NHS Services and Foreign Nationals in the UK: How to Proceed if Faced With a Serious Injury
(First printed in Brain Injury News, Autumn 2016.)
Suffering a traumatic brain injury, or any serious injury, is stressful enough. But when the injury happens away from home it can be even harder to cope with. [This article] looks at some of the key issues facing foreign nationals who suffer a serious injury whilst visiting or living in the UK.
An estimated 36.1 million foreign visits to the UK took place in 2015. Given that volume, it’s inevitable that a very small minority of people will suffer a serious injury that requires urgent healthcare. In addition, the number of foreign workers in the UK has risen significantly in recent years, with the Office of National Statistics recently reporting that the number of EU and non-EU workers was in excess of 3.45 million.
For any injured person the priority is, of course, prompt emergency care. Accident and emergency treatment in the UK is free to all, but once a person is admitted to hospital and needs continuing care, they are not automatically entitled to free healthcare.
The EEA consists of the EU countries plus Norway, Iceland and Liechtenstein. The regulations relating to healthcare also apply to Switzerland. Visitors from these countries are strongly advised to get a European Health Insurance Card (EHIC) before travelling and this is issued by their home country. An EHIC entitles a visitor to free necessary treatment during the course of their stay, but it is no substitute for travel insurance. Importantly, it will not provide cover for repatriation costs to their home country, which is usually a priority for a seriously injured person abroad. Without an EHIC,visitors from the EEA may be charged for their treatment.
Visitors from outside the EEA
The basic rule is that people from outside the EEA are responsible for paying for NHS treatment – and that includes former UK residents. Even worse still for the injured person, the charge will be 1.5 times the usual NHS rate. So any visitor must ensure they have sufficient insurance to cover the period of their visit.
Usually payment is requested before treatment starts. If that’s not possible, an undertaking is provided that payment will be made when the visitor is in a position to do so. For someone with a brain injury, for example, they may well be simply unable to deal with financial issues; they might be entirely reliant on family, friends, clinicians and possibly advice services for support and guidance.
Although emergency services are provided to all free of charge, once the condition has stabilised there is an expectation that healthcare will be paid for, either by the injured person or their insurers. People suffering a traumatic brain injury will often require long-term multi-disciplinary therapy, and substantial costs can mount up quickly. The ability to pay these costs will influence where the injured person receives any on-going care.
Reciprocal healthcare arrangements
Some non-EEA countries have an agreement with the UK that allows for certain treatment to be provided free of charge. These include Australia, New Zealand, Bosnia and Herzegovina, Macedonia, Serbia and Montenegro. The extent of treatment covered varies and in most cases it is limited to immediate medical treatment only, with the expectation that the visitor will return home for any continuing needs.
Foreign workers and people living in the UK
Access to healthcare on the NHS depends on a broad test of residency based on whether a person is ordinarily living and lawfully settled in the UK. Those from outside the EEA must also be able to demonstrate that they are entitled to live in the UK indefinitely. If someone meets the definition, they are entitled to receive free NHS hospital treatment.
The relevant NHS body is responsible for deciding if an injured person is a lawful resident. If they are not, they would be charged for treatment. If the injured person’s nationality is unknown or immigration documents cannot be produced, the NHS body will have to get advice from the Home Office.
Difficulties can then arise when a person is not eligible for free healthcare, perhaps because they are an unlawful resident, and they owe money to the NHS that they cannot afford to pay. Failure to pay these charges can adversely affect any immigration application to remain in the UK, and information that is unrelated to healthcare can be shared with the Home Office for this purpose.
Since April 2015, those from a non-EEA country who have applied for a visa to stay in the UK for more than 6 months (including overseas students, for example) must pay an immigration health charge. It is also now mandatory when making an immigration application and entitles the holder to free healthcare for the duration of their visa.
Since April 2016, an NHS body must notify the Home Office of a debt of £500 or more that has been outstanding for over two months. Generally speaking though, NHS bodies are willing to consider a repayment plan, particularly where the patient has been cooperative.
However the NHS body is legally obliged to identify people who are not entitled to free treatment and to recover the charges.
Considering the bigger picture
Most people who have a serious injury abroad, instinctively want to return to the familiarity and sense of security of their home country. Those with travel insurance will usually have cover to pay repatriation costs including the provision of an Air Ambulance or a flight home, together with the care and medical support needed for the journey. Those who are uninsured will be left facing a substantial bill. The NHS will, on occasion, financially support the repatriation of a foreign national who has long term care and rehabilitation needs, where it is more cost-effective to pay for their return home instead of their long-term care needs.
By appreciating cultural differences healthcare providers are able to build greater trust between the clinician, the patient and their family. This is particularly relevant when a foreignnational requires care on the NHS, and is even more important when there has been a brain injury as the injured person may not be able to fully express their views or may be behaving differently to their pre-trauma personality.
Cultural background needs to be taken into account, particularly when considering attitudes towards invasive surgery, prescribing medicine, dress and personal hygiene, family structure and respectful communication. A professional interpreter may be helpful, especially as family members may already be under huge stress.
Personal injury claims
A claim may provide the injured person from overseas with funding for the support and rehabilitation they need, as well as repatriation. But it can take many months for a payment to be made and by this time, they may have returned home. The injured person will need to instruct a specialist solicitor to manage the claim.
Impaired mental capacity
When someone has had a significant brain injury their mental capacity and ability to manage their own affairs may be impaired. A UK lawyer can advise on whether a deputy should be appointed to deal with property issues, financial affairs and, in some cases, personal welfare. Advice may also be needed from a lawyer in their home country if the injured person returns to their place of birth – particularly when financial compensation is involved.
Contact our brain and serious injury lawyers for claims advice
Simon Pimlott has spent nearly 20 years representing clients who have suffered serious and life-changing injuries. An experienced litigator and advocate, he regularly deals with complex high value disputes and has represented clients who have suffered injuries at home and overseas. For advice on making a NHS medical negligence claim please contact our personal injury compensation solicitors in confidence on 01895 207835. Alternatively, email us at PI@ibblaw.co.uk.
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