1.0 The NKF fully supports the Department of Health in its policy* to provide only free emergency NHS treatment to visitors to the UK and not to provide further NHS treatment (Renal Replacement Therapy) for those who are unlawfully living in the UK.

* There are a number of exceptions to this relating to countries within and outside the European Union, concerning planned treatment using the EHIC and unilateral health care agreements respectively.

1.1 However, the NKF believes that where an individual has received or is in receipt of Renal Replacement Therapy (RRT) from the NHS, and is unlawfully resident in the UK, they should be given the right to remain so long as it can be proved a return to their home country may reasonably be expected to lead to their death.

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NOTE 

Background

The reason for this policy stems from the fact that the NHS is being used illegally by many overseas visitors and is costing the government millions, highlighted by the BBC at the end of last year;

‘Hospitals in England and Wales are obliged to ensure NHS patients have lived in the UK for the past 12 months. But 45 out of 133 hospital trusts which gave details said they do not check. In responding to Freedom of Information requests from the BBC's Panorama programme, those hospitals that had identified overseas visitors who had received treatment on the NHS had written off more than £40m in losses.’

Others including Jeremy Hunt (Secretary of State for Health) estimate the cost beyond that and this blog provides more insight http://conservativehome.blogs.com/platform/2013/06/professor-joseph-meirion-thomas.html which suggests overseas visitors cost the NHS billions.

For the NKF to have a policy it is important to know what the rules are.

NHS hospital treatment

‘If you move to the UK, you will not be charged for NHS hospital treatment from the date that you arrive, as long as:

• you intend to live permanently in the UK, and

• you have the right to live permanently in the UK or have a ‘route to settlement’ that will allow permanent residence in due course

You’ll be expected to prove that you meet these requirements.

Your spouse or civil partner and children under age 16 (under 19 if in full-time education) are also exempt from these charges, if they live with you permanently.

If you’re not entitled to live in the UK permanently but you’ve applied to the Home Office to enter or stay, you’ll be charged for hospital treatment until:

• your application is granted, or

• you have 12 months’ lawful residence in the UK

If you have made a formal application for asylum you will be exempt from charges as long as your application (including appeals) is under consideration. Those granted refugee status will continue to receive free NHS hospital treatment.

If your claim for asylum is unsuccessful after all appeals, any on-going course of hospital treatment will continue to be free of charge until you leave the country. 

However, any new course of treatment will be chargeable unless you're in receipt of section 4 or section 95 UK Border Agency support.

Regardless of your residential status or nationality, you’re entitled to free emergency NHS treatment from:

• a primary care practice, such as a GP practice

• an A&E department

• an NHS walk-in centre

However, people who are not entitled to live in the UK permanently, or whose application is being considered by the Home Office, will have to pay NHS charges for emergency treatment if they are:

• admitted to hospital as an in-patient (this includes high dependency units and other emergency treatment, such as operations), or

• registered at an outpatient clinic ’ (NHS Choices)

The fact that visitors can attain an NHS number easily from their first GP visit has been cited as a key reason for overseas visitors to get access of free NHS treatment without further questions being asked. Until the government produce a new policy or paper on how to tackle the problem it is clear that the practice of ‘Heath Tourism’ will continue; reports suggest that a policy will be forthcoming in the next few months, likely in the autumn.

Therefore the NKF, in my opinion need a very simple policy statement to show that we are in accordance with the Department Health, suggested for approval by the Executive below:

1.0 The NKF fully supports the Department of Health in its policy* to provide only free emergency NHS treatment to visitors to the UK and not to provide further NHS treatment (Renal Replacement Therapy) for those who are unlawfully living in the UK.

* There are a number of exceptions to this relating to countries within and outside the European Union, concerning planned treatment using the EHIC and unilateral health care agreements respectively.

It does pose the question “what will the government do to stem the tide of so-called Health Tourists”, which will lead to a moral and ethical debate. The UK is by no means responsible for the health of overseas visitors and it is clear that current policy and procedure is flawed - it seems the right to free NHS treatment has been taken too far by some. Perhaps one way of stemming the tide would be to crack down on GP’s providing NHS numbers so easily, however the Borders Agency has a job to do and a radical idea might be to screen visitors?

However, in the case of renal replacement therapy, I know, and have heard of a number of cases where patients have been treated, lawfully, then their residency situation changes. Transplant or haemodialysis patients face a very real threat of being forcibly removed to their home country where the cost of drugs or treatment would be prohibitive - such individuals would effectively be sent home to die.

Therefore, to cover these situations I would ask the Executive to consider the addition 1.1 to the previous statement 1.0:

1.1 However, the NKF believes that where an individual has received or is in receipt of Renal Replacement Therapy (RRT) from the NHS, and is unlawfully resident in the UK, they should be given the right to remain so long as it can be proved a return to their home country may reasonably be expected to lead to their death.