Overseas Visitors and the NHS
The National Health Service provides healthcare for people who live in the UK. People who do not normally live in this country are not automatically entitled to use the NHS free of charge - regardless of their nationality or whether they hold a British passport or have lived and paid National Insurance contributions and taxes in this country in the past.
Primary Care
Primary care providers need to establish if a patient seeking treatment meets the definition of ordinarily resident as defined in WHC (1999) 32, if not, they are deemed an overseas visitor. When an overseas visitor requests non-emergency medical treatment or treatment that is not immediately necessary, it is for the primary care provider to decide whether to accept that person as a NHS patient or as a private patient.
Secondary Care
The National Health Service (Charges to Overseas Visitors) Regulations 1989 place a legal obligation on LHBs in Wales to establish if people to whom they are providing NHS hospital services are not ordinarily resident in the UK. If they are not, then charges may be applicable for the NHS services provided.
Implementing the Overseas Visitors Hospital Charging Regulations - Guidance for NHS Trust Hospital in Wales seeks to provide as much help and advice as possible on the implementation of Regulations. This does not reflect the amendments introduced as a result of the UK leaving the EU, guidance on this is to follow in 2021 to support the 2020 and 2021 regulations listed under Legislation.
LHBs are recommended to identify a designated Overseas Visitor Manager to oversee the implementation of the hospital charging-regime. LHBs should also ensure as a priority that all staff and patients are aware of the Overseas Visitors charging regime.
Legislation
The National Health Service (Charges to Overseas Visitors) Regulations 1989 (Statutory Instrument No: 1989/306) (baselined regulations)
Amendments to the baseline regulations
The NHS (Charges to Overseas Visitors) Amendment Regulations 1991 (SI No. 1991/438) introduced exemption for family planning services.
The NHS (Charges to Overseas Visitors)(Amendment) Regulations 1994 (SI No. 1994/1535) removing dental and optical emergency departments from the services exempt from charges and amended the list of diseases for which no charge shall be made.
The NHS (Charges to Overseas Visitors) (Amendment) (Wales) Regulations (SI No. 2004/1433) tighten loopholes and modernise the charging regime.
The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2008 (SI No. 2008/2364) introduced a new category of exemption for victims of Human Trafficking.
The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2009 (SI No. 2009.1512) introduced amendments to failed asylum seekers, Missionaries, schedule 2 and spouse, civil partner and child.
The National Health Service (Charges) (Amendments Relating to Pandemic Influenza) (Wales) Regulation 2009 (SI No. 2009/1175) adds pandemic influenza to the list of diseases listed in Schedule 1.
The National Health Service (Charges to Overseas Visitors) (Amendment) (Wales) Regulations 2020 (SI No 2020/113) adds Coronavirus to the list of diseases listed in Schedule 1.
The National Health Service (Charges to Overseas Visitors) (Amendment) (Wales) (EU Exit) Regulations 2020 (No. 2020/1607) preparing the UK to leave the EU.
The National Health Service (Charges to Overseas Visitors) (Amendment) (Wales) (EU Exit) Regulations 2021 reflects the UK deal with the EU.