NHS invoice after naturalisation

[BashirB]

I have used the forum for past 7 years for helpful guidance in my application. I got my citizenship a few months back and have now received a letter from local NHS Trust for a charge.

The charge relates to my child born in the UK for various dates between Sept 2022 to March 2023. We had applied for our citizenship in August 2022 and got a decision in September 2023 (13 months). We attended citizenship ceremony end October 2023. The letter has come this morning.

While I and wife got our ILR in Mar 2022, we didn't apply for our child. His PBS dependant visa ran out on 1 September 2021. He was born in the UK and has stayed here with us since birth.

We were, before naturisation, Indian citizens - which we have now given up formally. Child had Indian passport as well.

If there is any additional information I can provide, do ask.

Thanks

[BashirB]

Small typo. We got our ILR in May 2021, not 2022 as typed earlier.

My main query is that are we liable for charges while awaiting decision from Home Office - which was successful in the end.

[contorted_svy]

If your child wasn't British and you didn't apply for a visa, I believe you have to pay the invoice you received. Children without visas need private insurance because they are not eligible for free NHS care.

[alterhase58]

Worth noting that any nationality application in progress doesn't exempt applicant from NHS charges and it doesn't confer any residency right until applicant is British. Nationality applications are not covered by the immigration regulations.

[BashirB]

Is there a time limit within which the charges need to be sent by NHS.

I had private medical insurance from work, but cannot go back more than 6 months to make a claim with them.

Just a bit surprised at the charge because if HO would have made a decision in their time frame, this situation would not have arisen.

[contorted_svy]

I'm afraid they would have, because your child didn't apply for registration from your original post. If the care was for your child, the parents having applied for naturalisation doesn't change anything. I am not aware of internal rules for NHS charges.

[secret.simon]

When was the child's registration certificate received?

Your naturalisation is immaterial. The child, not having paid any IHS charge, is the person who incurred the NHS charges. It is the child's lack of immigration status that is pertinent, not your citizenship.

We got our ILR in May 2021

If you got your ILR in May 2021 and the child was born in the UK, why didn't you immediately register him as a British citizen? The British-born child had an entitlement to be registered as a British citizen when either one parent got ILR.

Is there a time limit within which the charges need to be sent by NHS.

Not to the best of my knowledge. There are two documents on the Gov.UK that deal with the charging of overseas visitors. I would treate your child as being in an analogous situation, being that they were in the UK without having paid IHS.

How charges for NHS healthcare apply to overseas visitors

Upfront charging operational framework to support identification and charging of overseas visitors

Ideally you should have been charged upfront and before any treatment for your child's treatment. I presume that the child's treatment was either medically urgent, or there was confusion whether the treatment was chargeable, which is the reason you are being presented with the bills now.

It is possible that an audit of the NHS trust flagged up the case and hence the late bill. As mentioned, I do not think there is a time limit by when the NHS must present its bills.

[BashirB]

When was the child's registration certificate received?

It is dated October 2023. I applied for his passport immediately and got it same month as well.

If you got your ILR in May 2021 and the child was born in the UK, why didn't you immediately register him as a British citizen? The British-born child had an entitlement to be registered as a British citizen when either one parent got ILR.

In hindsight, that would have been the best thing to do. I just thought I would apply for his citizenship directly with mine.

How charges for NHS healthcare apply to overseas visitors

Upfront charging operational framework to support identification and charging of overseas visitors

Thanks, I went through those and the main theme is for people who are visitors to UK for relatively short periods and use the NHS. There is little info on situations for someone who got caught out due to timing of application and response from Home Office on naturalisation process.

In our case, we had already applied for his citizenship in August 2022, decision received October 2023. The charges relate to period Sept 2022 to March 2023 while his application was still in progress.




