Hospitals have written off greater than £250 MILLION owed by overseas sufferers… due to failures to examine they had been entitled to NHS remedy

Cash-strapped hospitals have written off £256.4 million owed by foreign patients because of failures to properly check that they were entitled to free NHS treatment.

An investigation by The Mail on Sunday shows escalating debts from health tourists – who have had everything from spinal surgery to heart care and cancer treatment – is creating a growing black hole in NHS finances.

In the last year alone, £44 million has been lost – a 63 per cent increase on the £26.9 million that hospitals had to write off in 2017-18.

Damning findings from our research, based on an analysis of health service accounts over the past seven years and a detailed Freedom of Information request to trusts across England, reveal:

• Just a third of the £621 million owed by overseas visitors to hospitals has been repaid.

• One Nigerian patient who had planned treatment at Barts Health NHS Trust in London ran up a near £500,000 bill, and a Romanian patient owes Lewisham and Greenwich NHS Trust in south London £71,000.

• More than 400 overseas patients had non-urgent treatment last year at Barking, Havering and Redbridge University Hospitals NHS Trust in east London – with 285 invoices still outstanding for a combined total of £1.3 million.

• The number of healthcare tourists using the NHS for planned treatment has doubled in nine years, adding to growing waiting lists for taxpayers.

Last night, after being confronted with the MoS’s investigation, Health Secretary Wes Streeting vowed he would act to ‘clean up this mess’.

However, the figures are likely to be the tip of the iceberg as only patients who have been identified as having to pay are included – raising fears that many more millions of pounds are slipping through the net.

Tory MP Joe Robertson, who is on the Commons Health and Social Care Committee, said: ‘Britain is not a healthcare charity for the world. NHS management needs to charge these people upfront before they receive any planned treatment. That way chancers can’t abscond without paying the bill.

‘The NHS can’t claim it needs more money while writing off millions of pounds of debt owed by foreign nationals for elective, non-urgent surgery.

‘If a tourist has an accident on holiday in the UK it is fair they receive emergency care, but the NHS seems to be providing planned, elective surgery to foreigners who fail to pay.

‘If NHS management won’t get a grip then the Health Secretary needs to force their hand. There is no point scrapping NHS England and taking the NHS back in-house if Wes Streeting won’t stamp out more of this gross waste.’

The Government has been forced to shore up the NHS’s budget by a further £21 billion over the past two years, while waiting lists for hospital treatment remain at a record high with just 59 per cent receiving care within the 18-week target.

The £256.4 million written off could have paid for 8,500 new nurses or nearly 3,000 GPs. It would cover the cost of treating 27,000 breast cancer patients or fund 15,000 kidney transplants.

The fact many foreign patient bills are for treatment which is ‘elective’ – planned in advance – has added to the anger.

While GP services and emergency care are free for anyone, regardless of residency status, hospitals are supposed to identify chargeable patients and bill them upfront – at 150 per cent of NHS prices – before receiving any other care, such as specialist appointments and planned procedures.

But the figures reveal overstretched hospitals often fail to do this in time, and instead issue invoices to the patient afterwards – allowing them to leave the country without paying.

This contrasts with health systems in France, Ireland, the US and Australia, where payment is required upfront.

Alp Mehmet, chairman of Migration Watch UK, said it was ‘outrageous’ that only a fraction of overseas patients’ costs were being recovered.

‘Wes Streeting must push trusts to stop relying entirely on the taxpayer to pay for non-emergency treatment to those not entitled to it,’ he said.

‘The founders of the National Health Service, like Nye Bevan, would be horrified to find it had become the International Health Service.’

The NHS has billed overseas patients £621 million over the past seven years. Just £233 million – about a third – has been repaid, while the amount being written off is rising because patients can’t be traced, have died or because the hospital has chosen not to pursue the debt.

This is despite the fact that in 2014, amid concern the NHS was ‘overly generous’ to overseas visitors, the Government pledged to recover up to £500 million a year.

