The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 currently determine the rules over charging 'overseas visitors' for NHS care in England.
The BMA has been consistently critical of UK government policy on charging overseas visitors for NHS care. We believe this has deterred and delayed vulnerable groups from accessing the healthcare they need, while diverting vital NHS staff time away from patient care.
As a minimum, the present charging regulations must be suspended, pending a full, independent review into their impact on individual and public health, with a particular emphasis on vulnerable groups.
The BMA has passed new policy that recognises the detrimental impact of the Government’s ‘hostile environment’ policies for people with no official immigration status.
Read our briefing to see how these policies impact patients, doctors and public health.
NHS charging regulations
The policy of charging overseas visitors for healthcare in England has become increasingly restrictive over time.
In 2015, the UK government introduced new rules governing the charging of 'overseas visitors' accessing NHS services in England. These changes were made with the stated intention of ensuring that NHS bodies do not lose income by providing care to those not eligible for free treatment. This introduced a charge of up to 150% of the cost of treatment for overseas visitors using NHS services, alongside powers for trusts to make and recover funds from chargeable patients.
The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 extended the rules and practices on overseas charging, expanding charging to community services, introducing obligatory upfront charging for some non-urgent care, and requiring NHS services to record patients’ eligibility for free treatment.
In early 2018, DHSC (Department of Health and Social Care) launched a review into the regulations. In December 2018, the Government announced that this review had been completed and had found no evidence of the regulations deterring patients from accessing care.
The Government announcement, and communications from DHSC, have also made clear that the findings of the review will not be published. This is despite press reports that the review found evidence of patients being wrongly refused treatment due to misapplication of the regulations.
We have published guidance on access to healthcare for overseas visitors, which supports doctors in both primary and secondary care to navigate their legal and ethical responsibilities under the current charging regulations.
What the BMA is calling for
It is our strong and longstanding view that doctors should not have a role in assessing patients’ immigration status or eligibility for free NHS care.
The policy of charging some migrants for NHS care puts doctors in a difficult position and takes vital clinical time away from caring for their patients. We believe that the single role of doctors is to care for the patients in front of them, and that their clinical judgement must take precedence over any other considerations.
We have called for an end to the NHS charging system
- Immediate suspension of the National Health Service (Charges to Overseas Visitors) Regulations 2015 and the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 pending a full independent review of their impact on individual and public health.
- Full publication of the findings of the DHSC review of the regulations.
- Clear separation of the roles of the health care sector and the Home Office/immigration enforcement.
What the Government, at a minimum, should adopt for a reformed system
- Ending the policy of upfront charging for NHS care, so that all care is free at the point of delivery.
- Simplification of charging criteria and exemptions to improve clarity for patients and providers and reduce their misapplication.
- Introduction of safeguards to ensure that vulnerable populations are not deterred from seeking care, are able to access the care they are entitled to and that treatment is not denied due to difficulty or delay in proving eligibility.
- Investigation of OVM (overseas visitor manager) performance and action in cases of interference with clinical decision making.
- Rigorous testing of the cost-effectiveness of the regulations.
We have been actively lobbying policy makers to progress these recommendations. We have also produced reports and briefings that have informed the BMA position on the various iterations of the charging regulations.
See our responses to reviews and reports below.
Safe surgeries: improving access to primary care
The introduction of charging policies in secondary care has led to confusion around entitlement and access to care across the wider healthcare system. This has resulted in more administrative barriers to accessing primary care services for un/under documented groups.
NHS England produced guidance in 2015 clarifying that patients should not be turned away from registering with GP practices if they lack proof of ID, address or immigration status.
The BMA has endorsed the Doctors of the World Safe surgeries toolkit which provides support for GP practices on how to ensure their services are safe and accessible for vulnerable, un/under-documented migrants.
Safe surgeries is featured in the BMA toolkit for clinicians to reduce health inequalities in your local area.
In 2018, we surveyed our members to better understand the experiences and views of the medical profession regarding the regulations, and to provide a clearer picture of the impact they have had in practice.
Our survey found that:
- many doctors have faced pressure from OVMs (overseas visitors managers) when making clinical judgements regarding a patient’s need for care
- the regulations, and particularly upfront charging, are deterring patients from seeking care, including for treatments that are not chargeable
- based on their experiences thus far, our members have reported that the regulations are negatively impacting public health
- vulnerable groups are being, and will continue to be, negatively affected by the regulations
- the regulations have increased workload for doctors and wider teams, taking time away from patient care.
Our research adds to the growing body of evidence that highlights the adverse impacts of the charging regulations on the healthcare experiences of un/under documented migrants.
The regulations have led to care often being inappropriately denied and deterring vulnerable groups from accessing NHS treatment, threatening public health, and taking vital clinical time away from patient care.