UK, NHS Charging, updated guidance

[theoldgit]

The British Government have update the guidance for NHS Charging in the UK, including that for British Expats who are visiting the UK, this guidance supersedes all previous guidance/instructions.  Main_Guidance_post_24_August_2020_V2.pdf

 

I note the para that states that a British citizen, an EEA/Swiss national moving to the UK before 31 December 2020 and for a non-EEA national with ILR or a non-EEA national not subject to 25 immigration control, it is perfectly possible to be ordinarily resident here from the day of arrival, when it is clear that that person has, upon arrival, taken up settled residence. In each case, it is for the relevant body to decide whether the criteria within the ordinary residence description are met, this implies that the rules haven't changed for a British Expat returning to the UK to take up residence, and can satisfy the NHS Trust, is exempt from charging from day one. 

A tool has also been developed to assist them in considering whether an individual is properly settled in the UK in order to establish ordinary residence. It can be found as part of the Overseas Visitor Manager (OVM) toolbox available via this link: Ordinary_residence_tool

 

It's also worth noting that when charges apply, a relevant body must make and recover charges from the person liable to pay for the services provided to the overseas visitor. Since 23 October 2017 relevant bodies are required to recover these charges in full in advance of providing them, unless doing so would prevent or delay the provision of immediately necessary or urgent services. Care which is clinically considered non-urgent and can await the overseas visitor's leaving the UK must be paid for in full before it is provided.

[Baht Simpson]

Thank you.

[taxout]

Probably very timely though to note this broad exception:

 

"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

No immigration checks are needed if you only have testing or treatment for coronavirus."

 

https://www.nhs.uk/using-the-nhs/nhs-services/visiting-or-moving-to-england/visitors-from-outside-the-european-economic-area-eea/

[thaibeachlovers]

16 hours ago, theoldgit said:

It's also worth noting that when charges apply, a relevant body must make and recover charges from the person liable to pay for the services provided to the overseas visitor. Since 23 October 2017 relevant bodies are required to recover these charges in full in advance of providing them, unless doing so would prevent or delay the provision of immediately necessary or urgent services. Care which is clinically considered non-urgent and can await the overseas visitor's leaving the UK must be paid for in full before it is provided.

Years ago NZ decided to make everyone pay part of the cost of hospital care/ consultant appointment etc. The cost of collecting the money exceeded the amount collected so they abandoned the project.

 

Re the UK, if every elderly expat returned to live in the UK the cost to the NHS would bankrupt it, IMO. The elderly are the greatest burden on any health service, IMO.

[thaibeachlovers]

PS, when I worked in the NHS some years ago, NHS staff were forbidden to ask patients if they were UK citizens, and actually entitled to care on the taxpayer.

Seems it's OK to penalise UK citizens that chose to live overseas, but not people not entitled to NHS care in the first place.

 

NB, that may have changed since I left the NHS.

[baansgr]

UK health workers and unions have clearly stated they will not act as part of Border Force. Healthcare will not be refused to anyone in UK...returning expat, visitor or even aliens...this may be the ruling but in reality everyone is treated in an emergency without ID or funds.

[theoldgit]

10 hours ago, baansgr said:

UK health workers and unions have clearly stated they will not act as part of Border Force. Healthcare will not be refused to anyone in UK...returning expat, visitor or even aliens...this may be the ruling but in reality everyone is treated in an emergency without ID or funds.

 

Indeed, and the guidance confirms that emergency treatment will continue to be provided to all without charge, it's the ongoing treatment that's chargable.

 

Whilst the health care professionals, doctors and nurses, maintain that it's not their job to collect charges, NHS Trusts are required by law to do so,  many NHS Trusts have specific departments to carry out that role, I suspect they won't adopt the Thai system where patients are wheeled to the cashiers on completion of their treatment, or a member of staff comes to the patients bedside with a credit card swipe terminal.

 

Members will recall that in the UK visiting Expats who where in receipt of a State Pension used to be exempt from NHS charges, it was the Cameron/Clegg coalition government who slipped that change in on the quiet. 

[bert bloggs]

dont tell them you left, problem solved

[stouricks]

22 hours ago, theoldgit said:

it is perfectly possible to be ordinarily resident here from the day of arrival, when it is clear that that person has, upon arrival, taken up settled residence. In each case, it is for the relevant body to decide whether the criteria within the ordinary residence description are met

So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay. What criteria do I need to meet to be allowed in as a settled resident please?

[poohy]

4 minutes ago, stouricks said:

So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay. What criteria do I need to meet to be allowed in as a settled resident please?

I too would be interested as i am planning on an extended visit next year which will entail a hospital visit 

[polpott]

6 hours ago, thaibeachlovers said:

PS, when I worked in the NHS some years ago, NHS staff were forbidden to ask patients if they were UK citizens, and actually entitled to care on the taxpayer.

Seems it's OK to penalise UK citizens that chose to live overseas, but not people not entitled to NHS care in the first place.

 

NB, that may have changed since I left the NHS.

