Lack of a NHS charging exemption for people receiving local authority support
In England, the NHS is required to charge ‘overseas visitors’ for secondary healthcare provided in hospitals or delivered in the community. Patients who are classed as overseas visitors are required to pay the full cost of treatment up front, unless the care they require is deemed by clinicians to be urgent or immediately necessary. Overseas visitors are charged at 150% of the standard treatment rate.
Some types of secondary healthcare, such as treatment at an A&E service, are exempt from charging. Many overseas visitors will be exempt from charging, including people who paid the NHS surcharge when they applied for their visa.
A person will usually be required to pay for secondary healthcare in England if they have:
- Overstayed their visa
- Become appeal rights exhausted following an unsuccessful asylum claim, and are not receiving support from the Home Office or accommodation from their council under the Care Act 2014
- Leave to enter as a visitor for six months or less
A person who is required to pay for secondary healthcare will still need to pay upfront for treatment or to re-pay a NHS debt when they are receiving accommodation and financial support from their local council. Therefore, many adults with care and support needs, families, and care leavers (age 18+) who are homeless or who do not have sufficient income to meet their housing and/or basic living needs, will be denied access to vital healthcare or will have a significant debt to repay when treatment is provided on an urgent basis.
The charging exemption that relates to adults accommodated under the Care Act 2014 only applies to people who are appeal rights exhausted following an unsuccessful asylum claim. At the end of March 2023, this group made up only 27% of adults with care needs who were being accommodated by their council because they have no recourse to public funds.
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 may present a public health risk. When a NHS debt is accrued, this could lead to a refusal of leave to remain and people can experience financial pressures making repayments. Social care staff who are supporting people being denied or charged for treatment have reported that a consequence of this is that they have spent a significant amount of time meeting the person's exacerbated care needs and liaising with the NHS about repayments.
Guidance for NHS service providers on charging overseas visitors in England now includes more detail about what NHS staff should do when a person cannot afford to pay their debt. When a person is destitute or at imminent risk of destitution, the NHS can chose not to chase the debt, although the debt cannot be cancelled.
