NHS Entitlement - Department of Health Rules

A

Anonymous

Guest
[ QUOTE ]
Am I missing a big point? Haven't read all the thread

[/ QUOTE ]
Yes, you are missing the entire point which is probably because you haven't read the webpage, link posted in the original post.

[ QUOTE ]
...but then return to the UK to take up permanent residence here again, then you will be entitled to receive free NHS hospital treatment from the day you return

[/ QUOTE ] Yes, the key is your intent to take up permanent residency. If you are not taking up permanent residency you will possibly not be entitled to treatment and if you are given it, you might end up with a bill, on a scale of fees unpublished and outside your control.

[ QUOTE ]
From the day you return! So that's that surely? You step on British soil declaring 'right, I'm back now' and that's it. There's no mention of proving anything or tax status.

[/ QUOTE ]

NO! That is absolutely not correct. You might think that it ought to be correct but that doesn't make it correct. Read the Department of Health guidance.

From the Department of Health website, above:- <span style="color:blue">The Regulations place a responsibility on individual hospitals to determine whether, in accordance with the Regulations, a patient is liable to be charged for treatment or not. In order to establish entitlement, hospitals can ask you to provide documentation that supports your claim for free treatment, such as evidence of where you live, moving permanently back to the UK etc, as appropriate.</span> Forget the tax status thing, that has come from Lady Jessie, not the Department of Health.

As I pointed out in my original post, there is an inference - only an inference, we don't have the facts - that if you are travelling in Europe assuming that your EU Healthcard is valid, then if you have been out of the UK for more than three months it might be that you are not entitled to use the card. While it might work perfectly well in Europe, you might find that you have a bill waiting for you at your UK home or correspondence address at a later date. Maybe nobody will find out, maybe they will.

Let's give you an example. Suppose you have been in Spain on your boat for four months and then have a major op in Spain using your healthcard and then decide to go back to the UK to be with family and for further treatment (I know someone who did almost exactly that so it is not unusual). Suppose you play by the rules and declare that you are resuming permanent residency (if you have right of abode, of course). Obviously you give the doctors full details of the op you had carried out in Spain and the administrator wanders over for a chat... how long had you been out of the country for? Can you provide any evidence? The administrator only has to put your details into the database for find your healthcard and presumably any bills that have been charged to it, from Spain. If you were not entitled to NHS treatment while you were in Spain don't you think that they are going to try to re-charge it to you? Sure, you might argue that they are not clever enough or efficient enough to do that but you could be in for a nasty surprise. ADMINISTRATORS DO CHECK AND ASK QUESTIONS, WE HAVE BEEN THROUGH IT OURSELVES.

[ QUOTE ]
It explains the thread, but I still see the thread as being typical of a lot of threads as in it seems to be looking for a problem where there is none.

[/ QUOTE ] If you read the first post and the link you will get all the information you need. No need to read the whole thread which drifts into tax residency and euthanasia.


[ QUOTE ]
So, as a long term live-aboard / expat, call me what you will, I can confirm that I've recently gone through the NHS system for treatment and at no stage was I asked about my travels or residency status and I was treated. I wasn't even registered with a doctor, have no UK medical records and had no health card.

[/ QUOTE ] That's about as much sense as saying that speed limits are not enforced in the UK because you've just driven down the Bath Road at 70 mph without being caught. It's for everyone to decide for themselves what they are prepared to risk.

We were interviewed by the hospital administrator when we returned from Spain with my wife's ankle in plaster. I guess that was a dead giveaway because they asked where the cast had been applied. "Spain", we said, "we've been staying on our boat for a while"... We then had the third degree despite having a local address clearly marked on our driving licences as they wanted to know exactly how long we had been away for. The point is that you don't re-qualify for NHS treatment simply by coming home on a trip. You only qualify if you are returning to re-commence residency. Provided that you make it clear and can provide some supporting evidence (or are prepared to have an argument later if a bill arrives) then you shouldn't have a problem. You need to know what to say to the administrator, and what not to say. i.e. you need to know the rules that they administrator is applying. Where better to find them than on the Department of Health's website?

[ QUOTE ]
Unless of course you shout and scream at the doctors and nurses as you burst through the A&E doors on a trolley not to touch you until your right to treatment has been established or you throw your mastercard at the receptionist.

