Eligibility for other publicly funded services

Eligibility for other publicly funded services

4.10 NHS treatment

Many NHS services are provided free of charge to people in Scotland regardless of their nationality or immigration status, but some people may be required to pay for certain types of treatment.33

Free services

  • Services delivered by a GP
  • Prescriptions
  • Dental and optical examinations*
  • Community services, such as mental health and drug and alcohol services
  • Accident and emergency (A&E) services up until the point that the person is accepted as an in-patient
  • Family planning services
  • Diagnosis& treatment of contagious diseases, including HIV 34
  • Diagnosis & treatment of sexually transmitted diseases
  • Compulsory detention or admission due to a mental health condition (under the Mental Health (Care and Treatment) (Scotland) Act 2003
  • Treatment of a mental health condition as a requirement of a community payback order

* Most dental and ophthalmic treatment will also be free if the person meets one of the exemptions to these services or has obtained an HC2 certificate on the basis of having a low income, for example support from social services or a charity. NHS Scotland has produced a useful leaflet providing more information about these exemptions. 35

Chargeable services

  • Any treatment provided in a hospital, or by staff working under the direction of a hospital, that is not listed above.

A person may be charged for hospital treatment if they are an ‘overseas visitor’ and are not in a group that is exempt from paying the charges. A person will be an overseas visitor if they are not ordinarily resident in Great Britain or Northern Ireland.

People who do not have to pay for chargeable services

The following people will be ordinarily resident if they are living lawfully in the UK for a settled purpose:

  • British citizen
  • EEA national
  • Non-EEA national who has either:
    • settled status, for example, indefinite leave to remain; or
    • a right to reside under EU law, for example, the primary carer of a British child

Anyone else will be referred to as an ‘overseas visitor’ and will be required to pay for hospital treatment unless an exemption applies.

The exemptions are set out in the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989, and include a person who has:

  • Made a formal application for asylum, whether pending or unsuccessful
  • Refugee status
  • Leave to enter or remain in order to work or to be self-employed
  • Leave to enter or remain on a settlement route, for example, as a spouse of a British citizen, or as the parent of a British child/ child who has lived in the UK for seven years
  • Lived lawfully in the UK on any other basis for one year or longer prior to receiving treatment
  • Is studying full-time in the UK at a further or higher education institution
  • Is a survivor of trafficking or modern slavery who has either received a reasonable grounds decision and is still waiting for their conclusive grounds decision, or has received a positive conclusive grounds decision
  • Is detained for a criminal matter or immigration matter
  • Is the spouse, civil partner or child of a person in the above categories

An asylum seeker will be entitled to NHS treatment on the same basis as a UK national who is ordinarily resident in Scotland, even if their claim is unsuccessful and they become appeal rights exhausted (ARE). Asylum seekers who are granted Refugee Status or another form of leave to remain will continue to be exempt from NHS charges on the same basis as a person who is ordinarily resident in Scotland.

People who apply for leave to enter or remain in the UK for a limited period will usually need to pay the Immigration Health Charge (IHC) as part of their application, in order to receive most chargeable NHS treatment for free. This has not yet been incorporated in to the Scottish charging regulations, but such people will have the same access to free NHS care as a person who is ordinarily resident in Scotland.

People who may have to pay for chargeable services

A person may need to pay for hospital treatment if they are:

  • A person without leave who has not claimed asylum
  • On a short-term visit visa of less than six months

This could, therefore, include people who are being provided with accommodation and financial support by social services because they have no recourse to public funds (NRPF).

Maternity provision, including antenatal care, must not be delayed or refused due to issues arising regarding charging and inability to pay, because such treatment is classed as immediate and urgent medical care. However, when a pregnant woman is liable to pay for her maternity care, she may be charged after the care has been provided.

The NHS has the ability to write off debts and not pursue them if a person is destitute or genuinely without funds.

However, when a person accrues an unpaid NHS debt of £200 or more, this information may be shared with the Home Office. Where a person accrues an NHS debt of £500 or more, then this could lead to an immigration application being refused.

Further information and resources:

  • NHS Inform – Healthcare for asylum seekers, refugees and overseas visitors with helpline and webchat advice service 36
  • Scottish Government – Overseas visitors 37
  • Chief Executive Letter (CEL) 9 (2010) – Guidance on the charging regulations 38
  • NHS Circular: PCA(M)(2018) 10 - Guidance on GP registration 39