What are the new rules on immigration checks and upfront charging?

The Immigration Act 2014, which came into force in 2015, saw the expansion of pre-existing charging regulations for ‘overseas visitors’ using the NHS. This included broadening the group of people who are chargeable, introducing an ‘immigration health surcharge’ for those seeking visas to enter the UK, and up to 150% charge for treatment in secondary care at the discretion of NHS Trusts.

In October 2017, these regulations were once again expanded. Now, charging has been introduced into some community services, NHS Trusts have a duty to check the eligibility of all patients before providing treatment in secondary care, and, for certain treatments, patients may be asked to pay upfront or risk being turned away.

Where does charging occur? Charging occurs in secondary care, including hospitals and community services provided by both NHS and non-NHS funded providers. Most primary care, including accessing a GP is still free for everyone. Treatment in A&E, urgent care centres, and walk in centres is also still free. Have a look at our list of exemptions and excluded services.

These regulations undermine the key founding principle of the NHS: free care based on need, not financial ability. It is often the most vulnerable patients, some of whom are destitute, who are receiving bills of tens of thousands of pounds, or being denied care because they are unable to pay upfront. Worryingly, some people who require treatment are too frightened to seek it due to the cost and the possible impact on their immigration status.

NHS Trusts are now required to question everyone’s eligibility for care upfront. This undermines the patient-healthcare provider relationship from the very beginning. Until recently, NHS Digital systematically shared patient data with the Home Office for immigration enforcement purposes. This agreement was finally suspended in May 2018 after years of campaigning - but patient information continues to be shared with the Home Office through other means, including as a result of patient debt. Additionally, it is likely trust remains eroded as a result of this policy and we are awaiting clarification on various caveats. These policies not only deter people from seeking help when they are unwell but also compromise the quality of the care provided, damaging the health and well-being of patients in need.

The Department of Health and Social Care maintains that the decision to charge someone upfront should be made between overseas visitors managers (OVMs) and clinicians. However, the level of complexity of the guidance makes this an impossible feat that healthcare workers should not be asked to undertake. Healthcare providers are not immigration officials or experts; it is not possible to come to an informed and accurate judgement as to whether a patient is likely or even able to seek treatment elsewhere before their illness becomes urgent. Health providers’ primary duty of care is to their patients, and these charging regulations disrupt this.

The DHSC claims that the charging regulations are enforced not to contribute to the government’s ‘hostile environment’ for migrants or for immigration enforcement purposes, but in order to recover much-needed costs for the NHS. However, the government’s own figures show that deliberate ‘health tourism’ accounts for only 0.3% of the NHS budget. This is a high price to pay for the erosion of the principles of the NHS and putting thousands of patients’ lives at risk.