R U UK Expat & Need to return to UK for medical care ???

[Guest travelerjim]

Over on Sawatdee Forum, a discussion regarding an UK Expat's options regarding the need for medical care due to serious illness. Can a UK Expat retired and living outside the UK return to the UK and receive FREE medical care from the UK National Health Service?

 

I had asked my friend fountainhall to share what he had learned a few years ago when this question arose regarding changes made in the UK National Health Service rules relating to UK citizens who are living outside the UK and needs to return to the UK for medical care...

 

Thank you fountainhall for sharing this in your reply to my question...this may prove most helpful to some UK citizens who find themselves in need of major medical care and lives in Thailand.

 

"I have not logged in for a couple of weeks and so have just seen this thread, as well as Jim's request in one post for information from me. Unfortunately, a later post has meant this information is probably largely irrelevant.

However, for those from the UK living in Thailand, it is very important to note that merely returning to the UK and expecting to get medical treatment is no longer automatic. The law was changed some years ago. Now, even if your national insurance contributions were not all fully paid up - including the years when you were living overseas - and you decide that you will return to the UK PERMANENTLY, you will qualify for free treatment as soon as you land back in the country. Qualification is based purely on residency. However, if you just want to return for treatment and then plan to come back to Thailand or somewhere else overseas, you do NOT qualify for free treatment. You will be charged as a private patient.

You will therefore be subjected to a lot of questions about where you will be living, how you will support yourself in the UK, and so on, and you have to satisfy the doctors and hospital administrators that you are indeed genuine about having given up residence abroad.

My brother and sister are both doctors and two years ago I quizzed them on this particular subject. Both said there may be degree of latitude depending on the individual medical staff. But most doctors/hospitals do obey the regulations. What my siblings suggested is that anyone who even THINKS he may require medical treatment for a serious illness at some point in the future should take steps now that will help when it comes to proving that you are returning permanently. This can include registering a bank account in a town/city where a relative lives, having mail occasionally sent to the relative's address, registering with an estate agent on one earlier visit saying you are looking for a place to rent/buy and then keeping your name on their books - and so on. Anything that will help to prove your case.

The issue which no doctor or administrator will know for certain is whether or not you will actually stay in Britain after the treatment is over or disappear back to Thailand or wherever. Apparently the Health Authorities do not run such checks. So both my brother and sister advised not to pay too much attention to this regulation when returning for treatment! Just tell them you are back for good! But every little piece of evidence will help your case".

 

tj

[Guest fountainhall]

Like many other expats, I was infuriated by the UK government's decision to change the National Health regulations. When I left the UK in 1979, I continued to pay my monthly National Insurance contributions on a voluntary basis for two reasons: 1. it would assure me of medical treatment at any time, and 2) it would provide me with the state pension when I reached retirement age.

 

Not only am I now not guaranteed medical treatment, once I start to draw down the state pension it is then frozen without the annual increases awarded to pensioners living in the UK - despite my having paid similar contributions. This pension is now around Bt. 4,500 a week I believe. Not to be sneezed at, but what will it be worth after 10 - 20 years of inflation, I wonder?

 

So, I have ended up paying the government a great deal of money over 33 years which could instead have been saved to provide a better rate of pension. To add insult to injury, I - and I assume all others - was given no information whatever about the changes, despite the relevant government departments having all my contact details.

 

To add insult to injury, refugees in the UK or citizens of EU counties travelling in the UK are entitled to certain medical benefits rights that I as an expatriate UK citizen have zero entitlement to! The whole system stinks!

[Guest]

Not only that, but you lose your NHS entitlement after just 6 months, but it takes 12 months to escape the tax system.

 

I wouldn't mind if we were allowed to keep a larger proportion of our income. However, we spend our entire working lives paying very high taxes. That's partially to subsidise people who never have any intention of working for their entire lives.

Therefore some parasite who has been deliberately unemployed for life retains entitlements, yet someone who has paid several hundred thousand pounds worth of taxes loses entitlements within 6 months of leaving the country.

With so little incentive to work, no wonder the country is in a mess.

[NIrishGuy]

Have to say when I first heard about people travelling back for medical care my gut reaction was "man they have some nerve" - buggering off and living the high life when it suits them and then coming crawling back for medical care when it's all gone to shit in their lives etc, BUT I have to admit I'd never stopped to think of things being the way your guys have outlined above and I do absolutely agree with you, that's really shitty deal for someone who has contributed so much and for so long and just isn't fair or right - they should have it set up like a normal BUPA policy where as long as you keep paying in you get cover, end of !

 

I think i might have a different view if the person hadn't been working here nor paying in while they were away, but assuming all payments required were made and are up to date then why NOT cover your paying members ! Just doesn't seem right somehow.

[Guest scottishguy]

I think there's an assumption here that the NHS is in any way administratively efficient??

 

Walk through the door of A&E, talk/gasp/wheeze/moan in any kind of a British accent, and you will be treated as much as and speedily as required - with a minimum of information required (and often none at all!) 

 

NHS Doctors/Consultants/Surgeons are interested only in your condition, not in your ability or eligibility  to pay- and I would be gobsmacked if there is actually any checking whatsoever as to your eligibility - the NHS simply do not have the systems in place to do this in a consistent and universal way - any checks will be entirely random.

