Hospitals facing financial difficulties have waived £256.4 million in debts owed by international patients due to inadequate verification processes for their entitlement to free care. NHS treatment.
A probe conducted by The Mail on Sunday reveals rising debts incurred by health tourists – individuals who have received treatments ranging from spinal surgeries to cardiac care. cancer The treatment – is exacerbating the financial strain on NHS resources.
Last year witnessed a loss of £44 million—a 63 percent rise from the £26.9 million written off by hospitals in 2017-18.
Our investigation, which examined healthcare financial records spanning the last seven years and included an extensive Freedom of Information act request sent to various trusts throughout England, uncovers critical insights as follows:
- Only a third of the £621 million debt from hospital visits by foreign tourists has been paid back.
- A Nigerian patient scheduled for treatment at Barts Health NHS Trust in London incurred an expense of almost £500,000, while a Romanian patient owes Lewisham and Greenwich NHS Trust in South London £71,000.
- Over 400 international patients received elective care last year at the Barking, Havering and Redbridge University Hospitals NHS Trust in East London, with 285 bills yet to be paid, amounting to a sum of £1.3 million collectively.
- In nine years, the number of medical tourists utilizing the NHS for scheduled treatments has increased twofold, exacerbating the lengthening queues for patients funded by taxpayers.
Yesterday evening, following the confrontation with the MoS's findings, the Health Secretary was involved in an issue related to it. Wes Streeting pledged he would take action to 'tidy up this mess.'
Nevertheless, these numbers may just scratch the surface since they only encompass patients who were flagged for payment—prompting concerns that an additional vast sum could be going unaccounted for.
Conservative Party Member of Parliament Joe Robertson, who serves on the Commons Health and Social Care Committee, stated: "The UK should not function as a healthcare provider for the global community. The National Health Service administration must collect payment from individuals beforehand for any scheduled treatments. This ensures that those who might try to avoid paying their bills cannot do so."
The NHS cannot justify asking for additional funds when it writes off substantial debts owed by international patients for optional, non-emergency procedures.
If a visitor experiences an accident during their vacation in the UK, it is reasonable for them to get emergency treatment; however, the NHS appears to offer scheduled, non-urgent procedures to individuals from abroad who do not make payments.
If NHS management doesn’t take control, the Health Secretary must step in to make them act. It makes no sense to abolish NHS England and bring the NHS under direct government oversight if Wes Streeting isn’t going to stop such blatant mismanagement.
Over the last couple of years, the government has had to bolster the NHS’s funding by an additional £21 billion, yet wait times for hospital treatments continue to hit all-time highs, with only 59 percent of patients being treated within the targeted 18 weeks.
The £256.4 million that was forgiven could have financed the hiring of approximately 8,500 new nurses or almost 3,000 additional general practitioners. This amount would also be sufficient to cover the treatment costs for about 27,000 breast cancer patients or support as many as 15,000 kidney transplant procedures.
The anger has been exacerbated by the fact that numerous foreign patients’ bills are for treatments deemed ‘elective,’ which means they were scheduled beforehand.
Although general practitioner services and emergency treatment are provided free of charge to everyone irrespective of their residency status, hospitals are required to recognize chargeable patients and request payment up front—amounting to 150 percent of NHS rates—before providing additional services like specialized consultations and scheduled treatments.
However, the data shows that overburdened hospitals frequently cannot manage this promptly and end up sending bills to patients afterward—permitting them to depart the country without making payment.
This differs from healthcare systems in France, Ireland, the US, and Australia, where individuals must pay upfront.
Alp Mehmet, the chairperson of Migration Watch UK, described it as 'outrageous' that merely a small portion of the expenses incurred by foreign patients is being reclaimed.
'The NHS trust needs Wes Streeting to ensure they cease depending solely on government funding for providing routine care to individuals who aren’t eligible for it,' he stated.
The founders of the National Health Service, such as Nye Bevan, would be appalled to discover it has transformed into an International Health Service.
Over the last seven years, the NHS has charged overseas patients £621 million. Only around one-third of this, approximately £233 million, has been recovered so far. The sum being waived is increasing as patients cannot be located, have passed away, or due to hospitals deciding against chasing these debts.
Despite this, in 2014, when there were concerns that the NHS had been too lenient with international patients, the government committed to recouping as much as £500 million annually.
John O'Connell from the TaxPayers' Alliance urged Members of Parliament to revamp the system and "show proper respect for citizens' hard-earned money."
He stated: "The inability of the health service to make sure that those who aren’t eligible for free care pay their dues highlights a cultural indifference toward squandered resources."
