What the Government is proposing with the 2014 Immigration Act


According to the government, new measures are needed to combat ‘health tourism’ (i.e. visitors who come to the UK with the express intention of seeking free NHS care) and to improve the sustainability and fairness of the health system. It justifies this with “research” commissioned by the government to accompany the Bill, which claims to be a robust baseline estimate of health tourism.  However, this research has been widely criticised in terms of its validity and reliability, and the inferences that it draws.

The government claims that they can take steps to apply charges to non-eligible patients, while ensuring that urgent and immediately necessary treatment is provided and that public health is maintained.  However, existing evidence suggests that this is unlikely to be the case and the negative repercussions of these changes are likely to be vast.

The Immigration Act 2014

The Immigration Act 2014 was the first step in a larger draft of changes that were outlined in 2013.   The following changes with specific health implications have been made:

Changing the definition of  ‘ordinarily resident’ (Chapter 2, Clause 34)

The Act changes the current case law definition of ‘ordinary resident’ from those that are deemed to be living in the UK for a settled purpose to only those who have been granted ‘indefinite leave to remain’ (ILR).  A status that the Department of Health reports takes on average five years.  Consequently, many non-EEA documented migrants’ including students, workers and newly arriving family members of existing UK citizens will have restrictions placed on access and will become chargeable.

The Introduction of an Immigration Healthcare Surcharge (Chapter 2, Clause 33)

The Act enables the state to institute an annual healthcare surcharge for ‘temporary migrants’ from outside the EEA that will be payable on Visa application.  This is purported to be in the region of £150-200.

Proposed Changes

At the end of 2013, the Government announced its intention to implement charging, for those without “indefinite leave to remain”, for emergency services and most areas of primary healthcare services,

Phase 1 – Improving the current system of identification and cost recovery

As part of their wider plans the government also intends to develop more effective ways of claiming reimbursement from EEA member states for the treatment of its nationals within the NHS whilst maintaining their free access to services.

Phase 2 – A New Registration System

The proposals outlines plans to develop a new system aimed at identifying people’s immigration status at point of access.   Including the possibility of immigration status corroboration being required to register at the GP.   Details of the nature of this system have not been released as yet.

Phast 3 – Healthcare Surcharge

The ability to do this is contained within the Immigration Act 2014 and this will be implemented by the Home office.

Phase 4 – Extention of charging

At the end of 2013, the Government announced its intention to implement charging, for those without “indefinite leave to remain”, for emergency services and most areas of primary healthcare services, although GP consultations will remain free of charge. Despite the government acknowledging that their previous public consultation had raised substantial concerns with regard to extending charging both for pregnant women and children, no exemption for these groups has been agreed. Universal and free access to care for the treatment of certain communicable diseases and sexually transmitted infections (STIs) will remain; however, it is unclear as to how this can be achieved in a setting where access to healthcare is being hindered.

In addition to this, they propose changing the rules for dentistry, optics and pharmacy and to change the regulations to include allow all commissioned providers of NHS care (NHS and non-NHS organisations) ability to charge for services.

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