NHS Treatment Restrictions

[macd]

If a patient is going to be abroad for more than three months then all that he or she is entitled to at NHS expense is a sufficient supply of his/her regular medication to get to the destination and find an alternative supply of that medication abroad
ADVICE SHEET: NHS treatment for travel abroad https://www.coventrywarksapc.nhs.uk/mf.ashx?ID=ab0313dd-450e-40b1-960f-264a746ca03e

Tinto seems already to receive a prescription for three months, and doesn't intend to be away for more than that period. If so, that won't bother him. In any event, it does not affect his eligibility on his return, which is what he asked about. Besides, no-one's suggesting that NHS' treatment extends to UK patients overseas. NHS travel guidance makes clear that it does not.

Clearly any clinical implications of extended drug supplies would override any other entitlements, whether the patient was in the UK or not.

 

[macd]

We have two friends who have been refused NHS treatment on return to UK, despite having UK addresses.

I think you've mentioned that before (without saying when: eligibility assessment has changed). Besides, no-one's suggesting NHS/HMG is infallible in interpreting its own rules. Think Windrush.

P.S. I've never suggested, by the way, that full NHS entitlement is handed out willy-nilly. Just that your constant assertions of 3-months (or any other number of months) absence being definitive are plain wrong. Equally, neither we nor the NHS can begin to assess the correctness of your two friends' entitlement without a great deal more information . However, the eligibility tool I mentioned in post #37 does state this: "It is important to note that a person can be ordinarily resident from the first day they arrive in the UK if they have genuinely come to settle for the time being" which might apply to many returning yachtsmen. The tool also makes clear that assessment of "ordinarily resident" is based on an accumulation of factors and never just one.

 

[Tinto]

I don't have to go to my GP to get a repeat prescription. The prescription is written by consultant and the medication funded by the hospital. I just turn up once a year for a chit chat and three monthly blood tests to make sure its not damaging my liver.

My meds arrive in 3 month batches

 

[Graham376]

I think you've mentioned that before (without saying when: eligibility assessment has changed). Besides, no-one's suggesting NHS/HMG is infallible in interpreting its own rules. Think Windrush. The tool also makes clear that assessment of "ordinarily resident" is based on an accumulation of factors and never just one.

Although many of us retain a UK base and under tax regime are counted as normally resident, we actually spend more of the year away than here, unknown to them. Tinto it appears is planning on being away all year, interspersed with 3 monthly short trips back to see his consultant which, "may" under local NHS guidelines, call his residence status into question if they find out due to total time out of the country.

 

[macd]

Tinto it appears is planning on being away all year, interspersed with 3 monthly short trips back to see his consultant which, "may" under local NHS guidelines, call his residence status into question if they find out due to total time out of the country.

Possibly so. But I made no judgement as to whether he would be deemed ordinarily resident or not, but simply directed him to the criteria used by the NHS itself to assess such matters, unadulterated by spurious reference to three month cut-offs. He seems adult enough to weigh that information for himself.

 

[Tinto]

I may have to change plans. Anyone know how long you have to be back before heading out for 89 days again?

 

[jordanbasset]

I may have to change plans. Anyone know how long you have to be back before heading out for 89 days again?

You are allowed 90 rolling days days in every 180 (unless you have residency etc) as a non EU visitor in the Schengen area
Explanation and calculator here
Schengen Calculator - Calculate Your Legal Short-Stay in Europe

If it helps it probably wont kick in until the end of the withdrawal agreement, around December 2020

 

[macd]

I may have to change plans. Anyone know how long you have to be back before heading out for 89 days again?

I think jordanbasset got the wrong end of the stick.

As did you, in a different way. There is no 90-day absences limit for eligibility for NHS care, nor any prescribed period back in the UK which will retain entitlement. It depends entirely on having the status of "ordinarily resident". Do please read the links in post #37. They contain the official NHS guidance to their staff for determining eligibility for care. I didn't make them up any more than I supported them with 17 year-old newspaper articles.

Thank you, though, for demonstrating the irresponsibility of Graham376's repeated fictions.

