Guidance

Debt to the NHS: caseworker guidance

UK Visas and Immigration staff guidance on NHS debt.

• From: UK Visas and Immigration
• Published: 1 December 2020
• Last updated: 19 March 2026
  Show all updates

  1. 19 March 2026

     Updated to reflect Part Suitability replacing Part 9: grounds for refusal of the Immigration Rules, and to add a section advising when an NHS debt record should be removed from Home Office systems.

  2. 14 December 2022

     Guidance has been updated to amend the list of immigration routes which the NHS debtor rule doesn't apply to and include information pertaining to the actions to take if confidential medical information has been passed to the Home Office. Guidance has been restructured to make the content clearer and simpler to read. The full list of changes can be found on page 3.

  3. 22 December 2020

     Minor amendment to the introduction to clarify that this guidance applies to family reunion applications.

  4. 1 December 2020

     First published.

Documents

Suitability: debt to the NHS caseworker guidance (accessible)

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Suitability: debt to the NHS caseworker guidance

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Details

UK Visas and Immigration guidance for staff on when an application for entry clearance, permission to enter or permission to stay may be refused where an applicant has failed to pay charges under relevant NHS regulations.

A person is considered to have debt to the NHS (NHS debt) if a relevant NHS body has informed the Home Office that the applicant has failed to pay a charge to the NHS.

The burden of proof is on the Home Office to prove an NHS debt. The standard of proof is the balance of probabilities (which means it is more likely that not) but you must be able provide evidence of the debt if it is contested. You may need to seek further information from the relevant NHS body.