UK Residents in Thailand - The harsh truth about the NHS service

[louse1953]

Yes, it's appalling the way elderly ex pats are treated by the UK government. We don't vote so we're a great target when it comes to saving money. We don't get annual pension increases either, but I suppose we're lucky to get anything. Having worked in France for about 8 years, I get part of my pension (300 euro per month) from France along with the increases and for 80 euro per month get the benefit of French social security health cover worldwide.

We in GB regularly knock the French, but at least they look after their own (and people like me as well).

Well you can vote,you know.I am an Ozzy and write to both sides of politics and have a whinge and then vote for the opposition in my area.If the seat changed and i got results i would be happy.If no result,i would vote for the new opposition.and tell them why.Nothing a polly fears more is losing is position on the gravy train and the swinging voter.They rely on complacency and the rusted on voter.No good being in the seat for 20 years,they got their super sized pension by then.3-4 years is enough, then boot em out.Unfortunately my seat has never changed from Labor,and my member is ok,but he wont change the law to suit me unless he gets the fear.

[louse1953]

Just don't talk and don't speak any English. They will think your one of the many <deleted> immigrants that live there for free and will treat you for free.

The lady in questions tax money and NI contributions are probably paying for all the <deleted> immigrants free welfare now.

If people immigrate,they deserve the same rights as everybody else.

[partington]

Tax residence and residence for other purposes are not the same : definitions of tax residence do not define your eligibility for NHS services. NHS services are not contribution based and you don't have to be a resident tax payer to qualify for NHS treatment.

Clearly someone who arrives in the UK and has been there one day is not a resident for tax purposes but evidence of settlement (long term job contract, long term lease and so) still entitles them to NHS treatment from day one, even though they need to be in the UK for 180 days (or whatever it is now) to be a tax resident.

You can't use tax residency status as a test of NHS treatment eligibility, they are two parallel systems.

[louse1953]

In one of the documents in the link it says that the home office and NHS are linked and information shared - your passport number goes into the system and your movements in and out of UK are checked to ensure that you are a resident and entitled to care.

As I read it passport info is only requested if you tell them or they suspect that you live overseas, but they will enter your name, address DOB and get a match if they are not 100% sure that you are resident. In the future, it will be everybody treated, schooled, council taxed, tv licenced, pretty much everything all on one big database. Big brother will catch up with everyone, the cross checks will be (if they are not already) automated and people will be caught out.

Bit of a bugger if you still pay tax on your pension or superannuation. The rule is the same in Australia - we still pay taxes there and are officially resident, but Medicare can refuse us cover if they suspect then prove that we've been out of the country for a certain amount time, not sure how long, we go back once or twice a year to touch base and take care of business but I'm not sure that's enough.

I think it is 4 continuous years.I have been out of Oz for over a year and have been back 4 times this year for 3 ops and now radiation.Bloody expensive,but all free.

[chiang mai]

Tax residence and residence for other purposes are not the same : definitions of tax residence do not define your eligibility for NHS services. NHS services are not contribution based and you don't have to be a resident tax payer to qualify for NHS treatment.

Clearly someone who arrives in the UK and has been there one day is not a resident for tax purposes but evidence of settlement (long term job contract, long term lease and so) still entitles them to NHS treatment from day one, even though they need to be in the UK for 180 days (or whatever it is now) to be a tax resident.

You can't use tax residency status as a test of NHS treatment eligibility, they are two parallel systems.

That is correct but it's worth noting that the requirements for both are strikingly similar, they both look at the same aspects of a life and use similar time frames, a time will come I believe where there is a single test for all benefits, residency and the NHS.

And someone who has been in the UK for only one day can indeed be resident for UK tax purposes, using the split year treatment a returning expat can split his taxation between the old country and the new with the UK portion beginning on the day of arrival.

Edited December 19, 2015 by chiang mai

[Caspersfriend]

An emotive topic always brings about much huffing and puffing; even from those who are unaffected

huff and puff

(informal) to complain noisily about something but not be able to do anything about it

For those who fancy a nostalgic reflection of the birth of the Welfare State and the NHS

http://www.bbc.co.uk/archive/nhs/5139.shtml

[Mobi]

MOBI,

you're so naive, I wonder if you can find the bathroom.

