NHS debt £500 — the SUI 16.1 rule and how it works

01 The SUI 16.1 rule — how it works

• NHS hospital bodies (Trusts) report outstanding debts to the Home Office monthly.
• Reporting criteria: debt of £500 or more (or £1,000 incurred between 1 November 2011 and 5 April 2016) AND debt overdue by 2+ months AND no active repayment agreement.
• Home Office adds a note to the applicant's file → blocks future applications.
• Paying in full OR establishing a repayment agreement removes the record and the refusal ground.

02 Who pays for NHS hospital care

• ILR / "ordinarily resident" — free.
• Refugees + asylum seekers on S95/S4 support — exempt from charges.
• SW / Family / Student / H&C with IHS paid — free during visa period.
• Visitors — 150% of NHS price. Exemptions: A&E, certain infectious diseases, psychiatric detention, GP primary care.
• Refused asylum seekers — chargeable unless on Section 4 support.
• UPE / Homes for Ukraine — free while within the scheme.

03 Why this is a trap — typical scenarios

• A visiting relative is admitted to hospital. Without EHIC or travel insurance, charges are 150% of NHS price. If they leave the UK without paying, the debt may block their future entry clearance and in some cases affect the sponsor's application.
• Pre-status period. If someone received treatment while their visa application was pending as a chargeable visitor, debt may have accumulated silently.
• Refused asylum seeker. Without Section 4 support, charges accumulate for planned procedures.
• Late UPE registration. Before registration, the person is treated as a visitor → charges apply.

04 What to do if you have NHS debt

1. Contact the overseas visitors team at the NHS Trust where treatment was received. Request a statement of debt.
2. Set up a written repayment agreement before the 2-month reporting window closes.
3. Keep records of all payments.
4. If you cannot pay — Citizens Advice or StepChange can help negotiate.
5. After paying in full, the NHS Trust should notify the Home Office that the debt is settled.

05 If you have an upcoming visa / ILR / citizenship application

Check for NHS debts at least 3 months before applying:

• Contact all NHS Trusts where you or family members received treatment — request a no-debt confirmation letter.
• If debt exists — pay in full or establish a repayment agreement at least 2 months before submitting.
• NHS debt from visiting relatives can affect your application — confirm with a solicitor.

06 When relatives visit

• Ask the visitor to purchase travel insurance with medical cover before travelling.
• If they hold an EHIC/GHIC from an EU country — it covers some planned treatment.
• A&E (emergency care) is free for everyone. Planned procedures are chargeable for visitors.
• If a bill is issued — ensure it is paid before the visitor returns home.