The Home Office is currently undertaking a consultation on the provisions in the proposed Immigration Bill which the Government states is aimed at protecting public services by restricting free access to publically funded health services for non-EEA nationals.
There are three core proposals in the Home Office consultation:
1. To introduce a new “residency test”. This will involve a change to the “ordinary residence” test which governs free access to the NHS. “Ordinary residence” is a difficult concept and usually involves a fact-finding exercise. In practice all temporary migrants with valid leave for more than six months currently meet the ordinary residence test. Under the new proposals temporary non-EEA migrants will be excluded and only those non-EEA nationals with permanent residence (Indefinite Leave to Remain or “No Time Limit”) will have access to free health care. (Although there will be certain exemptions including those granted refugee status/humanitarian protection, asylum seekers, victims of trafficking and persons covered by reciprocal health agreements with the UK etc).
2. For those non-EEA nationals without permanent residence, the Home Office are considering the following options:
(i) “Enrolment” for access to NHS services by paying a charge (“a migrant health levy”) which would entitle them to access for free most NHS services.
Temporary migrants would pay a levy to access all NHS services to cover the period of their leave. Payment of the levy would be a condition of receiving leave to enter or remain in the UK. The whole levy would be paid up front in the same way the applicant pays a visa fee. The Biometric Residence Permit would be endorsed to show they are entitled to free NHS treatment.
Tiers 1 to 5 and family migrants would be liable to pay the fee. The government is also considering whether the requirement to pay the levy should also include those granted an extension of leave in-country, limited leave on the basis of their family or human rights, or granted immediate settlement on the basis of their family life.
The proposed level of fee is a flat rate of £200 for each year of leave granted. However, it is likely that the levy may not entitle access to all NHS services, for example, “discretionary” treatments such as IVF and cosmetic surgery.
(ii) A requirement to take out private health insurance – possibly under a scheme set up between the NHS and insurers.
Temporary migrants would be required to hold health insurance, possibly as a condition of leave to enter/remain. The Government considers the main advantages of this option are that the migrant will have freedom to choose the level of cover they require and of course, it will avoid the taxpayer having to underwrite the scheme, which will be the case if the levy option is chosen.
3. An extension to charging for NHS clinical services to cover all clinical services provided to non-EEA nationals without permanent residence, including primary medical care (e.g. GPs).
At the start it will only be new arrivals that are charged. Nevertheless, how the NHS will identify chargeable patients and recover costs is a key issue with these changes.
The suggestion is that there will be a separate “NHS registration” process that migrants will have to undertake. This would provide them with an NHS number and would differentiate between those exempt from charges, paying the levy, EEA nationals (where costs can be reclaimed from the home State) and those directly chargeable.