NATIONAL HEALTH SERVICE (TREATMENT OF FOREIGNERS) (Hansard, 18 March 1957)

§ Mr. Gerald Nabarro (Kidderminster)
The subject matter of the Motion is that of the charges for the National Health Service in the United Kingdom when foreigners come here. It is a matter of very considerable interest and of no great party-political content. At the present time everybody is concerned about the rising costs of the National Health Service and it has been part of the policy of Her Majesty's Government to try to recoup, by direct charges and otherwise, a portion of those very high costs.
I have been at very great pains, in view of the rules of order, Mr. Speaker, to establish that no new legislation would be required were the Minister mindful to take the necessary administrative action to charge foreigners, or any other aliens working in or visiting the United Kingdom, for any services they receive under the National Health Service.
I am informed that the legislative position is that under the National Health Service Act, 1949, Section 17, the Minister already has full power to charge foreigners for any services they receive under the National Health Service in this country. He has not used that power nor did the previous Minister nor any Socialist Minister. In fact, a number of Socialist Members of Parliament have now approached the Minister, and have conversed with me privately, expressing the view that, having regard to the heavy cost now falling on the British taxpayer, reconsideration—I put it no higher than that—should be given this evening to this important matter.

§ Mr. Wedgwood Benn (Bristol, South-East)
Will the hon. Member name the Socialist Members of Parliament?

§ Mr. Nabarro
I will come back to that matter later, and at an appropriate part of my speech. The hon. Gentleman should restrain his impatience for one minute.
The affairs of the National Health Service were scrupulously investigated by Mr. Guillebaud and his Committee about 160 twelve months ago, and a voluminous Report of their findings was published. No part of that Report, so far as my researches have discovered, made any reference to the question of charging foreigners for National Health Service.
I mentioned that the cost of the Service is now very high. The gross annual cost for next year, will, it is said, be about £690 million. Of that sum, about £40 million is recouped from National Insurance contribution under the existing arrangements. As a result of the proposals of the Chancellor of the Exchequer for levying, in fact, a poll tax of 8d. per week from each employee and 2d. per week from each employer, to be specifically devoted to National Health Service costs, a further £40 million per annum can be raised. Therefore, we must expect that within the next twelve months, taking a full year, a total of £80 million will be derived from National Insurance funds as a contribution to the gross estimated cost of £690 million per annum.
In addition there are other contributions. There is a contribution from the rate funds of local authorities. There is a minor but important contribution from superannuation funds. I estimate that the net annual cost of the National Health Service will be of the order of £575 million in the full year when all these arrangements have taken effect. Although that is approximate, I do not think much fault will be found in the figure.
The imagination boggles at figures of that kind and I prefer to reduce this amount to a sum per annum per caput of the population. My researches lead me to believe that the amount concerned is about £5 10s. per annum per caput. In other words, it a family of six persons is taken—father, mother and four children—the National Health Service will cost £33 per annum out of the general tax fund. That is approximately 12s. 6d. per week for every family in the country, assuming that the average family is of that size. That, of course, is in addition to any contribution which they make through the weekly stamp and National Insurance arrangements.
This is a considerable sum and we ought to put into perspective against it the services which foreigners are at present receiving. So far as I am aware, it has not been possible to assess exactly how much money would be recouped if 161 foreigners were charged the economic cost of health services which they obtain in this country—and "foreigners" in itself is a very generic term. I have endeavoured by Question to, and Answer from, the various Ministries to break this down, and I am surprised to find that the Ministries themselves have very little information on the subject.
For example, the most important single figure I was able to obtain was from the Home Secretary. I asked the right hon. Gentleman how many aliens passed through the British Customs in the calendar year 1956. I was told that the figure was 1,200,000. That probably covered four distinct groups of people. There were the immigrants, such as Hungarians, coming to this country to work. I suggest that they should be outside our consideration this evening, because immediately a foreigner starts work in this country he pays the full National Insurance contribution. In my view, therefore, he should be entitled to full National Health Service benefits from the date he makes his first payment. I do not dispute that.
Neither do I dispute the fact that in the very few cases where there are reciprocal arrangements between this country and foreign countries then foreigners from those countries should receive full services under the National Health Service in the United Kingdom without extra cost. The people I am getting at are the majority of foreigners who come to this country and avail themselves of these services. They are, broadly speaking, the tourists, the students and other visitors. It is with them I am principally concerned.
I will take, first, the tourists. Again it is difficult to say how many come to this country, but what is indisputable is the fact that the majority of tourists who come here can well afford to pay. I will not recite chapter and verse because it would involve me in naming medical practitioners, but there are cases known in the West End of London of well-to-do Americans staying in expensive hotels there calling in doctors and claiming that the cost of the service they receive should be shouldered by the National Health Service; in other words, that the British taxpayer should pay for it.
There are large numbers of tourists who come to this country and who, in 162 the course of the few weeks they are here, may have sicknesses of varying kinds and who generally call on the National Health Service to pay the cost. But what is the position of an unfortunate Briton going to a European country and, for the sake of example, suffering acute sickness, as was the case with one of my constituents, who also shall go unnamed? She, unfortunately, fell ill in the South of France and had to go into hospital, being charged there £86 for ten days in hospital, and they would not allow her to leave the country until she had paid the charges. They sought in fact to impound her luggage if she did not pay the charges, and when she came back to this country she appealed to me as her Member of Parliament to try to get part or the whole of the cost admitted as a charge against the National Health Service. The answer was "No, the Minister has no powers to do anything of that kind."
My hon. Friend the Member for Taunton (Mr. du Cann) had an even worse case which he brought before me this evening, and I hope, Mr. Speaker, that later, if he is able to catch your eye, he will relate the details of it. It involves a former German national.
I claim that if foreigners come here, particularly tourists, and expect medical services within the National Health Service—and we provide medical services of a very high order in this country—they should pay for them in the same way as Britons going to continental or other foreign countries are called upon to pay for them there.
I pass on from that to the question of students. There are a large number of foreign students in this country. It is becoming notorious in London that students who spend a part of the year in London arrange carefully that they will not have any attention to their teeth while in their own countries of origin but wait for their study courses in London, so that they can have their mouths attended to and completely refurbished at the expense of the British taxpayer while they are here.