John O’Connell, of the TaxPayers’ Alliance, called on MPs to reform the system and ‘treat taxpayers’ money with the respect it deserves’.

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.’

All hospitals have a legal duty to identify patients who are not entitled to free NHS care and recover costs, a duty overseen by overseas visitor managers.

This may involve the MESH system, an IT tool developed by NHS England which cross-references a patient’s information against other records, including those held by the Home Office.

Foreign patients should be told what the charge is likely to be and how to pay, and hospitals must take ‘all reasonable measures’ to recover the cost before treatment starts.

But for compassionate reasons, official guidance states care which a doctor rules is urgent should not be withheld – even if a patient has indicated they cannot pay.

This is particularly the case on maternity wards, where withholding care can harm mothers and babies.

In this instance an invoice is issued and efforts are made to recover the costs later, which may involve payment plans.

Hospitals can use international debt collectors to recoup these costs, but it is expensive with no guarantee that the patient will be willing or able to pay, even if they are traced.

One policy expert said: ‘The reality is that it’s often not worth the hospital trusts’ while as it can cost more to employ enough staff to check the status of every patient and to chase up the payments once an invoice has been issued. Some trusts are better than others.’

The figures include patients who have been treated in A&E and then admitted to a ward, where further care becomes billable. Others are referred to hospital by GPs for an assessment or treatment which is elective.

Most hospitals were unable to separate out bills for elective and non-elective care. But some, including Barking, Havering and Redbridge – whose £1.3 million unpaid debt in a year includes a Ghanaian who owes £18,000 for orthopaedic care – did supply figures. University Hospitals Coventry and Warwickshire NHS Trust revealed it provided elective treatment to 531 overseas patients last year, which includes a £22,000 unpaid bill for spinal surgery.

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust confirmed that 396 foreign patients had elective treatment last year, with 194 invoices worth nearly £300,000 outstanding. Other examples include a Hungarian who received kidney and heart treatment at The Royal Wolverhampton NHS Trust and owes £23,000, and several patients from India and Cameroon who received cancer treatment and owe tens of thousands of pounds.

Separate figures from the Department of Health and Social Care (DHSC) show overseas patients appear to be increasingly seeking elective NHS procedures.

While statistics for those receiving emergency care have not substantially changed, the numbers admitted for day procedures have more than doubled in nine years from 3,885 to 8,585 in 2022-23. That dipped to 6,205 last year.

The Mail on Sunday’s data shows Nigerians had by far the most outstanding debts, followed by Romanians, Indians, Albanians and US citizens. Mid and South Essex NHS Foundation Trust revealed that, in one year, 92 Nigerians had debts totalling £238,553 – around £2,600 each. It also billed 76 Romanians for a total £178,936 and 33 Albanians for £106,959.

The Mail on Sunday asked several large hospital trusts to explain the hurdles to identifying chargeable patients and recouping these costs, but all refused.

Nottingham University Hospitals NHS Trust did admit ‘capacity’ issues meant only about half of patients flagged by MESH as potentially chargeable could be further analysed by its staff. Of more than 8,000 patients flagged by MESH, 5,130 were prioritised for further checks and 982 ended up being invoiced for treatment. Some were discounted as they had a valid exemption or turned out not to be chargeable.

The DHSC said it has recouped £4.4 billion from overseas patients since 2015-16, but this includes all payments made via the Immigration Health Surcharge – which charges people with a student or working visa £776 a year to use the NHS – and income from countries within the European Economic Area to treat their patients.

Mr Streeting said last night: ‘Just as Brits abroad have to pay for healthcare, so should visitors to this country. At a time when patients are waiting unacceptably long for a GP appointment, an operation or even an ambulance, it is unacceptable for the NHS to be stuck with the bill for treatment that should be paid for.

‘We will act to clean up this mess. As we work to cut waiting lists, we’ll also work to cut freeloading at the British taxpayers’ expense.’