On 2nd November 2017 the Bishop of Durham, Rt Revd Paul Butler, received a written answer to a question about the impact of changes to NHS charging on refused asylum seekers, trafficking victims, the homeless and those with mental health problems:
The Lord Bishop of Durham: To ask Her Majesty’s Government what is their assessment of the impact of changes to NHS charging regulations on refused asylum seekers and other vulnerable groups, including (1) victims of trafficking, (2) homeless people, and (3) those living with mental health conditions.
Lord O’Shaughnessy: Entitlement to free National Health Service care is largely based on being ordinarily resident in the United Kingdom, or being otherwise exempt from charges under the NHS (Charges to Overseas Visitors) Regulations 2015 (the Charging Regulations). Being ordinarily resident broadly means living here on a lawful and properly settled basis. A person can be ordinarily resident without having a fixed address.
Following a detailed public consultation, the Government set out in its response, Making a fair contribution: Government response to the consultation on the extension of charging overseas visitors and migrants using the NHS in England, that it intended to amend the existing Charging Regulations to ensure, amongst other things, that chargeable overseas visitors make a fair contribution towards the cost of NHS care they use regardless of the setting in which it is provided.
Some providers of NHS-funded care were not included in the previous Charging Regulations so could not apply a charge to overseas visitors, whilst in some circumstances care that would be chargeable if provided to an overseas visitor at a hospital would not be chargeable if it was provided in a non-hospital setting. Consistent with its existing published guidance, the Government also set out in its response its intention to require upfront charging in respect of non-urgent treatment. A copy of Making a fair contribution is attached.
However, some services remain free to all, including primary medical services, the diagnosis and treatment of infectious diseases, and accident and emergency services until admission to hospital as an inpatient. Also, some groups of vulnerable overseas visitors remain exempt from charge for all their treatment, including victims, and suspected victims, of modern slavery and human trafficking, asylum seekers and refused asylum seekers receiving specified packages of state support, and those liable to be detained under the Mental Health Act 1983 or deprived of their liberty under the Mental Capacity Act 2005.
During the decision-making process, the Government carefully considered the impact of the proposed changes on vulnerable groups. Further, the Government will review the impact of upfront charging and extending charges to out of hospital care and care provided by non-NHS organisations. This work will help ensure that the policies are working as intended.