§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
I should inform my hon. Friend that I am advised that students from abroad are residents within the terms of 163 the Act and therefore there is no power to charge them.

§ Mr. Nabarro
If that is so I should be out of order in pursuing the question of students, but I merely reply to my hon. Friend that if that is the present state of the law, the sooner it is amended the better.
I pass from the students to the question of these reciprocal arrangements. Whenever I have discussed this matter with hon. Members of this House, it has been said "Oh, yes but in the passage of 10, 20, 30, 40 or 50 years, or even more, we shall have reciprocal arrangements with all countries overseas by which all our nationals going agroad will receive the same service free, gratis and for nothing.

§ Mr. Cyril Osborne (Louth)
We shall all be dead in the meantime.

§ Mr. Nabarro
That is exactly right. It will probably be in the 21st century. It is interesting to see what progress has been made in one whole decade. The Minister of Health gave me these particulars and I think they will interest the House. A reciprocal agreement is in force between the United Kingdom, France, Belgium, the Netherlands and Luxemburg for giving medical treatment to indigent persons. A Convention extending this agreement to all members of the Council of Europe is in force between those countries which have ratified it (the United Kingdom, the Irish Republic, the Netherlands, Belgium, Norway, Denmark. the Federal Republic of Germany and Sweden)". Then there are a few bilateral agreements. Under a reciprocal agreement with the Channel Islands visitors from the United Kingdom are provided with free in-patient and out-patient hospital treatment in Jersey and Guernsey and general practitioner services (excluding dental or ophthalmic treatment other than emergency ophthalmic treatment) in Guernsey. I have always regarded the Channel Islands as part of the United Kingdom and my remarks about foreigners are not directed to our countrymen in the Channel Islands. I do not, therefore, regard a bilateral agreement between the United Kingdom and the Channel Islands as any evidence of good will on the part of the Minister of Health in extending reciprocal services. Agreements are in force whereby British subjects employed in France, Italy, the Netherlands and Luxemburg who participate in the social insurance schemes of those countries 164 can have their United Kingdom insurance taken into account in reckoning their entitlement, and that of their dependants, to medical benefit. An agreement with Sweden, which is expected to be ratified shortly, entitles all British nationals in Sweden, including tourists, to use the Swedish health services. A similar agreement with Norway awaits signature. Under Australian legislation free medical treatment is available to various classes of pensioners and their dependants … In general, the countries with whom agreements have been made meet the major part of the cost of treatment. My right hon. Friend then makes the surprising admission that he … will make inquiry as to how far dental treatment is provided in each country."—[OFFICIAL REPORT, 14th March, 1957; Vol. 566, c. 211–2.] As far as I am aware, a British national cannot get dental treatment in any foreign country, whereas all these foreigners coming here take full advantage of every opportunity to secure dental treatment—and cases are not unknown of expensive sets of dentures—all obtained on the British health service. They include the numerous students to whom I referred earlier.
I would expect that there would be a conflict of conscience and policy between Socialist Members and Tory Members. As I am a Tory, I can only speak on behalf of the Tory Party——