[/ QUOTE ] Nobody is suggesting that. I am suggesting that if you read the rules you won't need to throw a tantrum or your Mastercard at the doctors, nurses or administrators. Of course, there is a large group of liveaboards who have gone to live elsewhere in the EU (and outside the EU) permanently. They are official residents of those countries and when they visit the UK they have limited access to the NHS (read the link, it's all there).

The group of people that is most at risk is those who just wander on their boats here and there without registering for residency or medical care as they are travelling. That group becomes disenfranchised possibly with no right to non-emergency treatment in the EU or the UK unless they proclaim their intention to re-commence UK residency.
 

grumpygit

Well-known member
Joined
29 Jul 2007
Messages
1,169
Location
Sailing the Aegean
Visit site
Bit of a bun fight on this thread I see.

There was sometime ago an article in our local paper on someone who had been in the Caribbean for a couple of years and had an accident. He got a badly damaged leg that needed more surgery to put it right so he came back to the UK. He had the op and told them he had be working abroad, he got a bill for it.
I would say it's quite plain they only know what you tell them and their judgement will be made from that. Say that he had said that he had just been on holiday I wonder if the outcome would have been the same, I doubt it.
Each of you will have to decide for yourselves how you go about the situation if it ever arises. No one is tracking a normal law abiding citizen so they with not have a clue if you go for treatment.
I know what I will do. /forums/images/graemlins/wink.gif
 

jb2008

New member
Joined
22 Jul 2008
Messages
518
Visit site
Lemain, in your example of Spanish treatment then further treatment in the UK, was it new treatment in the UK they had an issue with, in which case the returning to be a permanent residence thing should apply or was it the cost of the treatment in Spain that was the issue?

Or were they in denial that you intended to be a permanent resident? Given that you don't need an address at all to be a permanent resident how do they hope to prove it?
 
A

Anonymous

Guest
In our case, my wife had had emergency treatment for a broken ankle in a Spanish hospital. We did produce her European Health Card but I suspect that in any case a broken ankle is regarded as 'emergency'. We then came back to the UK for Christmas 2006, during which time the cast needed to be changed and the ankle looked at.

We were not allowed past the administrator before the entitlement was sorted out -- no nurse, doctor or anyone medical. When we booked in we explained that the cast had been put on in Spain, and that's when the administrator was called. I said that we hadn't been out of the country for 'very long' - 'only a matter of weeks' which happened to be true as we'd come back for a family do shortly before the broken ankle. I was not asked to prove that though I could have done by getting copy tickets from EasyJet and producing a few credit card statements. I think I mentioned that to the administrator.

We never heard any more about it but we were grilled about whether we lived most of the time outside the UK. In this case, they accepted that we had entitlement (though I'm not sure that we really were entitled) and in any case the broken ankle would have been treated anywhere in Europe under the rules for emergencies.
 

jb2008

New member
Joined
22 Jul 2008
Messages
518
Visit site
Thanks for highlighting the trap the NHS appears to be trying to set. It looks like it's best to describe any trip away as a holiday and that you're permanently returning.

It's like builders isn't it, they hate finishing off someone elses work.. /forums/images/graemlins/wink.gif

Is it possible that they might have thought they could bill Spain for the treatment if you were a Spanish resident rather than trying to bill you personally?
 
A

Anonymous

Guest
[ QUOTE ]
Is it possible that they might have thought they could bill Spain for the treatment if you were a Spanish resident rather than trying to bill you personally?

[/ QUOTE ]I think it's probable. We have many friends in Spain who clearly not entitled to NHS as it stands. There are hundreds of thousands of people in this position. Many of them have apartments and/or boats but don't register with the Spanish authorities for healthcare. The NHS is required by the Department of Health to establish the bona fides of people saying they are re-commencing their residency in the UK. The spat we had with the hospital administrator certainly wasn't the first spat she'd had on this subject!!

The trouble I found was a sense of indignation. Born and bred Brit, sending an annual Tax Return to the Inland Revenue, no other country, address in the UK, only have UK banks, UK Driving Licence, etc. You feel "Who are you to be asking ME?" when the administrator cannot construct an entire sentence in English without serious grammatical errors. That's a big mistake, they have a legal right and obligation to follow these things up and it is what they are paid to do. The trick is to understand the rules.

