Submission on National Health Service treatment for overseas visitors to the Health & Social Care

Commission of Labour’s National Policy Forum

Aligning the NHS's 'ordinarily resident' test with HM Revenue & Customs' Statutory Resident Test
and using National Insurance numbers instead of NHS numbers to identify patients would answer in
part the questions “How can we ensure that we maintain a universal health care system, free at the
point of delivery?”, “How do we ensure the NHS and social care receives adequate funding in order
to meet rising demand?” and “Looking to the future, what opportunities using new technology
could enhance our health and care services for patients?” asked in the Health & Social Care
Commission’s discussion paper. It would allow effective identification of overseas visitors who
fraudulently claim to be 'ordinarily resident' in the UK and thus entitled to free NHS treatment when
in fact this is not the case.

I would like to submit the following proposal to:

(1) Align the NHS's 'ordinarily resident' test with HM Revenue & Customs' Statutory Resident
Test(a).

(2) Deprecate the use of NHS numbers as unique patient identifiers and replace them with National
Insurance numbers as unique patient identifiers. When an individual seeks NHS treatment an
automated electronic enquiry could be sent to HMRC via the Government Secure Intranet to
establish whether that individual is considered resident in the UK by HMRC and thus whether they
are entitled to free NHS treatment.

My proposal does not apply to overseas visitors who do not claim to be 'ordinarily resident' in the
UK, nor does it apply to those aspects of NHS treatment which are always free, such as emergency
treatment, treatment for most infectious diseases to limit the spread of those diseases etc.

There may be a very small number of permanent migrants to the UK who do not have NI numbers
(such as dependents of another person who do not pay tax or claim benefits) and it may be that new
immigrants to the UK should be advised to apply for an NI number as soon as possible. For any
permanent migrant that does not have an NI number emergency treatment would remain free, as
always. Any permanent migrant without an NI number requiring non-emergency treatment should
have ample time to obtain an NI number before being charged.

Children would be treated in the same manner as adults. Children have NI numbers which are
created when their birth is registered but at present the Department of Work and Pensions does not
routinely issue them until 15 years and 9 months of age. However there is no reason why their NI
numbers cannot be issued earlier if there is a use for them.

(a) https://www.gov.uk/tax-foreign-income/residence