The real tax 'cheats' are the global corps & fat rats operating in the UK , but avoiding ALL taxation by 'offshoring'. The Con gov looks on them with forgiving & indulgent eyes, since they are all part of the same billionaire's club. It is the Aristocratic Mafia, & QE2 is Top Don.

'Offshoring' is legal, since it is done by the extremely rich. Ordinary expat Brits trying to use the NHS are 'cheats'. Crooks come from all over the world to stash their loot in the bankers' thieves kitchen, The City of London; for this very reason - they can avoid paying billions in taxes.

I don't know about being naive, but I certainly must be very dim.

You have completely lost me. I fail to see what global tax cheats have to do with the rules governing free - or otherwise treatment - on the UK National Health service by Brits living in Thailand.

Either you or I have lost the plot, and I don't think it's me.

If you want to rail against the:

"real tax 'cheats' are the global corps & fat rats operating in the UK , but avoiding ALL taxation by 'offshoring'. The Con gov looks on them with forgiving & indulgent eyes, since they are all part of the same billionaire's club. It is the Aristocratic Mafia, & QE2 is Top Don."

and so on… I respectfully suggest you start your own thread. Clearly you feel very strongly about them.

If I had the time and inclination I would refer you to the government report I read. It is available online if you know where to look and it is very illuminating.

The rules are the rules and the penalties are the penalties… regardless of what other rules are broken or avoided by billionaires. I reiterate - there are plenty of benefit cheats languishing in British jails and I don't want to join them anytime soon.

Let's get back to the NHS please....

[i claudius]

Mobi

check the statistics ,you have to be a very large benifit cheat to end up in prison , in fact these days short of rape and multiple murders its hard to get prison time , very few cheats are even actually prosecuted , someone i know spent a year tooing and froing about how much to pay back per week , and for fraud you go to Butlins ,oh sorry open prison , where it is about as good as Butlins or some would say even better .

[lungbing]

Just don't talk and don't speak any English. They will think your one of the many <deleted> immigrants that live there for free and will treat you for free.

The lady in questions tax money and NI contributions are probably paying for all the <deleted> immigrants free welfare now.

If people immigrate,they deserve the same rights as everybody else.

Having lived here more than 15 years I'll tell that to the Thai hospital when I next need to go.

[emilymat]

A long, interesting and at times,complex thread.

The way I look at it, as a(so far) healthy 74 year old is this.

1. Some people (not on this thread by the way) say I am irresponsible for not having medical insurance in Thailand. It's not that simple as I have tried dozens of ways with numerous quotes.. Essentially it would cost me about 500 pounds per month - a third of my income. So, I could get some form of insurance but then would find it difficult to live here. Catch 22.

2. It is said the NHS is the second largest employer in the world (after the Indian railways). This is slightly misleading as the NHS probably only directly employs a few thousand people. The vast majority of 'NHS' workers are employed directly by NHS Trusts, Sure, these autonomous trusts have to follow guild lines and instructions from the centre, but local implementation is down to the individual organisations and there certainly will not be a 100% common approach.

3. Unless you are a 'shifty' character or clearly a non English speaking foreigner, and you have an address, a NHS number and registered at a local GP practice, then why would the staff in the NHS Trust query your eligibility?. My daughter is a manager in the NHS and has told me they are aware of the need to make checks - where they consider it appropriate, based on 'concerns' about an individuals rights to be treated on a no cost basis. But they are also concerned about allegations of harassment if there was no justification. Suing the NHS for various reasons is a national pastime and there has to be a balance between recovery of costs from a patient against the substantial cost of successful litigation against the Trust.

4. The BMA and other health unions have always made it clear to government that they cannot support the principle of medical staff and doctors acting as an extension to the border agency functions.

So, whilst there have been many well informed and detailed posts on the thread, I'm not going to let it get me paranoid. I'm sure if I go back to the UK next year for a few weeks and fall ill, I will be able to access the NHS services. Mind you, the last time I went back to watch England in the football world cup I was poorly and the European championships next year may have the same effect!.