The government has always asked hospital staff to check the status of incoming patients. The various unions/professional bodies always advised their members not to. Thus its rarely, if ever questioned for hospital admissions. Also, if referred by a GP they assume that the GP has made those checks (which they rarely do).

[howerde]

4 hours ago, stouricks said:

So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay. What criteria do I need to meet to be allowed in as a settled resident please?

If you have a british passport why would you tell 'the border' man anything?  they aren't interested and would not even ask, getting to see a GP and getting treatment is all covered in the link theoldgit provided.

[taxout]

"So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay."

 

Automatic gates now -- not just for Britons, but for Americans, Japanese and a few others too. You never face a "Border man." Unless you want to.

[Eff1n2ret]

On 10/16/2020 at 10:59 AM, stouricks said:

So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay. What criteria do I need to meet to be allowed in as a settled resident please?

As others have said, no "Border Man" can deny your Right of Abode as a British Citizen, and you do not have to be "allowed in". If you want to know the criteria a hospital would use, and the questions they would ask to ascertain whether you were genuinely resettling in the UK, I suggest you read the stuff in the links kindly provided by theoldgit. If they decide you've only come back to get treatment and then you're off again, then make sure you have no UK assets that they can pursue in settlement of a hefty bill.

[JusticeGB]

If your only asset is your pension then the NHS can't take money from your pension. If you have an emergency they treat you anyway. If you want cosmetic treatment even UK residents have to pay for it.

[Guderian]

Many expats who worked in the UK all their lives and only moved overseas to retire to a pleasant climate will be paying thousands of pounds a year in income tax on their pension. It seems a bit unfair to be demanding they pay their tithe every year and yet aren't entitled to get anything back in return. If they've been overseas for more than 15 years then they won;t be entitled to Overseas Voter registration either, so we have taxation without representation and also without any reciprocal benefits. Time to chuck something symbolic in the harbour, I'd suggest Matt Hancock, lol.

[mrfill]

2 hours ago, Guderian said:

Many expats who worked in the UK all their lives and only moved overseas to retire to a pleasant climate will be paying thousands of pounds a year in income tax on their pension. It seems a bit unfair to be demanding they pay their tithe every year and yet aren't entitled to get anything back in return. If they've been overseas for more than 15 years then they won;t be entitled to Overseas Voter registration either, so we have taxation without representation and also without any reciprocal benefits. Time to chuck something symbolic in the harbour, I'd suggest Matt Hancock, lol.

You forgot to mention the thousands in tax they avoided by off-setting their pension contributions against tax (often higher rate tax). You also forgot to mention double tax agreements whereby you get to pay no tax on the pension in the resident country, if it is taxed at source. Such is the case with Thailand. Without that agreement, you can end up being taxed twice - at both ends.

[NightSky]

On 10/16/2020 at 4:51 AM, thaibeachlovers said:

Years ago NZ decided to make everyone pay part of the cost of hospital care/ consultant appointment etc. The cost of collecting the money exceeded the amount collected so they abandoned the project.

 

Re the UK, if every elderly expat returned to live in the UK the cost to the NHS would bankrupt it, IMO. The elderly are the greatest burden on any health service, IMO.

I think that smokers and heavy drinkers of all ages are the highest cost to the NHS. 

 

Edited October 19, 2020 by NightSky

[NightSky]

3 minutes ago, mrfill said:

You forgot to mention the thousands in tax they avoided by off-setting their pension contributions against tax (often higher rate tax). You also forgot to mention double tax agreements whereby you get to pay no tax on the pension in the resident country, if it is taxed at source. Such is the case with Thailand. Without that agreement, you can end up being taxed twice - at both ends.

You forgot about national health contributions that funds the nhs which is separate to income tax.

[jesimps]

On 10/16/2020 at 4:55 AM, thaibeachlovers said:

PS, when I worked in the NHS some years ago, NHS staff were forbidden to ask patients if they were UK citizens, and actually entitled to care on the taxpayer.

Seems it's OK to penalise UK citizens that chose to live overseas, but not people not entitled to NHS care in the first place.

 

NB, that may have changed since I left the NHS.

That doesn't surprise me since the border service are actually towing the illegals into dover.

[mrfill]

6 minutes ago, NightSky said:

You forgot about national health contributions that funds the nhs which is separate to income tax.

Which has no bearing on pension taxation as it is not levied on pension payments. Pensioners pay no NI contributions on their pensions.

[NightSky]

18 minutes ago, mrfill said:

Which has no bearing on pension taxation as it is not levied on pension payments. Pensioners pay no NI contributions on their pensions.

They have already paid whilst earning the money to pay into the pension in the first place.

[Eff1n2ret]

2 hours ago, Guderian said:

It seems a bit unfair to be demanding they pay their tithe every year and yet aren't entitled to get anything back in return.

In my mind the iniquitous part of it is the moving of goalposts. Unlike the "frozen pensions" issue, which has been the case for decades, up till April 2016 the NHS rules were that any UK expat citizen drawing the State Retirement Pension was entitled to free in-patient emergency treatment. You couldn't go back there for, say, a hip operation, but I thought that was fair enough, I only wanted the assurance that if I fell ill on a visit to friends and family I would be looked after. All of a sudden that was removed, without any real justification. I wrote to an MP and asked, inter alia, what evidence there was that the previous arrangement had been abused. Judging by the reply he got from a Minister there was no such evidence, in effect they don't really care. 

