Guidance on charging EU nationals following a no-deal Brexit sparked concerns about significant administrative burdens being forced on trusts. But past experience suggests providers may simply ignore orders to claw back cash from tourists, writes James Illman

The government published updated guidance this week stating European Union citizens arriving in England after a no-deal Brexit will “no longer automatically be entitled to free NHS-funded healthcare”.

The Department of Health and Social Care guidance said existing EU citizens living in Britain will continue to be eligible for free care while EU citizens visiting after a no-deal Brexit will be charged.

Its tone is stark, arguably threatening, almost as if its intended audience were negotiators in Brussels rather than hospital managers in Blighty.

It sparked accusations from the 3million group, which campaigns for the rights of EU citizens living in the UK, that with only one of the three million EU citizens living in Britain registered under the “settled status” programme the move was contributing towards a new “hostile environment” for immigrants.

The guidance dropped just days before today’s latest announcement on arrangements for an “express freight service” to deliver medicines and medical products into the country by air in the event of a no-deal Brexit (see below: Ministers launch search for new no-deal Brexit medical freight provider). 

It said: “Visitors from the EU, Norway, Iceland, Liechtenstein or Switzerland who visit the UK will not be covered for healthcare in the same way they are now if there is a no-deal Brexit.”

It adds: “Should a visitor from the EU…who arrives after exit day want to stay in the UK for longer than three months, to be exempt from charging for relevant NHS services, they will need to meet the ordinarily residence test. They may also be required to comply with any immigration requirements set by the Home Office.”

There are however some significant caveats. Emergency and GP services are exempt from the arrangement and will still be universally provided free at the point of care. So, services in scope are largely elective procedures.

NHS Providers has raised significant concerns on behalf of trusts. The lobby group warned the guidance would require hospitals to check the immigration status of “all patients that they assume to be EU citizens who are accessing care that will be chargeable” in as little as 11 weeks’ time.

Chief executive Chris Hopson added: “We must not underestimate the significant administrative burden [this would place] on trusts. They will also need to recover costs from those patients who are liable to pay under the rules. Trusts will need to urgently increase capacity and put additional resources in place to meet these requirements.”

It is certainly correct that administering such a scheme would require a significant extra resource.

But as the Nuffield Trust’s head of public affairs and chief Brexit watcher Mark Dayan told me, should the UK crash out without a deal, trusts will do what they have often done with orders to charge EU visitors – ignore them.

Mr Dayan said: “If trusts do carry out this guidance to the letter, it would be a significant on-demand on them. But the experience of DHSC charging initiatives for overseas visitors to date suggests many trusts do not bother doing them. I am not convinced it would be different this time.”

There could also be an unexpected group of extra patients visiting the UK and using the NHS after Brexit: UK residents currently living in Europe.

Mr Dayan added: “Many EU health systems are set up for charging in a way the NHS is not, so arrangements for charging UK residents living in Europe could be followed far more firmly and consistently. This could result in a lot of people coming back to the UK to use the NHS. With over one million UK citizens living in Europe, this could potentially be quite a large patient group.”

Like many other recent attempts to get the NHS to charge EU visitors, and there were several under previous health secretary Jeremy Hunt, this may well turn out to be an issue de-prioritised by NHS trusts.

But the confusion caused by this week’s announcement is a nasty taster of the chaos to come as the government’s 31 October Brexit “do or die” deadline date approaches.


Ministers launch search for new no-deal Brexit medical freight provider 

The government is tendering a £25m contract for a provider to set up an “express freight service” to deliver medicines and medical products into the country in the event of a no-deal Brexit.

The DHSC said the service was “intended to deliver small parcels of medicines or medical products on a 24-hour basis, with additional provision to move larger pallet quantities on a two-to-four-day basis”.

Potential bidders have until August 21 to submit proposals for the 12-month contract, details of which are set out in an Official Journal of the European Union contract notice, which has a possible further 12-month extension.

The £25m contract is part of a £434m package “to help ensure continuity of vital medicines and medical products, including through freight capacity, warehousing and stockpiling”.

The Nuffield Trust’s Mr Dayan said the preparations to fly urgent medical supplies into the UK for a year after a no-deal Brexit shows “the scale of disruption the government is preparing for”.

He added: “In the circumstances, this new air service is a good idea. But the delays and extra paperwork that Brexit without an agreement will cause will still be there when the plane lands.

“There will be complicated new processes for customs and gaining permission to use these flights. Companies and suppliers will have to reroute all their supply lines overnight. Any teething problems that result will have a sharp impact on care as vital supplies that can’t last more than a few days become useless.”