§ Mr. George Thomas (Cardiff, West)
The hon. Member cannot.

§ Mr. Nabarro
I beg the hon. Member's pardon? I will sit down if he wishes to intervene.

§ Mr. Thomas
I am surprised and grateful to the hon. Member for giving way. May I ask whether he really thinks that he is speaking for the Conservative Party on this question?

§ Mr. Nabarro
The hon. Gentleman, of course, is extremely impatient. If he will allow me to continue for one moment I will tell him to what extent I am speaking for the Conservative Party. For example, it cannot have escaped the hon. Gentleman's researches on this important matter that at a meeting of the Central Council of the National Union of Conservative and Unionist Associations the following resolution was passed on 15th March. 1956, by an overwhelming majority: That this Council while welcoming the publication of the report of the Guillebaud 165 Committee and noting with satisfaction that the National Health Service is being efficiently run within its present limits urges the Minister of Health to give early consideration to amending the appropriate Acts so as to ensure that a charge is paid by users of the National Health Service who are not residents of the United Kingdom, unless some reciprocal arrangements have been made with their own Governments.

§ Mr. Speaker
I thought that the hon. Member opened by saying that the object that he was trying to secure could be achieved without amending any Act.

§ Mr. Nabarro
That is so, Mr. Speaker, but that mistake was, of course, made by the National Council of Conservative and Unionist Associations and not by me, and I have no doubt that my hon. Friend will confirm that legislation would not be necessary.

§ Mr. T. L. Iremonger (Ilford, North)
My hon. Friend has quoted that resolution which was passed on 15th March, 1956. He may be interested to know that on the very anniversary of that date, namely 15th March, 1957, an almost similar resolution, or one to the same effect, was passed by the Ilford North Divisional Conservative Women's Advisory Committee.

§ Mr. Nabarro
If I may say so, I regard my hon. Friend's intervention as both constructive and apposite.
I was about to reinforce the opinion of the Conservative Party in this important connection. The annual conference at Llandudno on 13th October, 1956, used these words: That this Conference is of the opinion that facilities under our National Health Scheme should be made available to nationals of those countries where similar facilities are available to visiting British subjects. All that confirms amply what I am putting to the House tonight. Where reciprocal agreements exist, I have no desire to see foreigners charged in this way. I have no desire at all to see foreigners who are working in this country and paying National Insurance contributions charged for National Health Service attention. I do believe, however, with strength and conviction, and I believe that the overwhelming majority of Conservatives believe—and a lot of Socialists as well—that other foreigners ought to pay the full economic cost for all medical treatment which they receive 166 in this country within the National Health Service, and for all hospital services, all drugs and all medicines.

§ Mr. Osborne
Has my hon. Friend any estimate of how much the public purse would be saved if his proposals were put into effect?

§ Mr. Nabarro
It is the fact that nobody knows. The Ministry does not know. Nobody knows—I have asked numerous Parliamentary Questions on this topic—how many foreigners have been treated in the course of a year. One can only postulate that as there were 1,200,000 aliens passing through British Customs, the figure which has been mentioned on earlier occasions, namely £100,000 per annum, for treating foreigners is probably an understatement.
The hon. Member for Bristol, South-East (Mr. Benn) shouted at me within the first minute of my speech this evening. I will tell him the name at random of one Socialist Member with whom 1 have discussed this matter—the hon. Member for Morpeth (Mr. Owen) who tells me that medical practitioners in Northumberland have approached him and have expressed great anxiety and concern that no attempt is being made to charge foreigners the full economic cost for this service. In fact, if the hon. Member for Bristol, South-East would take the trouble tomorrow to question his hon. Friend the Member for Morpeth he will confirm that he gave me this information. He authorised me to use it this evening and apologised for the fact that, due to a pressing engagement outside this House, he could not benefit from listening to these words of wisdom that I am addressing to the House.

