Do foreign nationals owe the NHS £40 million?

3 May 2012

"Foreign nationals, including migrants and tourists, have received £40m of free NHS treatment in last three years"

Daily Mail, 03 May 2012

"Health Tourists Land NHS with £40m in Unpaid Bills"

Daily Express, 03 May 2012

Telegraph, 03 May 2012

Several reports yesterday carried the startling headline that foreign nationals supposedly owe the National Health Service £40 million. The reports also mentioned that trusts had average unpaid debts of around £230,000.

So where does the figure come from?


The data behind the figures in the articles has been taken from a series of Freedom of Information Requests made by Pulse magazine. The data collected by the magazine are only published to subscribers, but Pulse kindly provided Full Fact with its findings.

Pulse asked all hospitals in England for outstanding debts they are owed as a result of treating foreign nationals since April 2009. 35 trusts responded, of which 24 provided directly comparable figures (those provided to Full Fact). 

By calculating the average unpaid debt across the trusts and applying this across England as a whole - across 168 trusts in total - they were able to arrive at an estimate of the sums likely to be owed to all trusts nationwide.

According to the raw data, the 24 trusts with comparable data had total outstanding debts of £5,688,446 - or around £237,000 on average. Extrpolating this to the whole of England takes us to a very rough estimate of £40 million total money owed to all the 168 trusts.

So the reports are correct? Almost. 

It is important to note that the numbers quoted in the media all refer to the 'outstanding' fees: sums yet to be paid by relevant parties for care of foreign patients. However, this is not necessarily the same value as the amount the Government no longer anticipates being able to recover, which they classify as "written off". Whether this is "free" treatment, as some of the papers claimed, is therefore a moot point.

The Pulse data records total written off debts of just over £365,000 since April 2009, which amounts to over £2.5 million when extrapolated across England.

It is also worth comparing Pulse's findings with the other data on the cost of treating foreign patients, to see if we can guage how representative its 24 trusts are of the wider situation across England.

In March 2011 Health Minister Anne Milton told the House of Commons that nearly £7 million of foreign debts were written off by the NHS in 2009-10, which may suggest that official estimates for these figures could be higher.

The label of "health tourists", used by the Express, could also be misunderstood. The data collected by Pulse covers foreign nationals of all types, including migrants that have settled here.


The figure of £40 million in unpaid debts is correct according to the research, but needs to be carefully understood. It is based on data from 24 - not 35 - trusts out of 168 nationwide, with the findings extrapolated to apply to the country as a whole. Figures given by the Health Minister in the Commons suggest that if anything, the true figure could be higher.

In addition, only a small proportion of the debt has been written off by the NHS trusts, anbd the remainder could still be recovered. To describe the care received by these foreign nationals as 'free' might no be strictly accurate therefore.


The BBC's Panorama programme conducted a similar study in October 2012 and found similar results. According to the show, 'health tourism' cost the taxpayer £40 million over a four year period.

Full Fact fights bad information

Bad information ruins lives. It promotes hate, damages people’s health, and hurts democracy. You deserve better.