New Clause.—(CHARGES TO BE PAID BY CERTAIN CLASSES OF PERSONS.) (Hansard, 19 October 1949)

§ Lieut.-Colonel Elliot
I beg to move, "That the Clause be read a Second time."
630 I am sure this Clause will appeal to the Minister. He has been saying that all the Opposition's Amendments tended to increase the cost of the scheme, but by this Clause there is no such danger. The Minister has objected to the suggestions outlined in the Clause because he feared they would place an unreasonable administrative burden on those who would have to administer them, but I think we have met that point. We have made it a simple test of ordinary residence in the country. Further, I think we have been able to deal with his point that administrative difficulties might involve prolongation of the practice of carrying an identity card. That cannot arise because even at present the Minister, in the case of applications for dentures or appliances of one kind or another, requires the production of an identity card. It must be ascertained that a person has not gone to a number of places and obtained a number of subscriptions for sets of dentures or spectacles.
The Minister's vigilant eye has to be turned in the direction of those who make no contribution to the expenses of the scheme. He said that these people make certain contributions by paying indirect taxation, but the great weight of that taxation is escaped by them. The amount may not be great, but it is felt to be an anomaly which, in our present straitened circumstances, should be removed. It is an anomaly which could be removed without difficulty. We have given full latitude to the Minister to prescribe conditions by means of regulation. A number of visitors from America and elsewhere are insured. It would be easy for them to pay a charge, and all the Minister is doing by not charging anything is to relieve the funds of certain large insurance companies abroad. I am sure that this is not a line which he would wish to follow.
The Minister has been so impressed by this argument that he himself has taken steps to deal with it, though we contend that those steps are of an indefensible character. He stated at a Press conference, and his words were subsequently broadcast, that he had arranged for immigration officers to turn back aliens who were coming to this country to secure benefits of the Health Service—

§ Mr. Bevan
For the purpose of securing them.

§ Lieut.-Colonel Elliot
The Devil himself cannot detect the mind of man, yet this burden is placed on the immigration officers. To place this duty on them is placing an entirely unheard of responsibility on them; it is asking them to carry out duties which they are in no way competent to do.

§ Mr. Bevan
It is the normal thing for the immigration officer to ask immigrants what is their intention in visiting this country.

§ Lieut.-Colonel Elliot
The Minister has a powerful and able wrist, but he is flagging this evening in dropping his guard to an extent to which he would not drop it if he fully applied his mind to the subject. Does he suggest that any alien coming to this country for the purpose of carrying out a fraud on the Revenue would volunteer a statement to that effect to the immigration officer?

§ Mr. Bevan
That applies to every other question which is put.

§ Lieut.-Colonel Elliot
The right hon. Gentleman has himself at times animadverted on the singular folly of the questions put by immigration officers and to which affirmative answers are expected, notably the one in America, "Is it your intention to overthrow the constitution of the United States?" the suggestion being that the answer would be "Yes," thus leading to the instant rejection of the immigrant.
Here we have an opportunity of removing this question from those which the officer has to ask. I wonder whether, in these circumstances, the late Lord Snowden would have ever got into any country at all. Anybody with his obvious physical defect would be held by an immigration officer to be likely to be coming into the country for the purpose of obtaining treatment. Will it be said to me on shore, when I have been hanging over a ship's rail, after a rough crossing, "You are entering the country for the purpose of benefiting under the scheme"? I have seen many of my fellow passengers in this position.
I ask the Minister to consider whether he has not admitted a wrong and is choosing an impossible administrative vehicle for correcting it. He says it is not desirable that people should come into this 632 country solely for the purpose of obtaining benefits under the scheme. Surely, the proper person to examine and discuss that matter is one with medical skill, to whom the visitor would eventually apply. What would have been the position of the Chancellor of the Exchequer at the Swiss frontier if such a set of questions had been asked of him? This would happen if the Minister tried to make the Service free, without any check at all. There has been produced a new kind of check administered in a new way by people who are not suitable to administer it. The proper person to check whether someone applying for medical assistance is genuine is one with proper qualifications. I do not believe that an immigration officer is the kind of person to judge.
We propose a solution here which would meet the difficulty which the Minister himself has agreed. It would meet it in a practical way. The Minister could allow a person who was seeking assistance to pay a sum according to circumstances which the Minister would determine. He could get rid of the difficulties of the foreign seaman whom it was desirable to treat in an emergency, or somebody in poor circumstances to whom there could be no objection on humanitarian grounds. These are all left in the hands of the Minister. What we say is that the difficulty is here. The Minister has produced a solution, which we contend is ineffective as a solution, and what we propose would have in addition the advantage of relieving the financial strain upon the National Health Service, an ideal which the Minister himself has held out to us as being a very desirable one, and one which should be brought forward by the Opposition. Having, therefore, fulfilled all these criteria, we trust that the right hon. Gentleman will be able to accept the new Clause.

