Currently, there’s confusion around exactly what EC health ministers have or have not agreed for the future, and when, and we have Spain, France and the UK all seeking to show how they are clamping down on ‘health tourists abusing local health services for free’. So, it is no surprise that NHS hospitals and UK expatriates are unable to separate fact from political rhetoric.
Currently, there’s confusion around exactly what EC health ministers have or have not agreed for the future, and when, and we have Spain, France and the UK all seeking to show how they are clamping down on “ health tourists abusing local health services for free’. So, it is no surprise that NHS hospitals and UK expatriates are unable to separate fact from political rhetoric. Spain and France are still at the “waving sticks at foreigners ‘ stage. It should be emphasized that this has nothing to do with commercial medical tourism where people pay to travel to the UK, France and Spain for private treatment, but where EU citizens and others use free health services. Separating real abuse from political cant, is almost impossible as while all three nations are happy to accept the considerable amounts of money they get from millions of tourists, they seem reluctant to allow these same tourists to have treatment for illnesses and accidents they have when in their country. Particularly in off-peak times a large number of these short term and long holiday tourists are retired, so tend to have a higher number of falls and heart attacks than younger visitors. One in four of the EU adult population is now over 65.When pressed, the three countries have found it impossible to give any accurate figures for the number of people who travel to their country as deliberate medical tourists, and get free treatment or leave bills unpaid.
It is no wonder that NHS hospitals are thoroughly confused as to what treatment they can give even to their own UK nationals who live or work abroad on a full or part –time basis. The Department of Health privately admits that much will depend on who wins the UK election, as to what rules will stay, which will change, and which hospitals will be instructed to ignore or strictly enforce.
Meanwhile, the current rules on NHS treatment of UK expatriates are-
• Entitlement to NHS hospital treatment is based on ordinary residence’ in the UK, not nationality, having property in the UK or the payment of UK taxes or national insurance contributions- as has often been suggested in the press.
• Anyone not ordinarily resident in the UK is deemed an overseas visitor and is subject to the NHS (Charges to Overseas Visitors) Regulations 1989, as amended. These regulations place a responsibility on NHS hospitals to establish whether a person is ordinarily resident, or exempt from charges under one of a number of exemption categories, or liable for charges.
• New guidance has been issued to the NHS on how best to implement the charging regulations and most hospitals have an overseas visitors manager to oversee this. It is for hospitals to decide what evidence is acceptable in each individual case.
• Anyone who lives outside the UK for more than three months is no longer automatically entitled to free NHS hospital treatment. If the person is away on a one-off extended holiday, then they will continue to be fully entitled to free hospital treatment as soon as they return to live permanently in the UK. They will then be ordinarily resident again.
• Members of the Armed Forces and Crown Servants, together with their dependants, retain full eligibility.
• UK state pensioners who live for six months or more each year in the UK and six months or less in another EEA member state, without registering as resident in that other member state, are exempt from charges for all hospital treatment during the time they reside in the UK. Other UK state pensioners who are not considered ordinarily resident in the UK are entitled free of charge to treatment the need for which arises during visits here, but not pre-planned treatment, as long as they have lived for ten years or more in the UK in past.
• UK ex-pats who have previously lived in the UK for ten years or more and who are now working overseas are exempt from charges for all hospital treatment during visits back to the UK for a period of five years.
• An ex-pat who is not considered exempt from charges under the charging regulations will be charged for any treatment they receive during a visit to the UK.
• An ex-pat who resumes their permanent residence in the UK is exempt from charges immediately.
• The rules are enforced by trusts. Hospitals are advised in the guidance to ask baseline questions to all patients to establish if they have lived lawfully in the UK for the previous year or not, which can then be probed at interview if necessary.
• *Proof of simply owning property in the UK is not sufficient evidence of entitlement. Examples of residence in the UK might include bank transaction details, utility bills in the name of the person (not the tenant) or immigration stamps. It is down to the hospital to make a judgement on what evidence is acceptable in each case.
What has confused hospitals is a proposal to extend the period of absence allowed for expatriates from three months to up to six, as politicians announced it as if it was a certain change. The proposal is currently only a consultation called Access to the NHS by Foreign Nationals, and this also covers some treatment for NHS expatriates. What happens will depend on the results of the UK election. The political nature of the proposals and why any new government could change or scrap them are that the proposals concentrate on the rights of failed asylum seekers and a proposal to refuse entry to the UK to those who have significant outstanding debts for previous NHS treatment, both of which are insignificant in real terms.
NHS hospitals are required under European law and official instructions to provide free treatment to EEA nationals. The NHS does not offer cosmetic surgery or cosmetic dentistry, and the provision of dental care is not at hospitals- so the reasons that EU nationals mainly travel across Europe are not covered either by the NHS or other country’s health systems. The “ abuse” that some EU politicians claim is costing their hospitals lots of money is for non-emergency surgery only, and none of the countries can provide anything more than a few word-of-mouth sample cases. Perhaps most telling that this is all political is a sentence in the official consultation, “ The NHS does not collect detailed data on the overseas visitors it treats or charges so the precise scale of health tourism is difficult to quantify. “