MEDICAL TREATMENT (FOREIGN CURRENCY) (Hansard, 14 March 1949)

§ Colonel Stoddart-Scott (Pudsey and Otley)
I want to raise tonight the question of the method by which foreign exchange is allocated for the treatment of diseases abroad. We are all agreed that there are certain medical conditions which are best treated abroad, where such factors such as high altitudes, sunshine and even certain spas come into the question. Treatment for these diseases cannot be obtained in this country. From time to time there are certain specialists or medical pioneers who work abroad and lead the world in some directions, and who are prepared to undertake cases which lesser men would give up as incurable. In the past, Britain has led the world in many forms of medical treatment, and individuals have travelled from all over the world to this country to receive treatment.
There is always some specialist who can attend special cases, but it can only be done of course, if patients are permitted to travel abroad for such treatment. At present a type of treatment of Parkinson's disease is given in the United States which cannot be given in any other country in the world, and it has always been acknowledged that a certain type of tuberculosis and a certain type of kidney disease, can best be treated in Switzerland. It is rather a tragic affair that at present some forms of treatment, both new and old, are not available to our own people. The value of the treatment for tubercular and kidney disease in Switzerland is recognised by all, and before 5th July last year county councils and county boroughs made it possible for people to go to Switzerland, whatever their means were, by paying either the whole or part of the cost of the treatment from public funds. In my county, the West Riding of Yorkshire, on 5th July we actually had two individuals receiving treatment in Switzerland at the expense of the local authority.
The Public Health Act, 1936, which made it possible for local authorities to pay the whole or part of the treatment abroad, was repealed by the National Health Act, and although that Act brought a lot of advantages to our 1868 citizens, it removed one advantage in that no longer can an individual go for treatment abroad at the public expense. This treatment, which was previously available to all classes, is now only available to those people who can afford and can obtain foreign currency with permission from the Exchequer.
What happens if a patient is recommended treatment abroad by his doctor or specialist? Very often the doctor or the specialist decides, after a very full examination, after X-ray, after clinical tests and, quite often, after having tried out some other form of treatment, that the only treatment which will do any good at all is the treatment which can be got in a foreign country. The patient has then to apply to the Exchequer to be permitted to receive foreign exchange, for the purpose of getting that treatment. In 1948, 914 cases were refused foreign currency by the Exchequer for treatment abroad although in every case the treatment had been recommended by a doctor or a specialist. The Chancellor always gives as a reason for declining such foreign exchange, that he has been recommended by the Exchange Control Medical Advisory Committee that such foreign currency should not be granted.
What is this Exchange Control Medical Advisory Committee which seems to have great power over the life and death of certain citizens? We are told in answer to a Question that there are 10 medical members of it and that they receive for their services £500 each year. The Committee has control of life and death in some cases. I have received a letter from an individual in Kent who simply writes this: The Committee were informed by my doctor that a visit to Switzerland was essential to the life of my wife. They refused it. She died on 8th October last. The Committee thus has control not only over the treatment but also over the life of the individual.
We have never been told of whom the Exchange Control Medical Advisory Committee is composed. Is the reason why we are not told, that it is composed of medical nonentities? Is it composed of Treasury "Yes-men" who do as the Chancellor wishes them to do when he wants to conserve foreign currency or when he wants to expend it, or is it composed of distinguished consultants? Most probably it is composed of very distinguished consultants. I do not 1869 accept for one moment that Treasury "Yes-men" man this committee, because I feel that the Treasury is as interested in the health of the people as it is in other matters. 1 do not accept the view expressed to me in another letter on this subject which said: Can it be that the Treasury prefers the thought of Death Duties to that of the prolongation of life? I do not accept that view. I am sure that this committee is composed of distinguished consultants. If these men are distinguished consultants, why does not the country know who they are? If the country could know, there would be much less anxiety and dissatisfaction among the relatives of people whose applications for foreign exchange are turned down, as they were turned down in 900 cases last year. Also, it would settle some of the unrest among members of the medical profession who dislike to see their recommendations, made after full investigation and examination, turned down by a committee of men who have never even seen their patients. The Ministry of Food had a similar medical advisory committee which advised the Minister on which individuals should have extra food for the treatment of disease.