§ Mr. Bing (Hornchurch)
Earlier on, when we were discussing other matters, there was some discussion on ethical values, and in the course of some researches, which I happened to be making in the Library on another matter, I came across an old Book in the reference department, which contained a passage from which the right hon. and gallant Gentleman opposite and probably some of his friends, who have put this case in a much more raucous manner than 633 he has done, probably drew their moral. The passage in this particular Book dealt with a stranger and foreigner who was on a journey to a place called Jericho. In the course of this journey he fell among thieves and was wounded and left for dying. Then it happened that two members of the ruling class passed, and they, realising that in the interests of national economy they should restrict their personal expenditure, passed him by on the other side. It happened that a little later there came some untutored fellow from an outlandish part—

§ Lieut.-Colonel Elliot
Would the hon. Gentleman tell us whether that untutored man asked the Immigration Officer, who examined this injured man, if he had pronounced upon his fitness for relief?

§ Mr. Bing
That part of the story is left untold. This untutored person from, I suppose, what would roughly correspond in the Palestine of those days to Wales in this country, without making any proper inquiries at all as to the origin of the stranger, stooped and at once gave him medical attention. Not only that, but he made a small monetary payment towards his support, and, worse than that, he said—I have taken the exact words: Take care of him; and whatsoever thou spendest more, when I come again, I will repay thee, thus leaving the way open for a supplementary estimate. This parable has been quoted time and time again to show the contrast between the prudent conduct of the ruling class and the reckless extravagance of this ordinary man, who was prepared to squander not only his own money, but that of his fellows on helping a mere stranger.
It is, after all, purely a question of principle, because the amount involved through providing strangers with medical attention does not come to a very big amount. I do not know whether the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) has looked into the figures, but there are about 635,000 visitors to this country in the course of a year, and on an average they stay rather less than a month, so that would make it that on a whole they would be equivalent to a population of round about 50,000 extra people requiring the 634 health services, and the cost, even supposing they made the same demands as the people in this country, would be somewhere between £200,000 and £250,000.
In order to exclude these people, the very machinery that would be required to insure the presentation of identity cards would, in itself, involve an administrative cost that was probably as great as, if not greater than, the cost of the health service. What would be said by hon. Members opposite if somebody came along needing urgent treatment, and because his or her identity card could not be found he or she would have to be denied the service? This service would be denounced by hon. Members opposite. What would happen if we did not treat any of our visitors from the Dominions or from the United States? What would hon. Members say then?

§ Lieut.-Colonel Elliot
I do not think the hon. Member for Hornchurch (Mr. Bing) is doing himself justice. He should read the powerful remarks of the Minister of Health on this subject, where he says … if a foreign visitor or a British visitor falls ill he immediately goes along, if he wishes, to a general practitioner, and if he wishes to take advantage of the Service he must enter into a contract with that practitioner, who must sign a form, and the local executive council must agree with it and approve it."—[OFFICIAL REPORT, Standing Committee B; 6th July, 1949, c. 158.] These are the steps which have to be taken now.

§ Mr. Bing
That may well be, and I should think it is proper. I am glad that the right hon. and gallant Gentleman refutes the more inescapable statements which appeared in some newspapers which, at any rate, nominally support his side, that this Health Service is being wantonly squandered on foreigners. They are subject to the same obligations as people in this country.

§ Mr. Bevan
As temporary visitors.

