treatment is that which a patient needs:
- to save their life, or
- to prevent a condition from becoming immediately life-threatening, or
- promptly to prevent permanent serious damage from occurring.
And must always be provided irrespective of whether or not the patient has been informed of, or agreed to pay, charges. Also it must not be delayed or withheld to establish the patient’s chargeable status or to seek payment.
All maternity services, including routine antenatal treatment, must be treated as being immediately necessary. Clinicians and other Trust staff should be especially careful to inform pregnant patients that further maternity care will not be withheld, regardless of their ability to pay.
Urgent treatment
Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the person can be reasonably expected to return home.
The Trust should make every effort to secure payment in the time before treatment is scheduled but if that proves unsuccessful the treatment should not be delayed or withheld for the purposes of securing payment.
While the urgency of treatment is a matter of clinical judgement, this does not mean that the treatment should be unlimited; there may be some room for discretion about the extent of treatment and the time at which it is given.
Non-urgent treatment
Non-urgent treatment is routine elective treatment that could wait until the patient can return home.
The Trust will not provide non-urgent treatment unless the patient pays the full estimated cost of the treatment in advance. However, in order to decide if a patient’s need for NHS hospital treatment is urgent or can safely await their return home, clinicians will need to know when a patient can reasonably be expected to return home. The decision can be made on the basis of this information.
However, the decision should be reassessed if the patient informs the Trust that their return date has been postponed for valid reasons or if their medical condition unexpectedly changes.
Charges
If the Trust is satisfied that the patient is an overseas visitor then the Trust must charge the patient for the NHS services provided.
If there are any doubts over the validity of exemption for a patient the patient should also be charged for their treatment.
If the patient refuses to pay or states that they have no funds available to pay (this is treated as a refusal to pay) then a payment plan can be negotiated in order to settle the debt however this is at the discretion of the Trust.
It is not acceptable for an invoice not to be raised for treatment because it is believed or claimed that there is an inability to pay.
Overseas visitors with travel insurance will be required to pay for their treatment and then claim back from their insurer on their return home.
Treatment is not made free of charge by virtue of being provided on an immediately necessary or urgent basis. Charges found to apply cannot be waived. However, any patient undergoing ‘immediately necessary’ treatment will be reassured that this will not be withheld or withdrawn in the event of the patient being unable to pay.
Tariff and payments
The Stage 2 Officer should have access to the national / NCA tariff so that they can advise the patient what the likely cost of treatment will be. Overseas visitors treated as emergencies will normally be charged National Tariff rates, overseas visitors presenting for elective treatment will be charged private patient rates. DH advice on how much to charge is that the full cost of treatment should ALWAYS be recovered and may include an element to cover reasonable cost of administration.
Payments should be taken from overseas patients at the earliest opportunity. Portable Credit Card terminals are available to facilitate this.
Pharmacy
Overseas visitors are not entitled to receive an NHS subsidised prescription therefore they must pay the same charge for a private prescription.
Deceased Patients
Where a patient dies without making or completing a payment to the Trust the debt then becomes recoverable from the deceased’s estate. An offer from relatives or another person to meet the debt can be accepted but this must not be actively pursued, unless it was they who had signed the undertaking to pay form.
Recovery of Income
Reasonable measures must be taken to pursue overseas visitors’ debt and debt recovery agencies will be employed.
Complaints
Where a patient is unhappy with the care they have received then they (or someone acting on their behalf with their consent) should be advised on how to make a complaint through the Trust’s complaints procedure.
Contact Details
If you have any further questions, please contact
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