My thoughts are, and happy to be corrected as I want to make sure I dont send a wrong written response to NHS on this:
- The guidance talks about overseas visitors and persons not ordinarily resident in the UK. My child was born and has lived in the UK since (we even had one BRP with NHS surcharge paid for him) and is a resident here.
- Agreed that his BRP expired and there is a late citizenship application, but per guidance in the links, a person could be a British Citizen and not reisdent in the UK, so still ineligible for NHS treatment - my argument is that having citizenship is not sole determinant of residency
- I was never informed of the charges when we went for treatment
- I inquired from my current travel insurance provider on the above hypothetical situation and in theory they would not cover my child in the UK and he is not a "traveller". I have had travel insurance from 2021.
- If he is regarded as a visitor, then where is his residence?
- Home Office never raised a concern when we applied for citizenship and granted it already. So on what basis is NHS claiming the child to be a non-resident in between.

If members can be kind enough to poke holes on the above points, so I know which ones would hold and which ones wouldn't please.

Thanks

[contorted_svy]

The basis you were charged on is, as you say, that your child's visa with NHS surcharge paid was expired. The guidance's definition of "visitors" is intentionally left vague - even if in practical terms a child that has lived here all their life isn't a "visitor", if they aren't British or have a visa, they are considered visitors. The fact you had a pending nationality application wouldn't really affect your case as it is not an immigration application. Maybe I would question why you were not presented with these charges straight away, so from their response you can see on what grounds they are charging you. From what I can see though, it does seem they have a right to charge you for your child's treatments.

[BashirB]

True, I am not denying that such situations could potentially be chargeable. Just a bit annoyed that HO took over a year to decide on our application and if they had worked to their 6 month timeliness, the question of charging would be mostly avoided.

Just trying to see if there is any defence/mitigation I can propose.

Obviously if they had told me upfront that he is chargeable when they admitted him, I would have made a call to proceed with admission to NHS or not. I don't know how much they plan to invoice me, but from what I read elsewhere, it could go potentially to thousands. If I had known upfront, I could have even taken him to a private clinic and claimed on my insurance. The workplace insurance won't cover retrospectively as it was not pre authorised (and at present I have nothing other than a letter with intention to charge).

[contorted_svy]

Sadly, the law doesn't admit ignorance - they were late in charging you, but arranging healthcare for your son isn't their responsibility. You and your son at the time were immigrants and delay from the HO is unlikely to be a mitigating factor. Difficult to say also without knowing the amount and whether it would strain your finances or not. Maybe you could speak to a solicitor and explain your son's registration application was in progress and see what they say, if the bill is very high.

[secret.simon]

I agree with the advice above about speaking to a solicitor, because this is really not immigration law at all.

Your child had no visa and in a sense, he was not legally resident in the UK at all while he underwent NHS treatment. Legal residence requires some form of either citizenship or other legal right to reside in the UK (such as under EU law before Brexit or under the Immigration Rules).

A non-British child born in the UK is in a legal grey space. They are not lawfully resident in the UK and hence can't be ordinarily resident for the purposes of NHS treatment, even if they are physically present here and not in breach of immigration law.

I suspect that the reason you got the bill quite late and the reason that you were not told of the charges is likely the same; the hospital/NHS staff did not realise that the treatment was chargeable.

Most NHS trusts have a bills or accounts team who deal with obvious cases, such as somebody on a visit visa. In a case like yours, where the child was without any legal right to reside in the UK but the parents did, the case was probably filed and fell through the cracks. It is possible that an audit of the NHS Trust (after all the NHS is looking for all sources of income at the moment) dredged up the treatment, its circumstance and hence the late bill to you.

You could file a Pre Action Protocol against the specific NHS trust, making the arguments that you made above, with the exception that the child's registration application was in progress. That argument is irrelevant as citizenship applications are not immigration applications and do not give people the right or ability to reside in the UK while they are being decided (in any case, the child would not have been covered even if it were treated as an immigration application. An immigration application only extends existing leave to remain. If the child had none to start with, there is no leave to extend - Nothing comes from nothing, nothing ever could...as Julie Andrews sang in the Sound of Music).

