Government is set to miss target to recoup £500m from treating overseas visitors

The government is unlikely to meet its target to recover £500m (€560m; $610m) a year from the cost of treating overseas visitors who are not entitled to free NHS hospital treatment by 2017-18, the National Audit Office has concluded.1

The Department of Health in England launched a programme in 2014 to extend the scope of charging for overseas patients and implement existing regulations more effectively to tackle concerns that the NHS was “overly generous” to overseas visitors.2

In a progress report, the NAO found that the total amount of income identified had almost trebled since the start of the scheme, from £97m in 2013-14 to £289m in 2015-16.

But most of the increase (£164m) has been generated through a new immigration health surcharge, introduced by the Home Office in 2015-16, for students and temporary migrants from outside the European Economic Area and not through direct patient charging.

If current trends continue, the NAO forecast that the government would charge only £346m in 2017-18, around £150m short of its target.

The auditors found “significant variation” in the amount of overseas visitor income identified by NHS trusts. The NAO urged the Department of Health and the regulator NHS Improvement to gain a clearer understanding of why such variation exists, to try to identify areas for improvement.

The report said that the complexity of charging regulations was one reason why NHS staff may have to rely on their judgment in determining whether to charge patients.

It highlighted a recent survey commissioned by the department showing that only 58% of hospital doctors were aware that some people were chargeable for NHS healthcare. Even among those who were aware, 48% said that they did not believe that they had a role regarding chargeable patients.

The report added that trusts faced a particular challenge in recovering the cost of treating patients who were personally liable for the cost of their treatment (mainly visitors from outside the EEA).

While the amount that NHS trusts invoiced to patients directly—mostly to visitors from outside the EEA—was 53% higher in 2015-16 than in 2013-14, this increase was likely to have been driven by a rule change that allowed trusts to charge 50% above the NHS tariff, the NAO said.

And, while amounts charged to patients from the EEA increased slightly, the NAO said that this remained well below the target that the department had set in 2014.

Amyas Morse, head of the NAO, said, “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.

“If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18.”

Mark Porter, BMA council chair, said, “While those accessing NHS services should be eligible to do so, systems to charge migrants and short term visitors need to be practical, economic, and efficient, and must not jeopardise access to healthcare for those who need it. A doctor’s duty is to treat the patient in front of them, not to act as a border guard.”