 

[jordanbasset]

I think jordanbasset got the wrong end of the stick.

As did you, in a different way. There is no 90-day absences limit for eligibility for NHS care, nor any prescribed period back in the UK which will retain entitlement. It depends entirely on having the status of "ordinarily resident". Do please red the links in post #37. They contain the official NHS guidance to their staff for determining eligibility for care. I didn't make them up any more than I supported them with 17 year-old newspaper articles.

Thank you, though, for demonstrating the irresponsibility of Graham376's repeated fictions.

Yes you are right, thought he was referring to the Schengen rules

 

[Gentleman of Leisure]

AFAIK foreigners will have the same access to medical services after Brexit as existed before. The problem is that it varies from country to country at the moment and will continue to do so.

 

[macd]

AFAIK foreigners will have the same access to medical services after Brexit as existed before. The problem is that it varies from country to country at the moment and will continue to do so.

That's pretty woolly.

If you're talking about overseas visitors to the UK, all can received limited forms of free treatment (emergency treatment at A&E, treatment of infectious diseases, treatment under mental health law, etc.) Most treatment is not free, although visitors from the EEA can receive care if registered under EHIC. EHIC cover will continue throughout the transition period; whether it continues after that is one of many things to be negotiated. A few other countries also have reciprocal healthcare arrangements with the UK. Most don't.

Incidentally, the word "foreigner" is irrelevant here. NHS healthcare, unlike that in many other countries, is residence- rather than insurance-based. To be eligible for full, free NHS care you must be "ordinarily resident", period**. I'm sick of having to explain this to ignorant pig-heads, but it's so. From yet another official source, which makes this clear, adding that "it is not dependent on nationality, payment of taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK. "
NHS - Advice for overseas visitors to London

This seems to be a defining gov.uk document on the subject (ch3 covers ordinary residence): https://assets.publishing.service.g...the_overseas_visitor_charging_regulations.pdf

It goes to some effort to define ordinary residence (which earlier legislation tended to shy away from), including that it means:
"living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration...
...The concept of ‘settled purpose’ has been developed by the courts: There must be an identifiable purpose for their residence here, there can be one purpose or several, and it may be for a limited period. The purpose for living in the UK must have a sufficient degree of continuity to be properly described as ‘settled’. "

The Q&A sections are worth reading, notably this:
"A person can be ordinarily resident in more than one country at once [my bolds]. As long as they are properly settled here, despite spending more time in their other place of residence, they will meet the ordinary residence test. There is no requirement that the time be equally split between the UK and another country in order to maintain ordinary residence in the UK. Where a person has lived in more than one country for several years, consideration needs to be given to whether there is a pattern of regular trips to the UK over the years that demonstrates a sufficient degree of continuity to establish ordinary residence in the UK. The length and number of trips to the UK, family and other relationships with people in the UK, financial, property and other connections to the UK will all be relevant factors in determining if the person is ordinarily resident in the UK despite spending time living in another country. If they live only in Spain, and are only here as a visitor, not as a resident, then they will not meet the ordinary residence test. Although the patient may be deemed to be ordinarily resident they may still be insured in Spain, and may be entitled to a Spanish EHIC. "

** Or be entitled under special provisions, such as S1 arrangements, temporary employment or study in the UK.

 

[Graham376]

Thank you, though, for demonstrating the irresponsibility of Graham376's repeated fictions.

Whist you are quite correct about what the "rule book" says and that the old 3 month limit has been changed to 6, it is certainly not fiction that some health authorities have their own interpretation in practice. As I have made you aware, I was warned this year by a consultant (in Wales, if that makes any difference) about the possibility of treatment being withdrawn.

 

[macd]

Whist you are quite correct about what the "rule book" says and that the old 3 month limit has been changed to 6

You misrepresent what I wrote. Yes, there has in the past been a specified time limit, variously three and six months. This was unlawful and has been superseded. There is now no specified time limit of any sort. "Ordinarily resident" is the test, and the only test, and this is explicitly based on a multi-factor assessment with no single factor being definitive.

