Caroline Flint

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Health chiefs must take urgent action to recover more money from NHS patients visiting from overseas, the Committee of Public Accounts says today.

In a new Report, the Committee calls on the Department of Health to improve systems for cost recovery and “do more to promote public confidence that the money due to the NHS is being recovered, and that the system is fair to taxpayers and to patients who are entitled to free care”.


Said Committee member Caroline Flint, who led for the PAC on preparing this report: “The chaotic way in which the NHS recovers payments from overseas visitors not entitled to free NHS services leads to less money being available for patients and more financial pressure on the NHS.


“We are rightly proud that our NHS offers a service free at the point of use for every citizen.  But many countries recover the costs of treatment from those who have no right to access health treatment free of charge.  British people who fall ill on holiday abroad frequently pay or claim on their travel insurance for hospital treatment.


“We want the Government to take a lead and establish some standardised actions to identify those entitled to NHS treatment and ensure more money is recovered from overseas patients.  If hospitals are failing to collect payments due to them for treatment they provide – the Government – as the custodians of our NHS – have to step up and fix this problem.”


The Public Accounts Committee report states: “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 and even more pressure on NHS finances.”


Whether patients are supposed to pay for NHS treatment depends on whether they are resident in the UK and on the type of treatment.


Some treatments, including GP appointments and accident and emergency care, are currently free to all patients; and some patients, such as refugees and those applying for asylum, are exempt from charges.


In other cases, statutory regulations require hospital trusts to make and recover charges in respect of the cost of treating overseas visitors. Most hospital care is chargeable.


The Committee is not confident the Department is taking effective action to recover more of the costs of treating overseas visitors and concludes progress “is hampered because the NHS is not effectively identifying chargeable patients”.


The extent of unexplained variation between hospital trusts suggests that some have scope to make substantial improvement, says the Committee.


However, it concludes other parts of the health system – such as NHS England and clinical commissioning groups – have an important role to play and are not yet doing enough to support cost recovery.


Among its recommendations, set out in detail below and in the attached Report, the Committee urges the Department to publish by June an action plan “setting out specific actions, milestones and performance measures for increasing the amount recovered from overseas visitors.”


This should name senior individuals in the Department and NHS Improvement whom the Committee can hold to account.


Meg Hillier MP, Chair of the PAC, said today: “The Government’s failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds.


“Our Committee has reported extensively on the financial pressures facing the health service and it is simply unacceptable that so much money owed should continue to go uncollected.


“This is a problem for the health service as a whole and work to put it right must be driven by central government.


“We are concerned that financial progress to date does not reflect meaningful progress with implementing the rules and the Department for Health and NHS have much to do if they are to meet their target for cost recovery.


“That is why we are calling on the Department to set out a detailed action plan now. It must make clear what it will do to increase the amount recovered from overseas visitors, and who will be accountable for achieving this.


“The public rightly expects the Government to enforce the rules and more can and should be done to recover money where it is due.”


The Report can be accessed in HTML and PDF formats via the following links:


Additional material relating to this Report can be found here.

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