Every hospital is legally obligated to identify patients who do not qualify for free NHS treatment and must recoup expenses, with this responsibility monitored by overseas visitor managers.
This could include the use of the MESH system, an IT resource created by NHS England that compares a patient’s data with other records, such as those maintained by the Home Office.
International patients ought to be informed about the anticipated costs and payment procedures, and hospitals are required to undertake "all reasonable efforts" to collect these expenses prior to commencing treatment.
However, due to compassionate considerations, official guidelines assert that care deemed urgent by a physician should not be denied — even if the patient has stated they are unable to make payment.
This is especially true in maternity wards, as denying care can adversely affect both mothers and infants.
Here, an invoice is generated initially, followed by subsequent attempts to recoup the expenses through potential installment payments.
Hospitals may resort to international debt collection agencies to recover such expenses; however, this approach is costly and does not ensure that the patient will either agree or have the means to make payment, assuming they are located successfully.
A policy specialist commented, "In truth, hospitals frequently find it impractical because hiring sufficient personnel to verify each patient’s information and follow up on payments after invoices are sent can be too costly. The effectiveness varies among different trust organizations."
These statistics encompass individuals who received initial attention in the emergency department before being hospitalized, making subsequent treatments chargeable. Additionally, they involve cases where general practitioners refer patients to hospitals for scheduled evaluations or procedures.
Many hospitals struggled to distinguish between billing for elective and non-elective services. However, certain institutions like Barking, Havering, and Redbridge—where an outstanding unpaid amount of £1.3 million over one year encompasses a debt from a Ghanaian patient for orthopedic treatments totaling £18,000—did provide detailed numbers. The University Hospitals Coventry and Warwickshire NHS Trust disclosed that they treated 531 international patients for elective procedures last year, with one case involving an uncollected sum of £22,000 related to spinal surgery.
The Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has verified that 396 international patients underwent planned procedures over the past year, leaving approximately £300,000 in unpaid bills for 194 services provided. Additionally, a patient from Hungary was treated at The Royal Wolverhampton NHS Trust for both kidney and heart issues and now owes around £23,000. Furthermore, numerous individuals hailing from countries such as India and Cameroon have been billed significant amounts—tens of thousands of pounds—for their respective treatments related to cancer care they received elsewhere within these healthcare systems.
Data provided by officials from the Department of Health and Social Care (DHSC) indicate that international patients seem to be more frequently opting for elective treatments through the NHS.
Although the figures for patients seeking emergency care haven’t significantly altered, the number of individuals admitted for day procedures has nearly tripled over nine years, rising from 3,885 to 8,585 between 2014 and 2022-23. However, this figure dropped to 6,205 in the previous year.
Data from The Mail on Sunday indicates that Nigerians held the highest amount of outstanding debts, trailed closely by Romanians, Indians, Albanians, and U.S. citizens. According to Mid and South Essex NHS Foundation Trust, within just one year, 92 Nigerian individuals accumulated a debt totaling £238,553—approximately £2,600 per person. Additionally, they charged 76 Romanian nationals with a combined bill of £178,936 and invoiced 33 Albanian people an aggregate sum of £106,959.
The Mail on Sunday sought explanations from multiple major hospital trusts regarding the challenges of recognizing chargeable patients and recovering such expenses, yet none agreed to comment.
The Nottingham University Hospitals NHS Trust acknowledged that due to capacity constraints, only approximately half of the patients identified by MESH as possibly eligible for charges could undergo additional evaluation by their team. Out of over 8,000 individuals flagged by MESH, around 5,130 received further assessments, with 982 ultimately receiving bills for their treatments. A number were excluded either because they possessed a legitimate exemption or upon determination that they weren’t subject to charges.
The DHSC stated that they have recovered £4.4 billion from international patients since 2015-16. This figure encompasses all payments received through the Immigration Health Surcharge, which requires individuals holding work or study visas to pay £776 annually for access to the NHS. It also includes revenue generated from treating citizens of countries within the European Economic Area.
Mr. Streeting stated yesterday evening: "Similar to how British citizens overseas must cover their medical expenses, visitors coming to this nation should do the same. Given that patients are experiencing unbearably lengthy waits for general practitioner visits, surgeries, or even emergency services, it is unjustifiable for the National Health Service to bear the cost of treatments that ought to be covered financially."
We will take action to clear up this situation. While we strive to reduce waiting lists, we will simultaneously tackle those who benefit unfairly at the cost of British taxpayers.
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