§ Mr. Bing
As my right hon. Friend says, as temporary visitors. Is not really the basis of it—and I do not blame the right hon. and gallant Gentleman because I think he was extremely moderate—a general complaint and a general attack on foreigners, rather a sort of thoughtless attack that the foreigners are doing us 635 out of something? It is rather a peculiarity in some people's mind that that is the way we ought to behave to foreigners. There is a class of person in this country who, instead of extending the warm hand of friendship, will if possible present the cold muzzle of the dog in the manger. There is no question, after all, from hon. Gentlemen opposite of any economies in the Health Service. That is not their object, because if one reads a document entitled, "The Right Road for Britain," which I understand has, at any rate, the support of some hon. Members opposite, they will see very interesting proposals for giving free medical treatment to people who are well enough off to pay for a private medical service. In other words, hon. Gentlemen opposite, while they would be prepared to save £250,000, would, at the same time, be prepared to spend on the wealthy an extra sum of £5 million.
Visitors to this country are not, after all, all wealthy people. Visitors to this country, one is glad to think, are very often poor people, delegations of ordinary working people and such like. There is no reason at all why these people should not be given an opportunity of experiencing something which is now a National Health Service and part of our national life. Hon. Members opposite quite often spend their time decrying this country, and putting forward all sorts of reasons why people should not visit us because, so they say, they cannot get the same sort of food as can be obtained in other places or cannot get this or that. But when there is an actual service, which visitors can enjoy, then they suggest that we should cut them out. In fact, what they would be prepared to do is, in order to save one-tenth of the money that they spend on rich people, to deprive us of giving to the ordinary man or woman from other countries who comes to this country the same sort of service as our people enjoy. I hope my right hon. Friend will not give way to that.
If there is any abuse of the service by foreigners—and there may be some—that abuse must pass through the practitioner. Therefore, if there is any charge to be made it must be against the practitioner, for the charge made that foreigners are exploiting the Health Service means that they are only exploiting 636 it by the connivance of the medical profession in this country. This, if it is the charge made by hon. Members opposite, is a far more serious charge than that made by my hon. Friend the Member for East Wolverhampton (Mr. Baird), for which he was reproved by hon. Members opposite. But I do not believe that that is so. I do not believe that there are all these abuses.
The right hon. Gentleman the Member for Woodford (Mr. Churchill) has described what a paradise other countries are compared with his own, and it is a little odd that from these paradises, as described by the right hon. Gentleman, there should be this pathetic stream of people in search of glasses, teeth and all the rest of it. There may be some impoverished nobleman from some other country who may think it possible to pick up an eyeglass here on the cheap, and if, in fact, that is so, it is very desirable that we should deal with it by regulation. This country has a great reputation for the hospitality of the ordinary men and women of the country. I do not think many people grudge the way in which we give to foreigners who are visiting this country the Health Service that we ourselves enjoy. I hope that, while my right hon. Friend will deal with abuses, he will preserve the reputation for hospitality which this country so rightly deserves.

§ Mr. Bevan
I am very glad that this subject is being discussed in the atmosphere which exists in the Committee, and which is very different from the kind of climate of opinion which irresponsible newspapers try to create around some subjects and irresponsible speakers also attempt, when they address mass meetings and do their utmost to denigrate the Health Service, while pleading at the same time that they are supporters of it. It has been rather sickening in the last 15 months to witness members of the party opposite trapesing around the country, following their extensive posters on the hoardings saying that they fought for the Health Service, yet spending most of their time on the platform poking fun at it, denigrating it and undermining it. This subject is one of the categories under which that has been done.
It amazes me that we should assume that there is something wrong in treating 637 a stranger who is visiting this country with medical attention if he or she falls sick. That assumption is one of the curses of modern nationalism. It was not part of the ethics of mediæval society or of the Dark Ages. Any person wandering about the Continent of Europe could seek the sanctuary of the Catholic Church and get treatment. It was never considered at that time to be wrong that a sick person should receive the hospitality, medicaments and skilled attention that were available at the time. The present attitude is a by-product of the existence of the Conservative Party.

§ Lieut.-Colonel Elliot
Surely the right hon. Gentleman will agree that that was a reciprocal arrangement?

§ Mr. Bevan
No.

§ Lieut.-Colonel Elliot
Oh, yes. The Catholic Church was not a narrow nationalist church. It existed in all countries. It was done under a reciprocal arrangement. Reciprocal arrangements are specifically provided for in the proposed new Clause.