You could also try contacting organisations such as the Project for the Registration of Children as British Citizens, who may have dealt with similar issues in the past.

As mentioned, this is not an immigration matter, so i think this thread should not be responded to further. However, if you do take legal advice and action against the NHS Trust, please keep us posted about the outcomes (of both the advice and the action).

I am inclined to make this thread a sticky, to point out to others that children born in the UK who are without a visa are charged for NHS usage.

[BashirB]

So I received a charge of approx £6000.

Around £500 related before citizenship application and rest was when application was in progress.

Spoke with a solicitor and he told me I can fight the £5500 bit on the grounds that the charges were incurred 4 months after my application and had there not been unreasonable delay from Home Office (due to IT issue in August 2022 application), this would not have occurred. Key to point out is that him being a child born in the UK, his citizenship was an entitlement, not something that is at discretion or needed checks to keep it on hold for 13 months. We would argue that an applicant can not be penalised by one state organ due to delays by another.

He also mentioned that NHS debt is enforceable to those who are subject to immigration control. Given we were informed of the charges almost 3 months after getting our passports, we can just ignore it. We were honest throughout our application that we have not been asked by NHS to pay, so there is no question of providing wrong information on our applications that can lead to rescinding the citizenship.

He also said this being a child under 5, they most likely won't bother, especially as the only leverage they had was "immigration control threats".

We agreed to wait and see what happens next.

[secret.simon]

Would the debt impact the credit report for either parent or child?

[AmazonianX]

So I received a charge of approx £6000.

Around £500 related before citizenship application and rest was when application was in progress.

Spoke with a solicitor and he told me I can fight the £5500 bit on the grounds that the charges were incurred 4 months after my application and had there not been unreasonable delay from Home Office (due to IT issue in August 2022 application), this would not have occurred. Key to point out is that him being a child born in the UK, his citizenship was an entitlement, not something that is at discretion or needed checks to keep it on hold for 13 months. We would argue that an applicant can not be penalised by one state organ due to delays by another.

He also mentioned that NHS debt is enforceable to those who are subject to immigration control. Given we were informed of the charges almost 3 months after getting our passports, we can just ignore it. We were honest throughout our application that we have not been asked by NHS to pay, so there is no question of providing wrong information on our applications that can lead to rescinding the citizenship.

He also said this being a child under 5, they most likely won't bother, especially as the only leverage they had was "immigration control threats".

We agreed to wait and see what happens next.

Keep thread updated.

[BashirB]

Would the debt impact the credit report for either parent or child?

The invoice is addressed to "parents of XXXXXX", so I guess they will end up on ours eventually.

[THO]

I guess you also need to figure out how much the solicitor will charge you, and decide whether you want to spend ages fighting this battle racking up an extra bill, with the hope that the NHS either loses in court or backs down.

I also guess you're hoping that 1 strongly worded solicitor's letter will work, but NHS may well just put your case in the hands of a debt collection agency who will work the case for them on a no win no fee basis. So, then your cost will be 6K plus your solicitor. Also, if you do lose, then you might well end up paying NHS legal costs too.

Be careful, the legal system in the UK works very well for the rich, just look at the Post Office scandal. 20 years, and it was only won because hundreds of people took a class action. it could end up costing you 6K to get them to drop the case, and if they did that before going to court, you might not even be able to claim your legal costs back, and at best you'd get 80% if you won.

I've no idea if you have a case or you're clutching at straws, but be also aware that the immigration solicitor is not going to lose anything fighting your case for you, he will just make money, and he will probably ask for a large lump sum up front.

As has been pointed out, ignorance is no excuse in the eyes of the law, and you could well be technically wrong and the NHS could be right in charging you.

Before engaging a solicitor, I'd do what was advised and write a polite letter asking them to please explain why you have the invoice (unless you have their reasoning already but not shared it yet), and lay out your case yourself. Get it checked by a solicitor before sending. See what they come back with.

Tread carefully.