HIV treatment and overseas visitors
The NHS provides treatment which is free at the point of delivery to those ordinarily resident in the United Kingdom. A person is ordinarily resident in the UK if he is living voluntarily and lawfully in the UK with a settled purpose, with an identifiable purpose for his residence and a sufficient degree of continuity to be properly described as settled. This test is usually simplified by asking a potential patient whether they have lived in the UK for 12 months or more.
The National Health Service (Charges to Overseas Visitors) Regulations 2011 (the Regulations) provide for patients who are not ordinarily resident to be charged for NHS treatment.
The Regulations provide several exemptions to this principle where no charge is made for treatment, including for many infectious diseases. The rationale is that if the disease is contained the eventual cost to the NHS will be lower than if many people contract the disease and require treatment. At present the exemptions provided for by the Regulations do not include the treatment of HIV but do allow a free initial diagnosis and counselling associated with the test and its result.
There is no clear reason for the exclusion of HIV from the exemptions list, but the cost of treatment is likely to be a factor.
Cost estimates for treating an individual with HIV vary from around £7,000 to £18,000 per individual per year. Effective antiretroviral therapy can transform HIV from a fatal disease to a manageable condition, and with prompt diagnosis and treatment individuals can expect a near-normal life expectancy. This has meant that the overall cost to the NHS of HIV treatment is quickly accelerating. The Health Protection Agency estimates the lifetime cost of HIV treatment at between £280,000 and £360,000, with a large proportion of those costs relating to treatment in the last stages of an individual’s life.
Many have argued that it is morally wrong to decline free HIV treatment to those living in England who do not meet the ‘ordinarily resident requirement’. But they have been met with arguments of cost and the risk of health tourism. However, in terms of acquiring the infection, recent statistics from the Health Protection Agency demonstrate that of the people diagnosed with the virus in the UK, the greater number now are those who have become infected in the UK rather than abroad.
The current position in relation to the HIV treatment for those not ordinarily resident is set to change, with the Government planning to introduce changes to the Charges to Overseas Visitors Regulations. The planned changes would allow non-ordinarily resident individuals to receive free NHS treatment for HIV if they have been living in England for six months. The changes were first proposed in the Health and Social Care Bill. The Public Health Minister, Anne Milton, said that the measure would protect the public and bring HIV treatment into line with other infectious diseases, and also into line with the position in Wales and Scotland. The Health Protection Agency’s HIV prevalence map does not suggest that the existing policy of Scotland and Wales led to an influx of overseas visitors seeking free HIV treatment, and one would hope that England’s experience will be similar. Anne Milton has promised tough guidance to ensure that the increased access to HIV treatment is not abused.
For now, individuals not ordinarily resident in the UK cannot receive free HIV treatment on the NHS, but hospital managers should be aware that this is likely to change before the end of this year.