[Mobi]

Mobi

check the statistics ,you have to be a very large benifit cheat to end up in prison , in fact these days short of rape and multiple murders its hard to get prison time , very few cheats are even actually prosecuted , someone i know spent a year tooing and froing about how much to pay back per week , and for fraud you go to Butlins ,oh sorry open prison , where it is about as good as Butlins or some would say even better .

Butlins eh? that brings back some happy memories...and anyway, I would be in the special needs wing for pensioners, with my own nurse to give me blanket baths. A bit like Kaman Poh.

Yeah, I guess you're right about HM prisons. I was exaggerating for effect.....

If you're broke you have little to worry about, but what if you're not? What bothers me that I tell them I'm broke and they might find out I have some cash stashed away in an offshore bank account!

Worst case scenario - the NHS fees for a major operation are still way less than I might pay at a top Thai hospital, and I probably stand a better chance of survival.

I had my heart valve replaced at a Thai government hospital whose charges were probably on a par with NHS rates. The op was excellent, but the follow-up service was appalling. I nearly died a couple of months later....

It's the UK for me next time - assuming I can make it there.

[Jip99]

Just don't talk and don't speak any English. They will think your one of the many <deleted> immigrants that live there for free and will treat you for free.

The lady in questions tax money and NI contributions are probably paying for all the <deleted> immigrants free welfare now.

If people immigrate,they deserve the same rights as everybody else.

You can't be serious ?

[chiang mai]

A long, interesting and at times,complex thread.

The way I look at it, as a(so far) healthy 74 year old is this.

1. Some people (not on this thread by the way) say I am irresponsible for not having medical insurance in Thailand. It's not that simple as I have tried dozens of ways with numerous quotes.. Essentially it would cost me about 500 pounds per month - a third of my income. So, I could get some form of insurance but then would find it difficult to live here. Catch 22.

2. It is said the NHS is the second largest employer in the world (after the Indian railways). This is slightly misleading as the NHS probably only directly employs a few thousand people. The vast majority of 'NHS' workers are employed directly by NHS Trusts, Sure, these autonomous trusts have to follow guild lines and instructions from the centre, but local implementation is down to the individual organisations and there certainly will not be a 100% common approach.

3. Unless you are a 'shifty' character or clearly a non English speaking foreigner, and you have an address, a NHS number and registered at a local GP practice, then why would the staff in the NHS Trust query your eligibility?. My daughter is a manager in the NHS and has told me they are aware of the need to make checks - where they consider it appropriate, based on 'concerns' about an individuals rights to be treated on a no cost basis. But they are also concerned about allegations of harassment if there was no justification. Suing the NHS for various reasons is a national pastime and there has to be a balance between recovery of costs from a patient against the substantial cost of successful litigation against the Trust.

4. The BMA and other health unions have always made it clear to government that they cannot support the principle of medical staff and doctors acting as an extension to the border agency functions.

So, whilst there have been many well informed and detailed posts on the thread, I'm not going to let it get me paranoid. I'm sure if I go back to the UK next year for a few weeks and fall ill, I will be able to access the NHS services. Mind you, the last time I went back to watch England in the football world cup I was poorly and the European championships next year may have the same effect!.

An excellent post.

[Konini]

Different trusts in different parts of the country, experiences will vary I suppose. It would be interesting to try and understand which trusts are proactive on this issue and which are not, my guess is that the ones sited in areas with high levels of immigrants probably are.

They are all supposed to, but if I turned up with my (still) broad northern accent, they would have no reason to think that I don't live in UK. If English is my second language and I have an accent, it is much more likely that they will check up on me, but as it stands unless I bring attention to myself they have no reason to ask me if I am entitled to services.

[Konini]

Bit of a bugger if you still pay tax on your pension or superannuation. The rule is the same in Australia - we still pay taxes there and are officially resident, but Medicare can refuse us cover if they suspect then prove that we've been out of the country for a certain amount time, not sure how long, we go back once or twice a year to touch base and take care of business but I'm not sure that's enough.