§ Mr. Anthony Greenwood (Heywood and Radcliffe)
Surely it was not which individuals should receive special diet, but which classes of individuals?

§ Colonel Stoddart-Scott
No, it was to advise on which individuals should have extra food. The Minister refused to give the names of that committee, but after a little pressure he gave them. The committee was found to be composed of most distinguished men. I believe that the giving of those names stopped a great deal of criticism and gave a considerable amount of confidence.

§ Dr. Segal (Preston)
Does not the hon. and gallant Gentleman consider that it would be totally contrary to medical ethics if the names of these people were divulged, seeing that they are actually in private practice, in addition to rendering advice in a consultative capacity to the Minister?

§ Colonel Stoddart-Scott
I think that was the argument put forward by the Minister of Food but, on further consideration, he gave way and published the names.
1870 When the applications are refused it is done by means of a chit which says that the Exchange Control Medical Advisory Committee have carefully considered the medical report upon the case of Mr. Smith and greatly regret that they cannot recommend granting the foreign exchange. Does the committee really meet and consider these applications? This is a most dishonest chit to send out. In a case in which I was interested I found that although the application was made last December and turned down in January the Committee had not meet since the previous October.
Therefore, it is most misleading to send out a chit saying that the committee have carefully considered the matter, or for the Chancellor to say that he is advised by a committee which so rarely meets. I know what happens. Probably two members ring up one another and discuss a case. If they cannot come to an agreement, they take the matter to consultation with the chairman of the committee. That is not the decision of the committee. It is the decision of two members of a panel, and I think that that is what the Chancellor ought to say when these cases are turned down.
I wish to be constructive and to suggest that it would be much more satisfactory to the whole country and to the people who have their cases considered if the size of this Committee could be increased from 10 to 18, so that one member could be on the committee for each regional hospital board area. Before any application is refused the patient should be seen by one of the members of the committee. These patients are capable of travelling to Switzerland. Therefore, they are equally capable of travelling to a consulting room in some city to be examined by one of the consultants. Therefore, I want to make that suggestion as being one way of removing the dissatisfaction and dislike involved in having one's case turned down when the patient has never been examined by a member of this committee.
My second suggestion is this. The hon. Gentleman who is to reply told us a fortnight ago that an agreement had been reached, or was about to be reached, with Switzerland on the allocation of Swiss currency to people travelling there in future. A larger proportion of that exchange than was allocated last year 1871 should be allocated for the treatment of disease. I know that the Swiss have some say on how much money is to be allocated and for what purpose it is to be used, but it would be very satisfying if a larger percentage could go for the treatment of disease, so that we should not have a repetition of these 900 cases of people recommended by doctors and specialists turned down, as they were last year.

§ Earl Winterton (Horsham)
I only want to stand between the Minister and the House for two minutes. I feel very strongly on this matter, not from a medical, but from a moral point of view. I must tell the hon. Gentleman who is to reply that I think a great moral responsibility rests upon him and the Chancellor of the Exchequer, in so far as the Chancellor permitted a large sum of money to be sent abroad to sustain the French strikers on the alleged ground that those strikers were in need of money, because of the condition of some of their families, and yet at the same time he refused the same right to be given to patients in this country whose doctors alleged that, if they could go to Switzerland, their lives would be saved.
My hon. and gallant Friend gave us one or two instances, and I say that a moral responsibility rests upon the Government in this regard. The present system is wholly unsatisfactory; we do not know the names of this advisory committee and there should not be even a suspicion that money can be sent abroad for political purposes but refused for saving the lives of Englishmen. That is a stigma which must rest upon any Government, however powerful, and I hope we shall be informed that all this nonsense—because that is what it is —of preventing people from going to various countries in which they can recover is going to be swept away, and that there will be some reciprocal arrangements with Switzerland, and with any other country which has therapeutic facilities, by which patients from other countries may be able to go there. I ask the hon. Gentleman to absolve himself, if he can, from the stigma that rests upon the Chancellor as a result of the action he has taken.

