Patients who may be charged for NHS care
Lewisham and Greenwich NHS Trust serves a diverse community with a catchment of around one million people living in South East London. We take pride in providing quality care for all our patients, and do not wish to deter anyone from seeking treatment.
National regulations by the Department of Health state that patients must be living in the United Kingdom lawfully and on a settled basis to receive free treatment. We have a legal duty to to recover costs from patients who are not entitled to free NHS hospital treatment. Nationals of countries outside the European Economic Area who have indefinite leave to remain in the UK are eligible for free care, but many British nationals who now live overseas may not be eligible for free care.
Treatment in our emergency department is exempt from charges and there are not charges for Covid testing, treatment or the Covid vaccine. We will always provide care that is immediately necessary or urgent to anyone – including maternity care - and will not turn people away, even if the patient indicates they cannot afford to pay.
Find out more below.
Are you entitled to NHS care without charge?
We will always provide any urgent or necessary care to any patient, including non-UK residents whose care cannot wait until they return to their country of residence. We reserve the right not to provide treatment that, in the opinion of a clinician, is not immediately necessary or urgent. In this event payment of an estimated cost of care (proforma invoice) must be paid in full in advance before treatment commences.
All maternity care will always be treated as immediately necessary and no patient will ever be denied care. Please see further details on ‘Maternity Patients - Overseas Visitors below’.
The NHS provides free hospital treatment to people who live in the UK with valid immigration documentation from the Home Office. You must live here lawfully and on a settled basis to receive free treatment. If you are not ordinarily resident in the UK, you may have to pay for your hospital treatment.
NHS Trusts have a statutory obligation to identify patients who are not entitled to free NHS treatment and to charge them for the treatment they receive under the current NHS Charging Regulations July 2024.
To establish your eligibility, the Trust may ask you questions about your residential status when you register for a clinical appointment. This can apply to any patient regardless of nationality or if you've paid National Insurance contributions or taxes in the past.
Undocumented patients
If you are living in the UK with insecure immigration status or you have overstayed your visa, you may have to pay for your hospital care unless you meet one of the other exemptions in the NHS Charging Regulations. A member of the Overseas Team can discuss these exemptions with you on a case by case basis.
Coronavirus (Covid-19) testing, treatment and vaccine for overseas visitors
Overseas visitors to England, including anyone living in the UK without permission, will not be charged for:
- testing for coronavirus (even if the test shows you do not have coronavirus)
- treatment for coronavirus
However, charges may apply to any secondary illness that may be present even if treatment is necessary in order to successfully treat the condition unless a personal or medical exemption applies.
The Covid-19 vaccine is outside the scope of charging.
Maternity treatment for overseas visitors
Under the DHSC guidelines all maternity patients must never be denied care even if they are not a resident in the UK, here illegally or being supported.
Some maternity patients who are not resident may still be charged for care; however we also encourage all maternity patients to attend all their appointments. The Trusts primary concern is the welfare of the mother and baby.
The Overseas team will always advise and offer instalment plans for those patients who are unable to pay upfront, or who are vulnerable and advise them of charities that will be able to help them.
For further advice on vulnerable patients, please visit the DHSC guidelines.
Treatment to overseas visitors in A&E
Treatment received in our Emergency Departments (A&E) is free. If you are admitted to hospital as an inpatient or receive any outpatient appointments charges will apply.
- For those overseas citizens in possession of a valid European Health Insurance Card (EHIC) please present your card to our A&E reception staff.
- If your country of residence has a reciprocal agreement covering your emergency treatment in the UK please advise our A&E reception staff.
In these instances we will re-coup the cost of your care from your country of residence.
Visiting the UK – do I have to pay for treatment?
There are a number of circumstances when you might still be entitled to free healthcare as follows:
EHIC/PRC
- The UK is no longer part of the EU; however the reciprocal agreement is still in place. If you are visiting the UK and you normally live in a country with a reciprocal healthcare agreement with the UK, you might be entitled to free healthcare if you become unwell during your visit.
