The National Health Service provides healthcare free of charge
for people who are ordinarily resident in the United Kingdom. When
a person who is not ordinarily resident in the UK (an "overseas
visitor") needs NHS treatment they will be subject to the
National Health Service (Charges to Overseas Visitors) Regulations
2020 (the "Charging Regulations") and may incur a charge for
treatment.
How charges for NHS healthcare apply to overseas
visitors - most upto date
information from the Department of Health and Social
Care.
This page provides an overview of how the Trust fulfils its
obligations under the regulations but cannot represent the full
extent of the regulations. Further information can be found on the
NHS England Overseas Visitors webpage.
In accordance with the Charging Regulations the Trust has a
legal obligation to make and recover charges for NHS treatment in
relation to any person who is not ordinarily resident in the United
Kingdom. This is not optional and no one in the Trust has the
authority to waive these charges.
Our approach
University Hospitals Bristol and Weston NHS Foundation Trust is
committed to implementing the Charging Regulations consistently
across the Trust, using a robust and common sense approach.
NHS services are provided free of charge to people who are
deemed to be "ordinarily resident".
Ordinary residence is defined under the Charging Regulations as
when a person is:
"Living lawfully in the United Kingdom voluntarily and for
settled purposes, as part of the regular order of their life, for
the time being"
A person is not ordinarily resident just because they are
British; hold a British passport, are registered with a GP, have an
NHS number or have paid tax into the UK revenue system at any
point.
In order to ascertain a person's eligibility, the Trust applies
baseline questions to all patients, without discrimination.
Questions may be asked to ascertain where you lived in the last 12
months.
Evidence of identity, insurance or residence may be requested by
the Overseas Visitor Team or other appointed Trust staff.
Anybody who can demonstrate that they lawfully reside in the UK
is unlikely to incur treatment charges.
The Trust works closely with the Home Office in order to verify
information provided.
The law
The Statutory provisions which enable overseas visitors to be
charged for NHS treatment are found in section 175 of the National
Health Service Act 2006. Section 175 allows the Secretary of State
for Health to make regulations for making and recovery of charges
in relation to any person who is not ordinarily resident in the UK
for NHS services provided to them.
The National Health Service (Charges to Overseas Visitors)
Regulations 2020 place a legal obligation on the Trust to make and
recover charges for NHS treatment provided by that relevant NHS
body. The Trust therefore has a legal obligation to ensure that
patients who are not ordinarily resident in the UK are identified,
that their liability for charges is assessed in accordance with the
Charging Regulations, that those liable to pay are charged in
accordance with the Charging Regulations and that those charges are
recovered.
Services exempt from charging
The following services are free at the point of use to everyone.
A charge cannot be made or recovered from any overseas visitor
for*:
- Accident and Emergency (A&E) services, this includes all
A&E services provided at an NHS hospital, e.g. those provided
at walk-in centres or urgent healthcare centres. This does not
include those emergency services provided after the overseas
visitor has been accepted as an inpatient, or at a follow-up
outpatient appointment, for which charges must be levied unless the
overseas visitor is exempt from charge in their own right.
- Services provided outside an NHS hospital, unless the staff
providing the services are employed by, or working under the
direction of, an NHS hospital.
- Family planning services (this does not include termination of
established pregnancy)
- Diagnosis and treatment of specified infectious diseases
(Diagnosis remains exempt even if the outcome is negative).
- Diagnosis and treatment of sexually transmitted
infections.
- Treatment required for a physical or mental condition caused
by: Torture, Female Genital Mutilation, Domestic Violence, Sexual
Violence
*Except where the overseas visitor has
travelled to the UK for the purpose of seeking that
treatment.
Care of overseas visitors
The Charging Regulations place a legal obligation on the Trust
to make and recover charges for NHS treatment.
The Trust will ensure that treatment which is immediately
necessary is provided to any patient regardless of chargeable
status. Failure to provide immediately necessary treatment may be
deemed unlawful under the Human Rights Act 1998.
Urgent treatment will be provided to any patient, even if
deposits have not been secured.
Non-urgent or elective treatment will not be provided unless the
estimated full charge is received in advance of treatment.
