London Hospitals Write off Foreign Patient Bills
London hospitals have written off more than £112m in unpaid treatment bills from overseas patients between 2018 and 2023, according to figures obtained by the BBC.
Under current NHS regulations, hospital trusts in England must charge patients who are not “ordinarily resident” in the UK for non-urgent treatment.
Critics argue that the current system for recouping these costs is unfair and ineffective.
The Department of Health and Social Care (DHSC) said it expected all NHS trusts to recover any charges not paid in advance wherever possible.
The BBC contacted all 32 of London’s acute hospital trusts about their overseas patient billing. The responding NHS trusts invoiced a total of £223m for such treatments over the five-year period, but £112m was subsequently written off as bad debt.
Though 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 ordinarily reside in the UK and charge at 150% of standard NHS rates.
This premium is meant to cover the administrative burden of identifying patients and pursuing payment.
While aimed at tackling “health tourism”, the charging system has exemptions for vulnerable groups including asylum seekers and trafficking victims. But hospitals often struggle to recover costs, particularly when patients return overseas.
Trusts balance their legal obligation to recover costs and the realities of treating patients in need, many of whom have limited means or face other barriers to payment.
Barts Health, serving a large population in east London, wrote off £35m in unpaid bills over the five years – the highest among all responding London trusts.
A spokesperson said: “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 abandoned £17m, while 10 other trusts each wrote off more than £1m in unrecovered fees.
A spokesperson for King’s College Hospital said: “We take seriously our legal obligation to identify patients presenting at our hospitals who are not eligible for free NHS treatment.”
The spokesperson added that the trust works “to ensure we embed fairness and proportionality principles into our income recovery processes”.
Lewisham and Greenwich Trust, which wrote off £11m, said it would “never deter anyone from seeking treatment, especially as many of these patients are using our maternity services”. A spokesperson emphasised that they “work closely” with patient groups and partners on charging arrangements, “always ensuring we act in an empathetic, compassionate and supportive way towards all patients”.