A consultation document was released by the Department of Health (UK) in July 2013. ‘Sustaining Services, ensuring fairness’ is the first steps towards finding ways of balancing the books in relation both to those who enter the UK and look for support and those who leave it and want support to continue. It has already caused some anxiety on the expat forums in Spain and it seems appropriate to consider some of the main messages it contains.
It is important to remember that it is a consultation document and the final proposals are yet to be made. Even when the white paper is drawn up it will need to receive the approval of those in Parliament for it to reach the statute books and become law. However, it is still a very good indication of what we might expect and always worth being aware of.
The ‘case for change’ put forward by the DoH is that the NHS cannot continue as an international rather than a national health service. It is combined with a two-phase independent ‘audit’ of NHS used by visitors and temporary migrants. The purpose of the consultation is to consider who should be charged for health care in the future and what services they should be charged for.
The consultation isn’t just about immigrants in the UK. It makes specific reference to expatriates in other countries and has implications for their health care too. Currently expats lose their entitlement to free NHS treatment when they go to live in another country. The proposal is that for those who have previously paid at least seven years of National Insurance contributions, they should continue to have an entitlement even when they have moved abroad.
Currently expatriates are not automatically entitled to free NHS treatment when they return to visit the UK although they are entitled to treatment according to European legislation. This means that if they are on a visit and require emergency treatment then they would be covered. However, officially, longer term health care should be accessed in the country where they reside.
The practice does not always reflect the legislation. Some expats do not inform the NHS, that they have moved abroad and stay registered with their GP in the UK, continuing to return to the UK for health treatment. These proposals would legitimise what already sometimes happens.
Paying for our health costs
EU countries reimburse costs between Member States. This means that the UK reimburses Spain for:
· Visitors to Spain using the EHIC card – all necessary care during their visit
· State pensioners and their dependents who have moved to Spain to live
The consultation recognises through ‘anecdotal evidence’ that many pensioners who ‘live’ in another country return to the UK for health care even if they should not. The consultation proposes that pensioners should officially be able to return for health care and that to compensate for this 5% will be deducted from payments to all countries to whom the UK makes lump sum annual payments.
They suggest that this will save up to £40 million a year. As people are already taking advantage of the NHS service and this treatment is going undetected it is not considered that it will cost the NHS much more to enable them officially to do this.
Proposal to stop issuing residual S1 forms from 1st April 2014
Currently the UK issues S1 forms for non-state pensioners. This is outside the requirements of the regulations. This currently covers UK nationals who are not in paid employment and are living in another EU country.
It was intended that paying for this health care would help early-retirees settle into their new country of residence. It provided them with health cover for up to 2 ½ years. The consultation document claims that this costs the UK around £4 million a year and proposes that this provision should end.
How will Spain see it?
It will be interesting to see how, if these proposed changes become law, they will be viewed by other countries. However you look at it, the reporting of the reduction in the lump sum payment is unlikely to be greeted favourably.
Will the foreign press pick up on the fact that pensioners can return to the UK for health care or that 5% is being deducted from the bill to take care of them in Spain? Most people who live in Spain do use the Spanish health service which, some would say, is better than the NHS.
The deadline for the consultation was 28th August 2013 and it is anticipated that there will be a formal response to the consultation no later than the Christmas Parliamentary Recess.
Many people will see the approach that the UK is taking positively. There has been much media spin about immigrants sponging off the tax payer. However, like with students, there may be unforeseen implications too as not only ‘scroungers’ but others with more to offer the UK are perhaps deterred from sharing their skills there.
Equally, those British citizens living in other countries may feel a little uncomfortable with the way the UK is treating its immigrant population. Will their host countries react and take the same stance to their immigrant populations too if they don’t already?
It must certainly deter those considering early retirement to Spain, unless they are able to arrange immediate health insurance and have no existing health issues that would make this impracticable.
There are possibly many unforeseen implications of this proposed legislation both at home and abroad and expats should watch its progress with interest
‘Sustaining Services, ensuring fairness’, Department of Health consultation document: