# Migrant access to the NHS in the UK



## xabiaxica (Jun 23, 2009)

https://www.gov.uk/government/consultations/migrants-and-overseas-visitors-use-of-the-nhs

some of this affects expats - one proposal is that British citizens who have the required amount of NI contributions should have full access the the NHS when visiting the UK

currently we only have 'holiday, emergency' access


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## Aron (Apr 30, 2013)

xabiachica said:


> https://www.gov.uk/government/consultations/migrants-and-overseas-visitors-use-of-the-nhs
> 
> some of this affects expats - one proposal is that British citizens who have the required amount of NI contributions should have full access the the NHS when visiting the UK
> 
> currently we only have 'holiday, emergency' access


They changed the rules two years ago. We now get our EHIC cards from Newcastle. About 6 months after, I had to see a doctor in the UK. Initially I was refused help because the surgery said I needed a Spanish card. I tried to explain but they said I was wrong. I asked them to phone the helpline on the reverse of the card. After an hour I saw a doctor, not because the helpline had explained, the surgery made the decision because the helpline never answered the call. I am a British citizen. I paid my NI until I retired. I am on the Spanish NHS, but do think British pensioners returning to see families should be allowed access to medical treatment.


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## xabiaxica (Jun 23, 2009)

Aron said:


> They changed the rules two years ago. We now get our EHIC cards from Newcastle. About 6 months after, I had to see a doctor in the UK. Initially I was refused help because the surgery said I needed a Spanish card. I tried to explain but they said I was wrong. I asked them to phone the helpline on the reverse of the card. After an hour I saw a doctor, not because the helpline had explained, the surgery made the decision because the helpline never answered the call. I am a British citizen. I paid my NI until I retired. I am on the Spanish NHS, but do think British pensioners returning to see families should be allowed access to medical treatment.


yes, as a pensioner your EHIC comes from Newcastle - mine comes from Spain so less confusing for the UK system (though I still had to explain why I have a Spanish card when I'm British..........)


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## JaneyO (Sep 24, 2012)

xabiachica said:


> https://www.gov.uk/government/consultations/migrants-and-overseas-visitors-use-of-the-nhs
> 
> some of this affects expats - one proposal is that British citizens who have the required amount of NI contributions should have full access the the NHS when visiting the UK
> 
> currently we only have 'holiday, emergency' access


I read the document- well most of it- and was a bit concerned to see the bit about the Uk wanting to reduce the payments it makes to other member states for pensioners healthcare to reflect the fact that they will be entitled to NHS care. What is the cash strapped Spanish government going to make of this? Are they going to limit pensioners heathcare here and tell us to go back to the Uk if we need anything expensive? How are we supposed to do that if we don't have anywhere to go in the Uk. If I'm ill in my old age I don't want to go traipsing round Europe I want to stay at home in Spain! Wonder what others make of this.
PS JUst checked again the actual wording is 'to reflect their having retained entitlement to NHS treatment on returning home' What does that mean-if you choose to return 'home' for treatment or if you return permanently? 
I also see they are proposing to do away with the S1 quote ' cease funding initial healthcare costs for early retirees'


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## CapnBilly (Jun 7, 2011)

JaneyO said:


> I read the document- well most of it- and was a bit concerned to see the bit about the Uk wanting to reduce the payments it makes to other member states for pensioners healthcare to reflect the fact that they will be entitled to NHS care. What is the cash strapped Spanish government going to make of this? Are they going to limit pensioners heathcare here and tell us to go back to the Uk if we need anything expensive? How are we supposed to do that if we don't have anywhere to go in the Uk. If I'm ill in my old age I don't want to go traipsing round Europe I want to stay at home in Spain! Wonder what others make of this.
> PS JUst checked again the actual wording is 'to reflect their having retained entitlement to NHS treatment on returning home' What does that mean-if you choose to return 'home' for treatment or if you return permanently?
> I also see they are proposing to do
> '


I don't see a problem with this, the way it is currently worded and explained. My understanding is that under EU rules, reimbursement can be made in two ways. Either direct reimbursement based on actual costs or a flat payment per person. The UK chooses the latter option. My understanding of the explanation, is that, if they allow pensioners the ability to return for treatment (if they want to, not that they have to), then the rules allow for a 5% discount. So instead of the average cost of about £3500 per person, ( which,as I recall, is the average cost per person in Spain of healthcare provision ) it would be £3150. This is really just a recognition that's its actually happening anyway, but the UK are still paying the full amount, when they could be getting a deduction.


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## JaneyO (Sep 24, 2012)

CapnBilly said:


> I don't see a problem with this, the way it is currently worded and explained. My understanding is that under EU rules, reimbursement can be made in two ways. Either direct reimbursement based on actual costs or a flat payment per person. The UK chooses the latter option. My understanding of the explanation, is that, if they allow pensioners the ability to return for treatment (if they want to, not that they have to), then the rules allow for a 5% discount. So instead of the average cost of about £3500 per person, ( which,as I recall, is the average cost per person in Spain of healthcare provision ) it would be £3150. This is really just a recognition that's its actually happening anyway, but the UK are still paying the full amount, when they could be getting a deduction.


