Feature / Frontier line

Plans are afoot to crack down on non-Europeans who have not paid for NHS care while visiting Britain. The UK Border Agency’s Tim Woodhouse explains

The UK Border Agency is consulting on possible changes to the immigration rules to refuse entry or stay in the UK for non-Europeans who have incurred debts with the NHS. The consultation, Refusing entry or stay to NHS debtors, proposes to make non-payment of NHS charges a reason for refusing entry or further stay in the UK. As part of the exercise the agency is keen to hear the views of financial staff in the healthcare industry.

Initial research with the NHS in England shows it raises more than £25m in invoices in a financial year against chargeable visitors. Half of these, where payment could not be secured in advance (for urgent treatment), were paid within a year. Some £5m of debt is written off within the financial year and some debt carried over to subsequent years. NHS bodies have to carry not only the original outstanding payments, but also the additional costs of managing these deficits and, in some cases,

the full costs when written off.

The consultation runs in parallel with a wider Department of Health consultation on measures to rationalise the current NHS charging regulations for overseas visitors and better regulate migrants’ access to NHS services. Both flow from a Department/UK Border Agency review of non-residents’ access to the NHS, which concluded last summer.  

The joint review suggested real-time data on payments still outstanding above a certain threshold should be shared by the NHS with the UK Border Agency; and that immigration rules governing entry and stay in the UK should be changed so that those with outstanding payments above a certain threshold should be refused if encountered as applicants at immigration control.

This will mean that for the first time, the UK’s immigration rules will state explicitly that a record of failing to pay the NHS will have an impact on a person’s ability to enter or stay in this country. The rules already provide a similar level of protection for UK state benefits. 

The UK Border Agency’s consultation also asks for views on the principle of whether non-payment of NHS charges is sufficient grounds for refusing entry or extension to stay and whether there should be a minimum level of outstanding payments owing before the new sanction is enforced. It suggests either more than £500 or more than £1,000 may be the right level, but the consultation gives the opportunity for alternative views.

The suggested £500 and £1,000 thresholds stem from research by the Department in England, which found that in a sample, non-payments of more than £1,000 represented 53% of patient invoices, whereas non-payments exceeding £500 represented 71% of patient invoices. This non-payment equated to 94% of all outstanding costs over the £1,000 threshold and 98% for those over £500.

It is not anticipated the proposed changes will create an additional burden on the NHS as hospital managers and professionals are already responsible for applying the respective regulations relating to access to NHS care. The hospitals are also responsible for identifying instances where a patient is liable to be charged for services and then securing payment.

The consultation proposes that data around outstanding payments should be gathered centrally. If the amount exceeds a set level, the data should be processed by the relevant NHS Counter Fraud Services (CFS) in England, Scotland, Northern Ireland and Wales. This would enable the CFS to develop an overview of unrecovered payments to the NHS and share this information with the UK Border Agency.

No clinical details or other personal medical data would be included in the shared data. CFS notification of an outstanding payment would be checked by UK Border Agency officers each time a non-European national made an application at one of the key immigration control check points.

No NHS treatment should be withheld from those who require it immediately and the proposed changes to immigration rules will not directly impact on access to NHS services. But they will assist the NHS in recovering payments and in ensuring NHS resources are protected from abuse.

Subject to the consultation, the aim is for the arrangements to go live this year alongside new consolidated NHS charging regulations in England. The consultation has been extended to 30 June and your views are welcome.