Hospitals struggling with finances have waived £256.4 million owed by international patients due to inadequate verification processes for their entitlements to free treatment. 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 within the NHS.
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 encompasses a thorough examination of healthcare financial records spanning the last seven years as well as comprehensive Freedom of Information requests sent to various trusts throughout England, uncovers some critical insights;
- Only a third of the £621 million debt from hospital visits by foreign tourists has been recovered.
- A Nigerian patient who was scheduled for treatment at Barts Health NHS Trust in London incurred an expense of almost £500,000, whereas 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, leaving 285 bills unpaid totaling £1.3 million collectively.
- In just nine years, the number of medical tourists utilizing the NHS for scheduled treatments has increased twofold, exacerbating the mounting backlogs for patients who fund public services through their taxes.
Yesterday evening, following the confrontation with the findings of the MoS's probe, the Health Secretary was 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 issues—prompting concerns that an additional substantial sum, running into millions of pounds, 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 entire globe. The National Health Service administration must collect payment from these individuals prior to providing any scheduled treatments. This ensures that those who might try to avoid payment cannot flee without settling their bills."
The NHS cannot justify asking for additional funds when they write off millions of pounds in debts owed by foreigners for elective, non-urgent procedures.
If a visitor encounters an accident during their holiday in the UK, it is reasonable for them to get emergency medical treatment; however, the NHS appears to offer scheduled, non-urgent procedures to individuals from abroad who do not settle their bills.
If NHS managers do not take control, then the Health Secretary must step in and compel them to act. It would be pointless to abolish NHS England and bring healthcare directly under government oversight if Wes Streeting does not put an end to 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 hospital waitlists continue to soar to unprecedented levels, with only 59 percent of patients getting treated within the targeted 18 weeks.
The £256.4 million forgiven could have financed salaries for 8,500 new nurses or almost 3,000 general practitioners. Alternatively, this amount could offset the expenses required to treat 27,000 breast cancer patients or support 15,000 kidney transplant procedures.
The reality that numerous medical bills from overseas patients cover treatments which were ‘elective’—planned ahead of time—has fueled further outrage.
Although GP services and emergency care are provided free of charge to everyone irrespective of their residential status, hospitals are meant to recognize chargeable patients and invoice them beforehand—charging 150 percent of what the NHS charges—prior to offering additional treatments like specialist consultations and scheduled procedures.
However, the statistics show 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 contrasts with health systems in France, Ireland, the US and Australia, where payment is required upfront.
Alp Mehmet, chairman of Migration Watch UK, termed it as 'preposterous' that merely a small portion of the expenses incurred by foreign patients is being reclaimed.
'Wes Streeting needs to encourage trusts to cease depending solely on taxpayers for funding non-urgent care provided to individuals who aren’t eligible,' he stated.
The founding fathers 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 is roughly one-third of this total, has been reimbursed so far. The sum being waived 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 was being overly generous to international patients, the government committed to recovering as much as £500 million annually.
John O'Connell from the TaxPayers' Alliance urged Members of Parliament to overhaul the system and 'show proper respect for citizens' hard-earned money.'
He said: 'The fact that the health service is unable to even ensure those who are not entitled to free healthcare are paying what they owe is indicative of a culture that doesn't care about wasted money.'
Every hospital must legally determine which patients do not qualify for free NHS treatment and recoup 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 details against other databases, such as those maintained by the Home Office.
International patients ought to be informed about the anticipated charges as well as payment procedures, and hospitals are required to undertake all feasible steps to reclaim costs prior to initiating treatment.
However, for compassionate grounds, 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 especially true in maternity wards, as denying care can adversely affect both mothers and infants.
Here, an invoice gets generated first, followed by attempts to recoup the expenses subsequently. This process might include setting up repayment schedules.
Hospitals may resort to international debt collection agencies to recover these 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 cannot be located.
A policy specialist commented, "In truth, hospitals frequently find it unprofitable because hiring adequate personnel to verify each patient’s status and follow up on payments after invoicing can be too costly. The efficiency varies among different trust organizations."
These statistics encompass individuals who received initial attention at emergency departments before being transferred to wards, leading to additional charges. Some cases involve referrals from general practitioners for scheduled evaluations or treatments.
Many hospitals struggled to distinguish between charges for planned and emergency treatments. However, several institutions, such as those in Barking, Havering, and Redbridge — where an outstanding debt of £1.3 million over one year encompasses a person from Ghana responsible for £18,000 related to joint procedures — managed to provide these details. The University Hospitals Coventry and Warwickshire NHS Trust disclosed that they treated 531 international patients for scheduled services last year, with an uncollected sum of £22,000 owed for back operations.
The Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has verified that 396 international patients underwent planned treatments in the previous year, leaving 194 unpaid bills totaling almost £300,000. In addition, a patient from Hungary was treated for both kidney and heart issues at The Royal Wolverhampton NHS Trust and still owes £23,000. Furthermore, numerous individuals from countries such as India and Cameroon have undergone cancer care but remain indebted by tens of thousands of pounds each.
Data 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 individuals seeking emergency care haven’t significantly altered, the number of people admitted for day procedures has nearly tripled over nine years, increasing from 3,885 to 8,585 between 2014 and 2022-23. However, this 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 individuals from Nigeria accumulated debts totaling £238,553—approximately £2,600 per person. Additionally, they charged 76 Romanian nationals with a combined debt of £178,936 and billed 33 Albanian citizens an aggregate sum of £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 'capacity' constraints led to approximately half of the patients identified by MESH as possibly eligible for charges being unable to undergo further assessment by their team. Out of over 8,000 individuals marked by MESH, around 5,130 were selected for additional scrutiny, with 982 ultimately receiving bills for their care. A number were excluded either because they possessed legitimate exemptions or upon determination that they weren’t subject to charges.
The DHSC mentioned that they have recovered £4.4 billion from international patients since 2015-16. This sum encompasses all payments through the Immigration Health Surcharge, where individuals holding work or study visas pay an annual fee of £776 for access to the NHS, along with earnings from treating citizens of EEA nations.
Mr Streeting stated yesterday evening, "Similar to how British citizens overseas must cover their medical expenses, individuals visiting this nation ought to 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 should be covered financially."
We will take action to clear up this situation. While addressing the backlog issues, we will simultaneously tackle those taking undue advantage of British taxpayers’ funds.
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