NHS HEALTH CARE CHARGES

1. NHS HEALTH CARECHARGES NORTHERN REGION OVERSEAS VISITORS ADVISORY GROUP -15th February 2019 Rachel McIlvenna, Health Improvement Specialist, South Tees Public Health & Coordinator North East Regional Migrant Health Group

2. Outline of Presentation • Background • Our approach in the North East • Next Steps

3. Background • The Immigration Act 2016 heralded changes to how overseas visitors could access healthcare & included criteria for exemptions. • We carried out a survey in 2017 to understand the implementation of the NHS (charging) regulations in the North East and published the results at a PHE conference in September 2017.

4. Background Contd • National policy/regulations like the NHS overseas charge are likely to affect specific sub groups disproportionately compared with the whole population. • Vulnerable groups in the main were most likely to be affected but this group was heterogeneous encompassing a wide-ranging group of people such as: • overseas visitors, • failed asylum seekers (including pregnant women) • undocumented migrants • Visitors who have not paid the HIS • Destitute asylum seekers and their dependants • INEQUALITIES IN HEALTH OUTCOMES

5. Background Contd • In October 2017 the government introduced amendments to the NHS Healthcare (charges to Overseas Visitors) Regulations of 2015. • The Regional Migrant Health Group in the North East was concerned about the Health Impact of these charging regulations amendments on the most vulnerable. • A rapid Health Impact Assessment was carried out between November and February, and a report was published in April 2018

6. Findings of the Health Impact Assessment • Access • Quality of Life • Unintended consequences • Shift in demand • Impact on public health • Short term savings vs long term costs • Demand for resources and practicalities

7. Mitigating the negative impact? • Education & Information • Best Practice Events • Use of Community Champions • Lobbying & Influencing National Policy

8. Recommendations of HIA • Muti-agency approach that fosters partnership working to ensure consistency across the healthcare system and implementation of the changes. • A process/approach to cascade information within migrant communities and education for frontline professionals. • Sharing best practice and standardisation of practice across all health services (trusts etc.) so that equitable access is in place and migrant communities can navigate the complex healthcare system. • Robust evaluation & data collection at all levels to facilitate feedback • Support of organisations lobbying for change.

9. Our approach in the North East • Organised a best practice event in partnership with North Tees Hospitals , DHSC & NEMP in March 2018 in North East. • We have briefed a number of forums locally in South Tees (NE VCS, BAME & Specialist GP practice, Migration Multi-agency meetings). • We developed an attractive resource that simply explains what the entitlements, exemptions and charges were. This resource has been shared with over 25 organisations including local MP office in Middlesbrough and refugee organisations.

10. Our approach in the North East • We have arranged briefing sessions to frontline Social Care Workers & NeigbourhoodTeams in Middlesbrough. • This resource is due to be translated into 5 languages by March 2019. • South Tees NHS Foundation Trust have agreed to utilise this developed resource within majority of departments/wards.

11. Next Steps • How can you/we utilise this resource at scale? • Would your trust be willing to adopt this?

12. Questions?

13. Contact Details Rachel McIlvenna rachel_mcilvenna@middlesbrough.gov.uk 01642728208 South Tees Public Health