North Bristol NHS Trust

3. Mr I complains about the charges letter he and his wife, Mrs M, received 5 months after their appointments for diagnostic fertility investigations in January 2024. He complains the Trust did not inform them before or during the appointment they would be charged. He says they were told explicitly during the appointment they would not be charged.

4. Mr I says these charges have caused 16 months of emotional and mental trauma for both he and his wife impacting their mental health and causing lack of sleep. He says what should have been a journey of hope has turned into a period of administrative conflict, financial anxiety and fear, further impacting their ability to conceive. Mr I says he and his wife no longer feel safe seeking medical help and are constantly worried this could lead to an unexpected financial or legal penalty.

5. As a result of bringing this complaint to us, Mr I is seeking an apology, an explanation for what happened, and for a refund of the £710.00 charges paid.

6. At the time of events complained about, Mr I and his wife, Mrs M, had been trying to conceive for 5 years without success.

7. Mr I was on a skilled worker visa and Mrs M was on a Dependent visa, with validity from March 2023 to April 2026.

8. A dependent visa is a type of non-immigrant visa that enables immediate family members, such as spouses and unmarried children under a specific age (often under 21), to live with a primary visa holder in a foreign country. This visa is designed to keep families together when one member is pursuing opportunities abroad, such as work or study. The dependent visa is linked to the primary visa holder’s status, meaning that the dependent’s legal status is reliant upon the primary visa holder maintaining their own valid immigration status.

9. On 6 October 2023 they went to their GP Practice to begin the fertility treatment referral process.

10. On 13 November 2023 the GP referred them to the fertility clinic at the Trust.

11. On 3 January 2024 they attended the hospital for the appointment. During this appointment, Mrs M underwent a transvaginal scan and blood tests. Mr I had a sperm test.

12. Mr I says they received the letter dated 26 November 2023 informing them of the charges on 16 January 2024. Following this, he says they decided to discontinue treatment.

13. He says on 17 April 2024 they received two separate invoices for the appointment they attended totalling £710 (£355 each).

14. Mr I complained to the Trust on 29 May 2024. The Trust sent responses on 12 June 2024, 23 July 2024 and 5 September 2024. Mr I paid the charge in full on 9 September 2024. Mr I brought his complaint to us on 23 January 2025.

15. We initially closed the complaint as premature on 30 April 2025. Mr I received a final response from the Trust on 11 July 2025 and brought the complaint back to us on 28 August 2025.

18. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

19. Mr I complains the Trust did not inform him before or during the hospital appointment they would be charged. He says he and his wife they were told explicitly during the appointment they would not be charged.

20. Mr I says these charges have caused prolonged emotional and mental trauma for both him and his wife. He says this has further impacted their ability to conceive and they no longer feel safe seeking medical help.

21. In its complaint response, the Trust explained it sent a letter to Mr I and his wife on 17 November 2023 prior to the appointment, where it outlined that individuals who come into the UK under the Immigration Health Surcharge (IHS) route are no longer eligible to receive free fertility treatment. It says it is the patient responsibility to know that surcharge payers do not qualify for NHS funded fertility treatment and are therefore chargeable. It also says this information was available to them when they made their visa application through the IHS route on the government website.

22. Our Principles say public bodies should give people information and, if appropriate, advice that is clear, accurate, complete, relevant and timely.

23. The Department of Health’s charging regulations for overseas visitors in the UK, particularly regarding NHS services, includes the following key point:

• Legal requirement: NHS Trusts are required to identify and charge overseas patients for hospital treatment, as outlined in the National Health Service (Charges to Overseas Visitors) Regulations 2015.

24. The Trust’s appointment attendance form and letter sent on 17 November 2023 explains;

‘The Immigration Health Surcharge says under changes to the Overseas Visitors Charging Regulations which took place on 21st August 2017, individuals who come into the UK under the Immigration Health Surcharge route are no longer eligible to receive free fertility treatment, although they may be entitled to other hospital treatment free of charge.

Therefore, if you are a health surcharge payee or are exempt from paying this will include any fertility/Gynaecology appointments/treatment if they are related to assisted conception and an invoice will be raised separately.

Where two people are seeking assisted conception services with NHS funding, and one of the two people is covered by health surcharge arrangements and the other is ordinarily resident in the UK and therefore not subject to charge, the services required by the health surcharge payee will be chargeable. Any services required by the ordinarily resident person will continue to be freely available, subject to the established local or national commissioning arrangements.

By completing and returning the form we can establish whether you will have to pay for your fertility treatment.’

25. This information would also have been available to Mr I and Mrs M when they made their visa application through the IHS route on the government website which says people who pay the immigration health surcharge will still need to pay for certain types of services, including assisted conception.

26. Mr I says he received the Trust attendance form letter dated 17 November 2023, 6 days later on 23 November. This clearly outlined the criteria for when charges would be payable so we can see he was informed in writing prior to the appointment in January about the potential charges they would incur following the appointment. As well as this, the information was available via the government website.

27. Mr I says they were told explicitly during the appointment they would not be charged. It is not possible for us to say if the consultant told them there would be no charge during the appointment. However, ultimately it is not a clinician’s role to discuss the charges. The Regulations and Home Office guidance makes it clear that it is the patient’s responsibility to look up the policy based on their status.

28.We can see Mr I and Mrs M were pre-warned before the appointment via the booking form letter sent in November 2023 there could be a charge so we can see they were informed by the Trust in writing. This is in line with Our Principles.

29. We have seen the charges were applied correctly and in line with the above government guidance and have seen no indications of failings. We recognise it has been a distressing time for Mr I and Mrs M and we were sorry to hear of this. We hope they are reassured by our investigation and understand the reasons we are taking no further action on their complaint.

1. We have carefully considered Mr I’s complaint about North Bristol NHS Trust (the Trust) charging him and his wife, Mrs M, for a fertility investigation appointment in January 2024. We are sorry to hear of the financial and emotional impact the event had on Mr I and Mrs M.

2. We have seen no indication the Trust was incorrect to charge them for their appointment.