News

Migrant Treatment Charges

posted: 17/12/2008

Before Christmas we expect the Appeal Court's decision on the government's appeal against the ruling early this year that all refused asylums seekers and many other migrants are in fact "ordinarily resident" and so fully entitled to all NHS free treatment, including HIV.

We are hopeful the Appeal Court will uphold the High Court's decision in the case which was supported by the entire HIV sector. But the Department of Health and the Home Office both still appear intent on restricting access to the NHS even further. They plan to extend the rules to cover primary healthcare, such as GPs. The department has been sitting on the results of a consultation on these proposed changes for four years, but is expected to release them shortly.

There is concerted opposition to banning migrants from primary healthcare, because a stitch in time saves nine - catch problems early and they are cheaper to treat and diseases don't spread; delay treatment by putting up charging barriers and we can safely predict expensive emergency hospital treatment and the spread of transmissable infections costing society far more than earlier care. But more important, it is the human and "right" thing to do for people in the country - and we made a commitment to treating all who need it to the world over 30 years ago in an international Convention that we are still breaking. The department does know what to do - it has recently published a guide to NHS trusts on the Human Rights approach to local healthcare.

Passports for treatment

Under the current system, asylum seekers who are awaiting a decision on their status are entitled to free primary healthcare, while even those who have been refused can be treated at a GP's discretion. But clinical decisions about who gets free care at times never reach doctors, says Dr Sally Hargreaves, of Imperial College London.

A study of GP practices in Newham Primary Care Trust, London, found that almost 70 per cent of practices asked for passports and about where patients had come from. This suggests frontline reception staff are inappropriately stopping migrants from seeing a GP. The government has said that the new ID cards now being issued to migrants (coming to everyone else over the next few years) will soon be used instead of passports to prove the right to healthcare and other services.

Confusion

Adam Hundt, the lawyer who won the court case, often gets calls from doctors who are unsure about what they should do with patients. “The clinicians are left with the decision between disobeying management or disobeying their Hippocratic oath,” he says.
 

Frustration and confusion surrounding who is entitled to free healthcare is echoed by the NHS. Nigel Edwards, director of policy for the NHS Confederation, says that the rules are “quite complex and keep changing. The Home Office has got to get its act together in not having large numbers of people waiting for their status.”
 

Donna Covey, chief executive of the Refugee Council, says: “The rules are complicated and people don't know how to apply them. You have the Immigration Minister not knowing the difference between asylum seekers and economic migrants, and if the minister responsible doesn't understand those differences, then you can't expect overworked and underpaid healthcare professionals to understand them.”

Thousands in healthcare no-man's land

There are thousands living in the UK stuck in a healthcare no man's land, including the estimated 155,000 to 283,500 failed asylum seekers, who, after their refugee status is refused, have nowhere else to go and often no means to pay for healthcare.

Charities that work with migrants say that the Government, in its effort to crack down on the supposed problem of “health tourism”, is victimising people such as failed asylum seekers and that because of confusion over entitlement, migrants often receive patchy and inconsistent care.

Treatment Catch-22

Many people are confused about their rights. Refused asylum seekers are caught in a Catch-22 situation: they cannot be deported immediately, yet cannot have free healthcare; nor can they afford to pay for it because they are not allowed to work. “We can't send them back tomorrow, so what can we do in the meantime?” 

 
How other European countries do it
Susan Wright, director of the health charity Médecins du Monde UK, says the problem with the government's claim that a “pull factor” exists - that people come to the UK for free healthcare - is that other countries in Europe offer equally flexible, if not more flexible, policies for free healthcare for undocumented migrants or asylum seekers.

• Italy: There are payment exemptions for asylum seekers and those with low incomes from the national health service.
• France: Undocumented migrants can access a state-financed insurance fund.
• The Netherlands: The Government has set aside money for “medically necessary” care for undocumented migrants.
• Belgium: Undocumented migrants can access government-sponsored Emergency Medical Aid, which gives free access to A&E and other services.

Includes material from source

Help with Prescription Costs

posted: 01/12/2008

Who has the right to help with prescription costs?

Greater Manchester HIV clinics will now only prescribe HIV treatment drugs and drugs for managing any side effects. This leaves medicines for anything else (depression, sexual dysfunction, contraception etc.) to GPs to prescribe, and that means some people have to pay for those GP prescriptions.

Many people are entitled to free prescrriptions; some can get free prescriptions because of low income, and there is a discount scheme to cut your costs. 

Other help with healthcare costs is available, including for travel expenses to and from hospital.

Citizens Advice Bureau has clear infomation here on all the help that is available for healthcare costs.

For prescriptions, some people can get them free, some people can get a full exemption on grounds of low income, and some people can get a discount by buying a prepayment certificate.

Free Prescriptions

You are entitled to get prescriptions free of charge if you:

• are over 60
• are on Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or the guarantee credit part of Pension Credit. Your partner and children will also be entitled to free prescriptions. (If you are getting Working Tax Credit and/or Child Tax Credit, you may be entitled to free prescriptions, depending on your income - see below - Help with health costs if you are on a low income)
• have a listed medical condition (HIV is NOT listed, see page 30 here for full list) and have a valid medical exemption certificate. You have to ask your GP if you think this might apply to you - ask for Form FP92A
• have a continuing physical disability which means you cannot go out without help from another person and have a valid medical exemption certificate - ask the doctor, hospital or pharmacist for Form FP92A
• are under 16 in England or Scotland. You must show age proof to the pharmacist
• get a war or service disablement pension, need prescriptions for your war / service disability and hold an exemption certificate - ask the doctor, hospital or pharmacist for Form FP92A
• are a prisoner
• are pregnant, or have had a baby in the last twelve months and have a valid exemption certificate. This includes if you have had a miscarriage after the 24th week of pregnancy, or your baby was stillborn. Ask the doctor, midwife or health visitor for Form FW8.
• you live in Wales

To claim, just tick the box on the back of the prescription form.

