Overseas patients

Overseas visitors to England, including anyone living in the UK without permission, will not be charged for:

• testing for coronavirus (even if the test shows you do not have coronavirus)
• treatment for coronavirus

However charges may apply to any secondary illness that may be present even if treatment is necessary in order to successfully treat the condition unless a personal or medical exemption applies.

The Covid-19 vaccine is outside the scope of charging.

The overseas visitor charging regulations are complex and often misunderstood by the public. For example, they apply to hospitals but not GP surgeries. During 2019, we worked extensively with community and patient groups to understand their concerns and share information about our how we apply the regulations.  

We used their feedback to inform our approach, and made improvements to better support patients and their communities. An overseas visitor steering group chaired by the chief medical officer meets regularly to review progress.

• We refreshed the trust policy in line with the latest guidance from the Department of Health and Social Care (DHSC) and undertook our own equality impact assessment.
• We put more information on our website and staff intranet, including contact details for the overseas visitors team 
• We reviewed communications materials for patients, and commissioned a short film to show how the Trust implements the national regulations
• We revised a patient facing leaflet 1MB for distribution in each hospital, giving details of external agencies that provide independent patient support and guidance
• With the input of local campaigners we redesigned the standard attendance form 189KB and supporting information - attendance form 376KB issued on arrival to all patients. This will include contact details for the overseas visitors team and the option for a patient to name an advocate for communication purposes. 
• We enhanced the standard DHSC clinical assessment form to ensure clinicians alerted the overseas visitors team when patients were being treated for exempt medical conditions  
• We developed a comprehensive training package to increase knowledge and awareness among reception and administrative staff, and ensure all new patients are asked about their residency status. This is being piloted and will be rolled out over the coming months, to form part of our statutory and mandatory training requirement for all frontline staff.

We recognise that charging is a sensitive issue for many people and are committed to being transparent, fair and equitable to patients and staff in fulfilling our statutory obligations.

Important information  - We may provide non-clinical information about you to external agencies for the purpose of confirming your entitlement to free NHS treatment or to recover debts owed to the trust for treatment provided. Please click here for more information.

We have worked closely with local Save our NHS groups in particular to address their concerns about the implementation of the national charging rules. We would like to take this opportunity to clarify the trust’s position.  

We have consistently made clear that anyone requiring treatment that is deemed immediately necessary or urgent – such as all maternity care – is treated. 

We invoiced 739 patients for maternity care in 2018-19. That treatment was not delayed whilst entitlement to free care was established. No care was ever refused. All maternity care is classified as immediately necessary. 

We billed these patients either if we established they were not entitled to free NHS treatment, or if it was not possible to confirm their residency status. We make every effort to obtain information from people that would prove their eligibility, through telephone calls and offering face-to-face meetings as well as writing to them.

Subsequently, it transpired that a large number of these invoiced patients were able to prove their eligibility for free NHS treatment after all. Of the revised cohort of 449 maternity patients, we received payments from 162 individuals, leaving 287 outstanding. 

We are continually reviewing our processes and in the light of this latest learning, we will amend our standard billing procedure. In future, we will send out an advisory “notice to charge” rather than an invoice in the first instance.  

We do not report patients to the Home Office. We do ask the Home Office for information about the immigration status of some patients, to help establish their eligibility for free treatment. For example, the Home Office can confirm a patient is a documented asylum seeker and therefore eligible for free NHS hospital treatment. 

Our new information leaflet (accompanying the attendance form that is given to all new arrivals) sets out what we share with the Home Office: name, gender, date of birth, nationality, address and treatment dates. No medical information is disclosed. 

The 2019 MBRRACE study on maternal deaths notes (but does not endorse) that three women who died may have been reluctant to access care because of concerns over the costs of care and the impact of their immigration status. These unidentified women were not Barts Health patients. The study observes that while no woman can be refused maternity treatment, this may not be commonly known.

We would welcome the opportunity to discuss these issues in more detail with Save our NHS groups and others. Our door is always open and the chief executives of our hospitals are keen to establish a regular dialogue with local campaigners.  

On the most recent questions submitted in writing by Newham Save our NHS and asked verbally at the March 2020 board meeting:

1. No-one was denied maternity care. All 739 women referred to were treated in our hospitals. The issue at stake is whether they were eligible for free NHS treatment.

We do not routinely report on the numbers of overseas visitors patients who are not eligible for free NHS treatment, in either our public or private board papers. 

We provided a short paper to the 27 January 2020 INEL JHOSC meeting about our policy on overseas visitors, as requested. We were not asked to attend to speak to the paper, and agreed in advance with the clerk to the committee that Dr Alistair Chesser, our chief medical officer, would give a fuller update in person at the forthcoming meeting on 24 June 2020. 

We reject the charge of secrecy. We have answered all the questions asked by Save our NHS groups in writing and at board meetings. We would be happy to supply figures about overseas visitor numbers and eligibility for free NHS treatment in 2019-20 at the next public board meeting, as a step towards publishing some annual statistics on this topic.     

2. The so-called MESH tool is an efficient method of accessing any information held centrally on the NHS spine about the immigration status of patients. It would allow us to check multiple records at the same time instead of keying in individual names one at a time. However, the trust did not use this tool at all during 2018-19. In practice, we find telephone calls with individuals are the most effective way of establishing eligibility to free NHS treatment, as it is more supportive to the patients and allows them to ask questions of us. 

