NHS trusts are failing to recoup the cost of treating overseas patients which is squeezing the amount available to fund services for those eligible for free care, a report by the Public Accounts Committee has warned.

Since the Department of Health launched its overseas visitor and migrant cost recovery programme in 2014, the amount charged for so-called health tourists has jumped from from £97 million to £289 million (in 2015/16), but this is still far below the £500 million target.

Crucially, the PAC found that most of the progress to date has been driven by changes in the charging rules rather than from trusts implementing existing rules more effectively, and it stressed that current systems for cost recovery "appear chaotic".

"If the NHS does not recover the cost of treating patients who are not entitled to free care, then there is less money available to treat other people and even more pressure on NHS finances," the report stressed.

Also, the UK recovers far less from other European Economic Area and Switzerland (EEA&S) states than these countries claim from the UK: in 2014/15, the UK recovered only £50 million but paid out £675 million, the report said, noting that while some of the difference can be explained by the cost of treating British state pensioners who live abroad, "it is clear that hospitals are not identifying all the overseas patients they treat".

The Committee is calling on the Department of Health to improve systems for cost recovery and "do more to promote public confidence that the money due to the NHS is being recovered, and that the system is fair to taxpayers and to patients who are entitled to free care".

While the DH is planning further changes relating to policy and regulation, good practice and IT, the PAC said it is "not convinced that enough is being done to identify and charge overseas patients".

"The Government's failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds," said PAC chair Meg Hillier. "We are concerned that financial progress to date does not reflect meaningful progress with implementing the rules and the Department for Health and NHS have much to do if they are to meet their target for cost recovery."

Action plan
The PAC recommends the DH publish, by June 2017 at the latest, an action plan setting out specific actions, milestones and performance measures for increasing the amount recovered from overseas visitors, which should also name senior individuals in the Department and NHS Improvement whom the Committee can hold to account.

It also says that NHS Improvement should collect and share data on the performance of trusts in charging patients and recovering money, and intervene when performance is clearly falling short, and argues that GPs "could do more to help the NHS increase the amounts recovered for treating chargeable overseas patients".

But Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners, warned against "perpetuating this idea that general practice should, in whatever way, assist with border control".

"Patients share information with their GP on the mutual understanding that it will remain confidential. We are very concerned that any process that undermines that crucial trust between doctors and patients will both deteriorate the doctor-patient relationship, and deter vulnerable people from seeking medical assistance when they need it".

She also argued that "we shouldn't exaggerate the amount of money that can be raised through GPs getting involved in cost recovery - particularly when balanced against the administrative and training costs that introducing such a process would incur."