Nasar Ullah Khan is lying in a hospital bed in Birmingham. He is 38 and has weeks, if not days, left to live. Khan, a Pakistani national who came to the UK nine years ago and overstayed his visa, was refused a lifesaving heart transplant just before Christmas because of his ineligibility for free healthcare. Now he’s been told that he will be charged before he can receive end-of-life care. He was handed his first invoice for £16,000 on New Year’s Eve, days after he was told he would probably die within a month. The payment for hospital treatment already received is due at the end of January.

“It’s completely gut-wrenching,” says Elizabeth Bates, a Birmingham GP who is working with Doctors of the World. “Knowing that he’s been handed bills in his hospital room after he’s been given a dreadful diagnosis … I cannot understand what the philosophy of the people running the hospital is and how they expect that to impact on the clinical staff and on the patient sitting in front of them.” Bates, who has been helping Khan, says refusing to help care for him while he is dying is especially unfeeling. “Everybody is appalled that he might be charged for palliative care. It goes against every professional ethic and our Hippocratic oath. We should be treating people according to need.”

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Before 2017, migrants and visitors to the UK not eligible for free healthcare were entitled to receive it and be billed afterwards. But two years ago, in a bid to eliminate so-called health tourism, the Conservative government introduced new regulations. These require NHS trusts in England to charge refused asylum seekers, those who have overstayed their visa, certain EU citizens and those from Iceland, Liechtenstein, Norway and Switzerland who are not studying or working for most healthcare. They can still see a GP free of charge, but they must pay up to 150% of the cost of their hospital care before they can be treated.

Patients needing urgent or “immediately necessary” hospital treatment are still entitled to it. However, healthcare professionals and charities say the rules are being flouted and applied inconsistently. “Hospitals are going overboard,” says Dr Dana Beale, a GP at Great Chapel Street Medical Centre in London who focuses on homeless people. “I heard of one case where a mental health trust was asking for a council tax bill, ID and a utility bill before they provided any treatment.” But a report by the World Health Organisation this week found that charging migrants for healthcare was a false economy and cost governments more. “Countries tend to use costs as a justification of limiting or delaying healthcare access to newcomers or providing emergency access only,” said Dr Santino Severoni, the coordinator of public health and migration for WHO Europe. “But this is not cost-effective – early identification costs less than delaying until absolutely necessary hospital treatment”.

Facebook Twitter Pinterest Nasar Ullah Khan, who was denied NHS treatment as he overstayed his visa Photograph: None

Meanwhile, the changes have left healthcare professionals powerless to treat patients as the government’s hostile environment policy encroaches on the NHS. “As a result of this cruel policy, overstretched NHS hospitals are put under increased pressure to carry out immigration checks. Meanwhile, vulnerable patients are dying from lack of treatment,” says Anna Miller, UK policy and advocacy manager at Doctors of the World, which runs a clinic providing free treatment in London to people excluded from mainstream healthcare. “Hospitals are getting much more efficient and better at identifying patients who can be charged for their treatment. When the law was first introduced, it didn’t bring about much of a change on the ground but it feels now that it’s beginning to bite ... On every level we’re seeing more patients refused treatment.”

In December, four medical bodies representing more than 70,000 doctors urged ministers to suspend the rules that force hospitals to charge overseas visitors upfront for NHS care. The situation has ramifications for the 3.7 million EU citizens living in the UK. In the event of a hard Brexit, they would need to apply for settled status, or pre-settled status if they have lived in the UK less than five years, while new arrivals to the UK from the EU after Brexit might not have access to hospital treatment unless they paid for it.

The policy is creating administrative headaches for already overstretched GPs. “Seven years ago, I’d do a referral and they [migrant patients] would get seen and sorted out,” says Beale’s colleague, Dr Natalie Miller. “Somebody might be billed in retrospect, but if they couldn’t pay nothing would happen. Now we are getting letters asking us if the patient has recourse to public funds. It’s not our job to assess that: I’m a GP, not an immigration adviser.”

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Back in Birmingham, a spokeswoman for University Hospitals Birmingham NHS foundation trust refused to comment on Khan’s case specifically. “While we are unable to disclose details of an individual patient’s medical records, we can state that the trust strives to offer entirely appropriate care to all of its patients and our actions in doing so are both compassionate and reasonable,” she says. “Treatment in NHS emergency departments is free for patients not ordinarily resident in the UK, although any subsequent treatment as a result of admission to hospital is chargeable. All patients receive the appropriate treatment as an inpatient; both on an emergency basis on initial admission and subsequently for the care which the trust considers immediately necessary or urgent. They are appropriately invoiced for non-emergency care in accordance with the charging regulations.”

But Khan has just found out that a bill for care was sent to his brother’s house a few days ago amounting to £32,313. He is destitute. There’s silence before he cries, “Oh my God” and sobs uncontrollably. After minutes of struggling for breath and being unable to talk, he says: “The doctor has said I can’t travel to Pakistan so why can’t they give a visa to my family in my last days. That’s all I want now. I’ve got two children and a wife I haven’t seen in nine years.”