MPs urge improvements on NHS cost recovery from overseas patients

1 Feb 17

The NHS is failing to recover enough money from overseas patients because its current systems are “chaotic”, MPs on the Public Accounts Committee have said.

In a report, the committee concluded that the NHS and Department for Health were recovering far smaller sums than they should, and were a long way short of the target to recoup £500m a year by 2017-18.

Some treatments, including GP appointments and accident and emergency care, are currently free to all patients, while refugees and those applying for asylum are exempt from charges. In other cases, the health service has a statutory duty to recover the cost of treatments for visitors who are not eligible for free care – for example, most hospital care is chargeable.

But the committee said it was not confident effective action was being taken to achieve this. In 2013-13, the NHS levvied only 65% of what it could have charged for visitors from outside European Economic Area, and just 16% from within the EEA. 

The amount of money recovered has increased since the Department for Health launched an overseas visitor and migrant cost recovery programme in 2014. Since then, the amount recovered has increased from £97m in 2013-14 to £289m 2015-16.

However, the committee found that this was mostly due to changes to charging rules, rather than the NHS trusts implementing the recovery programme more effectively.

According to the committee, the systems for cost recovery “appear chaotic”. Despite assurances from the DoH that it was improving policy and regulation, good practice and IT, MPs were “not convinced that enough is being done to identify and charge overseas patients.”

It followed that “if the NHS does not recover the cost of treating patients who are not entitled to free care, then there is less money available to treat other people” which only serves to increase the pressure on health service finances, its said.

Part of the problem stems from the difficulty establishing patients’ eligibility for care. Even showing a passport, for example, does not clearly establish a patients’ right to treatment. The committee noted there was “no single easy way to prove entitlement”.

Committee chair Meg Hillier said the NHS and DoH to do more to instil confidence in the public that money for such treatment was being recovered properly. “The government’s failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds.”

She added it was “simply unacceptable” that money was not collected properly when the heath service was under so much financial pressure, and said central government should be responsible for tackling the problem.

The committee called on the DoH to set out a detailed plan to address the issue by this summer, and assign responsibility for the programme to individuals who could be held to account. 

Responding to the report, the DoH said that the money recovery had more than trebled in three years, to £289m.

"However, there is more to be done to make sure that if people are not eligible for free care, they pay for it.

"We will be announcing further steps very shortly to recover up to £500m a year by the middle of this Parliament."

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