London Hospitals Forfeit £112 Million in Unpaid Overseas Patient Bills

Data acquired by the BBC indicates that hospitals in London have cancelled over £112 million in outstanding medical treatment charges owed by international patients during the period spanning 2018 to 2023. Existing NHS guidelines mandate that hospital trusts across England impose fees for non-urgent care on individuals not deemed “ordinarily resident” in the United Kingdom. Opponents contend that the present method for recovering these expenses is both unjust and inefficient. The Department of Health and Social Care (DHSC) stated its expectation that all NHS trusts would reclaim any fees not settled upfront whenever feasible. The BBC reached out to all 32 acute hospital trusts in London regarding their billing practices for international patients. The NHS trusts that responded issued invoices totaling £223 million for these services over the five-year timeframe, yet £112 million was later recorded as uncollectible debt. While emergency and general practitioner services are universally free, trusts are obligated to charge for other categories of non-urgent care provided to patients who are not typically UK residents, applying a rate of 150% of standard NHS fees. This additional charge is intended to offset the administrative effort involved in patient identification and payment collection. Although designed to address “health tourism,” the fee system includes waivers for vulnerable populations, such as asylum seekers and victims of trafficking. Nevertheless, hospitals frequently encounter difficulties in recouping expenses, particularly once patients have left the country. Trusts must reconcile their legal duty to recover funds with the practicalities of caring for patients requiring assistance, many of whom possess restricted financial resources or encounter other obstacles to payment. Barts Health, which caters to a significant population in east London, cancelled £35 million in outstanding invoices over the five-year period, representing the largest amount among all London trusts that provided data. A spokesperson for the trust commented: “Where appropriate, we make every effort to recover payment from patients who are liable for the cost of their treatment. “However, many patients may have limited funds available and some will not be resident in the UK, which means recovering payment can be difficult.” King’s College Hospital waived £17 million, and an additional 10 trusts each wrote off over £1 million in uncollected charges. A representative for King’s College Hospital stated: “We take seriously our legal obligation to identify patients presenting at our hospitals who are not eligible for free NHS treatment.” The representative further noted that the trust strives “to ensure we embed fairness and proportionality principles into our income recovery processes”. Lewisham and Greenwich Trust, which cancelled £11 million, affirmed that it would “never deter anyone from seeking treatment, especially as many of these patients are using our maternity services”. A spokesperson highlighted that they “work closely” with patient groups and collaborators on billing procedures, “always ensuring we act in an empathetic, compassionate and supportive way towards all patients”. The British Medical Association (BMA) has maintained a consistent stance of criticism regarding the charging policy, asserting that it discourages vulnerable individuals from obtaining essential medical care and redirects NHS personnel’s time away from direct patient services. Individuals such as Beni, whose name was altered by the BBC at his request, describe the impact as potentially ruinous. Beni, a disabled man in the process of applying for UK residency, faced a demand for £495 following two hospital visits for a prosthetic leg fitting at a London hospital trust. He recounted to the BBC: “It was a horrible experience or negative experience because the hospital was very rude with me and more aggressive with me even though I’m disabled and I needed some help,” adding, “I felt like I’m a negative person here, because I cannot do anything. Cannot work, I cannot do nothing. “They charged me £495 just for checking, and it was very expensive for me because at that time I couldn’t work and I didn’t have any income. “So, I tried to pay it monthly for a long time until I can finish it.” The BMA further contends that medical practitioners should not be involved in determining patients’ eligibility for complimentary NHS treatment. Dr. Omar Forge Risk, an advocate opposing NHS charges for international patients, asserted that the billing framework posed a threat to public health. He stated: “The reality is that if [patients] were paying back any more, it would push them into destitution,” concluding, “Ultimately, if you’re charging patients and pushing them more into ill health and into destitution, the costs from any perspective will be greater in the long run.” The BBC interviewed several medical professionals who shared their encounters with the charging mechanism, opting to remain anonymous. An emergency medicine practitioner, formerly based in London, reported treating “multiple patients” who arrived in the UK suffering from renal failure, originating from diverse nations, due to the unavailability or prohibitive cost of dialysis in their home countries. A central London oncologist contended that “health tourism is a massive problem, it’s a huge problem.” They remarked: “Everyone knows the NHS is free at the point of care and most doctors will say it’s not their responsibility to police the system,” adding, “It’s difficult when a patient is desperate for care. Policing needs to occur at an earlier stage.” Government projections, released in 2023 by the then-health secretary Jeremy Hunt, calculated that a more uniform application of charges to international patients could generate an additional £500 million annually for the NHS. Nevertheless, the actual scope of outstanding invoices is uncertain, given that the £223 million billed only accounts for patients identified as liable for charges, whereas numerous others might receive medical attention without ever being invoiced. The present government has defended the charging framework, stating that “tens of millions of pounds” are recouped annually. A DHSC spokesperson further commented: “Overseas visitors – and those who are not lawfully settled here – should contribute towards their treatment in recognition of the additional cost to the NHS.” The spokesperson concluded: “We are committed to getting maximum value for taxpayers’ money.”