1. Access to Healthcare & Charges to Overseas Visitors “…no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.” Aneurin Bevan, 1952 “…This is not just about making the UK a more hostile place for illegal migrants; it is also about fairness.” Theresa May, 2013

2. Some important distinctions England Charges to overseas visitors today What’s not in the Immigration Act 2014 NHS charges to overseas visitors Undocumented migrants and visitors What’s supposed to happen The rest of the UK Charges to overseas visitors in future What’s in the Immigration Act 2014 The surcharge Other temporary migrants What does happen

3. Some important questions Who must pay the surcharge & who cannot? Who is liable to NHS charges & who is not? Which NHS services are chargeable & which are not? What treatment should be provided regardless of ability to pay a charge? What are the consequences of unpaid charges?

4. The surcharge Only for migrants coming to or staying in the UK lawfully for six months or more (students, workers, family members not visitors) Payment in full at time of immigration application for each year of intended stay Provides full access to NHS on same basis as resident British citizens Students £150 per year/ Others £200 per year

5. NHS charges to overseas visitors: who is liable? Now Asylum-seekers Refugees Refused asylum-seekers Victims of trafficking Pregnant women Children Detainees Other undocumented migrants Visitors Other lawful migrants Permanent residents In future Asylum-seekers Refugees Refused asylum-seekers Victims of trafficking Pregnant women Children Detainees Other undocumented migrants Visitors Other lawful migrants Permanent residents

6. NHS charges to overseas visitors for which services? Now GP services Mental health services Family planning Maternity care (hospital) Child immunisation Communicable diseases & sexually transmitted infections Accident & Emergency Urgent and necessary treatment Other hospital treatment Dentistry, Optics & Pharmacy In future GP services Mental health services Family planning Maternity care (hospital) Child immunisation Communicable diseases & sexually transmitted infections Accident & Emergency Urgent and necessary treatment Other hospital treatment Dentistry, Optics & Pharmacy

7. Surveys among service users at MdM clinics across Europe in 2012 43.5% in UK have not previously tried to access healthcare 4.4% report having no difficulties accessing healthcare in the UK 42.0% experience administrative barriers in the UK 14.5% have been denied access to healthcare in the UK 19.5% have not tried for fear of being arrested or reported 3.4% have not accessed healthcare because of cost Service users in UK have on average been in the country for 3+ years before trying to access healthcare Compares to 40.6% in Belgium and 3.4% in France (av. 15.5%) Compares to 41.4% in Holland and 2.6% in France (av. 7.6%) Compares to 33.3% in Spain and 10.1% in Greece (av. 19.9%) Compares to 43.8% in Spain and 0.0% in France (av. 9.2%) Compares to 4.4% in Greece and 0.3% in Belgium (av. 2.9%) Compares to 30.5% in Germany and 0.0% in France (av. 1.3%) 1.6% undocumented service users across Europe cite health reasons as a factor in their migration

8. Timetable for change Department of Health timetable Nov 2013 – begin “intensive focus on improving the current system of… cost recovery” Mar 2014 – publish implementation plan & impact assessment Apr 2014 – test then introduce “better NHS registration system” Autumn 2014 – amend Charges to Overseas Visitors Regulations Autumn 2014 – introduce surcharge April 2015 – extend NHS charging in A&E and primary care Progress to date ??? Outstanding ???