Royal Devon University Healthcare NHS Foundation Trust

5. Mrs A complains Royal Devon University Healthcare NHS Foundation Trust (the Trust) incorrectly charged her mother for Acute Healthcare At Home (AHAH) care without consent from 17 to 25 January 2024.

6. Mrs A explains she has experienced ongoing stress since she received the NHS charges invoice for her mother’s care. She says the stress has impacted her pregnancy and she has been referred to a mental health team by the maternity triage as a result.

7. By bringing her complaint to us Mrs A is looking for the Trust to reconsider its NHS charges invoice. She says she does not want to pay the outstanding amount of £2,275 for the AHAH care.

8. Mrs A’s mother visited the UK in December 2023. Mrs A’s mother has a history of high blood pressure and needed medication to manage her blood pressure during her visit to the UK in January 2024.

9. In January 2024 Mrs A took her mother to the pharmacy, who advised her that her mother should be seen by a GP. During January Mrs A registered her mother at her GP Practice where she was prescribed a medication to manage her blood pressure.

10. Mrs A’s mother continued to experience high blood pressure and headaches. Mrs A contacted her GP Practice who advised her mother should visit the Trust for treatment.

11. On 17 January the GP referred Mrs A’s mother to the Trust to attend the Same Day Emergency Care (SDEC) unit.

12. While on the SDEC unit, Mrs A’s mother was given medication to manage her blood pressure. She also had an Xray, a CT scan and was referred to an ophthalmologist (an eye doctor) because of her headaches.

13. The Trust discharged Mrs A’s mother the same day and referred her to a virtual ward to be monitored by the Acute Healthcare At Home (AHAH) team from 17 to 25 January.

14. On 18 January Mrs A took her mother back to the GP Practice for the same symptoms of high blood pressure and headaches.

15. On 16 February Mrs A received an NHS fees invoice of a total of £4,714 for her mother’s visit to the Trust.

16. The Trust told Mrs A the total amount of £4,714 noted in the invoice was incorrect and reduced it to a total amount of £2,718.

17. The NHS fees invoice shows Mrs A’s mother was charged a total of £443 for a chest Xray, CT scan and referral to an ophthalmologist. Mrs A says she and her mother consented to this treatment and she is happy to pay for this.

18. There is an outstanding fee of £2,275 for Acute Healthcare At Home (AHAH) care which Mrs A does not want to pay.

21. Section 4 of the Charging overseas visitors in England: guidance for providers of NHS services says:

‘Urgent or immediately necessary care must never be withheld or delayed because of charging issues. Failure to provide urgent or immediately necessary treatment may be unlawful under the Human Rights Act 1998. This means that treatment must go ahead even if the patient has not yet been informed of possible charges, or there are ongoing investigations into a patient’s charging status or the patient has indicated that they are unable or unwilling to pay.

This does not mean that the charging regulations cease to apply in cases where urgent or immediately necessary care is required. Relevant bodies must still charge overseas visitors (unless exempt) and obtain upfront payment if it is possible and appropriate to do so without causing a delay and should continue to inform patients of potential charges at the earliest possible opportunity.’

22. The Royal College of Emergency Medicine (RCEM) guidance says:

‘The purpose of Same Day Emergency Care (SDEC) is to provide urgent clinical care without admission.’

23. The evidence shows on 17 January 2024 Ms A’s mother was referred by her GP to the Trust’s SDEC unit.

24. The Trust’s website says the SDEC unit provides same day care for emergency patients who would otherwise be admitted to hospital. It says the service is for patients arriving in hospital after being referred by their GP and is felt that they need rapid medical assessment but can be managed safely as an outpatient.

25. The Trust has explained how the treatment Mrs A’s mother received from 17 to 25 January 2024 was urgently necessary due to being referred rapidly the same day from her GP into the SDEC unit.

26. On 17 January Mrs A’s mother was discharged into the care of the Acute Hospital at Home Team (a virtual ward) for ongoing management of high blood pressure. The evidence shows how the virtual ward admission was part of the original admission via GP referral to the SDEC for Mrs A’s mother.

27. We consider the treatment Mrs A’s mother received from 17 to 25 January was urgent or immediately necessary in line with the RCEM guidance. We consider the Trust acted in line with the Charging overseas visitors in England guidance when it did not withhold or delay the treatment for Mrs A’s mother because of charging issues. We acknowledge how this has been a distressing time for Mrs A and we do not underestimate how she has been impacted as a result of her experience. We see no indications that anything went wrong. Therefore, we will take no further action.

28. Step 3 of the Charging overseas visitors in England: guidance for providers of NHS services says:

‘Overseas visitors should be identified and informed about potential charges at the earliest possible opportunity (Care Quality Commission (CQC) regulation 19, fees) to maximise cost recovery and ensure that patients can make informed choices about their care.’

29. Step 6 of the Charging overseas visitors in England: guidance for providers of NHS services says:

‘if treatment has already been given to a chargeable overseas visitor (either because they were not identified in time or treatment was urgent or immediately necessary), relevant bodies must still issue an invoice and make efforts to recover the charges (debt) afterwards.’

30. Due to the short amount of time Mrs A’s mother was in the hospital and because she was seen and treated in the SDEC unit for care that is deemed to be urgent or immediately necessary, we are satisfied the Trust acted in line with the above guidance when it carried out a Home Office check with the Status Verification and Enquiries Checking (SVEC) service on 23 January to establish Mrs A’s mother’s status in the UK. The Home Office check was carried out while Mrs A’s mother was still under the care of the Trust, during her admission to a virtual ward.

31. On 30 January the Home Office check confirmed Mrs A’s mother was on a visit visa. The Trust then put together the invoice for her treatment and posted it on 16 February 2024.

32. Based on the information we have reviewed as part of our assessment we have seen no indications of failings here.

33. We understand how difficult it must have been for Mrs A to bring her complaint to us and thank her for giving us an opportunity to look into her concerns. We hope we have explained our decision clearly.

1. We have carefully considered Mrs A’s complaint about a Trust in the Devon area (the Trust).

2. We are sorry to hear and read about the impact this had on Mrs A and the ongoing stress this caused her.

3. We have carefully considered the available evidence and have found no indications that anything went wrong.

4. We have explained the reasons for our decision below.