Immediately necessary treatment
Immediately necessary treatment is that which a patient
needs:
- to save their life, or
- to prevent a condition from becoming immediately
life-threatening, or
- promptly to prevent permanent serious damage from
occurring
This will always be provided irrespective of whether or not the
patient has been informed of, or agreed to pay, charges. Also it
will not be delayed or withheld to establish the patient's
chargeable status or to seek payment.
All maternity services, including routine antenatal treatment,
are treated as being immediately necessary. Clinicians and other
Trust staff will be especially careful to inform pregnant patients
that further maternity care will not be withheld, regardless of
their ability to pay.
Urgent treatment
Urgent treatment is that which clinicians do not consider
immediately necessary, but which nevertheless cannot wait until the
person can be reasonably expected to return home.
The Trust does make every effort to secure payment in the time
before treatment is scheduled but if that proves unsuccessful the
treatment will not be delayed or withheld for the purposes of
securing payment.
While the urgency of treatment is a matter of clinical
judgement, this does not mean that the treatment should be
unlimited; there may be some room for discretion about the extent
of treatment and the time at which it is given.
Non-urgent treatment
Non-urgent treatment is routine elective treatment that could
wait until the patient can return home.
The Trust will not provide non-urgent treatment unless the
patient pays the full estimated cost of the treatment in advance.
However, in order to decide if a patient's need for NHS hospital
treatment is urgent or can safely await their return home,
clinicians will need to know when a patient can reasonably be
expected to return home. The decision can be made on the basis of
this information.
However, the decision will be reassessed if the patient informs
the Trust that their return date has been postponed for valid
reasons or if their medical condition unexpectedly changes.
Charges
If the Trust is satisfied that the patient is an overseas
visitor then the Trust must recovery costs via the relevant
charging route for the NHS services provided.
EEA Members holding a valid European Health Insurance Card
(EHIC) issued from their permanent home state must present their
EHIC or PRC on presentation at the Trust to prove eligibility to
access free NHS treatment. Further information can be found
here
If there are any doubts over the validity of exemption for a
patient the patient will be liable to pay charges for their
treatment.
Overseas visitors with travel insurance will be required to pay
for their treatment and then claim back from their insurer on their
return home.
Treatment is not made free of charge by virtue of being provided
on an immediately necessary or urgent basis. Charges found to apply
cannot be waived. However, any patient undergoing "immediately
necessary" treatment will be reassured that this will not be
withheld or withdrawn in the event of the patient being unable to
pay.
Tariff and payments
The Overseas Visitor Manager will liaise with clinical teams to
advise patients of the estimated cost of treatment where
requested.
Invoices are due to be paid on receipt. Deposits may be
requested.
The Trust accepts the following forms of payment:
When you pay you will be provided with a receipt for your
records.
If you are unable to pay the full amount prior to receiving your
treatment, it will not affect the level of urgent care you will
receive.
Pharmacy
Overseas visitors are not entitled to receive an NHS subsidised
prescription therefore they must pay the same charge for a private
prescription.
Deceased patients
Where a patient dies without making or completing a payment to
the Trust the debt then becomes recoverable from the deceased's
estate.
Recovery of income
Reasonable measures are taken to pursue any amounts owing to the
Trust and international debt recovery agencies will be employed
where necessary.
Patients should be aware that under immigration rules 320, 321,
321A and 322. a person with outstanding debts of over £500 for NHS
treatment that are not paid within three months of invoicing, may
be denied a further immigration application to enter or remain in
the UK.
In the absence of prompt, full settlement or a reasonable
repayment schedule, non-clinical information relating to the debt
is provided routinely to the Home Office and may be used by the
Home Office to apply the above immigration rules. The information
will remain active for the purpose of the above rules until the
debt is settled and a record of the settled debt will also be
retained, both subject to normal limitation periods.
In the event that a person may seek entry to the UK or make an
advance immigration application after settling an NHS debt in the
previous three months, they are advised to retain and carry
evidence of payment for potential examination by Home Office
officials.
Complaints
Where a patient is unhappy with the care they have received at
the Trust, patients have the right to address complaints through
the
Trust's complaints procedure.
Contact details
If you have any further questions, please contact the Overseas
Visitor Team at overseasvisitorsteam@UHBW.nhs.uk.
Helpful videos
Clarifying NHS entitlements for migrants
Keeping up to date with vaccinations for migrants
NHS entitlements
