Healthcare in London
Access to healthcare is an integral concern of every expatriate, and no expat should even think of moving to another country without securing health insurance first. For expats and their families preparing to live and work in London, it is essential to find out how the public healthcare system of the United Kingdom works, and what treatments are available for expats. In particular, as an expat, what services are you entitled to when it comes to getting medical care in London? Are you eligible to use the National Health Service?
The State of Private Healthcare in the UK
While private healthcare in Britain can be expensive, more people are availing of these services as waiting times at National Health Service (NHS) hospitals grow longer. In 2015, over 4 million people bought private healthcare coverage, with companies and individuals spending GBP 4.7 billion on private healthcare plans. A report by The Telegraph says this has resulted in an increase of British residents seeking health and care services overseas, jumping from 48,000 in 2014 to 144,000 in 2016.
British excellence in medicine also brings an increasing number of foreign patients in many of the larger private hospitals in Central London. These overseas patients also opt to take the self-pay route for shorter stints in their preferred leading health specialist's waiting room. With these developments, London hopes to leverage its reputation as a global center for healthcare excellence.
The United Kingdom is one of the countries that have a universal public healthcare system. Known as the National Health Service (NHS), the system is one of the most recognized healthcare systems in the world. England, Scotland, and Wales have their own public health systems which are NHS England, NHS Scotland and NHS Wales. In Northern Ireland, the public healthcare program is called Health and Social Care in Northern Ireland or HSC.
Before the establishment of the NHS, private hospitals, municipal hospitals and voluntary hospitals flourished in the eighteenth century. In Central London, several former voluntary hospitals are now part of the NHS, such as Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, and University College London Hospitals NHS Foundation Trust.
More recently, the UK's total expenditure on healthcare in the year 2016 was GBP 191.7 billion, with the government financing 79.4 percent or GBP 152 billion, according to the Office of National Statistics (ONS). On average, around GBP 2,920 was spent on healthcare per person through financing schemes like compulsory insurance, voluntary health insurance, occupational healthcare, and out-of-pocket expenditures.
The Immigration Health Surcharge
If you're moving to the UK, your introduction to the country's healthcare system and the National Health Service (NHS) is during the visa application process where you're required to pay the Immigration Health Surcharge (IHS) of GBP 200, and GBP 150 for students or those under the Youth Mobility Scheme. After December 2018, it will be GBP 150 to GBP 300 per year for students or Youth Mobility Scheme applicants, and GBP 400 for all other visa tiers. The Surcharge is only paid by citizens of countries outside of the European Economic Area (EEA) applying for a visa in order to work, study or join their family in the UK for more than six months.
The Health Surcharge entitles you to free hospital treatment courtesy of the National Health Service, and its validity is tied to the visa. If you apply for an extension of your work visa thereafter, you need to pay an added surcharge. Expats who apply for and receive indefinite leave to remain (ILR) need not pay the extra surcharge. However, if your visa is canceled earlier than its expiry date by the UK government, you have to pay for any further NHS hospital treatment, even if you paid the surcharge. Paying the Health Surcharge is not a guarantee of preferential treatment and you'll get the same level of care as anybody else.
The European Health Insurance Card
A national who holds a European Health Insurance Card (EHIC) from any of the 31 EEA member states and Switzerland may also use it in the UK public healthcare system. The card is free and its validity depends on the issuing country. The EHIC allows anyone who is covered by the statutory social security system of the EEA and Switzerland to get medical treatment in another member state for free or at reduced rates.
The scheme enables people to continue staying in a country for work or study without having to return home for medical care. Routine or specialist care, such as monitoring for pre-existing conditions or the need for repeat prescriptions, may be covered by the EHIC but are determined by the healthcare provider if it's necessary.
The EHIC is only accepted at public hospitals and health centers, and should not replace travel insurance. Click here for more information about the European Health Insurance Card (EHIC).
