Health services

This section explores the health services available to homeless people from the A2 countries.

NHS services

Primary care
During a temporary stay in the UK EEA nationals are eligible for treatment that a GP (doctor) decides is medically necessary. Other treatment, including the treatment of a pre-existing condition, which in the medical opinion of the GP can wait until the individual returns home, is excluded. The EEA consists of the member states of the European Union, plus Norway, Liechtenstein, Iceland and Switzerland.

In addition, any person living in the UK lawfully and on a settled basis is regarded as resident in the UK and therefore entitled to free primary medical services.

The Department of Health states that on taking up residence in the UK it is advisable to approach a GP practice and apply to register onto its list of NHS patients. The practice may choose to accept or decline an application.

An application may be refused if the practice has reasonable grounds for doing so, such as if an individual is living outside the practice area. A practice would not be able to refuse an application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

When registering, GPs may request some proof that the prospective patient intends to stay in the UK for a settled period. GPs have discretion as to what type of documentation is required for registration but as a guide, any form of lawful documentation that states or proves that the overseas visitor intends to stay in the UK for a settled period is acceptable, e.g. letter from employer, visa papers, utility bills.

Other medical services accessed through GP referral are only free of possible charges if the treatment is deemed to be medically necessary. Examples include mental health or detox services.

Further information is available in the document EU enlargement and overseas visitors' rights to primary care treatment in the UK.

Hospital (secondary) care
The following services provided in a hospital or by staff employed by a hospital are provided free of charge to all:

  • treatment given in an accident and emergency department (excludes emergency treatment given elsewhere in the hospital);
  • treatment given in a walk-in-centre providing similar services to those of an accident and emergency department of a hospital
  • treatment for certain communicable diseases (excluding HIV/AIDS where it is only the first diagnosis and connected counselling sessions that are charge free)
  • compulsory psychiatric treatment
  • family planning services.

All other hospital treatment is free to anyone who is deemed to be ordinarily resident in the UK.

A full list of situations in which an individual is exempt from charges is available from the Department of Health's overseas visitors’ webpage.

Some important situations where charges will not apply are:

  • anyone who is working in the UK for an employer who is based in the UK or is registered in the UK as a branch of an overseas employer (this includes self employed people). An individual must be actually working, not just looking for work
  • anyone who has been lawfully living in the UK for twelve months immediately prior to treatment
  • anyone, including a refugee, stateless person or a member of the family of any of them, who normally lives in another EEA member state and is visiting the UK. (Treatment is limited here to treatment required for any condition that occurred after arrival in the UK (including pre-existing conditions which acutely exacerbate whilst here) and treatment for chronic conditions, including routine monitoring).

In the case of treatment given in an accident and emergency department or walk in centre, services will be subject to possible charge, depending on exemptions, once the patient is formally admitted as an in-patient (this will include emergency operations and admittance to high dependency units) or registered at an outpatient clinic.

Medical services, such as mental health or detox services, accessed through referral by a GP but not deemed medically necessary will also be subject to possible charge depending on an individual’s exemption from charges.

The Department of Health has recently published updated guidelines on charging overseas visiors for hospital services; 'Guidance on Implementing the Overseas Visitors Hospital Charging Regulations'. 

European Health Insurance Cards

A separate system coordinating sickness insurance schemes exists at EU level for EEA nationals. An EEA national (including A2 nationals) should be able to access ‘all the types of medical care and treatment that the patient’s state of health necessitate to enable him to continue his stay in [the] country under safe medical conditions’ which may go further than the treatment listed above (see European Commission web page). However to access these services you need a European Health Insurance Card (EHIC), which the authorities of home states provide. An individual who does not have the EHIC can also ask for a provisional replacement certificate from their home state’s authorities.

This system was aimed at EEA nationals temporarily in another member state who fell ill. However, the EHIC system is also meant to cover unemployed individuals seeking work in another member state, and so should apply to A2 nationals seeking work (whose stay as a visitor is temporary inasmuch as they are seeking work and will soon be covered under the NHS system). However, the care is intended to be temporary and may be limited in time or scope if it is something that is more appropriate to be taken care of in the country where the person is insured.

Further information on health

The Department of Health has produced leaflets that offer an Introduction to the National Health Service in a variety of languages, which explain the basic processes of registering and making appointments.

Contact Helen Mathie for more information.