§ Mr. Bevan
I thought I had reached that part of the argument just now. I did not know that there had been any contract drawn up between high contracting parties in mediæval Europe, sitting as a sort of Council of Nice, deciding what service they should give each other if they happened to wander into each other's countries. It was regarded as part of the normal conduct of a citizen.

§ Colonel Dower (Penrith and Cockermouth)
Mutual hospitality.

§ Mr. Bevan
Certainly it was regarded as hospitality but not necessarily as mutual.
No convent or hospice at which a traveller presented himself for lodging or treatment in the way of nursing, asked: "If we went to your country would they do this for us?" They did not even know about that. They did it as part of normal behaviour. I agree with my hon. Friend the Member for Hornchurch (Mr. Bing) that one of the anti-foreigner complexes that insular parties like the Conservative Party can stir up from time to time has been responsible for this agitation.
I have tried to point out on a number of occasions that if we set an example 638 of this sort in this country there is every prospect that other nations will follow. Somebody must start. The health services of the whole world are being stimulated by what is happening in Great Britain. It is astonishing—I do not know whether hon. Members are aware of this—to witness the constant stream of visitors to this country coming from all parts of the world to find out what we are doing in this matter. Most of them go back praising what is happening and hoping that what we are doing will succeed so that they can imitate it in their own countries.
If people come here from abroad for the purpose of exploiting the Health Service that is a different matter entirely. They ought not to be allowed to exploit it any more than a person in this country. If, for example, a person leaves another country deliberately for the purpose of going to Roehampton to get an expensive artificial limb, I would consider that to be an abuse and not a proper thing to do. Unless we stop that sort of thing we shall be drained.
If a person comes to this country and falls sick, it is perfectly proper that he should be treated. Indeed, some of our great institutions always did so. The great Scottish hospitals treat visitors freely. Does the right hon. and gallant Gentleman suggest that we should turn our backs on that splendid tradition and set the almoner at work upon people who, for generations and even for centuries, have been enabled to enjoy these benefits? The same thing is true of many of our great London hospitals. Until quite recently a very large number of them were following that tradition. It is only in recent years when revenues have fallen drastically and the costs of health ministration have been raised very substantially, that they have found it necessary to make charges at all.
It seems to me that the complaints—I am not making accusations against the right hon. and gallant Gentleman, because the façade presented this evening is one of comparative benevolence—conceal the grinning visage of malice.

§ Lieut.-Colonel Elliot
No more poniards?

§ Mr. Bevan
It is part of the duty of the House to deprecate the irresponsible propaganda which has been created 639 around this issue and to try not to pander to the worst appetites of people but to elevate them to a higher standard of citizenship.
The second point is that even if we wanted to withdraw this decent altruism the expense of doing so might be very substantial indeed. The administrative apparatus that we should have to establish would be very considerable. The right hon. and gallant Gentleman shakes his head. I assure him that under his proposed new Clause we should have to divide applicants for medical assistance into three categories. They would be those who came from countries with which we had reciprocal arrangements, those from countries with which there were no reciprocal arrangements and, lastly, our own people. Obviously, if we have reciprocal arrangements we shall merely reciprocate. We shall provide merely according to the reciprocal agreement. Let me put a case in point. If one country was only able to give our citizens bare hospital treatment, should we make available to their citizens the full range of the Health Service of this country? That would not be reciprocity, because it would go beyond reciprocity.
7.30 p.m.
Therefore, it would be necessary to have at least three classifications. The right hon. and gallant Gentleman shakes his head. Suppose that a person turns up at the dentist. He does not go to the dentist from the G.P., so there is no complication to start with. The man probably has an aching tooth, and the dentist says, "What is your name and address? How long have you been in this country? Where did you come from? Are you French? We have a reciprocal arrangement with France for hospitals only and not dentistry. With Belgium we have a reciprocal arrangement for dentistry as well. Or are you English? "By the time all these questions are asked and answered the poor man would be mad with pain.

§ Lieut.-Colonel Elliot
Really, really.

§ Mr. Bevan
The right hon. and gallant Gentleman says, "Really, really," but this point—some of my hon. Friends might call it the point of production—is the one at which the operation has to take place. That is the first time it 640 happens and that is where the screening would take place. The dentist would have to satisfy himself whether the person was a proper applicant for free dental treatment or not.

