Level of NHS debt reduced from £1000 to £500 as a discretionary basis for refusal on grounds of suitability

On 24 November 2016, the statement of changes in Immigration Rules (HC667) evolved the rules relevant to family members of British or settled persons even further. A family member who applies under Appendix FM, namely an application for leave to enter, leave to remain or indefinite leave to remain, as the partner or child of a British citizen or settled person, risk a refusal if they owe NHS money for medical care in excess of £500.

In applications for entry clearance, the rule is contained under S-EC.3.2 , for extension applications under S-LTR.4.5, and for indefinite leave applications under S-ILR.4.5. The wording is as follows:

“The applicant may be refused on grounds of suitability if one or more relevant NHS bodies has notified the Secretary of State that the applicant has failed to pay charges in accordance with the relevant NHS regulations on charges to overseas visitors and the outstanding charges have a total value of at least £500.”

This rule is not new. Indeed it has been a part of the  suitability requirements under Appendix FM since its inception in July 2012. What has changed is the level of debt. It was always set at a minimum of £1000 but this level has been reduced to a minimum of £500 with effect from 24 November 2016. A refusal is at the discretion of the decision maker and therefore not mandatory. 

Interestingly, the key to this rule is the notification by a relevant NHS body of a person's debt. There appears to be varied views as to how adept the notification systems are in practice. Some migrants have reported a failure on part of the professionals to bill them despite being aware of their status. Others have reported a more robust practice of a thorough discussion as to costs before the treatment and an invoice raised immediately after. Either way, the application forms seek information with regards to any medical treatments/debts and the applicants are advised to be fully transparent. 

It appears that this change in the level of NHS debt now brings Appendix FM rules in line with the level imposed within some other rules.  An example is paragraph 322(12) which provides a discretionary refusal for NHS debts of at least £500.  Indeed paragraph 322(12) does not apply to Appendix FM applications, and there is no need to either, since it is already included within their own suitability requirements. The same level across different rules sound like a justifiable move on part of the Secretary of state in the overall aim of ensuring the law is as equitable as possible. The same, unfortunately, cannot be said for all of the rule changes over the years.


Amna Ashraf

Amna Ashraf has worked for McGill and Co since 2011 and currently holds post as a solicitor. She has developed considerable experience in family immigration matters and holds a very high success rate owing to her meticulous attention to detail and tenacious approach.