3. Mr S complains University Hospitals Leicester NHS Trust (the Trust) has charged him £17,964 for a planned heart surgery on his newborn son, L, without notifying him of the charge in advance.
4. Mr S said the charge has caused emotional distress, financial hardship and ongoing uncertainty for him and his family.
5. Mr S would like the Trust to waive the charge and to make service improvements in its communication of overseas visitor charges.
6. Mr S is from India and has a visa to live and work in the UK. Mr S’s wife and children also live in the UK on dependant visas. They pay the Immigration Health Surcharge (IHS) and so they are exempt from overseas visitor charges.
7. In September 2024, Mr S’s son, L, was born at a hospital in Leicester.
8. Shortly afterwards, L was diagnosed with two holes in his heart which required surgery to treat. This surgery took place in January 2025.
9. Three days after the surgery took place, the overseas department at the Trust informed Mr S that there would be a charge for the surgery as L did not have UK resident status.
13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
14. DHSC guidance on 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 at the earliest possible opportunity. It says if the parent does not regularise their child’s status, which may include the parent paying the health surcharge on their child’s behalf, they will be liable for any charges for treatment provided to the child after they are three-months old.
15. Mr S’s son was born in September 2024, and the surgery took place in January 2025, over three months after his birth. This was therefore after the three-month exemption period, and the regulations required Mr S to regularise L’s status, or he would be liable for any charges incurred for NHS treatment.
16. Mr S says the Trust failed to notify him in advance of the charge, and he only found out after the surgery had taken place. Mr S said this was a planned surgery with an agreed date so there was no reason the Trust could not have told him in advance. Mr S said he attended several hospital appointments with his son in the months before the surgery and these were opportunities for the Trust to mention the charges.
17. Additionally, Mr S said he and his wife were dealing with an extremely distressing period and his son’s doctors advised him not to take him into public spaces due to his unvaccinated status and sensitive lungs. Mr S said this prevented them from taking his son to attend in-person visa appointments required for visa documentation.
18. Mr S said as soon as the Trust discharged his son and he received the documents, he submitted the visa application and paid the Immigration Health Surcharge (IHS), three days after L’s discharge.
19. The Trust said it understood Mr S was initially unaware of the requirement to pay. It said it had acted in accordance with government regulations and provided his family with the necessary information and guidance regarding the applicable charges at the earliest opportunity.
20. The Trust acknowledged Mr S attended outpatient appointments prior to the surgery. The Trust said all but one these appointments were within the exemption period, so they did not flag up on the Trust’s systems. The Trust acknowledged there was one outpatient appointment which fell after the exemption period which did not flag up on its system. This took place two weeks before L’s surgery.
21. The Trust said patients presenting as potential overseas visitors would now be immediately referred to the overseas service so they can be kept fully informed of any potential charges prior to treatment.
22. The Trust explained when L was admitted for surgery in January 2025, the overseas team attempted to call Mr S prior to the surgery taking place but were unable to reach him as his phone was switched off.
23. Additional DHSC guidance on cost recovery of overseas charges says it is important that patients are made aware as soon as possible that there may be a charge for treatment. However, the guidance is very clear that even when a relevant organisation has not informed a patient of charges, the patient will still be liable for that charge. It adds organisations have no power to waive fees once they identify an episode of care is chargeable.
24. We acknowledge there may have been a missed opportunity for the Trust to inform Mr S earlier than it did.
25. It is important to note, however, the guidance explains it is not the responsibility of the Trust to ensure the parents are aware of NHS charging regulations.
26. We appreciate what a difficult situation this is for Mr S and know this is a significant amount of money to pay. The DHSC cost recovery guidance permits patients and Trusts to formally agree repayment plans to make the payment over a period of time. We are pleased to see the Trust has offered to arrange this for Mr S.
27. The relevant guidance clearly states Mr S needed to regularise L’s status within three months or he would be liable for any charges. This was a planned surgery, and it is therefore reasonable to expect Mr S to make the necessary arrangements in advance.
28. We consider the Trust has acted in line with relevant guidance and we have seen no indications the Trust has done anything wrong.
1. We have carefully considered Mr S’s complaint about the Trust. We recognise Mr S and his family have been through a difficult experience since his son’s birth and receiving a significant charge for the treatment his son received has added to Mr S’s distress.
2. We have reviewed all the available evidence, and we have not seen any indications the Trust has done anything wrong.