I think it is 4 continuous years.I have been out of Oz for over a year and have been back 4 times this year for 3 ops and now radiation.Bloody expensive,but all free.

Sorry to hear about your condition, I sincerely hope that you make a full recovery.

It's changed, and only 6 months now, but as with UK they have no reason to question where you live unless you bring attention to yourself. Also, anyone on a disability pension is only allowed to be out of the country for 3 months; I know a couple of people who make very regular trips back home to make sure they don't lose their pension. Aged pension isn't included in this.

When we first started travelling around, I thought that as we were still paying tax we would be entitled to Medicare and we were using it as a last resort in case one of us got ill or needed intense care; I even kept up our private health insurance for Aus and worldwide travel insurance for outside Aus. I paid this for 3 years after leaving Aus before finding out that we weren't entitled to Medicare and wouldn't be entitled to insurance as we weren't resident. It really is unfair because we both pay tax as well as our super fund.

But we are getting off the subject which is UK NHS entitlement.

[chiang mai]

Different trusts in different parts of the country, experiences will vary I suppose. It would be interesting to try and understand which trusts are proactive on this issue and which are not, my guess is that the ones sited in areas with high levels of immigrants probably are.

They are all supposed to, but if I turned up with my (still) broad northern accent, they would have no reason to think that I don't live in UK. If English is my second language and I have an accent, it is much more likely that they will check up on me, but as it stands unless I bring attention to myself they have no reason to ask me if I am entitled to services.

I'm not sure who you're trying to reassure here, you or me! But let's start with a conspicuous tan no utility bills, no record on electoral roles and an address that's likely to be a B&B or similar. If I was the person doing the checking those things might cause me to pause for a moment, but maybe that's just me.

[emilymat]

Different trusts in different parts of the country, experiences will vary I suppose. It would be interesting to try and understand which trusts are proactive on this issue and which are not, my guess is that the ones sited in areas with high levels of immigrants probably are.

They are all supposed to, but if I turned up with my (still) broad northern accent, they would have no reason to think that I don't live in UK. If English is my second language and I have an accent, it is much more likely that they will check up on me, but as it stands unless I bring attention to myself they have no reason to ask me if I am entitled to services.

Absolutely. My last comment.

If you turned up at the A and E queue in, say, Bradford - where I believe from newspapers that some older members of extended families of immigrants, speak little or no English, but are legal 'residents' how on earth and why would the admissions staff pick out someone like you for interrogation?. Unless it's your sun tan!.

No offence to Bradford, it's just the first multi cultural city that sprang to mind.

[sandyf]

Tax residence and residence for other purposes are not the same : definitions of tax residence do not define your eligibility for NHS services. NHS services are not contribution based and you don't have to be a resident tax payer to qualify for NHS treatment.

The NHS is funded from general taxation and NI contributions, so effectively they can take your NI contributions and income tax and deny anything in return.

At least Dick Turpin had a mask.

[Konini]

Different trusts in different parts of the country, experiences will vary I suppose. It would be interesting to try and understand which trusts are proactive on this issue and which are not, my guess is that the ones sited in areas with high levels of immigrants probably are.

They are all supposed to, but if I turned up with my (still) broad northern accent, they would have no reason to think that I don't live in UK. If English is my second language and I have an accent, it is much more likely that they will check up on me, but as it stands unless I bring attention to myself they have no reason to ask me if I am entitled to services.

I'm not sure who you're trying to reassure here, you or me! But let's start with a conspicuous tan no utility bills, no record on electoral roles and an address that's likely to be a B&B or similar. If I was the person doing the checking those things might cause me to pause for a moment, but maybe that's just me.

No sun tan, lived in Australia long enough to be brainwashed; sun = bad. But yes, in those circumstances I would be knocked back, but my point was why would I be chosen for checking? Local accent, look the same as everybody else, not acting suspiciously or boasting about living in the best city in the world. They would have no reason to check me unless they were checking everybody - that is something that would take a fair bit of time, and nobody likes their own personal workload to increase, so I imagine the clerk booking you in isn't going to check very thoroughly because he/she doesn't want to do the extra work that has been dumped on them without a pay rise. Utility bills etc are only necessary for those proving that they are entitled to use NHS such as expats who have returned in the very ambiguous words used 'to settle for the time being'.