You are aware, I hope (but with no great confidence), that the law on this changed in 2017.

 

[Graham376]

You are aware, I hope (but with no great confidence), that the law on this changed in 2017.

I am now aware that the law changed but, that still doesn't explain why I have been warned this year and others have had treatment withdrawn - IIRC one by his GP and the other by her hospital consultant but, she may have been borderline 2017. Seems the UK is becoming like Portugal where every local official has his/her own interpretation

 

[macd]

I am now aware that the law changed but, that still doesn't explain why I have been warned this year and others have had treatment withdrawn - IIRC one by his GP and the other by her hospital consultant but, she may have been borderline 2017. Seems the UK is becoming like Portugal where every local official has his/her own interpretation

I suggested many posts ago that medical practitioners might be more inclined to keep up-to-date on matters clinical rather than regulatory, and with good reason so far as patients are concerned.
I think I also mentioned Windrush. There's little reason for the UK to feel smug on such issues.
Best for the new year, and fair winds.

PS: Clearly the presence or absence of a time limit has no absolute bearing on "treatment withdrawn". Ordinarily resident is a test, just like any other. People can pass or fail. I've no way of knowing either way (and nor, perhaps, do you) but the withdrawals meted out to your friends may have been based on more nuanced criteria than were described to you. Or maybe not, and some bureaucrat just screwed up.

 

[Graham376]

And all the best to you and other forumites, hope we don't lose any more this year!

 

[nortada]

An interesting debate but I think the most important issue is to make every effort to retain/maintain a significant presence in the UK. Then residency (ordinary or not) should not become a problem.

Mixing Up Schengen requirements with eligibility for free NHS care is a complete red herring. Schengen covers the time a non-Shengen resident can be in the Schengen Zone (90 days in 180). Nothing to do with the NHS.

As an aside the UK never joined Schengen but was given a dispensation not to observe Schengen requirements, which could be lost at the end of 2020.

 

[Lucy52]

As an aside, I do not know what the rules are but if you believe you have been unjustly refused treatment by the NHS then you can contact the local Healthwatch and explain your situation. Who if they feel like it can hold the hospital to account. This works with GP registration too. As with hospitals there may be variations as it seems to depend a little on who you are dealing with but may be well worth the effort.

 

[macd]

As an aside the UK never joined Schengen but was given a dispensation not to observe Schengen requirements, which could be lost at the end of 2020.

The Schengen opt-out will be irrelevant after the end of transition**. Unless something very surprising happens, the UK will become a third country, albeit one whose citizens will join those of 60-odd other third countries who enjoy visa-free travel to and within the Schengen area. (Common Travel Area freedoms will continue between the UK and Ireland.) However, assuming it's up and running, the new ETIAS on-line pre-travel visa waiver scheme will apply from 2021. There's a fee (yet to be decided although €7 has been suggested) for ETIAS registration, which will be required before travelling, but will be valid for three years for subsequent entries (unless the passport expires first). ETIAS will no doubt dampen enthusiasm for Schengen overstays.

It's unclear at present precisely how this might apply to travellers by private craft. Nor can I find any info on whether ETIAS would be required for a third country national returning from a third country to a Schengen country in which they are formally resident. I daresay it would, since that country would be a control-free gateway into the rest of Schengen.

Official ETIAS info here: ETIAS for Europe | European Travel Authorization System

** The UK does participate in some Schengen measures, such as on policing and security. It remains to be seen whether this continues, although the Political Declaration expressed the intention that much of it would. (BoJo made almost no changes to May's version in these respects.)

(I'm aware that you'll know much of this, nortada, but not everyone will.)

 

[Graham376]

(I'm aware that you'll know much of this, nortada, but not everyone will.)

First I've heard about ETIAS, thanks for posting. There's lots of info online but, as you say, nothing so far about private vessels. According to this info about Spain, any Brits staying in Schengen >90 days will also need a visa but no mention of what happens with those who have resident status - Travel Authorization for British Subject Citizens | ETIAS VISA Uk - British Subject