Three-quarters of NHS hospital trusts in England are using private debt firms to chase treatment costs from overseas patients and refused asylum seekers in a practice branded “inhumane” by critics, the Observer can reveal.
Debt recovery firms have pursued thousands of patients for millions of pounds in recent years, prompting complaints of harassing phone calls and intimidating doorstep visits. The debts relate to the cost of treatment for patients who are ineligible for free NHS care under government immigration rules, which were tightened as a result of the “hostile environment” approach Theresa May initiated as home secretary.
Data released under the Freedom of Information Act shows that 77 of 102 hospital trusts have used private debt firms to pursue ineligible patients. Of 60 trusts that provided patient numbers, 8,468 patient debts were referred to private debt collectors between 2016 and 2018.
However, of the 48 trusts that provided full financial details, only about £1.5m of the £21m of debt referred to private firms during those three years has been recouped – barely 7%.
It is not known how many of those pursued were people from abroad on a short-term visit or those in England longer-term, including visa overstayers, failed asylum seekers and undocumented migrants.
Official guidance from the Department of Health and Social Care says that trusts can write off debts as not worth pursuing “where it is clear that a person is destitute or genuinely without access to any funds”.
Lucy Jones, director of programmes with Doctors of the World (DOTW), which runs clinics in London providing free treatment to people unable to access mainstream healthcare, said: “Sending debt collectors to recover money from destitute people seeking asylum in the UK for essential healthcare is both unethical and pointless.
“Being hounded by bailiffs puts extreme pressure on people already living in poverty and struggling with homelessness and poor health. It’s inhumane, doesn’t save any money and needs to stop.”
One DOTW patient was a refused asylum seeker from Guinea who couldn’t be deported as Guinean authorities refused to accept him.
A month later a bailiff turned up at the friend’s house he was staying at, demanding £3,900 relating to treatment he had had a year earlier at London’s Royal Free hospital.
He told DOTW at the time: “I have explained over and over again that I am an asylum seeker, not working, with no income and no support from the state. I just live on handouts from friends, living from day to day.
“This unexpected visit at the address to collect the money makes me feel very uncomfortable. Not only I do not have the money but also I cannot cope with the unbearable stress of being chased up at the house.”
The Guinean man died in late 2018 from a stroke. There is no suggestion his death was related to the trust’s pursuit of his debts.
In a statement the Royal Free said: “When a patient is confirmed as an overseas visitor, NHS trusts have a legal obligation to recover the charges for their treatment. When charges for treatment remain unpaid, we refer cases on to an external agency to manage on our behalf.
“When it became apparent on this occasion that we would not be able to recover the monies owed, the decision was taken to write off the debt.”
Much of the debt referred to private firms relates to general medicine and maternity care, with smaller amounts for stroke care and heart surgery.
Some women have been harassed by phone calls from debt firms for the costs of maternity care, the charity Maternity Action said.
Carla Montemayor, its spokeswoman, said: “We’re talking here about women who’ve just given birth, or in one case just had a miscarriage, so they were already traumatised, and then they received these phone calls making threats.
“It’s repeated phone calls pressuring them to pay. And for those whose immigration status is insecure, it brings up the possibility of deportation … Because it’s the policy of NHS trusts that any debts coming above £500, unpaid within two months, will be reported to the Home Office.”
Lewisham and Greenwich NHS trust in London referred 1,085 debts worth £5.4m to debt firms CCI and LRC from 2016 to 2018, the highest in England – but has only recouped £88,000 of it, about 2%. A spokesman for the trust said that debts were only referred to private firms when all other steps had been exhausted, and that the collection rate was low as these are the hardest debts to recover.
