NHSI cash recovery programme

NHS Improvement plans to recover £44 million for 50 NHS trusts, income lost from overseas patients potentially ineligible for treatment.

New programme to help boost cash recovery from care provided to foreign visitors


We wrote last month about the High Court case of Lawal v North Middlesex Hospital, which reiterated that there is no requirement on trusts to provide free non-urgent treatment in the absence of evidence of entitlement to that care. With the NHS under unprecedented financial pressures, the issue remains topical, with NHS Improvement (‘NHSI’) now confirming that it has identified an “apparent overseas income opportunity” of around £44 million across 50 trusts, to whom it has written, with plans in place which will provide ‘intensive support’ to improve cost recovery.

In detail

While confirming that the NHS would continue to ensure urgent treatment was never delayed or denied and that protections were retained for the most vulnerable, NHSI has suggested that some trusts were not meeting their legal obligations on recouping funds from overseas patients which fell outside those red lines.

The regulator said that the trusts were chosen because they had been identified as the providers which had an “apparent overseas income opportunity of above £400,000 per annum”. Trusts should be claiming back around £167 million in charges but according to NHSI, only around £113 million is actually being recovered, with most of the deficit being found among the 50 trusts which have been identified.

These 50 trusts will each receive a “bespoke” support package including help from project managers “well versed in working with overseas patients” and “technical specialists depending on the potential themes and areas of opportunity (e.g. debt recovery, informatics)” with these specialist teams visiting the trusts this month.

In addition to tackling the identified financial shortfall, trusts are to be given help in improving waiting list ‘filtering’ with red flags against patients who should be charged, with the measures also including extra efforts to ensure that EU visitors, who are entitled to free care at the point of delivery, present their European Health Insurance Cards (EHIC), which will enable trusts to bill their home country for the cost of the care provided here.


This is a hugely sensitive topic and whilst is encouraging that NHSI has stressed that the principle of free care where there is entitlement must be upheld, the financial realities are such that opportunities to ensure that revenue is collected where it is due must be supported and will no doubt be welcomed by those trusts which will receive the specialist help.

If you have any questions or would like to know more about our legal update, please contact Rachel Kneale  (Partner), or Simon Turner (Partner).

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