HIV NHS Hospital Treatment Charging
Q: Is HIV NHS treatment free for all?
No, NHS HIV treatment is not free for all. Only HIV testing and associated counselling is free.
Who has a right to free NHS hospital treatment?
People who are ‘ordinarily resident’ in the UK.
People are exempt from charges for hospital treatment for certain illnesses and for any treatment in the A&E department. The list of free treatable conditions includes TB, viral hepatitis and STIs, but not HIV.
People who are exempt from charges include people who have been here legally for 12 months, and asylum seekers and refugees.
Anyone else not exempt, should be charged the full cost of everything.
Q: Who is not allowed?
Most people facing problems with HIV treatment charges are people diagnosed after their final asylum refusal and appeal decision; illegal entrants and overstayers; and temporary visitors.
Q: Has this always been the case?
There have been rules requiring checks on entitlement to free hospital treatment since before 1989.
Q: What has changed?
The government updated the rules from the beginning of April 2004, following the inaccurate tabloid media scares about ‘treatment tourism’ including for HIV care. Hospitals are now told explicitly to check people needing, or already getting any hospital treatment.
Q: What does this mean?
It means that if the checks are carried out, there will be people with HIV who do not fit the rules for free HIV treatment who may be asked to pay the full costs of seeing any clinicians, for monitoring tests and for drugs. Almost everyone who fails the test will not be able to afford to pay because of the high costs of HIV treatment.
Q: What do I do if I get a bill?
Don’t panic. The first step is always to get advice from an expert - the refusal and your right to free treatment need to be carefully checked. Mistakes and wrong decisions are common. Your expert adviser will support you so you can receive both the treatment you need and will deal with the debt for you.
If you receive a bill, it is unlikely you can afford to pay. The bill may be for a very large amount but no matter how large the sum, not paying a bill is not a crime – you can’t be deported, sent to jail or fined for not paying bills. You have nothing to be ashamed of and have done nothing wrong. This is an “unsecured” civil debt. The legal powers for collecting unsecured civil debts like hospital bills are limited.
If you can’t pay (because you do not have the money) you cannot be forced to pay. Don’t ignore letters from the hospital or any debt collection company – pass them to your expert adviser. Eventually the whole debt will be abandoned or written off when it becomes clear that it cannot be recovered. They may threaten court action and bailiffs but since this involves them spending even more money to collect money from someone who doesn’t have the means to pay, court actions and bailiffs are very rare. Lots of threatening letters are common but no real action will be taken as long as an expert adviser is helping you.
Q: Who will do the checks and what do they want to know?
In most hospitals, there is an Overseas Visitors Manager put in charge; and often this responsibility will be added to the Private Patients Manager’s job.The government’s guidelines require clerks to ask everyone using the hospital (except people at A&E) two basic questions: where have you lived for the last 12 months (evidence includes rental agreements, council tax, gas, electric and water bills and bank statements) and can you show that you have the right to live here (evidence includes UK or Irish birth certificate, passport, entry clearance documents).
If my CD4 count drops dramatically and I have an uncertain immigration status, what then?
In an emergency, treatment should be provided without question. “Urgent” or “immediately necessary” treatment should always be provided even if you cannot afford to pay (Guidance - Chapter 9, \page 41 ).
Q: Do clinics report back to the Home Office?
No. Overseas Visitors Managers can telephone a helpline at the Immigration and Nationality Directorate but only to get advice on interpreting different types of entry visas and visa stamps. The guidelines say ‘Under no circumstances should any medical information be divulged’.
Q: If I am charged for hospital treatment, what can I do?
All you can do is make a formal complaint to the hospital’s Complaints Manager. There is no independent body to which you can appeal. You need to get urgent expert advice from someone who understands the rules inside out, advise you about the best steps to take, and can help you argue a good case. You should either contact an expert on treatment charging at a HIV organisation or contact ICAS (see below). The second stage of the internal process is an Independent Review Panel and the third stage is the external Health Service Ombudsman. You need to always keep the hospital finance department or debt collection company fully informed of progress on your complaint.
Other possible options after a refusal are to consider applying for free treatment outside the rules, basing your case on the Human Rights Act right to life and not to be treated by the state in an inhuman or degrading way. Any human rights application should be made to the Overseas Visitors Manager and copied to the Chief Executive of the Trust. This should get the Trust to think seriously and carefully about refusing free HIV treatment and give the person a basis for quickly applying for Judicial Review if this is then refused.
You can also ask your MP to help – the hospital will want to be careful in dealing with your complaint and MPs create pressure for the rules to be changed. There is an Independent Complaints Advocacy Service (ICAS) for complaints about the NHS, and the ICAS service is usually provided by the Citizens Advice Bureau. ICAS contact and service details are available. The Patients Advocacy and Liaison Service (PALS) may be able to offer some help. There is one for each hospital. However, they are part of the NHS and are not independent and may have very limited experience or skills in dealing with treatment charging and HIV.
This information is based on Chris Morley’s guidelines on ‘HIV Hospital Treatment Charging’, written on June 2004 and updated on January 2006. Chris Morley (chris@ght.org.uk) works at George House Trust