Overseas visitors who may qualify for free healthcare

• A student studying full time in the UK or an individual who has come to work in the UK on a relevant visa.  If you were required to pay the Immigration Health Surcharge as part of your visa application please note free treatment does not include assisted conception.
• A refugee or an asylum seeker whose formal application to the UK Border Agency is being considered.  You will need to provide documentary evidence such as your Application Registration Card (ARC).  Please note that you will need to pay for any medication prescribed to you. 
• A citizen who normally lives in a country that is a member of the European Economic Area (EEA) and has a valid European Health Insurance Card (EHIC) in their name.  This card covers emergency treatment only.  You must bring this card with you to hospital.
• A citizen who normally lives in a country that has a reciprocal healthcare agreement with the UK.  This covers emergency treatment only and does not cover planned treatment.  Please note that if the agreement is withdrawn during your treatment you will become immediately responsible for the cost of the remainder of your course of treatment.
• You fall within a group of individuals who are entitled to receive healthcare on the same or similar basis as an ordinarily resident person.   For further information in this regard please see pages 12- 15 of The Department for Health's Guidance on Overseas Visitor Charging Regulations or contact our Paying Patients Team for guidance and support.

Overseas visitors acceptable documents 63KB

Who may not qualify for free healthcare

• An individual without legal status at point of treatment including failed asylum seekers and illegal immigrants.
• Ex-pats who now ordinarily reside overseas.
• An individual with a Biometric Residency Permit (BRP) whose card is marked to confirm their “visitor” status.  This may include academic visitors and private medical visitors.

Treatment received in our Emergency Departments (A&E) is free.  If you are admitted to hospital as an inpatient or receive any outpatient appointments charges will apply. 

• For those overseas citizens in possession of a valid European Health Insurance Card (EHIC) please present your card to our A&E reception staff.     
• If your country of residence has a reciprocal agreement covering your emergency treatment in the UK please advise our A&E reception staff.

In these instances we will re-coup the cost of your care from your country of residence.

The following summarises the position for European Union citizens living or visiting the UK. It should be noted that the European Free Trade Agreement (EFTA) countries (Norway, Iceland, and Lichtenstein) and Switzerland are negotiating separately.

All EU citizens who were resident in the UK by 31 December 2020 needed to apply to the EU Settlement Scheme (EUSS) to continue to live, work and study by 30 June 2021. This also applies to their family members including children and non-EU citizens. You may be asked to provide relevant documents to confirm your status in the UK in order to establish your entitlement to free NHS hospital care.

From 1 January 2021 free movement ended and the UK introduced a points based immigration system.  Any EU citizen who was not a resident in the UK by 31 December 2020 will need to apply for a visa to be resident in the UK from this date. 

The Trust has a legal duty to recover costs from patients who are not entitled to free NHS hospital treatment. Any patient not entitled to free hospital care must be charged for treatment they receive unless a medical or service exemption applies.

The regulations were tightened in 2017 to require full payment in advance of non-urgent treatment. 

We take pride in providing quality care for all our patients, and do not wish to deter anyone from seeking treatment.  Any treatment that is clinically deemed immediately necessary or urgent, including all maternity care, will always be provided promptly even if a patient indicates that they cannot afford to pay. 

Coronavirus (COVID-19) testing, treatment and vaccine

Overseas visitors to England, including anyone living in the UK without permission, will not be charged for:

• testing for coronavirus (even if the test shows you do not have coronavirus)
• treatment for coronavirus

However, charges may apply to any secondary illness that may be present even if treatment is necessary to successfully treat the condition unless a personal or medical exemption applies.

The Covid-19 vaccine is outside the scope of charging.

If you have any queries relating to the changes following the end of the transition period or require any support, please click here for site contact details and our Frequently asked questions where our team will be happy to assist you or answer any questions you may have.

National guidance states that for treatment assessed by a clinician as non-urgent the full estimated cost of treatment must be paid before treatment is provided.  This will include the cost of initial assessment and investigations to make a diagnosis.   Find out the different ways that you can make payments for your treatment [pdf] 160KB

We will always provide treatment that a clinician has assessed as immediately necessary or urgent.  All maternity treatment is regarded as immediately necessary.  Treatment is not free however by virtue of it being immediately necessary or urgent and you will still be charged.

There are some NHS services which are free to everyone.  Please see pages 30 and 31 of the Overseas Visitor Charging Regulations.  EEA citizens with an EHIC card should present their card to reception staff.  

If you have private health insurance you will be required to cover the costs to the Trust for all treatment it provides and then subsequently seek reimbursement from your insurer.  

Please contact the overseas visitors team for further guidance and support or to book an appointment to provide your documentation.  

Our offices are open Monday to Friday 9am-5pm except bank holidays.

The Royal London and Mile End hospitals

Overseas Visitors Team
The Royal London Hospital
1^st Floor, John Harrison House
London
E1 1BB

Email

Telephone numbers: 020 3594 6302 / 020 3594 6527

Newham Hospital

Overseas Visitors Team
Newham Hospital
House 12,
Glen Road
London
E13 8SL

Email

Telephone numbers: 0207 055 5626 / 0207 055 5717

Whipps Cross Hospital

Overseas Visitors Team
Whipps Cross Hospital
1^st Floor Junction 2
Leytonstone,
London
E11 1NR

Email

Telephone numbers: 020 8535 6976/ 0208 535 6712

St Bartholomew's Hospital

Overseas Visitors Team
St Bartholomew’s Hospital
3^rd Floor, SMLG
West Smithfield, London 
EC1A 7BE

Email

Telephone numbers: 0203 765 8565 / 0203 765 8566