London hospitals write off up to 96% owed by foreign patients

London hospitals have written off up to 96% of what they are owed by foreign patients not entitled to free NHS care, BBC London has learned.

A Freedom of Information request showed Newham Hospital Trust wrote off all but 4% what it had invoiced last year.

The hospital trust said it became too difficult to recover costs if foreign patients died or were failed asylum seekers.

In total, £7.6m was written off by 33 NHS trusts in the region, since 2009.

Across the trusts, a total of £26m is owed by patients, of which £18.4m continues to be actively sought.

All hospitals are required to recover money owed for treating these patients.

The figures show however, that there is a big variation between hospitals.

While Newham Hospital Trust wrote off most of what it was owed by ineligible foreign patients last year, West Middlesex Hospital wrote off just 3%.

Newham Hospital Trust said: "There are some cases where it is not possible or becomes difficult to recover costs, such as when a patient passes away, failed asylum seekers or if they leave the UK."

NHS health care is free to everyone who needs emergency treatment, but patients whose normal residence is outside of the European Union have to pay for services, with certain exceptions.

A "health tourist" could be someone who visits the UK specifically for free health care, or they may already be living here and are trying to avoid paying their bill.

One senior doctor at a large London hospital, who did not want to be identified, said the problem of outstanding debt was much bigger than official figures show.

'Can't afford it'

"It is probably about three or four times that figure," he said.

"These patients probably know somebody in this country. Very often they just take a plane and come to the first A&E department that deals with that type of condition and they know they will be treated because they are very sick."

He added: "Do I think we can afford it? No, I don't think we can."

Among other places, Kings College Hospital wrote off £343,000 last year.

A spokesman said: "We give patients ample time and opportunity to prove to us that they are entitled to receive free treatment.

"Under no circumstances would treatment fees be waived if proof of status is not received."

Mercedes Abelando, 69, lives in south London but is originally from Uruguay and did not qualify for free NHS treatment, says she was treated at the hospital while she was an illegal migrant.

Image caption Mercedes Abelando said she could not afford to pay for treatment

She told BBC London she did not know she would have to pay for the health care until she received a bill after treatment.

"I went to the hospital and I told them that I didn't have that kind of money and I couldn't pay," she said.

"The person who saw me at the hospital said to me: 'ok, that's fine'; took the letter and I haven't heard from them since.

"I was surprised, but I couldn't pay anyway."

Various hospital trusts, which had written off large amounts of their debt, said chasing the money was often difficult if patients leave the country and sums were only written off when all options to pursue it had been exhausted.

There are no official figures to measure what some suspect is a problem that is under the radar.

However, some believe that "health tourists" do not exist and are a sensationalised phenomenon.

Naomi Hartree, a volunteer doctor at Project London, a clinic in east London which helps vulnerable people like migrants and asylum seekers access healthcare, says foreign patients are over-policed.

"We've documented numerous cases where people have been turned away from hospital treatment because they're perceived to be health tourists, and they're people who are entitled to healthcare," she said.

Project London also argues that chasing debt incurred by foreign patients is more expensive than writing it off.

Immigration powers introduced in November 2011 mean overseas patients who owe the NHS £1,000 or more will not be allowed to enter or remain in the UK until the debt is paid off.

The Home Office has said it was still too early to see what impact this was having.

In the meantime, the government is currently reviewing access to NHS health care by overseas patients.

It is expected to report to ministers in the next few months.

Health Minister Anne Milton said: "Hospitals must take reasonable measures to recover any debts from overseas patients.

"The NHS has a duty to anyone whose life or long-term health is at immediate risk, but we cannot afford to become an international health service, providing free treatment for all."

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