I am baffled as to why those particular words were used; it seems to give a get out clause, the time being could be the foreseeable future or for the next 2 weeks or even the next 2 hours. It really isn't like the government to leave things so obviously open to interpretation like this, I've been hunting for a reason 'the time being' was used rather than permanently, but haven't found anything plausible yet.

[chiang mai]

Different trusts in different parts of the country, experiences will vary I suppose. It would be interesting to try and understand which trusts are proactive on this issue and which are not, my guess is that the ones sited in areas with high levels of immigrants probably are.

They are all supposed to, but if I turned up with my (still) broad northern accent, they would have no reason to think that I don't live in UK. If English is my second language and I have an accent, it is much more likely that they will check up on me, but as it stands unless I bring attention to myself they have no reason to ask me if I am entitled to services.

I'm not sure who you're trying to reassure here, you or me! But let's start with a conspicuous tan no utility bills, no record on electoral roles and an address that's likely to be a B&B or similar. If I was the person doing the checking those things might cause me to pause for a moment, but maybe that's just me.

No sun tan, lived in Australia long enough to be brainwashed; sun = bad. But yes, in those circumstances I would be knocked back, but my point was why would I be chosen for checking? Local accent, look the same as everybody else, not acting suspiciously or boasting about living in the best city in the world. They would have no reason to check me unless they were checking everybody - that is something that would take a fair bit of time, and nobody likes their own personal workload to increase, so I imagine the clerk booking you in isn't going to check very thoroughly because he/she doesn't want to do the extra work that has been dumped on them without a pay rise. Utility bills etc are only necessary for those proving that they are entitled to use NHS such as expats who have returned in the very ambiguous words used 'to settle for the time being'.

I am baffled as to why those particular words were used; it seems to give a get out clause, the time being could be the foreseeable future or for the next 2 weeks or even the next 2 hours. It really isn't like the government to leave things so obviously open to interpretation like this, I've been hunting for a reason 'the time being' was used rather than permanently, but haven't found anything plausible yet.

I don't know how the whole system works any more because I haven't used NHS for so long but I know that records are now computerized and centralized. When you go to a hospital/doctor, most seem to want to look at your records/history, my records on the NHS system show that I haven't been seen by a UK GP in over eight years, whereas prior to that I was seen at least yearly. That kind of time gap might typically cause the thinking hospital employee to pause, think and ask a question I reckon.

[Caspersfriend]

Most who decide to go back to the UK for NHS treatment have very significant, if not major, health issues. In some areas the NHS has improved [a bit] in recent years in the time period it takes to get seen by a specialist and scheduled for treatment; surgery being the most likely common reason for going to the trouble and expense of a trip back. However, and assuming it's not an A&E problem. I doubt there are many [if any] health authority areas in the UK where you can get an operation within a trip back home to see the family. By the time you have seen a GP, been referred to a specialist, seen the specialist, been scheduled for treatment and arrived in hospital for that treatment to be carried out, you will likely have exceeded the period required to prove residency. Just sayin'

[alfieconn]

Most who decide to go back to the UK for NHS treatment have very significant, if not major, health issues. In some areas the NHS has improved [a bit] in recent years in the time period it takes to get seen by a specialist and scheduled for treatment; surgery being the most likely common reason for going to the trouble and expense of a trip back. However, and assuming it's not an A&E problem. I doubt there are many [if any] health authority areas in the UK where you can get an operation within a trip back home to see the family. By the time you have seen a GP, been referred to a specialist, seen the specialist, been scheduled for treatment and arrived in hospital for that treatment to be carried out, you will likely have exceeded the period required to prove residency. Just sayin'

If not already dead

[harrry]

And after all that with the NHS you could end upon the Liverpool Pathway.

[chiang mai]

...or the Ealing bypass.

[Mobi]

It's quite amazing that this thread has attracted 174 posts and 5,850 views in only two days. I wish I could get that number of views on my blog....

