Foreigners will be vetted to get NHS treatment

Patients who have foreign accents may be asked to show passports, visas, travel documents, payslips, bank records and council tax paybooks before getting free treatment on the NHS, under a government crackdown on "health tourists".

John Hutton, the health minister, said that action was needed to close loopholes allowing foreign businessmen and failed asylum seekers to get healthcare to which they were not entitled.

He promised to introduce rule changes in April, subject to parliamentary approval, adding that, after a three-month consultation, NHS bodies were in favour of the plan.

Opposition MPs said the government was acting without knowing the scale of the problem and without being able to justify ministers' assertion that it was costing the NHS hundreds of millions of pounds a year. Doctors' leaders said the profession would not act as "state agents" policing patients.

Under the rules, free treatment will be denied to the visiting spouse and dependents of an overseas visitor resident in the UK. The government said this would "prevent the heavily pregnant wives of permanent overseas residents from coming to the UK just to give birth".

Others losing the right to free treatment include business travellers to the UK and their dependents who fall ill or are injured during the trip.

Asylum seekers whose case has been rejected by the immigration authorities will be denied free treatment "for conditions which arise after their legal case has been finally determined".

The rules will allow British pensioners to live up to six months a year abroad in Europe, and remain entitled to return for free treatment on the NHS.

The changes will affect most NHS operations and outpatient consultations, but emergency services will remain free to all-comers.

In a response to the consultation yesterday, the government remained silent on what procedures would be used to check entitlement. The NHS Confederation, representing its organisations, said that bona fide citizens and permanent residents with an NHS reference number should not need further vetting.

But 18 NHS trusts responding to the consultation said foreign patients should provide their passport and/or visa showing details of entry to the UK; and 14 said that they should show details of residency such as rent book, council tax book, benefits book, bank records, and a permanent address.

To verify a patient was employed in the UK, the hospital would need a payslip and working visa. The government said the Royal College of Nursing wanted this information to be included in referral letters from GPs - a move that would transfer the vetting from hospitals to family doctor surgeries. The Department of Health said it would deal with these procedural matters in draft regulations, to be published shortly.

Mr Hutton said: "The NHS is there to provide free treatment for those who live here, not those who don't. It is a national health service, not an international service.

"Irrespective of the financial scale of abuse, it is important we establish a closer link between free use of the NHS and residency in the UK.

"NHS staff have told us what abuses are occurring, and what rule changes they would like made. We have listened to them, and we are making those changes so that the NHS is no longer taken for a ride."

The BMA said that doctors wanted to work with the government to minimise fraud, but stated: "However, it is not the role of doctors to be the agents of the state in policing eligibility for healthcare."

Edwin Borman, chairman of the BMA's international committee, said: "We are particularly concerned about the health of failed asylum seekers awaiting deportation [who] have no access to money: it would be totally unjustifiable to leave them suffering from chronic illnesses, including mental health problems, for unspecified periods of time."

Tim Yeo, the Conservative shadow health secretary, said: "Simply modifying guidelines for NHS trusts will only scratch the surface of the problem and will leave the difficult ethical dilemmas for doctors and nurses unresolved."

Gill Morgan, chief executive of the NHS Confederation, said the health service always chased up foreigners after treatment for payment: "The issue here is tightening up the rules for more discretionary treatment - care which people have a choice about where and when it is provided."

Main points

· Failed asylum seekers to lose free treatment
· Resident foreign businessmen to pay for visiting relatives' health costs
· Their non-resident wives no longer able to travel to Britain to give birth on the NHS
· Overseas students to be exempt from charges
· British pensioners to be able to live abroad within Europe for six months a year and still return for free NHS treatment
· Regulations to specify how people without an NHS number prove their status to hospital staff