§ Dr. Segal (Preston)
I have listened with a great deal of sympathy to the two suggestions made by the hon. and gallant Member for Pudsey and Otley (Colonel Stoddart-Scott) but I cannot help feeling, in respect of the first, that I doubt whether it would work. If we have one member from each regional board on the Medical Advisory Committee how would a decision be taken? Does the hon. and gallant Member expect that one member would be able to get the remaining 17 to support him in any decision on this matter? I know from my own experience that no one could be more accommodating than the present members of the Medical Advisory Committee, in soliciting advice from county tuberculosis officers or from any medical officer, whenever that advice is available, before they come to a decision in any case. I appeal to the Minister to urge upon the members of the Advisory Committee that they should be as broad, as humane and as sympathetic as possible towards every case on which a decision has to be taken.

§ The Economic Secretary to the Treasury (Mr. Douglas Jay)
I think we all approach this subject with a wish to ensure that nothing is done which can in any way impair the health or the prospects of life of any of the people concerned. I should like to say to the hon. and gallant Member for Pudsey and Otley (Colonel Stoddart-Scott) that we have, as a matter of fact, already agreed with Switzerland that the amount of Swiss currency available for this purpose should be increased for this year. We were anxious to do that, and, as I say, it has already been done. I do not think there is any serious disagreement in substance between us over this; but I believe that there is some misconception as to what are the present facts.
There is, of course, no obstacle whatever in the way of people going to any part of the sterling area for health reasons. That is, of course, a very large area embracing, besides the United Kingdom, Eire, the Channel Islands, Cyprus, Malta, the West Indies, and a number of other places where health facilities are available. The only issue is how far we should grant the scarcer currencies for this purpose. There is no disagreement on the part of the Government, or anybody else, with the idea that a man 1873 should be given foreign exchange facilities if this would improve his chance of recovery from the disease, whatever it is, by allowing him to go to the country in question. There is no question in this procedure of refusing currency to anybody who would, as I say, improve his chances of recovery as a result.

§ Earl Winterton
Who says that?

§ Mr. Jay
That is what I am about to explain, if I may. The question is how we should decide which individuals fall into that category and which do not. Unfortunately, if one runs an exchange control system, one has to make that decision. The Treasury cannot make it, because it is a decision which rests on medical evidence and facts which we are incapable of assessing. The alternative suggestion—which I do not think the hon. and gallant Member actually made—is that the ordinary doctor of the individual in question should make the decision. The objection to that is not, as seems to have been supposed, that anybody is questioning the medical facts as stated by the patient's doctor. The Exchange Control Medical Advisory Committee, which we are discussing, does not call those facts into question at all; it accepts them from the doctor. The function of that Committee is, having accepted those facts, to decide whether a case is established for the patient to travel to the country in question in order to obtain some special treatment.

§ Colonel Haughton (Antrim)
How can a consultant possibly make a decision of that sort without a personal examination?

§ Mr. Jay
A personal examination is necessary to establish the facts of the case, and that is why, in our view, it is right that the patient's ordinary doctor should make that examination. He then states the facts of the case, and it is the function of the Committee to judge whether those facts justify the patient going to the country—

§ Earl Winterton
Without seeing the patient?

§ Mr. Jay
—in question. It is necessary in order that we should apply common standards in deciding what medical facts justify the particular journey suggested.

§ Earl Winterton
Do they see the patient?

§ Mr. Jay
If the noble Lord will allow me, I was going to say that the suggestion that the Committee should see the patient is simply a misconception of the Committee's functions. It is not for them to say that the patient is suffering from a particular complaint or evincing certain symptoms; that is for the individual's doctor to say. Their function is to say whether those symptoms or the complaint justify the particular journey to, say, Switzerland. The suggestion that the Committee should then see the patient would really be a question of checking up on the veracity of the statement made by the patient's doctor. I repeat, that is not the function of the Committee; their function is to apply certain common standards to ensure that we are being fair. On the experience which we gained before this arrangement came into force there is, unfortunately, little evidence that fair common standards would otherwise be applied. As the hon. and gallant Member knows, before the Committee was set up these decisions were taken on the basis of medical certificates saying that danger to life would result if the journey to certain foreign countries could not be made.

