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Background

In April 2004, regulations were introduced in the NHS which made 'overseas visitors' from certain countries liable to be charged for accessing most hospital services. A number of vulnerable groups, including refused asylum seekers and victims of trafficking, were affected by these regulations. This included both children and also refused asylum seekers in receipt of Section 4 support because they are acknowledged to be unable to travel safely home.

A number of treatments were exempt from charging. These included treatments delivered in A&E departments, family planning services, treatments for certain infectious diseases, and treatments commenced before an asylum claim was refused.

Treatment deemed 'immediately necessary' was chargeable. However, it could not be refused if upfront payment was not made or patients were unable to demonstrate ability to pay. Bills could be chased as far as was 'reasonable', including the use of debt collection agencies, though destitute individuals could have uncollectable debts written off. It was not clear what 'immediately necessary' meant. However, it did include maternity and antenatal care.

Access to primary care was not affected by the 2004 regulations. General practitioners can register 'overseas visitors' at their discretion and treat them without charge under the NHS.

In March 2009, the Court of Appeal judgement in Regina(A) v West Middlesex University Hospital NHS Trust muddied the water somewhat by suggesting that trusts should make an assessment of when an individual can reasonably be expected to return home before denying them treatment that is not 'immediately necessary'.

In April 2009, the charging regulations were amended to make victims of human trafficking exempt from NHS charging.