Home Office caseworker guidance on NHS debt, updated on 19 March 2026, now refers to Part Suitability of the Immigration Rules and says when an NHS debt record should be removed from Home Office systems.
Key facts
- Who: Applicants for entry clearance, permission to enter or permission to stay (including settlement) who may have an NHS debt; caseworkers who decide those applications
- From: Updated 19 March 2026 (version 4.0 published for Home Office staff on 18 March 2026)
- Source: Suitability: debt to the NHS caseworker guidance
Replaces the previous version of the guidance.
The guidance now reflects Part Suitability replacing Part 9: grounds for refusal of the Immigration Rules. The ground for refusal on NHS debt is set out in paragraph SUI 16.1. of Part Suitability.
The Home Office must prove an NHS debt on the balance of probabilities and must be able to provide evidence if the debt is contested. A person is treated as having an NHS debt if a relevant NHS body has told the Home Office that they failed to pay a charge. NHS bodies only notify the Home Office once a debt has been outstanding for 2 months or more from the date of invoice and no instalment agreement is in place.
The guidance says refusal may be considered for an outstanding debt, or cumulative debts, of £1000 or more incurred on or after 1 November 2011, or £500 or more incurred on or after 6 April 2016. For Appendix FM, Appendix Armed Forces and Appendix Private Life, the £500 date is 24 November 2016.
NHS debt is a discretionary ground for refusal. Caseworkers must not refuse automatically and must consider compassionate or other circumstances raised by the applicant.
The new section, "Removing a debt record where the NHS Debtor rule no longer applies", says an NHS debt record should be removed from Atlas, even where the debt remains unpaid, when the person has:
- settlement or indefinite leave to remain
- settled or pre-settled status under the EU Settlement Scheme
- refugee status
- British citizenship
Caseworkers granting these types of leave or citizenship must refer the case to Interventions, Sanctions and Compliance (ISC), which removes the debt from the person's immigration record and Home Office systems. The referral is made after the decision, and cases are not put on hold while the record is removed.
The guidance says the ground does not apply to protection claims (with listed exceptions), Appendix EU, Appendix EU (Family Permit), Appendix S2 Healthcare Visitor, Appendix Service Providers from Switzerland, Appendix Ukraine Scheme or nationality applications.
What this means for applicants
Applicants with an outstanding NHS debt at or above the thresholds may be refused, but each case is considered on its facts. Where a caseworker asks for evidence of repayment or a repayment plan, the guidance's example wording sets a 14-day deadline. If there is no response, the application is assessed on the available evidence. Evidence must come from the healthcare provider that charged for the treatment.
Once a debt is paid in full, there is no longer a ground to refuse under Part Suitability. A debt repaid in the 6 months before applying counts as recently discharged, and caseworkers may check whether paying it left the applicant without the required funds.
Where an applicant is granted settlement, indefinite leave to remain, EU Settlement Scheme status, refugee status or British citizenship, the caseworker refers the case to ISC after the decision, and the guidance says the debt record should be removed even if the debt is unpaid.
Related guide: General grounds for UK visa refusal
Sources
- Suitability: debt to the NHS caseworker guidance, UK Visas and Immigration, updated 19 March 2026