NHS HDL (2004) 40 abcdefghijklm

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1 abcdefghijklm = eé~äíü=aéé~êíãéåí= = aáêéåíçê~íé=çñ=péêîáåé=mçäáåó=~åç=mä~ååáåö= Dear Colleague THE NATIONAL HEALTH SERVICE (CHARGES TO OVERSEAS VISITORS) (SCOTLAND) AMENDMENT REGULATIONS This letter informs NHS Boards of further amendments to the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations Main Changes 2004 Amendment Regulations 2. The National Health Service (Charges to Overseas Visitors) (Scotland) Amendment Regulations came into force with effect from 28 September A copy of the amendment regulations is enclosed. 3. The amendments introduced by the new Regulations include three provisions which make changes to the current exemption provisions; the addition of Severe Acute Respiratory Syndrome (SARS) to the list of diseases for which there is no charge for treatment; clarification that exemption provisions within the regulations apply to those who are lawfully resident in Scotland (and the rest of the UK); and to allow a person who has been receiving treatment, on the basis that no charge would be made, to complete that course of treatment on the same basis, where it has been established that the person does not meet the residence qualification. More detailed information on the amendments is given in the attached Annex. 30 September 2004 Addresses For action Chief Executives, NHS Boards For information Local Health Councils Chief Executives, Special Health Boards Enquiries to: Miss K Glancy St Andrew s House EDINBURGH EH1 3DG Tel: Fax: kathleen.glancy@scotland.gsi.gov.uk ISBN Changes EEA countries (and Switzerland) 4. In addition to the changes being introduced by the new amendment regulations outlined above, Boards will wish to note a further change to the current charges for overseas visitors regime, in respect of reciprocal arrangements between European Economic Area (EEA) countries (and Switzerland). This further change, which emanates direct from the EU, came into force on 1 June

2 5. Residents of EEA countries (and Switzerland), who are insured under their country s health system, are now entitled, on the basis of the European health insurance card or its equivalent, to all medically necessary treatment during a temporary stay in another Member State, taking into account the nature of the care and the expected length of stay. Necessary treatment, in this context, includes treatment of chronic and existing illnesses and is aimed at enabling an insured person to remain in another Member State, under safe medical conditions, for the duration of their planned length of stay. The revised provision does not extend to elective treatment where the aim of the visit is specifically to obtain medical treatment. More detailed information is given in the attached Annex. Action 6. NHS Boards are asked to bring these changes to the attention of relevant personnel in hospitals and GP practices. 7. If you require further information on the Regulations and amendments, please contact Kathleen Glancy on or June Doig on Further copies of the Scottish Statutory Instrument may be obtained from The Stationery Office Scotland, 71 Lothian Road Edinburgh, EH3 9AZ, telephone: , Fax: , enquiries@tsoscotland.com. Yours sincerely J T BROWN Public Health Division 2.

3 ANNEX NATIONAL HEALTH SERVICE, SCOTLAND The National Health Service (Charges to Overseas Visitors) (Scotland) Amendment Regulations 2004 (S.S.I. 2004/369) Background One of the main principles underlying the setting up of the National Health Service was the belief that people living in this country should have access to the health care they need, regardless of race, religion or income. NHS care in Scotland and the wider UK, therefore, with only a few exceptions, is based on residency status, not nationality. In general, those residing elsewhere and visiting this country from abroad are not entitled to NHS care without charge unless they are accepted for care under one of the negotiated reciprocal health care agreements or fall within a specific exemption category as set out in the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989, as amended. England and Wales have separate (similar) statutory provisions. Changes The National Health Service (Charges to Overseas Visitors ) (Scotland) Regulations 1989 are amended to introduce three new exemption provisions; to add SARS to the list of diseases for which there is no charge for treatment; to clarify that exemption provisions within the regulations apply to those who are lawfully resident in Scotland (and the rest of the UK); and to allow a person who has been receiving treatment, on the basis that no charge would be made, to complete that course of treatment on the same basis, where it has been established that the person does not meet the residence qualification. The three new provisions are: an exemption for British state pensioners who spend up to 6 months of the year living in another European Economic Area (EEA) Member State, or the spouse or child of such a person. This exemption for British State pensioners increases by 3 months the amount of time that they can live in another EEA Member State and still be eligible to free NHS treatment on their return to Scotland (amending regulation 4); an exemption which will allow Scottish Ministers to determine that no charge shall be made in respect of a course of treatment for an overseas visitor in specific circumstances where it is considered that exceptional humanitarian reasons justify it. The exemption can only be made by Scottish Ministers and is introduced to cover the occasional practice of accepting patients from abroad (often children) where the circumstances of their injuries represent a humanitarian imperative to provide help and where the treatment specified is not available in the visitor s home country. As far as NHS Boards are concerned, their role, in the context of the charging regulations, is to establish whether such a determination has been made, not to make the determination themselves (amending regulation 6); 3.

4 an exemption for an authorised child or an authorised companion of a person coming to the UK for treatment under the new humanitarian exemption. The authorised child or authorised companion will only be exempt from charges for treatment the need for which arises while they are here, but not for other treatment (amending regulation 5); The inclusion of Severe Acute Respiratory Syndrome (SARS) in the list of communicable diseases exempt from charges (as listed in Schedule 1) has been made on public health grounds. The lawful qualification additions clarify that current exemptions apply only to people lawfully in the country, and not to people who may be illegally here. These amendments do not disadvantage anyone who is seeking to become a lawful resident (amending regulations 3 and 5). The change to the Regulations which allows a person to complete a course of existing treatment without charge where they no do not meet the residence qualification is designed to cater for a person whose application for residency has been turned down but they have not yet left the country. Should they remain in the country they would be charged for any new course of treatment (amending regulation 3(2)). EU Ruling In addition to the above changes, there is now in force, since 1 June 2004, (although not yet incorporated in the principal domestic Regulations) a further important change to the current exemption from charges regime. This change results directly from Regulation (EC) No 631/2004 of the European Parliament and of the Council of 31 March 2004, Decision No 191 of 18 June 2003 of the Administrative Commission on Social Security for Migrant Workers and Decision No 194 of 17 December 2003 of the Administrative Commission on Social Security for Migrant Workers. Access to different types of benefits in kind during a temporary stay in another Member State had traditionally depended on the category to which the insured person belonged, and drew a distinction between immediately necessary care and necessary care. The majority of citizens insured in a Member State and travelling to another Member State were entitled to health care in the country they visited only in cases of emergency. Pensioners, however, did not have to comply with this requirement, having a wider right of access to all necessary health care. Regulation No 631/2004 seeks to align the rights of all categories of insured persons so that all residents of European Economic Area (EEA) countries (and Switzerland), who are insured under their country s health system, are entitled to access all medically necessary treatment during a visit to another Member State, taking into account the nature of the care and the expected length of stay. Entitlement is to treatment in the public system under the same conditions as nationals of the Member State which the person is visiting. All necessary treatment in this context includes treatment of chronic and existing illnesses and is aimed at enabling an insured person to remain in another Member State, under safe medical conditions, for the duration of their planned length of stay. The revised provision does not extend to elective treatment where the aim of the visit is specifically to obtain medical treatment. 4.

5 The entitlement is certified on the basis of the European Health Insurance Card (introduced by Decision No 191 from 1 June 2004 to replace the E111 form) or its equivalent (the E111 form, which also continues in force for the time being under the transitional arrangements). Scottish Executive Health Department September