The term ‘fraudulent access to the NHS’ refers to when a patient falsely represents themself as entitled to NHS care without charge, fails to disclose they are chargeable, or an NHS staff member who has abused their position to facilitate the fraudulent access.
The financial vulnerability estimate has continued to improve through a collaborative approach with policy holders to maintain a more accurate and up-to-date figure. The increase is reflecting a rise in general inflation and an increase in the number of visitors to the UK.
£98.1m
vulnerable from an expenditure of £2 billion
Strategic intelligence picture
Non-residents falsely representing themselves to gain access to care without charge while in the UK is ongoing and highly likely within this thematic area. There is the potential for individuals to use false documentation to prove ordinary residence in the UK. Individuals could therefore use a false identity or the identity of another individual who is entitled to care without charge to gain access to secondary care but avoid costs.
Although primary care is free to all, it is highly likely some patients will manipulate the system to receive primary care, including prescriptions, whilst residing abroad. Potentially enabled through patients failing to update their GP that they have moved abroad, use of digital prescription services and the ability to collect a prescription on behalf of another.
It is likely that individuals are returning to or entering the UK to specifically access secondary care. Potentially enabled through the use of an associate’s address or a previous address to prove ordinary residence, combined with patients being registered at a GP practice, receiving an NHS number and / or use of a visitor visa.
Publicising fraudulent access to the NHS for non-ordinarily residents to access the NHS without charge is a realistic possibility. Posting a journey of accessing the NHS without charge when not entitled on a social media platform could potentially influence others who aren’t eligible.
Individuals returning to or entering the UK specifically to access secondary care without charge may also be enabled through NHS staff facilitation who may unintentionally or deliberately fail to check the charge status of the patient. NHS employees may help associates who reside abroad permanently to receive ongoing care without charge.
A&E is free to all individuals in the UK; however, any follow up treatment or specialist referrals may become chargeable. Patients can be discharged from A&E into attendance at Same Day Emergency Care (SDEC). It is possible that some individuals returning to or entering the UK specifically to access secondary care could avoid charges by accessing care via the A&E route.
There is a potential emerging issue around the misuse of visas, where individuals may gain treatment during a period and then leave the UK. If the individuals aren’t detected they can continue to manipulate this system using another visa at a later date.
Misuse of visas is a realistic possibility, individuals on student or work visas could sponsor relatives with long term health conditions to come to the UK with the intent of acquiring treatment. There is also the potential for individuals to claim asylum before their visa expires to access treatment without charge available to asylum applicants.
There is an emerging issue of individuals using a private treatment medical visa to enter the UK and then later gaining NHS treatment without charge. It is possible for individuals to transfer from a private medical company to the NHS or cancel the private appointment and attend A&E instead.
It is likely that individuals will enter the UK to access maternity services in the NHS. Maternity treatment in the UK is categorised as ‘urgent and necessary’ meaning costs are recovered after the treatment and not before. This enables individuals to come to the UK to get treatment, then potentially leave before costs are recovered. Another vulnerability of a non-ordinarily resident giving birth in the UK (including individuals on a visa) is that the cost of a baby’s care can become chargeable.
British Citizens now residing abroad who fly to the UK for treatment without an S1 or S2 demonstrates an emerging threat. Patients may keep cancelling appointments or inform staff that they have flown over for the appointment.
The National Care Records Service (NCRS) uses a traffic light score to show patients’ eligibility status. If ineligible patients have the wrong code recorded, they could potentially evade charges.
Information reports received for fraudulent access to NHS care from overseas-visitors
The change in the number of fraud reports received in relation to fraudulent access from 2020 - 2021 to 2024 - 2025 is illustrated in the below chart:
| 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 | 2024 - 2025 |
|---|---|---|---|---|
| 2020 - 2021290 | 2021 - 2022310 | 2022 - 2023297 | 2023 - 2024405 | 2024 - 2025387 |
Horizon scanning
In February 2024, the Immigration Health Surcharge (IHS) fees increased by 66%, the surcharge is designed to help fund the NHS and to ensure those who come to live in the UK contribute to the cost of the healthcare services. Once the surcharge is paid, the individual will have access to most NHS services, however they may still need to pay for certain services.
In April 2025 the Electronic Travel Authorisation (ETA) was introduced in the United Kingdom, an ETA can be cancelled if an individual has outstanding charges of at least £500 owed to the NHS.
In early 2025 tariffs imposed on trading partners by the USA were announced and are likely to cause healthcare costs to increase in the USA. This could result in individuals entering the UK with the intent to fraudulently access healthcare without charge as the USA is already reported to experience one of the highest costs of healthcare in the world.