London hospitals write off £112 million in unpaid foreign patient bills

According to figures obtained by the BBC, London hospitals have written up more than £112m in treatment bills for overseas patients between 2018 and 2023.

Under current NHS regulations, hospital trusts in England must charge patients who are not “ordinarily resident” in the UK for non-urgent treatment.

Critics say the current system for reimbursing these costs is unfair and ineffective.

The Department of Health and Social Care (DHSC) said it expected all NHS trusts to recover unpaid charges wherever possible.

The BBC contacted all 32 acute hospital trusts in London about the billing of their overseas patients.

The responding NHS trusts invoiced a total of £223m for such treatment over a five-year period, but £112m was later written off as bad debt.

While emergency and GP services remain free for everyone, trusts are required to bill for other types of non-urgent treatment for patients who do not normally live in the UK at 150% of standard NHS rates. Charge.

This premium is intended to offset the administrative burden of identifying and paying patients.

While aimed at tackling “health tourism”, the charging system has exemptions for vulnerable groups, including asylum seekers and victims of trafficking.

But hospitals often struggle to recover costs, especially when patients return overseas.

Trusts balance their legal responsibility to recover costs and the realities of treating needy patients, many of whom have limited means or face other barriers to payment.

Barts Health, which serves a large population in east London, wrote up £35m in unpaid bills over five years – the most of all London trusts.

A spokesman said: “Where appropriate, we make every effort to recover payment from patients who are responsible for the costs of their treatment.

“However, many patients may have limited funds available and some may not be based in the UK, which means recovery of payment may be difficult.”

King’s College Hospital gave up £17m, while 10 other trusts each wrote off more than £1m in uncollected fees.

A spokesman for King’s College Hospital said: “We take seriously our legal responsibility to identify patients in our hospitals who are not eligible for free NHS treatment.”

The spokesperson added that the trust “works to ensure that we incorporate the principles of fairness and proportionality into our revenue collection process”.

Lewisham and Greenwich Trust, which wrote the £11m claim, said it would “never stop anyone from getting treatment, especially with many of these patients using our maternity services”. .

A spokesperson stressed that they “work closely with patient groups and partners on charging arrangements”, “always ensuring we treat all patients in a compassionate, empathetic and supportive way”. Work from”.

The British Medical Association (BMA) has consistently criticized the charging policy, arguing that it prevents vulnerable groups from accessing essential healthcare while diverting NHS staff time from patient care.

Patients like Benny, who asked the BBC to change his name, say it can be devastating.

Benny, a disabled man applying for UK residency, was pursued by a London hospital trust for £495 after appointments at two hospitals for the fitting of a prosthetic leg.

“It was a terrible experience or a negative experience because the hospital was very rude to me and more aggressive with me even though I am disabled and I needed some help,” he told the BBC.

“I realized that I am a negative person here, because I can’t do anything, can’t work, I can’t do anything.

“They charged me £495 just for the cheque, and it was very expensive for me because I couldn’t work at the time and had no income.

“So, I tried paying it monthly for a long time until I could make ends meet.”

The BMA also maintains that doctors should not have a role in assessing patients’ eligibility for free NHS care.

Dr Omar Forge Risk, campaigner against NHS charging for overseas patients, said the charging system was harmful to public health.

“The fact is that if [patients] were paying more, it would push them into poverty,” he said.

“Ultimately, if you’re charging patients and pushing them toward worse health and disability, the costs will be higher in the long run from either perspective.”

The BBC spoke to several doctors who described their experiences with the charging system, although they did not want to be identified.

An emergency medicine practitioner who previously worked in London said he had “numerous patients” who had come to the country from different countries for kidney failure, either because they could not get treatment or in their own countries. Dialysis was very expensive. .

“Health tourism is a huge problem, it’s a huge problem,” argued a central London psychologist.

“Everyone knows the NHS is free at the point of care and most doctors would say it’s not their responsibility to police the system,” he said.

“It’s difficult when a patient is desperate for care. Policing needs to happen at the first step.”

Government modeling published by the then Health Secretary Jeremy Hunt in 2023 estimated that more permanent charging of overseas patients could bring the NHS an extra £500m a year.

However, the true extent of unpaid bills remains unclear, as the £223m receipt only represents patients identified as chargeable, with many others receiving unbilled treatment. can do

The current government has defended the charging system, saying tens of millions of pounds are recovered each year.

A DHSC spokeswoman added: “Overseas visitors – and those who are not legally settled here – contribute to their treatment in recognition of the extra cost to the NHS.

“We are committed to getting the most value for taxpayers’ money.”