Social services

NHS medical charges - overseas visitor appearing unable to pay for further treatment - hospital trust entitled to require payment or guarantee in advance of treatmentR v Hammersmith Hospitals NHS Trust, ex parte Reffell: DC (Kennedy LJ and Jackson J): 28 June 2000

The applicant Nigerian citizen arranged to have a kidney transplant operation at Hammersmith Hospital, having prepaid the respondent the costs of the operation of 35,000.

However, the transplant was deferred because of further medical complications requiring treatment.

The applicant's funds eventually became depleted and the respondent decided not to provide further treatment unless he paid in advance or produced an acceptable guarantee that the costs of treatment would be met.

The applicant could not afford to pay and applied for judicial review of that decision.

Richard Gordon QC (instructed by Leigh Day & Co.) for the applicant.

Philip Havers QC (instructed by Capsticks) for the respondent.

Held, that with the exception of emergency treatment and other special cases, NHS services were made available to overseas visitors as a commercial operation, not as a humanitarian gesture; that when Parliament imposed on the trust by reg 2 of the National Health Service (Charges to Overseas Visitors) Regulations (SI 1989 No 306) the express obligation to recover charges for NHS services from an overseas visitor, it gave it the ordinary means to discharge that obligation, including the right to require in advance payment or an acceptable guarantee of payment from those who seemed unlikely to be able to pay; that the respondent did not exercise its discretion not to require payment in advance incorrectly; that the treatment required by the applicant was now available in Nigeria and there was no immediate prospect of him being fit to undergo a transplant; that he was entitled to his views on the quality of care available in Nigeria, but they could not render unreasonable the trust's decision not to provide routine medical care when it appeared that charges for it would never be paid.