§ Mr. Benn
The hon. Member said earlier that a number of Socialist Members of Parliament had pressed for charges to be made to foreigners. He then cited one example of my hon. Friend the Member for Morpeth who, as far as I can make out, only quoted some doctors in his constituency who took that view and did not associate himself with that view at all.

§ Mr. Nabarro
One can be sure that if the hon. Member for Bristol, South-East reads the OFFICIAL REPORT tomorrow he will find the exact form of words that I used, and which did not contain any 167 reference to pressure. I said there was a great deal of sympathy with these views in all quarters of the House.
Many of my hon. Friends wish to catch your eye, Mr. Speaker, and I will conclude on this note. Charity begins at home. In present circumstances, the British taxpayer is being called upon to pay exceedingly heavily for these National Health Service facilities. Her Majesty's Government have been obliged to refuse an increase in remuneration to the doctors due to current economic circumstances. They have also been obliged to charge a great deal more for prescriptions, many of which have to be paid for by relatively poor people. Furthermore, there is to be this substantial increase in the weekly National Insurance payment, specifically for the National Health Service.
In circumstances of this kind, when the British taxpayer is being called upon to contribute so much, I would not let the foreigner get away with a single penny other than in those two categories to which I have referred—foreigners from countries where reciprocal arrangements exist, and those foreigners who are working in this country and paying National Insurance contributions.
I claim that there is no party political content in making observations of that kind. It is a sensible recourse. It is one which ought to commend itself to the majority of Members of this House, and certainly has overwhelming support in the country. It is scandalous that foreigners, including "plushy" Americans and others who can well afford to pay, are treated free, gratis and for nothing at the expense of the British taxpayer. I trust that my hon. Friend will take the first stops this evening towards remedying this thoroughly unsatisfactory state of affairs.

§ Mr. George Thomas (Cardiff, West)
So that my hon. Friends may have an opportunity to catch your eye, Sir, I shall be brief, but I want to say that I was dismayed to hear the hon. Member for Kidderminster (Mr. Nabarro) make an 168 appeal which was based on very narrow and selfish grounds. He was good enough to put before the House some of the arithmetic which he believes underlies the granting of medical aid to people who visit our shores. I suggest—and the Parliamentary Secretary may confirm it—that it does not cost ld. per head in Britain for the facilities which are given to foreigners who visit our shores. The hon. Member for Kidderminster said £100,000 a year.

§ Mr. Nabarro
I did not say so.

§ Mr. Thomas
Let the hon. Member sit down for a moment. He must wait until I have spoken a little longer.
This country gains a great deal by the Christian principles which find expression in caring for the stranger within our gates. This matter was debated at great length by a crowded House when the original Measure was being debated. I well recall the parable of the Good Samaritan being quoted in the House. It is not a bad thing for little Britain that she shall set an example in morality and considerations of this sort to the world. For one thing, we have to bear in mind that there is a material advantage. How anxious we are to bring tourists to this country.

§ Mr. Iremonger
The hon. Member has moved from arithmetic into higher spheres. He said that the cost was probably 1d. per head of the population per year and I understood that he ridiculed my hon. Friend the Member for Kidderminster (Mr. Nabarro), who suggested that the cost would be £100,000. As a matter of fact, 1d. per head is £200,000.

§ Mr. Benn
That shows how little it is.

§ Mr. Nabarro
I want to correct the hon. Member for Cardiff, West (Mr. G. Thomas). I did not say that the figure was £100,000. I said that that is a figure which is often used. I said that it was greatly underestimated, having regard to the fact that 1,200,000 aliens came into the country in 1956.

