London hospitals have written off over £112 million in unpaid treatment bills from overseas patients between 2018 and 2023, revealing a significant challenge in managing healthcare costs for non-residents. This sum represents half of the £223 million invoiced during the same period, according to figures obtained by the BBC.
Under NHS regulations, hospital trusts in England must charge patients who are not “ordinarily resident” in the UK for non-urgent treatments. These treatments are billed at 150% of standard NHS rates, a premium intended to cover administrative costs. Despite this, recovering payments has proven difficult, particularly when patients return overseas or face financial constraints.
While emergency and GP services remain free for all, the requirement to charge for other treatments has sparked criticism. The British Medical Association (BMA) has long argued that the system deters vulnerable groups from accessing essential healthcare while diverting staff resources from patient care.
Hospital trusts, caught between their legal obligations and humanitarian considerations, often struggle to collect payments. Barts Health Trust, serving east London, wrote off £35 million—the highest amount among responding trusts. A spokesperson emphasized their efforts to recover costs but noted that many patients have limited means, making recovery challenging.
King’s College Hospital and Lewisham and Greenwich Trust also reported substantial losses of £17 million and £11 million, respectively. Both trusts highlighted their commitment to fairness and proportionality, ensuring no patient is deterred from seeking care. Lewisham and Greenwich Trust noted that many of their billed patients required maternity services, further complicating the balance between cost recovery and compassionate care.
For patients like Beni, a disabled man applying for UK residency, the experience can be harrowing. Pursued for £495 after two hospital appointments for a prosthetic leg fitting, Beni described the ordeal as overwhelming. “The hospital was rude and aggressive with me,” he told the BBC. “I couldn’t work, I had no income, and paying the bill in installments was my only option.”
Doctors have also voiced concerns. One emergency medicine practitioner recounted treating patients with renal failure who traveled to the UK because dialysis was inaccessible or unaffordable in their home countries. Another oncologist acknowledged the challenges of addressing “health tourism” while stressing that it’s not the responsibility of medical staff to police eligibility for free care.
Critics argue the current system is inefficient and ultimately counterproductive. Dr. Omar Forge Risk, a campaigner against NHS charging policies, warned that pushing patients into destitution or ill health incurs greater long-term costs. “Charging patients exacerbates poverty and poor health, undermining the NHS’s fundamental mission,” he said.
Government modeling published in 2023 estimated that stricter enforcement could recover an additional £500 million annually. However, this figure only accounts for identified chargeable patients, leaving the true extent of unpaid bills uncertain. A Department of Health and Social Care (DHSC) spokesperson defended the system, stating, “Overseas visitors should contribute to treatment costs to reflect their impact on NHS resources.”
The NHS’s overseas charging policy raises fundamental questions about fairness, efficiency, and the balance between fiscal responsibility and equitable healthcare. As hospitals write off millions in unpaid bills, the debate over how to manage these costs without compromising care remains unresolved. What’s clear is that a solution will require addressing systemic inefficiencies, safeguarding vulnerable patients, and ensuring the NHS remains a sustainable and compassionate institution for all.
