Overseas visitors
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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 2015 (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
West Hertfordshire Teaching Hospitals Trust is committed to implementing the Hospital Charging Regulations consistently across the Trust, using a robust and common sense approach.
NHS services are provided without charge to people who are deemed to be "ordinarily resident". The vast majority of public* NHS funding comes from general taxation and National Insurance contributions (NICs). A small proportion of funding (1.0 per cent of the total Department of Health and Social Care budget in 2021/22) comes from patient charges for services such as prescriptions and dental treatment. *This excludes private income NHS public providers can earn, and Department of Health and Social Care spending on non-NHS providers. (Source: King’s Fund)
Ordinary residence is defined when a person is:
- Living lawfully in the United Kingdom voluntarily and for settled purposes, as part of the regular order of their life.
In order to ascertain a person's eligibility, the Trust applies baseline questions to all patients. This include, but are not exclusive to:
- "Where have you lived in the last 12 months?"
- "Can you provide evidence to show where you live?"
Anybody who can demonstrate that they lawfully reside in the UK is unlikely to incur treatment charges.
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. 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 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 identified, 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.
Services exempt from charging
The following services are free at the point of use to everyone. A charge cannot be made or recovered from any overseas visitor for:
- Accident and Emergency (A&E) services, this includes all A&E services provided at an NHS hospital, e.g. those provided at walk-in centres or urgent healthcare centres. This does not include those emergency services provided after the overseas visitor has been admitted as an inpatient, or at a follow-up outpatient appointment.
- Services provided outside an NHS hospital, unless the staff providing the services are employed by, or working under the direction of, an NHS hospital.
- Family planning services (does not include termination of pregnancy)
- Diagnosis and treatment of specified infectious diseases
- Diagnosis and treatment of sexually transmitted infections
- Treatment required for a physical or mental condition caused by the
following:
- Torture
- Female Genital Mutilation
- Domestic Violence
- Sexual Violence
Except where the overseas visitor has travelled to the UK for the purpose of seeking that treatment.
Care of overseas visitors
The Charging Regulations place a legal obligation on the Trust to make and recover charges for NHS treatment.
The Trust will 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 will be provided to any patient, even if deposits have not been secured.
Immediately necessary treatment
Immediately necessary treatment is that which a patient needs:
- To save their life
- To prevent a condition from becoming immediately life-threatening, or promptly to prevent permanent serious damage from occurring.
This will always be provided irrespective of whether or not the patient has been informed or agreed to pay, charges. In addition, it will not be delayed or withheld to establish the patient's chargeable status or to seek payment.
All maternity services, including routine antenatal treatment, are treated as being immediately necessary. Clinicians and other Trust staff will 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 cannot wait until the person returns home.
The Trust does make every effort to secure payment in the time before treatment is scheduled but if that proves unsuccessful the treatment will not be delayed or withheld for the purposes of securing payment, the patient will however be required to settle their bill during or after treatment.
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, (including secondary care provided after being admitted through A&E). Charges applied 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 Overseas Visitor Officers have access to the national / NCA tariff. Overseas visitors treated as emergencies will be charged National Tariff rates. Payments will be taken from overseas patients at the earliest opportunity.
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.
Recovery of income
Reasonable measures are taken to pursue overseas visitors' debt and international debt recovery agencies will be employed.
Patients should be aware that under immigration rules 320, 321, 321A and 322. a person with outstanding debts of over £500 for NHS treatment that are outstanding within three months of invoicing, may be denied a further immigration application to enter or remain in the UK.
In the absence of prompt, full settlement or a reasonable repayment schedule, non-clinical information relating to the debt is provided routinely to the Home Office and may be used by the Home Office to apply the above immigration rules. The information will remain active for the purpose of the above rules until the debt is settled and a record of the settled debt will also be retained, both subject to normal limitation periods.
In the event that a person may seek entry to the UK or make an advance immigration application after settling an NHS debt in the previous three months, they are advised to retain and carry evidence of payment for potential examination by Home Office officials.
Contact details
If you have any further questions, please contact the team via email westherts.ovt@nhs.net or by calling 01442 365361 ext: 6361
