Charge for treatment
10. Ms I says the Trust has incorrectly charged her £13,029 for her treatment. She says she was working abroad but still had her fixed address and bank account in the UK. She has a UK passport and UK driving licence.
11. The Trust says when Ms I returned for treatment it was told she planned to stay in the UK and would be finding work. But after the treatment it got an email from Ms I to say she needed to return abroad or she would lose her job. The Trust questioned if she was entitled to free treatment because of this new information which called her UK residency into question.
12. The NHS is a residency-based healthcare system (it depends on you being resident in the UK) and eligibility for relevant services without charge is based on the concept of ‘ordinary residence’. An ‘overseas visitor’ is any person who is not ‘ordinarily resident’ in the UK, despite keeping a UK address.
13. The Trust asked Ms I to give proof that she was returning to be resident in the UK and asked for the following information:
• ‘Proof of address within the last 3 months • Proof of work if obtained after return • Proof of initial flights when you had left the UK • Proof of flights back to the UK (once returned)’.
14. Ms I gave the Trust copies of her passport, driving licence, bank statements and documents relating to looking for employment. She also gave proof of her flights when she first left for work dated 4 February 2021.
15. While the Trust was considering her documents, Ms I made her complaint about what had been going on. This email is dated 5 July 2022. In this email she said ‘I travelled in good faith based on the information provided and I have to be back [in the country where she had gone to live and work] by the 25 July. I need this resolved as a matter of urgency.’
16. This email made the Trust aware that Ms I was not going to stay in the UK after her surgery. Because of this the Trust decided Ms I would be chargeable as an overseas visitor. It told her that ‘Under the NHS (Charges to Overseas Visitors) (Amendment) Regulations (“The 2017 Amendment Regulations”), there is a legal obligation on all NHS Trusts to charge patients who are not entitled to free NHS treatment for any care they receive, and to seek every opportunity to recover costs.
Former UK ordinary residents who have emigrated and no longer reside in the UK are usually chargeable for their treatment unless you are a person whose work takes them out of the UK but whose home which they return to remains here will be ordinarily resident (for example a pilot or a member of the cabin crew).’
17. We looked at the guidance and it says this about ‘ordinary residence’:
‘3.5. A person is not ordinarily resident in the UK simply because they have British nationality; hold a British passport; are registered with a GP in the UK; have an NHS number; own property in the UK; or have paid (or are currently paying) National Insurance contributions and taxes in the UK
3.7. When assessing the ordinary residence status of a person seeking free relevant services, a relevant body will need to consider whether they are: 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.’
18. The Trust says the information Ms I gave and her admission that she was going back to work abroad would mean she does not meet the criteria of an ‘ordinary resident according to the policies and guidelines’.
19. We can see no sign that the Trust failed to apply the guidelines when making its decision to charge Ms I for her treatment. It asked her to provide evidence that she would be staying in the UK for work after her treatment and she told it she would be returning abroad for work. Ms I gave no evidence that she was ordinarily resident in the UK. We are not considering this complaint further.
Monitoring her S-ICD
20. Ms I says that on 12 September 2021 she tried to send through a reading for her S ICD and thought it was broken because she could not use remote monitoring. She contacted the cardiac department and was told it had been told to turn off remote monitoring.
21. The Trust said that as she is living abroad and does not qualify for free NHS healthcare, remote monitoring would not be available. It explained this does not mean the S-ICD is no longer working. It said the device was functioning perfectly and is programmed to respond to life threatening arrythmias (a problem with the rate or rhythm of heartbeats). It said stopping remote monitoring did not affect how the device works. It reassured Ms I that the device has a safety function where it will produce an audible alert if there are suspected issues related to the device’s functioning.
22. The Trust recommended that Ms I register with healthcare where she lives to make sure she can have regular device follow-ups. It also said once she returns to live in the UK, she will be able to contact the Trust and have the remote monitoring restarted.
23. As we have said above, free NHS healthcare is only available for people ordinarily resident in the UK. As Ms I is living abroad she is not considered a UK resident according to the guidance.
24. As Ms I does not qualify for free NHS treatment, and the monitoring is provided by the NHS, we can see no sign that it was incorrect for the Trust to stop this service.
25. We can understand why Ms I has concerns about having to pay for her treatment, as she was born in the UK and has a British passport and driving license. The guidelines on free treatment are specific and Ms I did not meet the criteria at the time. As this is the case, we will not consider her complaint any further.
26. We understand the worry and stress Ms I experienced. We hope she is reassured that her device is not affected by the remote monitoring being turned off.