- If you are visiting the UK and you normally live in a country that is a member of the European Economic Area healthcare arrangement you will be entitled to free healthcare if you have a valid European Health Insurance Card (EHIC). This card covers emergency treatment only (not pre-planned). You need to bring this card with you to hospital – it must be in your name and within the expiry date.
If you have travelled without an EHIC, you can apply to your member state for a PRC (Provisional Replacement Certificate). These are issued to qualifying EU or qualifying EFTA visitors in cases where an EHIC cannot be produced. To to obtain a PRC from your member state, please click on this link and refer to the heading ‘National information and contacts’.
In addition for patients from Belgium and Germany the DHSC is unable to request a PRC without a person’s actual health insurance provider, therefore patents from these two countries must ensure they have insurance.
Support in paying for your care
If you unable to pay in full, the Overseas Visitors Team will be happy to discuss a monthly repayment plan. The team can let you know about charities that can provide help and advice. Here’s a list of national organisations who may be able to help.
Refugees or Asylum Seekers
A refugee is someone who has been granted asylum in this country.
If you are an asylum seeker whose formal application to the Home Office is being considered you will be entitled to free care, you will need to provide documents to prove your refugees/asylum status. However, refugees and asylum seekers will still have to pay for all prescribed medications, unless they are named on a valid HC2 certificate or are eligible for the NHS Low Income Scheme.
Studying and working in the UK
You may be entitled to free healthcare if you have come to study or take up employment in the UK. You need to show evidence, such as a payslips, p60, that you are working for a UK-based employer. Your ‘right to work’ does not count as evidence in this case. If you are studying you need to show evidence that you are attending a full-time course lasting at least six months, covering the dates you received treatment.
Non-EEA visitors
For visitors coming for less than six months, we would advise that you have travel insurance to cover for your healthcare.
For those visitors coming for six months or more, you must have paid the immigration health surcharge, and have a valid visa in place, to enable you to access free NHS healthcare.
Other exemptions
There are various other exemptions under the DHSC guidelines and will be reviewed on a case by case basis with a member of the overseas visitors team.
What do I need to do to prove I am entitled to free care?
To prove your entitlement to free NHS care you will need to supply various documents, eg ID card, passport, address. Please see section below for which documents you should provide depending on your status in the UK.
All patients admitted to our hospitals, whatever their nationality and residence status, are required to provide correct information when registering their details. If you are living lawfully with a settled purpose in the UK, or are a visitor in one of the categories stated below, you should be prepared to provide evidence. Please note: even if you have lived and worked in the UK all your life, you may still be asked to prove this by sending us information. This hospital is not able to access your personal data on your work, pay, or passport which is why we are asking for your documents.
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Lived in the UK all my life |
utility bill (eg gas or electric), council tax bill, benefit document, rent or pension book, tenancy agreement |
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Permanent UK Resident |
utility bill (eg gas or electric), council tax bill, benefit document, rent or pension book, tenancy agreement |
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Permanent employment |
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EEA settlement |
utility bill (eg gas or electric), council tax bill, benefit document, rent or pension book, tenancy agreement |
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EEA visitor |
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Visitor from outside of the EEA |
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Limited Leave to Remain in UK |
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Work Permit Holder |
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Full time student |
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Asylum seeker |
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Spouse/Dependant Visa |
utility bill (eg gas or electric), council tax bill, benefit document, rent or pension book, tenancy agreement |
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EU Dependant Visa |
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Medical Visa |
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Recovering outstanding debts
All Trusts are required to report outstanding debts that are more than two months old to the ‘Home Office’ via the ‘Department of Health and Social Care’, that are in the excess of £500. The Home Office may prevent you from returning to the UK, or if you are currently in the UK and have made an application for leave to remain for example, this may affect their decision if the debt is still outstanding. The Trust will always be happy to discuss a monthly payment plan which may help with your application process.
We may also provide non-clinical information about you to external agencies for the purpose of confirming your entitlement to free NHS treatment or to recover debts owed to the Trust for treatment provided.