Consultation outcome

Framework for funding healthcare abroad in exceptional circumstances: consultation response

Updated 18 August 2023

Executive summary

In 2022, the Department of Health and Social Care (DHSC) passed the Health and Care Act which amended our reciprocal healthcare primary legislation. Under the Healthcare (International Arrangements) Act 2019, DHSC can now implement reciprocal healthcare arrangements with any global partner. DHSC has also brought forward new regulations to give the Secretary of State new powers to fund healthcare abroad in exceptional circumstances, in countries where the UK has a healthcare arrangement. These changes will come into force on 18 August 2023.

To support these changes, DHSC ran a public consultation seeking views on the policy framework for the funding of healthcare abroad in exceptional circumstances (the framework). This proposed factors the Secretary of State would consider when making decisions on cases where exceptional circumstances may apply.

There were 8 responses to the consultation, from a range of stakeholders across the UK. The majority of the respondents found the principles in the framework to be sufficient for the Secretary of State to make decisions on discretionary funding. The remaining responses were unsure.

There were no responses disagreeing with the factors that we proposed would be taken into account in the determination of exceptional circumstance cases.

After careful consideration of all the responses to the consultation, alongside other relevant information and evidence, the UK Government has decided to implement the framework for the funding of healthcare abroad in exceptional circumstances from 18 August 2023. This policy provides transparency in decision making and ensures decision making is consistent across the UK.

Introduction

The UK has several international healthcare arrangements with countries and territories (‘partner countries’), often referred to as reciprocal healthcare arrangements. These arrangements support UK residents when they visit partner countries by enabling them to access public healthcare.

The Healthcare (International Arrangements) (EU Exit) Regulations 2023 (the HIA regulations) confer powers on the Secretary of State to fund healthcare abroad. The powers could be used to pay for treatment which is covered by an arrangement with a partner country. In the context of this policy, a partner country is a country or territory with which the UK has an agreed international healthcare arrangement. The powers could also be used to make discretionary payments for healthcare in a partner country outside of an arrangement if the Secretary of State considers the payment to be justified by exceptional circumstances.

DHSC developed and consulted on an exceptional circumstances policy framework to assist with the exercise of this power - making clear to the public and NHS agencies how we envisage discretion being exercised in practice. The objective of the framework is to guide decision-making for cases where exceptional circumstances may apply, ensuring a consistent and transparent approach.

The consultation ran from 24 April 2023 until 16 June 2023 and sought views on whether:

• the principles in this policy framework are sufficient for the Secretary of State to make decisions on discretionary funding
• there are other factors that are not listed in the framework which the Secretary of State should consider when making decisions on discretionary funding
• respondents had further views on the framework that they would like to share

This consultation response provides a summary of the feedback received from respondents, wider engagement with stakeholders and the UK Government’s response.

Overview of consultation activity

The government launched the consultation on 24 April 2023 and it ran until 16 June 2023. In total, we received 8 responses via the online survey platform, accessible via GOV.UK. We also received one response from direct engagement with stakeholders. This overview and the summary of responses only concern those who responded to the online survey. Please see the ‘stakeholder engagement’ section below for more detail on the stakeholder response we received.

Of the total 8 responses, 4 respondents responded on behalf of an organisation and 4 respondents responded as an individual sharing their personal views and experiences. Of the 4 organisations which responded to our consultation, 3 were NHS authorities and 1 was a charity. Of the 4 respondents who replied as individuals, 2 were interested in the consultation as NHS users and 2 had long term health conditions.

Stakeholder engagement

During the drafting of the framework, we worked closely with NHS stakeholders and devolved administration officials to make sure the policy supported their work and could be effectively delivered.

As part of the consultation process, we again contacted stakeholders who will be impacted by and will regularly interact with the framework. We contacted NHS stakeholders across the UK, devolved administration officials and charities in order to receive their views on the framework.

While some of these stakeholders responded directly to the survey on GOV.UK, we received one direct response by email from an NHS authority. We also received informal comments on our framework from NHS stakeholders and the devolved administrations before the consultation was published.

The responses from this engagement were largely around how to put the policy into operation and drafting suggestions, which we have incorporated into the framework prior to the consultation being published. We have also been working on operational guidance to provide further detail for stakeholders who will be able to refer cases to the Secretary of State.

Summary of responses

Question

Do you think that the principles in this policy framework are sufficient for the Secretary of State to make decisions on discretionary funding?

The majority of respondents to the consultation agreed that the factors within the framework were sufficient for the Secretary of State to make decisions on discretionary funding and no further explanations as to why they believed this were provided. The remainder indicated that they did not know whether the factors were sufficient.

In particular, feedback was given about phrasing within the policy which required clarifying, such as a suggestion to define what a ‘partner country’ is. We have taken this feedback on board and clarified this point in the framework.

Question

Are there any other factors that are not listed in the framework which the Secretary of State should consider when making decisions on discretionary funding?

Most respondents to the consultation indicated that they did not know whether there are other factors that are not listed in the framework which the Secretary of State should consider when making decisions on discretionary funding, and no further explanation was given in the free text box under this question.

However, it is possible that no further comments were provided as it is difficult to anticipate what ‘exceptional circumstances’ may look like. This is mitigated insofar as the Secretary of State will retain the flexibility to consider the circumstances on a case by case basis.

Two respondents indicated that there were no further factors which the Secretary of State should consider. Finally, one respondent indicated operational areas that the Secretary of State should consider.

This feedback has been considered and will be taken into account in the operational guidance to be provided to stakeholders who will be referring cases under the policy.

Question

Do you have any further views on the framework that you would like to share?

Half of respondents provided no further views on the framework, but some further helpful suggestions were made by other respondents which we outline below.

Firstly, it was suggested that only individuals who have followed due process, such as taking out comprehensive travel insurance to mitigate any risks, should be considered for discretionary funding. In response, our view is that the framework is clear that taking out travel insurance is advised by the UK Government to avoid any unexpected costs and ensure complete coverage. For example, our current arrangements do not cover:

• cruise travel
• private medical care
• costs of mountain rescue
• the cost of returning to the UK (repatriation)

The aforementioned costs would not usually be considered for discretionary funding.

Further comments were made on the operationalisation of the policy and an expected timeline for decision-making. However, we do not think a reliable timeline for decision-making could be provided as this depends on the circumstances of the individual case.

Government decision and next steps

We welcome the many useful comments and thank respondents for taking the time to carefully consider the policy framework for the funding of healthcare abroad in exceptional circumstances.

After considering the responses to the consultation, in addition to evidence gathered for the impact assessment for the exceptional circumstances framework and our broader stakeholder engagement, we have decided to adopt the framework with minor drafting amendments from 18 August 2023. A final version of the exceptional circumstances policy framework has been published alongside this response.

Having considered consultation responses and wider engagement with key stakeholders, we consider these factors to be sufficient to guide decisions in cases where exceptional circumstances may apply.

It is not possible to envisage every circumstance in which exceptional circumstances may apply. However, this framework sets out the underlying principles of the policy and how we expect funding decisions to be made. It retains the flexibility to ensure every case is considered in light of its particular circumstances.

We will continue working with NHS stakeholders, devolved administration officials and relevant charities to ensure they are aware of the decision to adopt the framework. Further, we will provide detailed operational guidance for NHS and devolved administration partners to ensure the exceptional circumstances policy framework is used appropriately and effectively.

We will review the policy periodically, ensuring any future impacts are taken into account and the policy amended appropriately.

We wish to thank everyone who submitted a response to this consultation and engaged with us during the development of the framework.