London North West University Healthcare NHS Trust

3. Mrs A complains London North West University Healthcare NHS Trust (the Trust) incorrectly charged her husband, Mr A £866 for treatment when he attended the ambulatory care unit on 6 August 2022. Specifically, she states:

• Mr A had applied for a graduate leave to remain visa which the home office delayed, so she feels the Trust should not have charged him for the treatment • The Trust did not ask Mr A to sign any documentation to show he agreed to pay for treatment on 6 August 2022.

4. Mr A has suffered a financial impact. He had to pay for his graduate leave to remain visa, and then in November 2024 received an invoice for £866 for the treatment received on 6 August 2022. Mrs A explained she thought this issue had been resolved in 2022 so was surprised to receive the invoice.

5. By bringing her complaint to us, Mrs A would like the Trust to retract the invoice. Mr A has not yet made this payment, and Mrs A explained she does not want him to have to go to court.

6. On 6 August 2022, Mr A attended the ambulatory care unit (an Ambulatory Care Unit (ACU) provides same-day medical care, allowing patients to be assessed, diagnosed, and treated without the need for an overnight hospital stay) as he was experiencing flank pain (pain occurring on either or both sides of the torso). The medical records show the Trust carried out investigations, including blood tests and a clinician assessed him. The Trust discharged him later that day with painkillers.

7. In September 2022, Mrs A contacted the Trust and explained she would send Mr A’s visa in the next 14 days. We have not seen any evidence that she did this. There has been no further correspondence provided by either Mrs A or the Trust to show any further conversations took place until 2024.

8. On 10 November 2024, Mr A received a letter explaining that he had to pay £866 for treatment received on 6 August 2022. He thought this issue had been resolved in 2022. This payment is still outstanding.

Treatment charge:

11. Mrs A complains Mr A had applied for a graduate leave to remain visa which the home office delayed, so she feels the Trust should not have charged him for the treatment

12. UK Government guidance for ‘Charging overseas visitors in England: guidance for providers of NHS services’ says:

• ‘Overseas visitors are required to pay for NHS services in scope of the charging regulations (‘relevant services’) unless they or the services they receive are exempt. For the purposes of cost recovery, an overseas visitor is defined as someone who is not ‘ordinarily resident’ in the UK.

13. It then goes on to say:

• ‘A person is considered ordinarily resident if they are living in the UK lawfully, voluntarily and for settled purposes. In addition: nationals who are subject to immigration control must be able to demonstrate that they have indefinite leave to remain (ILR) or equivalent (for example, indefinite leave to enter (ILE)) in the UK’

14. The Trust have stated Mr A’s immigration appeal rights were deemed exhausted as of 7 February 2022. A new application for Dependent spouse graduate leave to remain was submitted on 16 February 2022, however this was made after the appeal was dismissed and immigration appeal rights were exhausted, and the application is considered out of time and not entitled to free NHS secondary care.

15. The Trust say at the time of the treatment on 6 August 2022, Mr A’s immigration status did not entitle him to free NHS care as the application he had pending did not meet the criteria for exception from charges under the NHS (charges to overseas visitors) regulations, so the invoice was appropriately raised.

16. Mr A’s visa was received from the home office in September, the Trust says this cannot be backdated to cover the NHS care received in August.

17. The Trust has provided evidence from the Home Office of Mr A not having valid leave in the UK at the time of his hospital attendance. Mrs A has not provided us with any evidence to show Mr A was exempt from NHS charges at the time of his hospital attendance.

18. The Trust acted in line with guidance from the UK Government and we have not seen any indication the Trust was incorrect to charge Mr A for his NHS treatment.

Communication regarding treatment cost:

19. Mr A feels he should have been asked to sign something at the time of treatment to make him aware he would have to pay. With regards to this point, the Trust have said it is the individual's responsibility to understand the healthcare rules and entitlements in the country they are visiting or residing in, and staff are not responsible for determining this as it would take them away from their frontline roles.

20. We can appreciate Mr and Mrs A’s concern when they received the invoice as they were not expecting this.

21. The Department of Health and Social Care (DHSC) guide, ‘NHS cost recovery – overseas visitors’ says:

• ‘Throughout the process of identifying overseas visitors, it is important that patients are made aware as soon as possible that there may be a charge for treatment. Failure to inform patients as soon as possible about charges, may result in an invoice being presented to a person who was not aware that they were liable and could result in accusations of maladministration. However, under the Charging Regulations, even when a relevant body has failed to inform a patient of charges, and subsequently a patient is found chargeable, the patient is still liable for that charge.’

22. We requested a copy of Mr A’s records and could not see a conversation took place during his admission about his status in the UK or that he would be eligible to pay for the treatment he received. However, as the guidance says, whether this conversation took place or not, Mr A would still be eligible to pay the fees.

23. We appreciate it would have been better if Mr A was told at the time of attendance that he would have to pay for treatment costs. We will not investigate this complaint further, as the guidance states even if a patient is not informed about the costs, they are still liable to pay the fee.

24. We hope Mrs A is reassured that we have taken her concerns seriously.

1. We have carefully considered Mrs A’s complaint regarding London North West University Healthcare NHS Trust (the Trust) charging her husband, Mr A for NHS treatment in 2022 when she says he had a valid visa. We are sorry to hear of the financial impact the events have had on Mr and Mrs A.

2. We have seen no indication the Trust was incorrect to charge Mr A for his NHS treatment.