Intended for healthcare professionals

Feature Migrant Health

Migrant charging in the NHS: how doctors can support patients when hospital care is denied

BMJ 2019; 365 doi: (Published 29 May 2019) Cite this as: BMJ 2019;365:l2281
  1. Ingrid Torjesen, journalist, London
  1. Ingrid_torjesen{at}

Recent rules on charging to create a “hostile environment” in the NHS for some immigrants are complex, finds Ingrid Torjesen, but doctors can ensure they are appropriately applied

Since 2017 hospitals in England have been required to check patients’ entitlement to free NHS care and charge them upfront for care to which they aren’t entitled, at 150% of the national tariff.

The government introduced these rules as part of a range of policies to create a “hostile environment” to deter unofficial immigration to the UK and to tackle “health tourism.” But the rules may contravene a global commitment to universal healthcare coverage, as defined by the World Health Organization and the United Nations’ sustainable development goals, and several human rights treaties to which the UK is a signatory.1

Some migrants (people not ordinarily resident in the UK) who need treatment are being turned away, campaigners say, and some avoid seeking treatment at all because they fear their information will be shared with the Home Office, which might lead to their detention or deportation.2

Pending full publication of a recent formal review of the rules’ effects, medical royal colleges, including the Royal College of Physicians, the Royal College of Paediatrics and Child Health, the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, and the Faculty of Public Health, have joined charities and other organisations to call for the suspension of NHS charges to migrants.3

What doctors can do

Individual doctors can do much to support patients who are denied treatment by ensuring that they have the right information to challenge decisions and by signposting them to support organisations and lawyers (box 1).

Box 1

What doctors can do to help patients challenge decisions to refuse treatment

  • Ensure that the correct tests have been done to determine the patient’s condition

  • Repeat tests if the results are not current

  • State in the …

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