Chris Skidmore MP: How I unearthed the scandal of millions of pounds of unpaid NHS bills by foreign nationals

Chris Skidmore is the Member of Parliament for Kingswood.

No-one would deny that in recent years far too much of the NHS budget has been wasted, leading to a poor deal for taxpayers. One particular area that has recently attracted attention is the amount of unpaid bills by foreign nationals, who are required to pay for NHS treatment if their country does not have a reciprocal arrangement with the UK. I began last January by asking the Secretary of State for Health how much money had been written off by the NHS, which was owed by overseas patients. The answer suggested that £35 million between 2002 and 2010 alone. However, reading the small print of the minister’s response showed that this did not include data from NHS Foundation Trusts. Clearly this was just the tip of the iceberg.

I decided to investigate this further, sending a Freedom of Information request to every NHS Foundation Trust. By October 2011, I had gathered responses from over 118 trusts, showing that that more than £40 million had been written off or was still outstanding - and past performance suggested that even the payments still due were unlikely to be recovered in their entirety. Guys and St Thomas’ managed to rack up the most impressive deficit, with over £6 million being written off since 2004. Whilst I was waiting for trusts to respond, I spoke in the Summer Adjournment debate, reporting some of my initial findings and asking the minister for an update on the government’s plans to tackle the problem. I was reassured to receive confirmation that the department was reviewing the rules and practices in place for foreign nationals, and committed to providing the full results of my own research when it was complete.

Almost as surprising as the sums of money involved was the quality of the data. Some trusts could provide a detailed year-by-year breakdown, others only a single figure, some claimed not to record the costs at all. Given the wide disparity of reporting, it is no wonder that the Department of Health finds it difficult to crack down on this sort of abuse of the system by health tourists. The full results received coverage in October, and there seemed to be near unanimity that this was a serious financial problem, and that action needed to be taken. On the 18^th October at Health Questions I took the opportunity to further press ministers on the issue. The Minister of State, Simon Burns, answered with the welcome news that the UK Border Agency would be given authority to refuse entry to the UK for any visitor with an unpaid debt to the NHS. The Minister also agreed to meet with me to further discuss the issue, and receive the full results of my FOI requests.

This problem is symptomatic of the way that both the NHS and immigration were handled by Labour, with a gross disregard for what most British people would consider fair play. In 2008, a poll of NHS managers responsible for overseas visitors revealed that a third did not even routinely ask patients about their eligibility for free care. This suggests that there is a further category of foreign nationals who are receiving free care that they are not entitled to, and due to substandard administration, the details of this are not even being recorded. Whilst the current government’s assurances of action on this issue are welcome, we should look at more ambitious ways to tackle the problem of overseas visitors leaving the country without paying their bills.

West Middlesex University Hospital introduced a "stabilise and discharge" policy for foreign nationals, where doctors ensure that the patient is not in immediate danger. They are then told what treatment is required, the cost of it, and if they are unwilling to pay, they are asked to leave. This pragmatic policy is the reason that West Middlesex University Hospital only saw a tiny amount of debt written off, despite the fact that it is the closest hospital to Heathrow Airport.

I have also advocated an ‘Enterprise Card’ system, similar to American Green Cards, that would allow visitors to live, work and pay tax in the UK, without creating an automatic entitlement to benefits, schooling or NHS services without advance payment. At a time when the NHS is facing unprecedented budgetary pressures, we can no longer treat it as a free-for-all. We need to reintroduce the principles of fairness and responsibility into the system- where those who have worked hard and paid tax do not see it wasted on funding treatment for health tourists with no intention to repay what they owe. The NHS is a national health service, not an international one. 

For those interested to find out how much is still owed or written off by their individual trust, please visit my blog.