British doctors working overseas with mission agencies, humanitarian organisations and development charities may soon be required to pay 150% of the normal cost of any secondary health care they receive from the NHS. The new NHS (Charges to Overseas Visitors) Regulations 2015 will come into force on 6 April 2015, as part of an attempt to recoup £500 million a year by 2017 to 2018. The regulations are being changed so that the NHS does not lose out on income from ‘migrants, visitors and former residents of the UK’ – hardly a description that fits missionaries, volunteers and charitable workers.
Up until now, missionaries have been exempt from NHS charges when home on leave. Global Connections and Interhealth have campaigned to maintain this and also extend it to other humanitarian and development workers, but from April onwards the exemption will be removed altogether. The only criterion determining access to NHS treatment will be whether a person is ‘ordinarily resident’ in the UK. The definition of ordinary residence is open to some interpretation and will be decided on a case-by-case basis by Overseas Visitor Managers (OVMs) in hospitals. Guidance on implementing the regulations is now available online. A toolkit to help OVMs establish individuals’ status is being developed and should be published very soon, but in the meantime, some important points are;
- Access to A&E departments and primary care at GP surgeries will remain free to everyone.
- Access to free secondary care in the NHS will be available to those deemed to be ordinarily resident in the UK.
- Some people working abroad will be able to claim ordinary residence if they meet certain criteria – but these will be determined on a case-by-case basis.
- Factors such as owning a property in UK, frequent and regular visits back, being employed by a UK based organisation or being on a temporary contract may contribute positively to being deemed ordinarily resident.
- Those home on leave for a substantial period of time will be ordinarily resident while they are here, as long as they can be seen to be ‘properly settled here for the time being.’
- These changes relate to NHS England only – access to care in Wales, Scotland and Northern Ireland has not changed.
Britain’s contribution to Global Health
Our government is rightly proud of its commitment to overseas development, being the first G8 nation to spend 0.7% of Gross National Income on aid. It is therefore disappointing that they have decided to save what will be a very small amount of money by charging those working in the development sector. A number of government papers[1][2][3] positively encourage UK health professionals to volunteer overseas. They recognise the contribution they make not only to the countries where they serve, but also to the NHS when they return, bringing new skills and cultural awareness. The recent Department of Health framework for volunteering ‘Engaging in Global Health’calls for volunteers to be ‘fully supported by employers and professional associations, with robust human resources policies.’ However, rather than supporting those who go to serve overseas, the new regulations may make it difficult for some to continue their work at all, and may deter others from setting off.
The reality on the ground
A mission partner in Malawi explains how these changes would affect him;
‘I am a pharmacist working at Nkhoma Hospital – I’ve been residing here with my family for the past 4 years. We had to sell our property in the UK before commencing our contract as our missionary salary would not cover the mortgage payments. We maintain British bank accounts, have investments in the UK and our wills are held by solicitors in Perth.
We currently use my parents’ address as our residential address and call the UK our home. Our youngest daughter is a cardiac child (Transposition of the Great Arteries), who is required to have regular reviews as determined by her paediatric cardiologist in UK. If we were not eligible for NHS services, it would have big implications for our work with the poorest communties here in Malawi.’
A CMS mission partner working as a doctor in the Democratic Republic of Congo (DRC) tells her story;
‘A few years ago when I was on leave I had a lump in my breast that was suspicious, so my GP referred me to a consultant. In the letter he mentioned that I was home on leave from DRC. The letter was seen by a hospital administrator who told me that I was not eligible for NHS treatment – although I was in fact eligible as a missionary. I was told I should get treatment where I was working – at that time I was the only doctor in a rural part of DRC – so basically he was telling me to treat myself for potential breast cancer! Eventually the situation was resolved, it was agreed that I was eligible for NHS treatment and the lump turned out to be benign. But it was an extremely stressful time. Any woman with a breast lump will obviously be fearing the worst and to have to go through all that was not good. If I hadn’t been eligible for treatment and if the lump had been malignant, the story and probable outcome would have been very different.’
We await the Guidance Toolkit to assist with interpretation of the regulations and hope that many missionaries and aid workers will come into the category of those deemed to be ‘ordinarily resident.’ However, this may be one more uncertainty, along with changes in career structure and revalidation, that may bring missionary doctors home early or deter them from setting off in the first place.
Posted by Dr Vicky Lavy
CMF Head of International Ministries
references
[2] http://www.appg-globalhealth.org.uk/reports/4556656050