The National Health Service
Launched in 1948, the National Health Service (NHS) believes that good healthcare should be made available to everyone, regardless of social status or wealth. Changes made to the NHS in 2013 resulted in a restructuring of services. Under the old system, the NHS trusts helped with the management of NHS hospital care in England, including community care and mental health services. As an example, London NHS served as the primary care trust for London and helped in the management of NHS primary, secondary and community health services in the area. The present NHS system provides care through NHS foundation trusts and NHS trusts for ambulance services, emergency care, and mental health services.
To be eligible for public healthcare under the NHS, you should be ordinarily resident in the UK. This means you're living in the UK legally, and you may be asked to show proof of address and an ID with your name and birthdate such as a passport or driver's license. Any free NHS treatment you may receive won't affect your immigration status. Hospital treatment is free and does not depend on your nationality, being registered with a GP, having an NHS number, payment of UK taxes or the National Insurance, or owning property.
British expat retirees living in an EEA country or Switzerland can avail of free NHS hospital treatment once they return to England if they have a registered and valid UK S1 form with the relevant health authorities in their country of residence. Former UK residents residing outside the EEA should make sure their personal health insurance is currently active to obtain free NHS hospital treatment. Otherwise, they will be charged 150 percent of the NHS fees for any care they receive.
Some services and treatments at NHS hospitals are free for everyone such as accident and emergency services. But there may be instances where you may be asked to pay for in-patient treatment, so check if your international health insurance can cover the cost. For other free NHS hospital services, click here.
Dependents of expats including spouses, partners, and children under the age of 16 are also eligible for free treatment under the NHS as long as they also reside in the UK. Expats should check if their home countries have any bilateral healthcare agreements with the UK, which may exempt them from certain payments for NHS hospital treatments. Visit NHS Choicesfor the list of exemptions.
Independent general practitioners (GPs), dentists, optometrists, and pharmacists are the first point of contact in primary care for patients when they need medical treatment. Patients can also get primary care via the NHS walk-in centers or urgent care centers for minor injuries. They can also call the NHS 111 telephone service for medical help or advice as long as it's not for a life-threatening situation. Otherwise, call 999 for emergency service.
Once you're in London, register with a local GP and fill out the paperwork for you and your dependents. You can also get your 10-digit NHS ID number at your GP. There's no fee for NHS GP registration or consultation but it's up to the GP to decide whether to accept new patients or not. With your GP's help, you can ask for a referral letter for specialist treatment, and you may specify whether you wish to go to a public hospital or private hospital. The NHS also offers online GP services for patients, making it easier to book and cancel appointments, refill prescriptions, and view their GP records.
For dental care, note that dentists are self-employed contractors who work with NHS England. Thus, you may be charged for any dental services you receive under NHS coverage. This may include emergency dental treatment, examinations, and diagnosis including X-rays, fillings, root canal or extractions, and dental crown fittings, bridges, and other laboratory work. There are certain NHS dental treatments for free, and patients may be exempted wholly or partially due to age, pregnancy or income.
Getting Secondary Care
Secondary care is called acute healthcare in the UK and refers to emergency treatment or elective care. Elective care covers specialist consultations and surgeries as these can be scheduled in advance. Such services in NHS hospital and community services are managed by clinical commissioning groups (CCGs), which include rehabilitative care, urgent and emergency care, rehabilitative care, mental health and learning disability services, most community health services, and some GP services.
If you have a referral letter from your GP for specialist treatment at a hospital, you can choose to go to any hospital in England, including private hospitals and NHS hospitals. However, be prepared to wait because there are a limited number of specialists in the UK who accept NHS patients, and waiting times to get an appointment are notoriously long in certain circumstances.
What if you're not eligible for NHS cover? Then you need to pay for your medical treatments yourself. But if you find yourself with a life-threatening condition, you won't be refused treatment even if you don't qualify for public healthcare. If there's no real emergency but your treatment needs to begin immediately, the medical staff may ask you to sign an "undertaking to pay." Find out the cost of the treatment before signing anything. As a patient, you have the right to delay or even refuse treatment in the UK until you have the money available, as long as there is no medical emergency.
For a list of all NHS services available, please visit https://www.nhs.uk/using-the-nhs/nhs-services.