The list of exclusions in a Thai travel insurance policy, especially for someone in late 70s, is so long it's not worth bothering with. So if (ever!) I visit England again and fall ill my best financial solution might be to die. They can't claim you hadn't returned for settlement if that is your last resting place.

[Bangkok Barry]

On 10/16/2020 at 3:27 PM, howerde said:

On 10/16/2020 at 10:59 AM, stouricks said:

So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay. What criteria do I need to meet to be allowed in as a settled resident please?

If you have a british passport why would you tell 'the border' man anything?  they aren't interested and would not even ask, getting to see a GP and getting treatment is all covered in the link theoldgit provided.

Use the digital gate and you don't speak with anyone at all.

[Bogbrush]

I must say I find it weird; let’s say you’ve lived (as have I) out of the UK for many years. Prior to leaving, you paid NI contributions and latterly bought in, to enable a reasonable pension (£520 pm) to be paid, in my case into Barclays IoM. What is to stop you returning to the UK and going to a doctor, either a GP or hospital? I have my NI number; address? Certainly sir, I live with my brother. Occupation? Sadly, long retired. Haven’t visited a doctor in 25 years? Luckily I’m healthy in body and soul. 
 

What am I missing, that the whole of Eastern Europe and the Indian Subcontinent have got right..?

[Regyai]

Just show then a piece of rubber, tell them its part of the dinghy you paddled in on, shout allah hu akbar and tell them you are only here to stab people...

 

They'll not only treat you medically, but put you up in a four star spa hotel, give you pocket money and day trips to football stadiums

 

[polpott]

47 minutes ago, Bogbrush said:

I must say I find it weird; let’s say you’ve lived (as have I) out of the UK for many years. Prior to leaving, you paid NI contributions and latterly bought in, to enable a reasonable pension (£520 pm) to be paid, in my case into Barclays IoM. What is to stop you returning to the UK and going to a doctor, either a GP or hospital? I have my NI number; address? Certainly sir, I live with my brother. Occupation? Sadly, long retired. Haven’t visited a doctor in 25 years? Luckily I’m healthy in body and soul. 
 

What am I missing, that the whole of Eastern Europe and the Indian Subcontinent have got right..?

Nothing. Exactly what I do if I need treatment in the UK.

[sandyf]

14 hours ago, NightSky said:

They have already paid whilst earning the money to pay into the pension in the first place.

That is not how it works, no one has ever paid into anything. The system works on the basis that those earning today will fund the benefits required today, the idea being that when you require benefits it will be funded by those earning at the time.

Certain factors were not taken into account and circumstances have changed, but unlike a private pension plan they are quite free to change the rules as they see fit.

Currently there is insufficient revenue from the earners to meet the liability and each year about 12% of the income tax revenue is used to prop up the system, that is only going to get worse.

Every chance that NI will be consigned to the history books and the whole issue gets absorbed into general taxation.

[sandyf]

On 10/16/2020 at 8:57 AM, theoldgit said:

 

Indeed, and the guidance confirms that emergency treatment will continue to be provided to all without charge, it's the ongoing treatment that's chargable.

 

Whilst the health care professionals, doctors and nurses, maintain that it's not their job to collect charges, NHS Trusts are required by law to do so,  many NHS Trusts have specific departments to carry out that role, I suspect they won't adopt the Thai system where patients are wheeled to the cashiers on completion of their treatment, or a member of staff comes to the patients bedside with a credit card swipe terminal.

 

Members will recall that in the UK visiting Expats who where in receipt of a State Pension used to be exempt from NHS charges, it was the Cameron/Clegg coalition government who slipped that change in on the quiet. 

The document referred to in general talks mainly about non UK nationals and in the that context this paragraph could be read more than one way.

 

"An "overseas visitor" is any person who is not “ordinarily resident” in the UK. A person will be “ordinarily resident” in the UK when that residence is lawful, adopted voluntary, and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration."

 

All non UK nationals would have paperwork in one form or another indicating the duration of their time in the UK which is very unlikely to be less than 6 months.

For a UK national how short would the duration have to be for them not to be "ordinarily resident" for the time being.

At the end of the day it will come down to an interpretation by those that you have to deal with. Very little interpretation involved when it comes to HMRC collecting tax.

[polpott]

2 hours ago, sandyf said:

At the end of the day it will come down to an interpretation by those that you have to deal with. Very little interpretation involved when it comes to HMRC collecting tax.

If you are a British citizen and a British passport holder, its not open to interpretation, its down to your declaration, just tell anyone who asks (I have never been asked) that your return is permanent. The same day you arrive in the UK, you can register with a GP and avail yourself of the full benefits of the NHS. IME all you need is an address and two proofs of that address. I have always kept a postal address in the UK. I took 2 bank statements from 2 separate banks to my GP, no further questions asked.