University Hospitals Plymouth NHS Trust

4. Dr Y complains that the Trust failed to inform him that, when his son turned three months old, his care became chargeable as an overseas patient. He says the Trust did not inform him the care was chargeable until his son was around two years old and it has now asked him for a backdated payment of £9,327.66.

5. Dr Y says had he been told the care was chargeable, he could have applied for residency permit for his son and all his son’s care would have been provided by the NHS free of charge. He says he has been caused distress by the Trust asking for the payment as he is unable to afford it.

6. Dr Y says he would like a financial remedy to cover the charges.

7. Dr Y is from overseas and has a visa to live and work in the UK as a trainee doctor for the NHS. His wife also lives in the UK with a dependants visa. Due to his NHS workers visa, Dr Y and his dependants are also exempt from paying the Immigration Health Surcharge (a charge paid by some overseas patients when they use the NHS) when applying for a visa.

8. In April 2021, Dr Y and his wife had a son who was born three months prematurely, with several complex health conditions.

9. Dr Y’s son needed a significant amount of NHS care over the course of the next 18 – 24 months. This included home oxygen and overnight hospital visits. We understand this would have been a very difficult period for Dr Y and his family.

10. Dr Y believed his son could live in the UK and access the NHS for free, as long as he did not leave. He says he did not apply for a resident permit for his son, as he could not get a passport due to the COVID-19 pandemic and civil unrest Dr Y’s home country.

11. On 27 April 2023, the Trust wrote to Dr Y and advised it had investigated and found the care should have been chargeable. It asked Dr Y to make a payment of or put in place a payment plan for this amount. It said it was unable to waive the charges.

16. The DHSC guide, ‘Guidance on implementing the overseas visitor charging regulations’, says parents who are exempt from charges should ensure they regularise (apply for a visa for legal status to stay in the UK) their child’s immigration status. It says if the parent does not regularise their child’s status, they will be liable for any charges for treatment provided to the child after they are three-months old (5.14).

17. The DHSC guide, ‘NHS cost recovery – overseas visitors’ says it is important that patients are made aware as soon as possible that there may be a charge for treatment (107). Though it clarifies that even when a relevant body has not informed a patient of charges, the patient is still liable for that charge (107).

18. Dr Y is unhappy that the Trust did not inform him that his son’s care was chargeable after he was three months old. He says had he been made aware, he could have applied for the necessary resident permit for his son, and he would have been exempt from any charges. As the Trust did not tell him, he accrued a bill of nearly £10,000.

19. Dr Y explains there were several mitigating circumstances. We know he would have been very concerned for his son’s health at this time, particularly as he needed to take home oxygen after he was discharged. Furthermore, he explained there was unrest in his home country during the COVID-19 pandemic and he was unable to apply for a passport for his son. He also explains he broke his ankle around this time, and he was recovering from this.

20. The Trust says Dr Y failed to regularise his son’s birth within three months of his birth. It says because Dr Y failed to regularise the birth with the Home Office, its system did not know the status of his visa. Therefore, the Trust says it did not know the care was chargeable at the time.

21. The Trust explains it began a project in 2024 to identify cases where births had not been regularised, which is when it identified this case as chargeable.

22. A child born in the UK is entitled to NHS treatment for the first three months after birth, after which the parents should apply for a visa. DHSC guidance (5.14) tells us that Dr Y, as his parent, was responsible for regularising his son’s birth within the first three months. This guidance is clear that as this was not done, Dr Y is liable for the charges accrued after the first three months.

23. We have considered Dr Y’s view that the Trust should have made him aware of the charges prior to them being accrued. However, we understand that the Trust’s system responsible for flagging when a patient’s care is chargeable, is linked to the Home Office. As Dr Y did not regularise his son’s birth with the Home Office, it appears the Trust was unaware that the care was chargeable.

24. We consider the Trust does have a process in place to flag up if care might be chargeable, and can see the Trust made reasonable attempts to identify whether this was the case. It is important to note it is not the responsibility of the Trust to ensure the parents were aware of NHS charging rules, and we do not find there is a failing in the Trust’s identifying of the chargeable status and communicating this with Dr Y.

25. We can then see the Trust took action to identify whether this period of care was chargeable later down the line and it identified Dr Y’s case. We are also happy to see it has proactively started to send letters to mothers who give birth at its hospitals, whilst on a valid overseas visa, to explain their rights.

26. Once the Trust identified the care was chargeable, the DHSC policy (107) is clear that even where the patient was not informed prior to the care being given, they are still liable for the payment. The guide also confirms the Trust has no power to waive the fee once it realises the care is chargeable. We therefore find the Trust acted in line with guidance in requesting the charges are paid.

27. We appreciate what a difficult situation this is for Dr Y and know this is a significant amount of money to have to pay. The DHSC cost recovery guidance (143-145) does permit patients and Trusts to formally agree repayment plans to make the payment over a period of time.

28. While we have not found a failing by the Trust, we would again like to acknowledge Dr Y’s frustration and the impact this situation has had on him. We would like to wish Dr Y and his family well in the future.

1. We have investigated Dr Y’s complaint against University Hospitals Plymouth NHS Trust (the Trust). We are sorry to hear about the premature birth of his son, and the medical problems he faced in the first year of his life. We know receiving a significant charge for his son’s care must have added to Dr Y’s distress.

2. We have not found failings in the way the Trust communicated about the charges, and have found it acted in line with the NHS rules in attempting to recover these costs. We have therefore not upheld the complaint.

3. We would like to acknowledge this is likely to be very disappointing for Dr Y and do not wish to diminish the impact on him and his family given these difficult circumstances.