Hospitals with limited budgets have forgone £256.4 million owed by international patients due to inadequacies in verifying their eligibility for complimentary care. NHS treatment.
A probe conducted by The Mail on Sunday reveals increasing financial burdens due to health tourists – individuals who have received treatments ranging from spinal surgeries to cardiac care. cancer The treatment -- is causing an increasing drain on NHS finances.
Last year witnessed a loss of £44 million—a 63 percent rise from the £26.9 million written off by hospitals in 2017-18.
The critical insights from our study, derived from examining healthcare financial records over the last seven years along with an extensive Freedom of Information act submission to various trusts throughout England, show that:
- Only one-third of the £621 million debt owed by foreign visitors to hospitals has been returned.
- A Nigerian patient who was 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 located in East London. As a result, there are currently 285 unpaid bills amounting to approximately £1.3 million.
- In nine years, the number of individuals seeking healthcare as medical tourists through the NHS for scheduled treatments has increased twofold, contributing to lengthening queues for patients funded by taxes.
Yesterday evening, following the confrontation with the findings of the MoS's investigation, the Health Secretary was addressed. 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 recognized as needing to make payments—prompting concerns that an additional vast sum, potentially in the millions, might not be accounted for.
Conservative Party Member of Parliament Joe Robertson, who serves on the House of 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 prior to delivering scheduled treatments. This ensures that those who might try to avoid settling their bills cannot do so."
The NHS cannot justify asking for additional funds when they write off millions of pounds in debts owed by foreigners for optional, non-emergency procedures.
If a tourist encounters an accident during their vacation in the UK, it is just that they receive emergency care; however, the NHS appears to be offering scheduled, non-urgent procedures to individuals from abroad who have not made payments.
If NHS management doesn’t take control, then the Health Secretary must step in. Disbanding NHS England and bringing the NHS under direct government oversight would be pointless if Wes Streeting does not put an end to such significant wastage.
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 be at all-time highs, with only 59 percent of patients being treated within the targeted 18 weeks.
The £256.4 million wiped out could have financed salaries for 8,500 new nurses or almost 3,000 general practitioners. This amount could also bear the expense of caring for 27,000 individuals with breast cancer or support 15,000 kidney transplant procedures.
The circumstance where numerous foreign patients’ bills pertain to treatments that are ‘elective,’—meaning they were scheduled beforehand—has intensified the frustration.
Although general practitioner services and emergency treatment are provided without cost to everyone irrespective of their resident status, hospitals are meant to recognize chargeable individuals and invoice them beforehand—charging 150 percent of what the National Health Service (NHS) charges—prior to offering additional treatments like specialized consultations and scheduled operations.
However, the statistics show that overburdened hospitals frequently cannot manage this promptly and end up sending bills to patients afterward — enabling them to depart the country without settling their payments.
This differs from healthcare systems in France, Ireland, the US, and Australia, where individuals have to pay upfront.
Alp Mehmet, the chairman of Migration Watch UK, stated that it was 'absurd' that merely a small portion of the expenses incurred by foreign patients was being reclaimed.
'Wes Streeting needs to encourage trusts to cease depending solely on public funds for providing non-urgent care to individuals who aren’t eligible for it,' he stated.
The creators 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 international patients £621 million. Only around £233 million, which constitutes roughly one-third of the total, has been reimbursed. The sum being waived off keeps 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 worries that the NHS had been too lenient with foreign patients, the government committed to recouping as much as £500 million annually.
John O'Connell from the TaxPayers' Alliance urged Members of Parliament to revise the system and 'show proper respect for citizens’ hard-earned money.'
He stated: "The inability of the health service to make sure those who aren’t eligible for free treatment pay their dues highlights a culture that shows little concern for squandered funds."
Every hospital is legally obligated to recognize patients who do not qualify for free NHS treatment and must reclaim expenses; this responsibility is monitored by overseas visitor managers.
It might include the use of the MESH system, an IT resource created by NHS England that checks a patient’s data against other databases, such as those maintained by the Home Office.
International patients ought to be informed about the probable costs as well as payment procedures, and hospitals are required to undertake ‘every reasonable step’ to reclaim expenses prior to initiating treatment.
However, for compassionate considerations, official guidelines assert that care deemed urgent by a physician must not be denied — even if the patient has stated they are unable to make payment.
This is notably true in maternity wards, as denying care can adversely affect both mothers and infants.
Here, an invoice gets generated with subsequent attempts to recoup expenses at a later time; these efforts could include setting up 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 agree or have the means to make payment, particularly if they are located.
A policy specialist commented, "In truth, it frequently doesn’t make sense for hospital trusts because hiring sufficient personnel to verify each patient’s details and follow up with payments after invoicing can be too costly. The effectiveness varies among different trusts."
These statistics encompass individuals who received initial attention at the emergency department before being moved to wards, making subsequent care charges applicable. Additionally, some cases involve referrals from general practitioners for scheduled assessments or treatments.
Many hospitals struggled to differentiate between charges for elective and non-elective treatments. However, several institutions managed to provide such data; among them are those from Barking, Havering, and Redbridge—whose total of £1.3 million in uncollected debts over one year comprises an individual from Ghana owing £18,000 for orthopedic services. The University Hospitals Coventry and Warwickshire NHS Trust reported offering elective procedures to 531 international patients within the past year, with an outstanding amount of £22,000 related to an unpaid bill for spinal surgery.
The Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has verified that 396 international patients underwent elective procedures over the past year, leaving approximately £300,000 in unpaid bills across 194 invoices. Additionally, a patient from Hungary was treated for both kidney and heart issues at The Royal Wolverhampton NHS Trust and currently owes around £23,000. Furthermore, various individuals from countries such as India and Cameroon were provided with cancer treatments but still have substantial debts amounting to tens of thousands of pounds each.
Data provided by the Department of Health and Social Care (DHSC) indicates that international patients seem to be more frequently opting for elective National Health Service (NHS) treatments.
Although the figures for individuals seeking emergency treatment haven’t significantly altered, the number of admissions for day procedures has more than doubled over nine years, increasing from 3,885 to 8,585 between 2022 and 2023. 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, closely trailed by individuals from Romania, India, Albania, and the United States. According to Mid and South Essex NHS Foundation Trust, within just one year, they charged 92 Nigerian nationals with a collective debt of £238,553—approximately £2,600 per person. Additionally, bills were issued to 76 Romanian residents totaling £178,936, as well as to 33 Albanian residents summing up to £106,959.
The Mail on Sunday sought insights from multiple major hospital trusts regarding the challenges of recognizing chargeable patients and recovering these expenses; however, none agreed to comment.
The Nottingham University Hospitals NHS Trust acknowledged that due to capacity constraints, only around half of the patients identified by MESH as possibly eligible for charges could undergo additional analysis by their team. Out of over 8,000 individuals marked by MESH, 5,130 received further scrutiny, with 982 ultimately receiving bills for their care. A number of cases were excluded either because the patients qualified for an exemption or it was determined they weren’t subject to charges.
The DHSC mentioned 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 study or work visas to pay £776 annually for access to the NHS – as well as revenue generated from treating citizens of nations belonging to the European Economic Area.
Mr Streeting stated yesterday evening: "Similar to how British citizens overseas must cover their medical expenses, tourists visiting 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 aim to reduce waiting lists, we will simultaneously address the issue of people taking advantage of British taxpayers' money.
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