Community, Diaspora and Immigration
Visitors to the UK: Who can get free treatment and who can’t
The rules about who can and who can’t get free treatment on the National Health Service (NHS) are complex, and often change. It sometimes happens that hospital officials wrongly tell people that they can’t get treatment. The following information was compiled by sexual health charity Terrence Higgins Trust (THT) to help inform overseas visitors, including asylum seekers and people living with HIV.
The NHS is free to anyone who is ‘ordinarily resident’, i.e. living legally in the UK. Those who are not ordinarily resident in the country can be charged for some NHS services, including HIV treatment. However, many migrants do not have to pay if they meet certain criteria.
Who gets free NHS treatment?
- You will get free NHS treatment for any medical problem if you are in the following categories:
- You have been lawfully living in the UK for the last 12 months before treatment
- You are a refugee, or an asylum seeker with a current application ongoing including appeals
- You are an asylum seeker whose claim has been refused, but you are currently receiving support under either Section 4 or Section 95 of the Immigration and Asylum Act 1999
- You are living and working in the UK on a valid visa
- You are studying full-time in the UK on a course lasting at least six months and have a valid visa
- You have taken up permanent residence in the UK
- You are a member of the UK armed forces
- You are in prison, or in immigration detention
- You are from one of the countries with a bilateral healthcare agreement with the UK, and your condition arose or was diagnosed after you arrived (the full list of eligible countries is included in the charging regulations)
All asylum seekers are entitled to the following services free of charge, regardless of their status:
- HIV testing
- All primary healthcare services, including primary dental and ophthalmic (eye) services
- Counseling, emotional and peer support.
Please note that even if you are in one of these categories, you may still be asked questions by the hospital to establish that you have access to free NHS treatment.
- And who may be asked to pay?
- You may be charged for HIV treatment if you are in the following categories:
- You are undocumented (entered the country without proper papers or permission)
- Your asylum claim has been refused and you are not are currently receiving either Section 4 or Section 95 support
- You are here on a visitor visa
- You have overstayed any kind of visa
- You have a British passport but do not usually live in the UK
If you are in a category that is not covered above, you can get further advice from THT Direct on 0808 8021221 (freephone, including on most mobile networks).
If I have a sexually transmitted infection (STI), will I have to pay?
For most STIs, services are free on the NHS. This includes both tests and any treatment. For HIV, however, the situation is different. The HIV test is free, but you may be charged for any other HIV treatment and hospital care if you do not meet the criteria for free treatment.
What if I cannot pay for HIV treatment?
If you need any treatment for a life-threatening condition, or to prevent a condition from becoming life-threatening, you should not be refused. This is called ‘immediately necessary treatment’. The decision is officially up to the doctor, but this means that if you have HIV, you should be able to use NHS treatment for HIV regardless of your ability to pay.
Anyone who is completely refused HIV or maternity treatment because they cannot pay should contact THT Direct or a local HIV support service immediately and get help in explaining to the hospital that they have made a bad decision. It is very important if you have HIV that you get proper care. Remember, with modern treatments people can stay well for decades, but the treatments may not work if you start on them too late, or if they are interrupted.
What happens if I am asked to pay?
If staff at the hospital think you may be liable for charges, you will be interviewed by an administrator. In some hospitals this is a dedicated Overseas Visitors Manager. If you feel they have made the wrong decision about whether you are liable to pay, you should get help immediately from a local HIV support organisation, or from THT Direct. Sometimes, wrong decisions have been made and they can get them changed. If you are chargeable, then after you begin your treatment you will start to receive bills.
What happens if I get treatment, but cannot pay the bills?
It’s extremely important that you tell the hospital honestly that you will have trouble paying as soon as you are told you must pay or you get the first bill. Hospitals have the ability to write off debt if they realise that someone simply cannot pay (for example, if they have no right to work and thus no income). If you are working, but not earning very much, they may settle for a ‘token’ amount of a few pounds a month. But if you ignore the bills and do not talk to the hospital, they are much more likely to hand the debt over to debt collectors who will pursue you for the debt and who are much harder to deter.
What happens if my residency status changes?
If your visa expires or your asylum claim is refused and you are already getting free NHS care for HIV, or any other condition, you still have a right while in the UK to continue to get treatment free of charge. NHS staff sometimes misunderstand this rule, but the Government has recently released new guidance making it clear. Call THT Direct or a local HIV support organisation for assistance if you have difficulties.
Will my details be passed to immigration authorities?
This should not happen — the NHS is supposed to treat you in confidence. Sometimes, if you say you are an asylum seeker or otherwise here legally, but cannot provide proof, the hospital may ask you if they can contact the Home Office to get proof that you should not pay. You can refuse to let them do that, but if you refuse and cannot provide any proof that you are in one of the categories entitled to free treatment, the hospital may charge you anyway. If anyone threatens to pass your details to anyone outside the NHS without your permission, get advice immediately from THT Direct or your local support agency.
If you want to read the NHS charging regulations in full, you can find them
For general sexual health information, please visit www.mambo.org.uk or www.tht.org.uk