Free NHS Care for Overseas Aid Workers

by Richard Kellow
Posted on 1st April 2007

In August 2006 having just returned to the UK from working abroad, I attended a routine hospital appointment and was asked: "Have you been living in the UK for the last twelve months?" I answered truthfully and was promptly questioned by a member of staff from the hospital's 'Paying Patients' department as to my previous whereabouts and my future intentions. I was not allowed to see the consultant until she was satisfied that I was eligible for treatment. I was warned that periods of residence outside the UK could render me ineligible for free NHS treatment until I could prove that I had permanently returned.

I had always assumed that as a UK citizen, who had previously paid tax and National Insurance that if I continued to pay voluntary NI contributions I would be eligible for free care even if I left the UK. However, my MP informed me that eligibility is for residents only - regardless of citizenship and is not dependent on payment of NI contributions.

I wrote to my MP, MEP the Department of Health and the Secretary of State for Health to seek clarification and discovered the following:

To prevent 'health-tourism' all UK citizens* who spend more than 5 years outside the UK must pay for their non emergency NHS care until they return to live permanently in the UK. Living here permanently means that you do not intend to leave again, not just that you are here on home leave.

There is no exception for those working for UK-based charities long term, even in developing countries. Neither is there exception for those with property in the UK, as some believe to be the case.

The Department of Health state that individual doctors and hospitals are responsible for upholding this policy - some do, others don't, which seems unfair. You may find yourself having to pay for NHS care on home leave or if you come home for treatment. The only solution is to pay for costly health insurance to cover you for your time here.

Whilst I understand the principle behind this law, I believe it unfair to include charity workers with other expatriates who perhaps have emigrated for work or financial reasons. This law discriminates against UK citizens who are involved in charitable work overseas, particularly those working in developing countries. As such, I have set up an e-petition to the Prime Minister to ask if unpaid charity workers, who are UK citizens but working overseas, can be exempt from this 5 year rule, because they are not generally in a position to obtain health care elsewhere, nor pay for treatment here. A minimum of 100 signatures are needed in order for this to reach the government - if you agree that an exception should be made, please join me in signing it at: and let others know about this.

Thank you.

Richard Kellow.

Latest Update 22/03/07

You may have read above that UK Citizens who work overseas in (unpaid) aid/charity positions for more than 5 years are no longer entitled to free access to the NHS until they return permanently to the UK. This still remains the case.

However, there is good news for those involved in Mission work overseas with a UK-based Mission Organisation.

The NHS (Charges to Overseas Visitors) Regulations 1989, were amended by Parliament on 18 December 2006 to the following effect:

Anyone who is working outside the UK as a missionary for an organisation with its principal place of business in the UK will be fully exempt from NHS charges. This is regardless of whether they derive a salary or wage from the organisation, or receive any type of funding or assistance from the organisation for the purposes of working overseas.

This applies from 15 January 2007 in England. This change of law was confirmed in the House of Lords on 12 March 2007 by Lord Hunt of Kings Heath.

As I contacted a number of UK-based mission agencies and charities recently, none seemed aware of this recent change in law, so it may be worth passing this information on.

I note that the DoH Guidelines have not yet been updated, but I have written to them to ask them to do so and have also contacted them to ask what proof missionaries need in order to benefit from this without undue hindrance at the point of delivery.

The Government states that there is no intention to extend this exception to other overseas charity workers. As such, the petition at: will continue to run until January 2008.

Thanks for your time and interest,

Best wishes,

Richard Kellow


Further Information on this matter:

Martin Campbell at the Department of Health Tel: 0113 254 5174 or e-mail:

can answer any queries regarding the Amendment of Regulations to allow Missionary exemption to the "five year rule" as outlined here.

Lord Hunt of Kings Heath's statement in the House of Lords on 12 March 2007:

The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2006 (Statutory Instrument 2006 No. 3306):

The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2006 - Explanatory Memorandum (point 7.6):

The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 1989 (Includes the "five year rule" which until 15 January 2007 affected UK missionaries (point K):
Department of Health Overseas Visitor Guidelines (currently not up to date):

Stewardship's briefing on the new law:​​​​​​​

* There are a few exceptions as noted on the Department of Health Website, although these are generally for government employees.

Richard Kellow is a language teacher and has worked in Eastern Europe with his wife, Susan.