§ Earl Winterton
Is the hon. Gentleman asking the House to believe that in this case a principle has been applied which does not exist in any other case; that the Committee which has to decide cannot see the patient, cannot make up its mind by seeing the patient?

§ Mr. Collins (Taunton)
Dealing with the journey to Switzerland, is my hon. Friend aware that foreign exchange is being denied to British subjects who are already in Switzerland for the cure of tuberculosis? I know of two boys, aged eight and 14 years, whose families and friends in Switzerland have maintained them there for some time. They were in a bad state of health, and they will have to come back now because my hon. Friend's Department has denied them foreign exchange.

§ Mr. Jay
Foreign exchange would not be denied a patient already in Switzerland, if it could be shown that he would benefit by remaining there. As I was saying, unfortunately the previous system led to considerable abuses which were liable to cost us a great deal in foreign exchange. I am afraid we must be realistic and realise that that was the case, 1875 and that some check of this kind, which we think is working well, had to be introduced.
The hon. and gallant Member asked about this Committee. It is a Committee, as he said, of ten leading specialists in tuberculosis and other diseases, in addition to the chairman and secretary. The reason it has not been thought prudent to give the names is, I understand, because it is the wish of the medical profession itself, as well as the wish of the members of the Committee. I understand that that, rightly or wrongly, is the view they take. Every case is, in fact, studied by two members of the Committee, and therefore the fact that the Committee, as a formal committee, did not meet in a certain period is really irrelevant. Each case is studied by two members of the Committee, and in the event of disagreement they refer the case to the chairman. The Committee is always willing to reconsider any case if fresh medical evidence is brought forward, and indeed that has occurred on many occasions.

§ Colonel Stoddart-Scott
Up to last December, when a refusal was sent out it was a printed slip which said that there could be no further correspondence on the subject and that the decision of the Committee was final.

§ Mr. Jay
I am saying now that if fresh medical evidence is produced, the Committee is willing to reconsider a case, and I can give that assurance. The Committee, therefore, is not a group of officials or bureaucrats who act in a formal and unsympathetic manner. It has considered these cases exceedingly sympathetically, and everyone who has had anything to do with the Committee confirms that. I think the figures themselves show that the cases are being dealt with in a sympathetic and liberal manner.
One has to remember, as I think the hon. and gallant Member, who has expert knowledge, will agree, that for many of these cases treatment is available within the sterling area. In 1948, 2,907 applications were made and nearly 2,000 of these were granted. The actual number granted, I think, was 1,993. Actually, of the tuberculosis cases, which I think most of us have in mind, only 101 were refused, and 1009 were 1876 granted. The ratio for tubercular cases has been about ten to one. I do not think that the hon. and gallant Member's suggestion about enlarging the Committee, and having local panels, is something which would really help, because the function of the Committee is to make judgment on classes of cases; and, therefore, having many committees all over the country would mean having experts on each class in order to deal with different types of disease. As we see it, that proposal would not really meet the procedure.
I do assure the House, however, that we are very anxious to have any constructive suggestions for dealing with the problem in a better way; and, indeed, we are considering whether there are any further relaxations, or further liberalisation of this machinery, which can be introduced. I have to emphasise, however, that the ruling principle of the whole procedure is that nobody is refused foreign currency for this purpose if it is shown to the independent experts that this will improve his chances of recovery as a result of a visit abroad.

§ Colonel Stoddart-Scott
If this Committee is not going to see a case, surely it is most stupid. Surely the only way to avoid abuse is for every patient to be seen, and surely no Committee, if it fails to see a case, can fail to make a mistake. If a patient has gone to Switzerland, and has improved, and is refused foreign currency to stay in Switzerland, will the Economic Secretary grant it?

§ Mr. Jay
I think the hon. and gallant Gentleman is impugning the veracity of the medical profession, because he implies that the diagnosis of the patient by the ordinary practitioner cannot be relied on. I should have thought that, in the great majority of cases, one could rely on the ordinary doctor for statements of fact of that kind.

§ Dr. Segal
Seeing the patient is not enough; just that is insufficient. Seeing the patient over a period is necessary, and one visit is surely not enough compared with the knowledge of the patient's own private doctor, who has been in contact with him over a long period.