§ Lieut.-Colonel Elliot
The dentist has to do that now.

§ Mr. Bevan
No. What happens now is that each person has to have a number—for convenience it is the registration number—for classification purposes. If registration were withdrawn some other number would have to be found, but it would be for classification and not for identification purposes. The right hon. and gallant Gentleman is confusing identification with classification. In this case the applicant would have to prove that he belonged to a particular class. The same thing is true about the general practitioner. We made arrangements with the medical profession—I apologise for speaking at length but there is such misunderstanding about the subject that I think I am entitled to be detailed—for them to accept collective responsibility for the population of Great Britain. It was a very important principle because it enabled us to deal with our mobile population; that is to say, we could deal with such people as visitors to the seaside. Such cases are met out of a general pool because these visitors who fall ill at the seaside are on the lists of other doctors and we had to have arrangements for them to have access to doctors at the seaside.
We therefore have the temporary visitor form, the purpose of which is to enable the doctor to claim his fee, not to screen the patient. The doctor satisfies himself that the patient needs attention. The form is for the purpose of enabling the doctor to recover the payments to which he is entitled from the general pool. It is not a form to discriminate between classes of people. Immediately that is introduced there must be more forms so that the doctor may be able to reject persons who cannot satisfy him, and, of course, if the person who comes to Great Britain can tell a lie to the immigration officer, so can the person who is ill and goes to the doctor. A lie can be told on a form just as well as by word of mouth. The same answer holds good.
641 I do not suggest that there are no circumstances in which regulations can be made for the purpose of preventing people abusing the service, but I am not prepared to establish administrative arrangements which would harass the whole population merely to deal with a handful of people who were visiting this country and might need treatment. Hon. Members will agree that we ought to examine each regulation and each protection on its merits and not have a general principle saying that no one visiting this country shall have access to the free Health Service. [Interruption.] Is that not what the Opposition want? I should like to know. It is a very important point.

§ Lieut.-Colonel Elliot
It is the Minister who says that somebody visiting this country must not have access to the Health Service. We say that the Minister should have power to make regulations by which the examination could be carried out by the medical man instead of the immigration officer, who is most unsuitable.

§ Mr. Bevan
Must the regulation start with the principle that the free Health Service is withheld from visitors? That is the important point.

§ Lieut.-Colonel Elliot
Our Clause is simple. It says: Regulations may provide for such charges as may be prescribed to be made to persons not normally resident in the United Kingdom. … Regulations may provide that in such cases as may be prescribed the charges may be made and recovered by the person providing the services. We are offering the Minister discretion—at present he has no discretion—to recover charges which he admits should, in many cases, be recovered.

§ Mr. Bevan
That does not answer my point at all. I want to know what obligations the passing of the Clause would impose on the Government. It is clear that we want to have power to make charges in certain cases or to withhold service, but I want to know if we are to begin with the assumption that the regulations must deny, if they can be made to deny, to all visitors access to the free Health Service.

§ Lieut.-Colonel Elliot
I do not wish to delay the House but the Minister asked the question. The assumption behind the 642 Clause is that in cases where people have not paid for the service—this is not a free health service, as the Minister will agree; it is a service paid for by the inhabitants of these islands—it is reasonable that they should make such payment.

§ Mr. Bevan
In other words, the Clause would impose on the Minister the responsibility for making regulations to recover from overseas visitors a charge for the use of the Health Service. I say at once that that is absolutely and utterly impracticable. Not only is it impracticable but, as I said earlier, it would be turning our back in the National Health Service on centuries of British tradition. In fact, it would be worse than the situation was before.

§ Colonel Dower
Cannot the Minister take power to prevent abuses?

§ Mr. Bevan
I can take power to prevent abuses in certain ways such as I have already described. When persons come to this country deliberately for the purpose—that is the point—of getting artificial limbs, I think we can prescribe regulations which will not harass others, but where a person comes to this country deliberately for the purpose of having spectacles—

§ Mr. Lipson (Cheltenham)
Does not the Clause give the Minister discretionary power? It says not "shall provide" but "may provide."