Declaring that you are resuming residency every time you come to Britain is a possible option for some of us. But if you have a house in Spain, that isn't going to work if anyone checks. Credit card bills, bank statements, tickets.... any legitimate argument can almost always be supported by some kind of paper trail. If you say that you are resuming UK residency as a result of changed financial circumstances they really can't argue with that, surely?

A big danger is something like a heart attack in Spain, for example. Suppose you are stabilised in Spain and then decide to come back to the UK for your triple bypass.... the cost could be massive. In those sort of circumstances you'd be advised to get your act together carefully. Write to the marina/urbanization explaining that you will be returning to the UK indefinitely, leaving forwarding address and phone numbers. A couple of letters to people in the UK confirming your plans would also be sensible.

These are just a few ideas but anything supports your argument is going to be useful when you are face to face with a hospital administrator or a bill arrives in the letterbox.

For most people, the bill probably won't arrive, but for those who receive one it could be a nasty and expensive shock.
 

Sammo

New member
Joined
23 Jan 2005
Messages
1,005
Location
Adrift
Visit site
There seems to be three arguments here …one says ….`beware new legislation`…another says `find and use loop holes` …..and lastly and probably the most popular is …`lie about your residency status`….

The gut reaction is ..I have paid into this all my life so I am entitled …but here they have moved the goalposts so that doesn`t count for anything, the common denominator now is whether or not you have UK residency…Then they have gone on to quite specifically define this by saying you are not a resident in the eyes of the NHS if you live elsewhere for more than 3 months…..

Lemain has said …“beware new legislation” and although he is right he`s having an uphill struggle as basically he`s raising pointers that people just don`t want to hear…..

Jesse says……“find and use loopholes” and again he is right but as there is a big push to close them this is not a good path to follow….at the end of the day the loophole you are using could disappear overnight…..

Nautibusby has said ..tell them a few white lies and you`ll get all the treatment you need…Well..
Remember how no-one took speed cameras seriously when they were first introduced ….or when you could smoke anywhere…or not bother with your seatbelt…..Bury your head in the sand and you are lining yourself up for a swift kick in the rear…

At the moment I`s easy to tick the box that asks `are you a UK resident` ..however this will not be the case once we are all obliged to carry an ID card …..


…..
 

Fascadale

Well-known member
Joined
15 Jan 2007
Messages
1,471
Location
One end of the A1
Visit site
I know of many young people who before university or soon afterwards go traveling, often out of the country for more than three months: I know kids who do the winter season in the Alps and then a summer season in the Med, usually away for more than three months. Some disappear off to the Antipodes for a few years

I have never heard of any of them being challenged about residency by the NHS on their return.

Equally in what contact I have had with the NHS I have never been quizzed on my residency status. (might have something to do with being a white, middle class old git though)
 

DaveNTL

Well-known member
Joined
26 Aug 2004
Messages
10,150
Location
Lake District (closed for maintenance)
Visit site
I fully understand where you're coming from. Don't disagree with a thing you say.

However, being an honest upstanding bloke just like you, If I'd read all this thread before going into the docs I might have been on edge with worry that I was doing something that perhaps I shouldn't. As NDH say's, that's just typical of us Brits who try to make sure we're always doing the right thing.

Even as an expat who hasn't paid UK income tax for 27 years I can still put my hand on heart and believe I'm entitled to NHS treatment. I'm British, I've paid voluntary National Insurance, I have a UK home on which I paid stamp duty etc, I pay council tax, I bring in foreign money to buy UK goods with VAT on them. I now KNOW that as far as the NHS is concerned my expatriate status can stop instantly that I have a medical problem that requires me to become a permanent resident again.

Could the thread not then be concluded as having resolved the following advice for long term live-aboards / expats? :-

You are entitled to free NHS treatment the moment you step on UK soil if you are returning permanently, therefore be resolved to be so in case you are asked. Only you can know what you are, a hospital administrator cannot arbitrarily decide for you and rule accordingly. Make sure you know the facts regarding your entitlement - it is printed on NHS directives that 'from the day you return' you are entitled to this treatment. Be clear and do not waver that yesterday you was a visitor - today you are permanent - and that this entitles you to treatment.
 

DaveNTL

Well-known member
Joined
26 Aug 2004
Messages
10,150
Location
Lake District (closed for maintenance)
Visit site
[ QUOTE ]
.....never been quizzed on my residency status. (might have something to do with being a white, middle class old git though)

[/ QUOTE ]

I'm sure that helped me too. Blimey, it has to have some uses apart from annoying the wife and kids eh?
 
