Access to the NHS

by Dr Clare Redstone
Posted on 1st October 2014

In August 2013, InterHealth wrote to its users about the UK Department of Health's consultation on access to NHS care in England.

The UK government has recently published its response to the consultation and is in the process of finalising the details. These currently include a number of proposed changes in access to NHS care which could affect many mission workers.

We wish to alert you to the proposed changes and to ask for your prompt action and feedback.

What are the changes being proposed?

At InterHealth we regularly see people who are back in the UK for under 6 months who are having difficulty accessing the NHS when they need it. People visiting the UK for less than 6 months, including many expatriates, are required to pay for their medical care. Some groups are exempt* from these charges.

Under the new regulations, there may be winners and losers. For example, at present, people working overseas for more than five years are not entitled to free NHS care when visiting the UK. However, the government is considering whether to exempt from charges those who have made significant National Insurance (NI) contributions in the past which could result in them being able to access the NHS free-of-charge in the future. No final decision on this has been taken. On the other hand, those who have only been out of the country for a short period of time but haven't paid NI contributions for long enough, would lose their entitlement. We are particularly concerned that this will affect younger personnel and others who, for whatever reason, haven't paid NI for very long. At the time of writing no indication has been given as to how long NI contributions should have been paid for in order to qualify for free NHS care.

We understand that many organisations also employ staff members from the European Economic Area (EEA) and non-EEA countries who base themselves in the UK between international assignments. Non-EEA migrants without indefinite leave to remain in the UK will be required to pay an immigration health surcharge of about £200 as part of any visa application, subject to limited exemptions. Yet, if posted overseas, and only back in the UK for short periods, they may find themselves in the same situation as UK citizens ie without entitlement to free NHS care.

A window of opportunity

The government consultation response in December 2013 stated that they intended to consider new exemptions. The Visitor and Migrant NHS Cost Recovery Team in the Department of Health, led by Sir Keith Pearson, is currently working on this and other details of the 'Visitor & Migrant NHS Cost Recovery Programme and Implementation Plan 2014-16'. This part of the work is scheduled for July to November 2014. You may like to take a look at the blog Sir Keith Pearson and some of his colleagues at the NHS Cost Recovery Team regularly update to give you a flavour of the wide-ranging issues they are grappling with during this major consultation.

In 2006, when access to the NHS was last reviewed, the mission sector successfully lobbied the government. This enabled people working internationally with mission organisations who were based principally in the UK, to continue their entitlement to free NHS care when visiting the UK. This exemption will no longer apply under the new regulations, as it is thought to be discriminatory.

We now have the opportunity to lobby for the aid, relief, development and mission sectors as a whole. InterHealth believes that those currently working internationally on behalf of UK Non-Governmental Organisations (NGOs) and mission agencies have a permanent relationship with the UK. While they may not have a permanent UK address, the UK is nevertheless their home base to which they return between international assignments. This mirrors the current situation for military personnel stationed overseas who remain entitled to free NHS care due to their permanent relationship with the UK.

InterHealth's proposals

The InterHealth doctors would like to see:

  • Free NHS access and care to remain available to any UK citizen working internationally in the aid, mission and development sector with a UK-based agency. Limiting access to the NHS based on National Insurance contributions risks excluding important groups of employees and volunteers.
  • Free NHS access and care for EEA and non-EEA nationals working for these agencies, whose 'home base' is in the UK between international assignments.

How can you help?

We need your help for a successful outcome to our proposals. You can do this by:

  • Writing to or emailing the Visitor and Migrant NHS Cost Recovery Programme (nhscostrecovery@dh.gsi.gov.uk). 
  • Contacting your MP to explain how much those working internationally with UK-based aid and mission agencies value free NHS access and care.
  • Consider forming a working group with representatives from the humanitarian and mission sectors to campaign for free NHS care and draw attention to the proposed changes and their impact. We at InterHealth can have some input into this if needed.

Please join us in lobbying for continued access to health care for overseas staff and volunteers.

*'Exempt/exemptions'

People who are living long-term in the UK, either UK or EEA citizens or non-EEA citizens with indefinite leave to remain, will be entitled to free NHS care. Most other people will be required to pay for healthcare in the UK apart from certain groups who will be exempt from these charges.

Dr Clare Redstone has worked as a GP in the East End of London since 1989 and started work at InterHealth in April 2004. She enjoys this opportunity to help people remain well for their work overseas.