Extending hospital charging regime – the new statutory regulations

Posted on Fri 27 Mar 2015

Share this

Leander Neckles is a freelance equalities consultant

About this briefing

Last month’s briefing reported on changes to the charging regime for hospital services and the introduction of a new immigration health charge.  This month’s briefing looks at the new NHS charging regulations and the charges. Certain services and groups are exempt:

  1. i) A&E services but not services where someone has been accepted as an in-patient or is given an outpatient appointment (regulation 9);
    ii) family planning services;
    iii) services for the diagnosis of certain conditions.

  2. Exempt groups:

    i) those who have paid the immigration health charge (reg. 10); 
    ii) those who have made certain entry applications before the immigration health charge is introduced (reg. 11); 
    iii) overseas visitors with EU rights or reciprocal rights (reg. 12, 13 & 14); 
    iv) refugees, asylum seekers, supported individuals and looked after children (reg. 15); 
    v) victims of human trafficking (reg. 16); vi) where exceptional humanitarian reasons apply (reg. 17); 
    vii) certain detained people (regs. 18 & 19); & 
    viii) members of armed forces, NATO & similar (regs. 20 – 22).
    ii) those who have made certain entry applications before the immigration health charge is introduced (reg. 11); 
    iii) overseas visitors with EU rights or reciprocal rights (reg. 12, 13 & 14); 
    iv) refugees, asylum seekers, supported individuals and looked after children (reg. 15); 
    v) victims of human trafficking (reg. 16); 
    vii) certain detained people (regs. 18 & 19); & 
    viii) members of armed forces, NATO & similar (regs. 20 – 22).

So who will be chargeable and what are the charges?

Overseas visitors who are not exempt from the charges will be required to pay for hospital services from 1st April 2015. People who are not UK residents and are not exempted will also be chargeable. The charges set out in the regulations are eye-watering:

  • ambulance services– rate £195 each way;

  • outpatient services– calculated on a daily basis – rate £647 per day;

  • in-patient services – calculated on a daily basis – rate £796 per day.

The maximum sum payable must not exceed £47,569 per patient although clarification will be sought about how this cap will be calculated.

Could some people be charged more?

Non-EEA nationals visiting the UK on a tourist visa will not pay the health surcharge, but will continue to be fully liable for the costs of any NHS treatment at the point they receive it. According to the Department of Health (DH) update published on 19th March 2015, the DH is still ‘working on proposals that will mean from April non-EEA visitors who use the NHS will be charged 150% of the cost of their treatment.’ This would mean that for ‘a £100 procedure, they could be billed £150’, which ‘reflects the additional cost burden the NHS carries when managing the administration for visitors to the UK.’ We await clarification from the DH with respect to whether, when and how this 150% rate will be introduced.

Our practical concerns about these charges

A House of Commons Standard Note SN03051 identified a patchy picture with respect to charging by hospitals. We doubt that it will be possible to recover anything like the sums envisaged from those subject to the regime, especially when administrative costs are added. It is therefore very worrying that the Government appears to suggest that the new health surcharge and charging regime will bring in hundreds of millions of pounds. Furthermore, if the recovery of hundreds of millions of pounds does prove impossible, we fear that this will result in another NHS financial deficit.

 

We are also concerned about the lack of up to date information on the new charging regime. For example, key NHS web pages on charging overseas visitors on the NHS Choices website have not yet been updated as at 19/3/15.  We are equally concerned that charging/mischarging errors will fall disproportionately on black and minority ethnic people.  We welcome the fact that the Government and the DH have stated that no immediately necessary or emergency treatment should be delayed because of the charging regime but we need to know how this will operate in practice. We are also concerned that some people may be told that their treatment is not ‘immediately necessary’ or ‘urgent’ and treatment will be withheld until they have paid. Following various meetings with the DH team responsible for developing the proposals, we hope to report back in April 2015 on whether, and if so how, these and our wider equalities concerns have been addressed.