It clearly demonstrates the depth of feeling that Brits living in LOS have for the olde country.... most of it very bad - which I guess makes sense or they wouldn't be living out here.

I feel quite ambivalent about the situation. I spent many years overseas when I was younger, including 8 years in Thailand before returning to the UK and staying there for 17 years. When I left Thailand, they all told me I'd be back within a year, but after a sticky start, I settled down very well and made my fortune. I only left again after retirement and after divorce. I enjoyed my 17 years in England - it is a beautiful country with a great culture and great people - if you know where to go and who to meet.

I've been going back every year for the past five years, and stay with various members of my family who are scattered around the country and I have a wonderful time, as does my Thai wife. We always get out and about and there is so much to do and see. If you look at all the pics I post on my blog you will see what I mean.

I understand and reluctantly accept the situation with non-residents not being given pension increases and having our rights to free NHI treatment being severely curtailed. I think its sad, but there's nothing I can do about it and I'll just play the system as best as I can. I don't bear any bitterness or resentment - there's no point - It'll just eat you up. Trust me, it's never going to improve - it can only get worse. That's the way the world is these days.

My purpose in starting this thread was to draw attention to those of you who were totally oblivious of recent changes and who thought that if they get ill, they can just jump on a plane to London and all will be well. There is no better illustration than an actual event - as per the poor lady with the £5K bill.

If I have informed a single person who was previously unaware of all this, then my job is done.

Take care everyone, and keep well.

Mobi

[chiang mai]

+1, I try to do the same so that people are aware, but it's a very emotive issue and many people refuse to accept the changes initially.

The psychology of it all is interesting, I think most people, if they really thought about it, know they probably wouldn't be able to make it to the UK in an emergency, but the idea of losing something that we always had access to and took for granted is quite a blow for many, it makes us second class UK citizens in many respects, especially when you combine this issue with frozen pension, credit card and bank account access, loss of onshore IFA access and so on.

What can be said, it's what it is and we're here so why worry about it all, better perhaps to put energies into enjoying life.

[roo860]

Lucky for me I've never been outside the EU.

Wonder how they found out she had been living in the USA?

Probably told them what "awesome" health care they have there "dude".

[roo860]

Lucky for me I've never been outside the EU.

Wonder how they found out she had been living in the USA?

NB : it is all based on examining PASSPORTS. You now have to present them for hospital procedures in the UK - i have done this recently. So it's simple - ah madam you landed in the US in 2010 (for example) and your passport shows no returns to the UK until now (2015), and only short trips to (say) Mexico and Canada in the intervening 5 years. Conclusion : you live in the US !

If you don't have one?

[chiang mai]

Lucky for me I've never been outside the EU.

Wonder how they found out she had been living in the USA?

NB : it is all based on examining PASSPORTS. You now have to present them for hospital procedures in the UK - i have done this recently. So it's simple - ah madam you landed in the US in 2010 (for example) and your passport shows no returns to the UK until now (2015), and only short trips to (say) Mexico and Canada in the intervening 5 years. Conclusion : you live in the US !

If you don't have one?

Electoral roll entry, utility bill, rent receipt, active bank account (with history), doctors visits (on NHS system) and so on.

[Mobi]

+1, I try to do the same so that people are aware, but it's a very emotive issue and many people refuse to accept the changes initially.

The psychology of it all is interesting, I think most people, if they really thought about it, know they probably wouldn't be able to make it to the UK in an emergency, but the idea of losing something that we always had access to and took for granted is quite a blow for many, it makes us second class UK citizens in many respects, especially when you combine this issue with frozen pension, credit card and bank account access, loss of onshore IFA access and so on.

What can be said, it's what it is and we're here so why worry about it all, better perhaps to put energies into enjoying life.TYhe lowest blow

The lowest blow for me was receiving an email from The National Lottery a few years back telling me that if I wasn't in the UK, I couldn't play.

I used to give them 3 quid a week by direct transfer, and actually won a few bob a couple of times....

ah well, I can't even be init to winit anymore....

Then as if to rub it in, on a trip to the UK this year my wife played once and won about 300 quid!

There's no justice!

Edited December 20, 2015 by Mobi