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What is the issue?

In England, the NHS is required to charge ‘overseas visitors’ for secondary healthcare provided in hospitals or delivered in the community. People who are classed as overseas visitors will be required to pay the full cost up front if the treatment is not deemed to be urgent or immediately necessary. Only certain treatments are exempt from charging, such as the diagnosis and treatment of Covid-19.

The main groups of people who are required to pay for chargeable healthcare include:

  • Visa overstayers
  • Appeal rights exhausted (ARE) asylum seekers who are not receiving support from the Home Office or are not accommodated by social services
  • People with leave to enter as a visitor for less than six months

When a family or adult with care needs is being provided with accommodation and financial support by social services then they will be charged for secondary health care if they fall into one of these groups. The only exemption related to social services’ support applies to adults accommodated under the Care Act 2014, so does not apply to the majority of people supported by councils. When a person is unable to receive the treatment they need because they cannot afford it, this can exacerbate any care needs they have and present a public health risk, as well as placing additional pressures on social services’ staff time.

Different rules apply to charging for NHS healthcare in Wales, Scotland and Northern Ireland.

What needs to change

We recommend that the Government:

  • Introduces a charging exemption for all overseas visitors who are in receipt of accommodation or financial support from social services, including: adults, families (children and their parents) and care leavers age 18+.
  • Conducts an in-depth review of how charging impacts on health inequalities

What we have done

We have been working with the Local Government Association (LGA) and Association of Directors of Children’s Services (ADCS) to put forward the case for a charging exemption for people receiving social service’s support and to raise concerns about the impact of NHS charging on communities through government consultations.

Following a government review into the effect of the charging regulations, the Minister of State for Health informed Parliament in December 2018 that no changes to the charging regime or exemptions were needed.

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