They do random checks afterwards to check that people who ticked the box were eligible. There is a penalty charge and possible prosecution for people caught claiming when not eligible.

In England, for full details of people who can get help with prescription charges, see the Department of Health leaflet HC11 Help with health costs.

If none of the categories mentioned in this list applies to you, you may still be able to get free prescription on the grounds of low income – see next section: Prescriptions for low income

Prescriptions for low income

If you have difficulty in meeting your health costs and do not qualify for any other kind of help, you may be able to get help under the NHS low income scheme.

The amount of help you get will depend on the amount of income you have. You might not be entitled to any help at all if you have too much in savings / capital. There are two types of certificate: a full help certificate (HC2), and a limited help certificate (HC3), which tells you how much you have to pay.

Full help certificate

If you are entitled to a full help certificate, you will get:-

• free NHS prescriptions
• free NHS dental treatment, including check-ups
• free NHS sight tests (including sight tests at home) and full value vouchers for glasses or contact lenses
• full repayment of necessary travel costs for hospital treatment
• full repayment of travel costs if travelling abroad for treatment
• free NHS wigs and fabric supports
• travel costs if travelling abroad for treatment.

Limited health certificate

If you are entitled to a limited help certificate, you will get no help with prescription charges (but see Prepayment Certificates for prescriptions below) but may be able to get some help with the costs of:-

• dental treatment and check ups
• private sight tests
• vouchers for glasses or contact lenses
• wigs and fabric supports
• necessary travel costs to and from hospital for NHS treatment
• travel costs if travelling abroad for treatment.

How to apply for help on the low income scheme

To apply for either a full help certificate (HC2) or a limited help certificate (HC3), complete form HC1, which is available from local benefit offices, NHS hospitals, dentists, opticians and pharmacists. Form HC1 can also be filled in online.

Do not wait until you need a prescription or treatment before you apply for a certificate. Getting a refund after you have paid is better avoided. You would need to ask the pharmacist for a special receipt when you get your prescription, which you then have to use to reclaim the money. If you don't get the special receipt when you hand in the prescription, you can't claim a refund.

Remember, if you don't qualify now because your income is too high, if your income drops you can always make a fresh claim.

Send the completed form HC1 to

NHS Business Services Authority
PO Box 370
Newcastle Upon Tyne
NE99 2ZA
0845 850 1166
website

Prepayment Certificates for prescriptions

If you need frequent prescriptions but do not qualify to get them free of charge, you can buy a prepayment certificate which could save you money.

Prepayment certificates save you money if you have to pay for more than three prescription items in a three-month period, or more than 14 items in a twelve month period. Remember each drug prescribed counts as a seperate item, so two drugs on one prescription counts as two items.

In England prepayment certificates last for either three or twelve months. You can pay for the twelve month certificate by direct debit, in ten equal monthly instalments.

Before buying a prepayment certificate, make sure you are not entitled to free prescriptions, as it can be difficult to get a refund once you have paid for your certificate.

You can buy a prepayment certificate:

• over the phone from the NHS Business Services Authority 0845 850 0030
• online from the NHS PPA website
• from the pharmacist
• from your Primary Care Trust

You are sent a plastic card (like bank card) that you show to the pharmacist each time you hand in your prescriptions and tick the box on the back of the prescription to say you have a Prepayment Certificate.

Health Care Help

Help with health care costs can be for:

• prescription charges
• NHS dental charges, including check-ups
• sight tests
• vouchers towards the cost of glasses and contact lenses
• travel costs to and from hospital for NHS treatment
• travel costs if travelling abroad for treatment
• wigs and fabric supports, for example, abdominal and spinal supports, and support tights.

Details of all the NHS health care help available.

Manchester Social Care Consultation

posted: 07/10/2008

Manchester city council is asking for your views on its plans to change the way social services manages care services for adults. The deadline for replies is 7 November.

There is a questionnaire to complete, some guidance notes and a social care guide You can download all of these from the links below.

They say:

Adult Social Care Service Consultation
We are currently making a number of improvements to the way we offer support to adults in Manchester.

Recent changes include:

• Introducing a reablement service focusing on helping people to regain their independence after an illness, accident or crisis. This service is provided free of charge.
• Offering individual budgets to all eligible customers increasing the choice and freedom in the way their care is provided.
• Introducing a new home care service to improve quality and customer focus.

We want to find out more about what people think about the services we offer and some of the changes we are considering. By filling in the consultation questionnaire, you can give us valuable feedback about our services and the way we charge for them.

You can also have the chance to win a £50 Marks and Spencer's Voucher in a free prize draw.
All responses will remain confidential and only summaries of the results will be published.

Please answer all questions in Sections 1 & 2. There are guidance notes to help you.

Filling in Section 3 is optional, but will help us to get a better understanding of the opinions of different groups of people. If you would like to be entered into the free prize draw for a chance of winning a £50 voucher, please also enter your name and contact details.

This questionnaire is available in other formats and languages on request. Please contact 0161 234 3880.

Please email your completed questionnaire by 7th November to: Promotionpublicity@manchester.gov.uk

Consultation questionnaire

Guidance Notes

Adult Social Care Guide (large file)

The direct link to the city council's adult social care consultation page is here.