It's the 'if they want to not that they have to' bit that concerns me. Call me Mrs Paranoid but given the current state of relations between Spain and the Uk, and the fact that they already do their best to stop other nationalities from accessing the Spanish healthcare system= witness EHIC problems and the fact that they cancelled healthcards and made us reapply last year I can just see them jumping on this as an excuse to deny us full access here in Spain.


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## mrypg9 (Apr 26, 2008)

I look at it like this: it is really quite recent in historical terms that British people have been able to retire in Spain, France, Italy or anywhere within the EU. It is a right, enshrined in EU law, but that right is dependent on one's ability to support one'sself in the country of one's choice.
Since leaving the UK in 2008 we have seen a drop of around one-third in the value of our income. It has been eroded by inflation, poor exchange rates, QE and the usual less remarkable increases.
Imo being able to live in Spain is a privilege as well as a right. Sadly it cannot be freely available to everyone as like most things it depends on affordability.
It is inevitable that things will change. That's life. I am bemused when people whinge that twenty years ago their £ was worth so much more. Did they really think exchange rates were carved in stone? I note the £ is down again, presumably because of the almost insignificant growth in the eurozone, albeit powered by Germany and France.
When you choose to live abroad, you are taking a chance. It's so important to plan for the worst case scenario. As I have said before, when we were planning to move to Spain from Prague the rate was £1-1.23 euros. We planned on the basis of parity. Friends said we were uber-cautious.
Yet when we arrived in Spain in December 2008 the rate was £1-1 euro, even less at airport bureaux de change.


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## Hombre62 (Jun 13, 2013)

xabiachica said:


> https://www.gov.uk/government/consultations/migrants-and-overseas-visitors-use-of-the-nhs
> 
> some of this affects expats - one proposal is that *British* citizens who have the required amount of NI contributions should have full access the the NHS when visiting the UK
> 
> currently we only have 'holiday, emergency' access


I don't see how they could bring citizenship into it. Can you direct me to the section that suggests this? I can't seem to find it.


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## baldilocks (Mar 7, 2010)

The UK claims that once we move abroad, we lose our right to treatment on the NHS.


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## Hombre62 (Jun 13, 2013)

I've managed to download the full consultation document now (using a very slow 3G dongle here at the moment). I hope Jeremy Hunt didn't pay very much for this atrocious piece of work.

The sections of immediate interest to forum members commence on pages 20 and 46.

From page 20:



> *Proposal
> We propose that those expatriates and former legal residents of the UK not subject to immigration control, who have paid National Insurance (NI) contributions for a significant period (we propose at least seven years), should also retain access to all NHS treatment free of charge, both when returning to live in the UK and when just visiting. *


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## Hombre62 (Jun 13, 2013)

baldilocks said:


> The UK claims that once we move abroad, we lose our right to treatment on the NHS.


I understood that. It was the suggestion that there was a proposal to discriminate on the basis of nationality that caused me to raise a metaphorical eyebrow.


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## xabiaxica (Jun 23, 2009)

Hombre62 said:


> I understood that. It was the suggestion that there was a proposal to discriminate on the basis of nationality that caused me to raise a metaphorical eyebrow.


yes, that wasn't the best way for me to write it!!

however - in other parts of the document there are proposals that immigrants (even those who have taken/are taking/are entitled to take British nationality) to the UK should pay something extra towards healthcare, depending upon how long they have lived there


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## CapnBilly (Jun 7, 2011)

xabiachica said:


> yes, that wasn't the best way for me to write it!!
> 
> however - in other parts of the document there are proposals that immigrants (even those who have taken/are taking/are entitled to take British nationality) to the UK should pay something extra towards healthcare, depending upon how long they have lived there



Actually I thought it was a good way to describe what the paper meant. These are the definitions of different British citizenship - http://www.ukba.homeoffice.gov.uk/britishcitizenship/aboutcitizenship/


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## Hombre62 (Jun 13, 2013)

CapnBilly said:


> Actually I thought it was a good way to describe what the paper meant. These are the definitions of different British citizenship - UK Border Agency | What is British citizenship?


The proposal is that the NHS remain open to all citizens of the EAA, to those who legally reside there, or those have made significant contributions in the past. In this respect, British citizenship is not a factor, regardless of how it is defined.


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## CapnBilly (Jun 7, 2011)

Hombre62 said:


> The proposal is that the NHS remain open to all citizens of the EAA, to those who legally reside there, or those have made significant contributions in the past. In this respect, British citizenship is not a factor, regardless of how it is defined.


I'm not sure i read the particular clause that Xabiachica highlighted in that way. It doesn't say or have made NI contributions, it says have. And whist you're probably technically correct with regard to the terminology, if you read that particular section, it's really relating to citizens who have moved elsewhere. This is actually confirmed in paragraph 12 of the executive summary, where it specifically talks about expatriate British citizens.


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