[Guest fountainhall]

NHS Doctors/Consultants/Surgeons are interested only in your condition, not in your ability or eligibility  to pay- and I would be gobsmacked if there is actually any checking whatsoever as to your eligibility

 

Prepare to be gobsmacked! When you enter a National Health Service doctor's surgery or a hospital for the first time, you have to show your national insurance number. If you have not been paying in to the NI scheme, you don't have one. And if you did pay decades ago and then stopped, one click on the computer will tell the doctor or hospital administrator that you are too far in arrears to qualify for free treatment. The government would not have changed the system unless it had a reasonable expectation that the new one would work. I suspect a few people probably do get past the checks - particularly if they have been in a nasty road accident and require immediate surgery to save their life; but according to my family, they will be few and far between.

 

Certainly, when I had treatment in the UK for a small ailment before the rules were changed, I still had to show my NI number. Without that, the doctor/hospital could not claim the cost of my treatment back from the NHS!

[Guest scottishguy]

I think there are growing disparities between what "the Govt" announces, what they expect to happen, and what actually happens on the ground - in almost every sphere of responsibility (including North Korea it appears  )

 

And we have to bear in mind that "the Govt" you refer to (Westminster) has authority over the English Health Service only.  Their desire to privatise the English Health Service as far as possible is not shared by the Scottish or Welsh Govts, or the Northern Irish Executive, and it may well be this desire that has pushed the "checking" culture you have experienced.

 

So yes, I accept your experience and can only qualify my response by saying....it's different here.

 

[Guest fountainhall]

I don't think so! My brother works in Aberdeen and my sister works in Glasgow. One for a time was the head of community health for the city. If you have direct experience that what I have said is wrong, do tell us. If not, then I have to suggest that my information is 100% accurate according to 2 doctors I happen to know extremely well - and incidentally also to 2 cousins in the medical profession, one of whom works in England and the other in Wales!

[Guest scottishguy]

Founty I am not for a moment saying that your experience or experience is not 100% accurate - all I'm saying is I've never had to produce any ID or to "show an NI number" when changing doctor or registering at any NHS Dentist or Optician. I may have been asked to write down my NI number but never to show any evidence of it.

 

Further, I have accompanied people being admitted to NHS hospitals over the years and the information required to admit them was extremely basic indeed - name and address basically.

 

So, I am trying to think why that would be the case when you clearly have had a completely different experience.

[Guest]

The NHS requires you to register with a GP.
As this is a state monopoly, set up in the days before communism was proven to be a complete failure, the consumer has very little choice in the matter.
Mover 20 mile up the road & as soon as your local surgery hears about this, you will be de-registered.  I've had that, even though my move was temporary and my workplace was about 1.5 miles from the GP who de-registered me.
For non-emergency cases, your GP is your first point of contact.

[if your GP is totally useless, it can still be rather difficult to change GP. I've seen cases in very close family where GPs failed to order the tests that would have diagnosed cancer and serious heart problems.]

 

So if you emigrate, I guess it makes sense to try not to tell your local GP & remain registered with them.  Maybe it would be better to register from the address of a relative.

[Guest fountainhall]

Sorry SG, I cannot give my own experience of changing doctors or seeking treatment since I don't live in the UK. But this is what the NHS regulations (in all four jurisdictions) clearly state -

Anyone who is deemed to be ordinarily resident in the UK is entitled to free NHS hospital treatment in England. “Ordinarily resident” is a common law concept interpreted by the House of Lords in 1982 as someone who is living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, with an identifiable purpose for their residence here which has a sufficient degree of continuity to be properly described as settled.

 

Anyone who is not ordinarily resident is subject to the National Health Service (Charges to Overseas Visitors) Regulations 2011. These regulations place a responsibility on NHS hospitals to establish whether a person is ordinarily resident; or exempt from charges under one of a number of exemption categories; or liable for charges.

 

What about British Nationals? I have paid taxes in the past.

 

Nationality or past or present payments of UK taxes and National Insurance contributions are not taken into consideration when establishing residence. The only thing relevant is whether you ordinarily live in the UK.

 

‪http://webarchive.nationalarchives.gov. ... /DH_074374

 

If you are planning to live overseas for any length of time, i reckon you should act on z909's suggestion. Stay registered with your GP no matter how long your absence, maintain a UK address (it can be that of a relative) to which all government communications can be sent and from which your replies will be directed, and a UK bank account with occasional withdrawals and deposits. Even better, if you return to the UK for occasional visits, pop in and see your GP about some ailment - real or imaginary. It all adds to the illusion that you are actually "ordinarily resident" in the UK.

[Gaybutton]

Have you seen the Michael Moore film, "Sicko"?  In it, he says if a foreigner wants free medical attention, all he needs to do is go to England.  Not only will he receive full medical attention, including operations, long term care, etc, but when he goes to the cashier, he won't have to pay a thing and will actually receive money.

 

That makes no sense to me, but is any of that actually true?

 

He says the same thing about Cuba, completely free medical care, although they don't give money back.

[ceejay]

That makes no sense to me, but is any of that actually true?

So far as I understand it, only a little.

Accident and Emergency is always free. General treatment is not. So, if a non-resident has a heart attack on the street, he will be treated. If he arrives in the country for the purpose of getting a bypass he will not.

I'vs no idea where this "actually receiving money" comes from. For a start, I have never seen a "cashier's office" in an NHS hospital. I know of no mechanism whereby money might be paid to a patient.

[Guest fountainhall]

I really don't wish to become further involved in this issue. On another forum, Jim asked my views based on discussions he knew I had had two years ago. With the best will in the world, he reposted my post on every forum, it seems. If anyone doubts the veracity of the advice I have provided, they are perfectly able to call their UK GP or local hospital administrator and find out for themselves what is the exact situation. The NHS rules I posted above seem pretty clear to me, but I am ready to stand corrected if I have posted any inaccurate information.