§ Mr. Bevan
We want to be quite honest about this. I must not give the House the impression that it is either desirable or practicable to insist upon a charge being made to all and every user from abroad of the British Health Service. I must be quite clear on that point.

§ Sir H. Lucas-Tooth
Will the right hon. Gentleman say under what section of the principal Act he has power to impose a charge on someone who comes here deliberately to get treatment?

§ Mr. Bevan
I have not got the power. I have not said I have. Because we knew that there were certain people who believed that they could get things in this country merely by coming here, we used, not a very dexterous or very good—

§ Lieut.-Colonel Elliot
They may lie.

§ Mr. Bevan
The right hon. and gallant Gentleman must not be so jejune. We 643 brought in a great Act of Parliament and as time went on we discovered certain abuses, and we are proposing to deal with them. The right hon. and gallant Gentleman must not assume that everybody tells lies to the immigration officers. In fact, some people have come to this country believing that they could have certain things if they came here, without any question of defrauding the country. People have informed the immigration officers that they came to Great Britain to get certain things. It is not true to say that all men are liars in this case. I have too great a respect for the right hon. and gallant Gentleman to believe that he has always moved in company like that. I know he has not. People do tell the truth sometimes, and they have told the truth in these instances, and certain people have therefore been prevented from making improper use of the Health Service.
I cannot accept the form of words suggested in the Clause because it says: Provided that this section shall not apply to any person normally resident in any country with which His Majesty's Government have made … reciprocal arrangements. We must have a little more latitude there to frame our regulations in the nature of the reciprocal arrangements made. Furthermore, unless we are careful we shall find ourselves denying the Health Service to many Britishers not normally resident in the country. So what I am proposing to do in another place is to take power to frame regulations where "it may be practicable so to do" to prevent abuse of the Health Service in this country by overseas visitors. I define "abuse" as being people who deliberately come to this country for the purpose of making use of the Health Service. However, there is this qualification, that I shall not take power in such a fashion as to worry large numbers of British subjects merely in order to find a few needles in the haystack. I do not think the House would want me to do that.
I hope, therefore, that the Opposition will withdraw the new Clause in the light of that statement because it solves nothing. It merely shifts the problem from a statute to regulations. What we ought to do is to look at the regulations when they are issued to see how far they 644 go towards meeting the difficulties of certain cases. However, I must not be understood to be accepting the principle that it is desirable that any person in this country, not a resident in this country, who falls sick ought to pay a charge for the use of all or any part of the Health Service.

§ Lieut.-Colonel Elliot
We find ourselves mostly in this Debate in strange accord with the Minister on his conclusions and in strange disaccord with the Minister in his arguments. The Minister offers a form of words which will go some way at any rate towards meeting the objective which we had when we set down these words upon the Order Paper. Furthermore, the right hon. Gentleman says he will do it in another place, which is to say that this is not the last opportunity the House will have of considering the matter, because obviously this House will have an opportunity of either accepting or disagreeing with an Amendment made in another place when it comes down, and we shall be able to see it on the Order Paper and examine it.
Certainly I would be the last to cast back any convergence of views between the Minister and ourselves. Several times tonight the Minister, though arguing vigorously against us, has eventually turned up on our side in the Lobby—[An HON. MEMBER: "In the Lobby?"] In the spiritual lobby. That ghostly lobby, that powerful lobby in which his ectoplasmic self succeeded in defeating the hon. Member for Wolverhampton (Mr. Baird).
We have an admission by the Minister that here is an abuse. That is the first point of comment. Secondly, he proposes to deal with it and submit words to make an Amendment to the Bill. Very well, I recommend my hon. and right hon. Friends here to accept that and to see what the position is when the Amendment of the Minister is tabled and discussed in another place, and when it finally returns to us here. I will leave the Minister to discuss with his hon. Friend the Member for Hornchurch (Mr. Bing) and others the parable of the Good Samaritan and the many other edifying things which were talked of earlier on this evening, including the Minister's account of the charitable arrangements of the Middle Ages. I would recommend him 645 to study the rules and orders of the various friars who dealt with those things, because I think he will find that their duties were definitely international and it was understood by every member exactly what those duties were in every country.
For that matter, we can leave both mediaeval history and mediaeval theology for tonight and I now beg to ask leave to withdraw the Motion.