Immigration Ethics

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Entitlement to NHS care

In all four nations of the UK, refugees and asylum seekers with an active application or appeal are fully entitled to free NHS care. The situation for refused asylum seekers is more complicated and is not the same across all nations.

Assessing entitlement to free NHS care can be complex. As a doctor, it is not your role to determine whether patients are eligible for free NHS treatment. However, you will play a key role in identifying when a patient requires care which cannot be delayed, or which is exempt from charge.

Further information on how these considerations apply in primary and secondary care, and differences across nations, is provided below.

 

  • Primary care

    Refugees, asylum seekers and refused asylum seekers can register for and receive primary care free of charge in the same way as any other patient in any nation of the UK.

    In EnglandScotland and Wales, this is because immigration and residency status have no bearing on a patient’s entitlement to register with a GP practice.

    In Northern Ireland, entitlement to NHS care, including primary care, is generally based on ordinary residence. However, refugees and those who have made a claim for asylum, including refused asylum seekers, have a specific exemption.

  • Secondary care

    All refugees and asylum seekers with an active application or appeal can access the full range of secondary care services free of charge in any nation of the UK.

    In Northern IrelandScotland and Wales, any person who has previously made a formal application for asylum, regardless of the outcome, is entitled to access secondary care free of charge.

  • Refused asylum seekers in England

    In England, refused asylum seekers are not necessarily entitled to secondary NHS care free of charge. Their ability to access care depends on:

    • whether the care is immediately necessary/urgent or non-urgent
    • whether specific exemptions apply

    Information on the factors that doctors should consider when making a judgment about the urgency of a patient’s treatment, exempt services and persons who are exempt from charging is available in our guidance on access to healthcare for overseas visitors

    Immediately necessary, urgent and non-urgent treatment

    Refused asylum seekers must always receive immediately necessary and urgent treatment regardless of their chargeable status or ability to pay. The patient may be billed at a later date.

    For non-urgent care, NHS Trusts and some community services are required to charge refused asylum seekers who are not exempt before providing the care.

    Making a judgement about the urgency of a patient’s clinical needs is your responsibility as a doctor.  

     

    People who are exempt from charging

    Refused asylum seekers who are supported by the Home Office are exempt from charges for NHS treatment. Some people may be exempt from charges for other reasons, for example if they have been victims or suspected victims of trafficking or modern slavery.

    Refused asylum seekers’ entitlement to NHS care can change during the course of treatment. Patients who become chargeable during a specific course of treatment are able to complete the course free of charge.

    It is the role of the Trust, not doctors, to identify these patients and assess their eligibility.

     

    Services exempt from charging

    Refused asylum seekers are able to receive some services free of charge regardless of their overall entitlement to NHS care.

    This includes treatment in an accident and emergency department, for many communicable diseases and for conditions caused by certain types of violence, such as torture, domestic violence or sexual violence.