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Should non-UK citizens pay for NHS services? RGU Law and Ethics Group debate

ON April 12, the Robert Gordon University (RGU) Pharmacy Law and Ethics group hosted the following debate: Should non-UK citizens pay for NHS services?

This is a very relevant topic as there has been increasingly negative press on the subject following the 4th episode of BBC2’s Hospital [1], in which a Nigerian woman named Priscilla gave birth to quadruplets at Queen Charlotte’s and Chelsea Hospital. The complexities of providing free treatment based on clinical need, not ability to pay, and the financial burden on the NHS, made this a great topic to debate.

Our guest speaker, Dr Brian Addison, module co-ordinator for Public Health for Pharmacists (PHM133) at RGU, gave students background on the topic at the beginning of the debate. Firstly, he stated the three core principles of the NHS:

  • It meets the needs of everyone.
  • It is free at the point of delivery.
  • It is based on clinical need, not ability to pay.

He also stated an important point which was to get the best value for taxpayers’ money. Scotland has a population of over 5.3 million people with 161,656 of those people employed by NHS Scotland [2].

The NHS Scotland budget is £12.2 billion [3] and a large amount of that budget is used to fund staff. There are approximately 32 patients to every member of staff. The NHS Imperial College Trust has a population of 2 million people and 10,200 NHS staff. That is 190 patients to every member of staff.

In 2015/2016, the NHS Imperial College Trust spent £4.1 million on overseas patients. They have managed to recoup £1.6 million of this spend. Dr Addison advised that we need to consider the scale of the problem against the NHS budget and that there are mechanisms in place in which we can charge non-UK citizens.

After Dr Addison’s introduction, the two student speakers were introduced. One led an argument for the question and one led an argument against. The student who was in favour of non-UK citizens paying for NHS services argued that when we travel abroad, we are expected to pay for healthcare treatment or have insurance which includes the European Health Scheme. They also argued a case for using taxpayer’s money wisely. They argued that before going to another country, we have a responsibility to check what regulations are in place in regards to paying for healthcare treatment. They also discussed the financial impact and implications of spending money on treating overseas patients.

The student who was against non-UK citizens paying for NHS services stated that the NHS has a duty to provide free healthcare to all in an emergency. This should be at the discretion of the healthcare professional and NHS Board. They also stated that in 2010, 63,000 UK citizens went abroad to seek healthcare treatment whilst 52,000 non-UK citizens travelled to the UK to seek healthcare treatment [4].

They acknowledged the Queen’s Speech (2016) in which it was announced that legislation will be introduced to ensure that overseas visitors pay for the health treatment they receive in the UK. The purpose of the Bill is to recover costs by extending the rules on charging migrants and overseas visitors for NHS treatment, to ensure that only UK residents (who live here lawfully and make a financial contribution to the UK) receive free NHS treatment.

Students were then separated into two groups to discuss the arguments for and against in more detail. A vote was then taken. Students voted in favour of non-UK citizens paying for NHS services at a ratio of 2:1. The following motion was proposed: The RGU Pharmacy Law and Ethics Group believes that non-UK residents should pay for NHS services either directly or indirectly through insurance. All students supported this motion.

Although, this was a very interesting topic to debate, the topic should be viewed in the wider context of the pressures the NHS currently faces, such as the increasing elderly population and the amount of people who are living with multiple co-morbidities.

In 2014, the NHS was declared the best healthcare system by an international panel of experts, ranking highest in efficiency, quality and access [5]. To maintain the NHS, it is perhaps time to re-examine how the NHS is funded and the original core principles upon which it was founded.


[1] BBC2. 2017. Hospital – Episode 4.

[2] ISD SCOTLAND. 2016. NHS Scotland Workforce Information.

[3] AUDIT SCOTLAND. 2016. NHS in Scotland 2016.

[4] HANEFELD et al. 2013. Medical Tourism: A Cost or Benefit to the NHS?

[5] COMMONWEALTH FUND. 2014. Mirror, Mirror on the Wall, 2014 Update: How the U.S Health Care System Compares Internationally.

Lara Seymour, RGU Pharmacy Law and Ethics Group

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