A

Anonymous

Guest
No, there is more to it than that. For the umpteenth time....

If you use your European Healthcard when not entitled to NHS treatment you might end up with a bill.

If you are going to claim that you are returning to permanent residency then expect to be asked to show some evidence....the Department of Health, which pays the hospital administrators, has instructed the administrators to obtain such proof where appropriate. It seems that is for the administrators to decide, not you, though no doubt you have some right of appeal. Appealing to hospital administrators when hoping to get medical attention in a hospital, is not habit-forming.
 

DaveNTL

Well-known member
Joined
26 Aug 2004
Messages
10,150
Location
Lake District (closed for maintenance)
Visit site
You seem to want to include every medical circumstance and expect NHS treatment on demand in Europe then? Or presume that others go about their lives under that misapprehension? I don't.

Once you're talking about outside the UK system, personally I wouldn't be overseas without private medical cover. If I can't afford that then I can't afford to be living abroad on a boat. End of. But that's just me.

That's where I agree with the intent of the NHS directive only to cover people who are entitled to cover under all reasonable circumstances and, maybe, only maybe, that wouldn't cover those who are off doing stuff outside that. EU or not I wouldn't expect (whether I should be able to expect or not) to get the same treatment as the NHS and would make sure I'm protected privately. Mine and my families health is worth more than that.

My wife and I were in South Africa for many months, she fell off a step and broke her leg. Went into a private hospital and had surgery. Paid for on the credit card and claimed back later from insurance. A week after surgery our flights were upgraded to first class courtesy of insurance for the return home, it was the only way to fit her on the plane. I had a ball on first class food and booze while she was drugged to sleep - but that's another story. /forums/images/graemlins/grin.gif

Once home she was fully treated on NHS for the next six months. The NHS new the full story, again, no problems.

So, there isn't one set of circumstances here, there's your ability to 'come home' and go on the NHS if you're able to do so, and you can, and there's emergency cover when abroad. You can't and shouldn't expect that in my opinion.
 

pgurnett

New member
Joined
29 Oct 2007
Messages
92
Location
Oswestry, Shropshire.
Visit site
Ladies and Gentleman, whilst i sense a little difference of opinion and do not want to take sides: I am no expert but I am a Chartered Physiotherapist both in private Practice and do some NHS contracted work. As far as i am aware, people seem to be worrying over nothing. I can not think of anyone being challenged if they were to seek medical help if they were registered as a tempary resident via a families GP. There is no need to volounteer too much information. I like others am thankful to Lemain for informing forumties of useful information. /forums/images/graemlins/smile.gif
 

Sammo

New member
Joined
23 Jan 2005
Messages
1,005
Location
Adrift
Visit site
[ QUOTE ]
I can not think of anyone being challenged if they were to seek medical help if they were registered as a tempary resident via a families GP. There is no need to volounteer too much information.

[/ QUOTE ]

.if you are out of the country for three months or more your doctors practice will delete you…..so when you come back to visit (not live) you have to sign back on…the form will ask you specifically, `are you a UK resident`...if you tell erm you’re just visiting …you pay….if you say your back to resume residency…you don`t …

….
 

capsco

New member
Joined
20 Nov 2001
Messages
1,619
Location
North
Visit site
[ QUOTE ]
[ QUOTE ]
I can not think of anyone being challenged if they were to seek medical help if they were registered as a tempary resident via a families GP. There is no need to volounteer too much information.

[/ QUOTE ]

.if you are out of the country for three months or more your doctors practice will delete you…..so when you come back to visit (not live) you have to sign back on…the form will ask you specifically, `are you a UK resident`...if you tell erm you’re just visiting …you pay….if you say your back to resume residency…you don`t …

….

[/ QUOTE ]

I often do not go to the doctors within 3 months, sometimes 12 but they have never mentioned "deleting" [is this painfull]? me
 

capsco

New member
Joined
20 Nov 2001
Messages
1,619
Location
North
Visit site
[ QUOTE ]
not so much painfull as expensive....keep smiling... /forums/images/graemlins/grin.gif



.....

[/ QUOTE ]

If I keep smiling my teeth may fall out, would I then have the same problem with my dentist? /forums/images/graemlins/confused.gif
 
Top