A confidential internal report on health tourism estimates that the bill for treating foreign patients amounts to at least £62 million a year, The Times has learnt.

The figure is “bound to be an underestimate” since new rules intended to prevent the abuse of the NHS by foreign patients are being ignored, according to the report.

A survey has found that NHS managers are failing to ensure patients are asked to prove their eligibility and are chasing only around half of the debts owed. The findings suggest that taxpayers are picking up hospital bills for foreign patients that come to more than £30 million a year. Some of the £62 million is paid back by the patients.

The Government promised a crack-down three years ago. Hospitals were told to charge patients who were found not to be resident in Britain or from countries with reciprocal arrangements. John Hutton, when he was a health minister, said in April 2004: “I expect trusts to make enforcement of the regulations part of their core business.”

Ministers have repeatedly refused to answer questions on how much health tourism costs the NHS, claiming that statistics are not collected on the number of patients treated who are not entitled to free care.

The scale of abuse was estimated internally following the introduction of the new regulations. The Department of Health last week lost an 18-month battle to suppress findings of an internal report when they were released to the Conservative MP Ben Wallace under the Freedom of Information Act.

In addition to the first official estimates the documentbears out previously anecdotal suggestions that maternity and HIV services are being targeted.

“Maternity . . . was frequently mentioned as an issue,” the report states. The problem uncovered by the survey, carried out in late 2004 to early 2005, was so acute that officials suggested that the Government contacted air-lines to ask them to prevent heavily pregnant women from flying to the UK from Nigeria, India or Pakistan.

Treatment for HIV was “widely recognised to be a problem area” with cli-nicians “hostile” to the idea of charging foreign patients. Department of Health officials found that the manager responsible for checking eligibility “was not welcome” in one hospital’s HIV ward. “We are currently being criticised by the the Terrence Higgins Trust without actually charging many people or collecting the money,” the official notes.

Last night a spokeswoman for the Department of Health said that it refused to accept the findings of its own report, insisting that it was based on a sample of only 12 trusts. She claimed that the “situation is much better than it was three years ago” but conceded that the department could not produce figures to prove it.

She added: “We are in the middle of a review with the Home Office, which is looking at tightening up enforcement of the regulations.”

Mr Wallace, who uncovered the report, said: “This Government is conniving at a ‘Don’t ask, don’t charge and don’t chase’ policy that is leaving the NHS wide open to abuse.”

Foreign bodies

36% of money received from overseas patients is for maternity care

50% or more of the £62 million worth of treatment on overseas visitors is not recovered

75% of foreign patients are not charged in most hospital trusts

25% are from Africa

20% are from the Indian subcontinent

18% are from North America

Source: Overseas Visitors report

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