§ Mr. Thomas
I am grateful to the hon. Member for Ilford, North (Mr. Iremonger) for underlining the argument I was putting to the House.
The very fact that these people feel secure when they are here is an additional attraction to them to come to Britain. 169 We get far more dollars from the Americans. I traced in the speech of the hon. Member for Kidderminster just another anti-American jibe, just another chance to "have a go" at the Americans. Of course, it produces a cheer outside the House these days, and appeals to people's selfish interests, to say that the foreigner should pay.
The hon. Member appealed to the Ministry of Health on behalf of one of his constituents. Appearently he wanted the Ministry to try to help a constituent who had had to pay and the hon. Member for Taunton (Mr. du Cann) is waiting to produce another case. A constituent of mine who was taken ill in Italy had to pay a heavy hospital bill, but I am grateful that we have better standards for dealing with these people. The hon. Member's argument is that we must behave as other people whom we criticise and condemn have behaved.
The good name of this country means a great deal to both sides of the House. The hon. Member is quite right when he says that there are certain considerations which do not normally fall within the sphere of party difference, and one is the good name of Britain. I believe that over the world people admire what we do in our Health Service. They admire the fact that we do not ask the visitor whether he is able to pay, but treat him as our guest in time of trouble and of sickness. We are not so poor that we cannot do that.

§ Mr. Osborne
The hon. Member has quoted the Good Samaritan and I appreciate his sincerity in doing so, but the Good Samaritan used his own 2d. to pay for the stranger. He did not borrow it from the Americans and then refuse to pay interest on it, as we are doing.

§ Mr. Thomas
I would have expected that argument from somebody other than the hon. Member, but every man has to apply his own yardstick for measuring principle and the hon. Gentleman's measurements are not mine.
On reconsideration, we might bear in mind that we are doing this country a favour in terms of hard cash by the people we attract to the country. Even if that were not so, it is well to do the right thing because it is the right thing. This old country is giving a lead to the world 170 in this matter. I am hoping that the hon. Member's pessimism may be unjustified.

§ Mr. Nabarro
I was not pessimistic.

§ Mr. Thomas
Oh, yes—the hon. Member was as pessimistic as he was loud.
I suggest that when the hon. Member says that reciprocal arrangements will not come until the twenty-first century he is not having much confidence either in himself, in his party or in the future of this country. I urge the Minister to continue the efforts to obtain reciprocal arrangements among an ever-increasing number of countries.

§ Mr. Edward du Cann (Taunton)
I am grateful to my hon. Friend the Member for Kidderminster (Mr. Nabarro) for ventilating this matter tonight, although I do not agree with his argument. In that, I realise, I do not agree, apparently, with the Conservative Party nor with the good ladies of Ilford, North, but that, I am afraid, cannot be helped.
I am grateful to my hon. Friend for raising this matter, because it gives me the opportunity to mention the case of a constituent which has given me great personal concern and which emphasises how unsatisfactory is the state of affairs concerning the lack of reciprocal arrangements for hospital and other treatment. I know that my hon. Friend the Parliamentary Secretary is aware of the details of the case and I am grateful to him for his sympathetic interest. My gratitude is shared by my constituent. The Parliamentary Secretary has written to me about the case and I realise how disappointed he is, as I and my constituent are, that he is unable to help in the matter.
The case came to my notice when touring a housing estate in my constituency. I asked my constituent to write to me, and the best way of telling the House the facts is by reading his letter. He says: My wife and son went to … he mentions a foreign country in Europe— to her home for a holiday in November. She was formerly a national of that country. While she was there she had to have medical treatment which has resulted in her having an operation. This is going to cost me approximately £100. 171 My constituents are members of a working-class family without any great capital at their disposal, or, indeed, the opportunity to gain it.
The letter continues. I am not in a position to be able to pay this. If she was here it would have been covered by National Insurance. I have already borrowed money to pay for four outstanding bills that had to be paid for her treatment and X-rays while she was there. These bills have been settled for the time being, whilst I have been making inquiries as to how I am going to get the money to pay them. One can well imagine the anguish of the man, wondering where the money was coming from. I think that most people in this country feel that it is deeply shocking that visitors to this country on holiday—and I wish to emphasise that they are on holiday—can get treatment under the National Health Service, whereas our own nationals who go abroad on holiday are unable to get that kind of treatment if they need it.

§ Mr. W. Griffiths (Manchester, Exchange)
How on earth would it help the hon. Gentleman's constituent? I sympathise very much with his point of view, and I am sure it would be a very good thing if Britishers abroad were placed in the sort of situation which the hon. Gentleman outlined to the House and were able to get some assistance, but how can it possibly help his constituent if we prevent foreigners who come to this country from getting assistance in such circumstances?

§ Mr. du Cann
I do not think the hon. Member for Manchester, Exchange (Mr. W. Griffiths) was paying attention to what I said before, because I said that I did not agree with the argument of my hon. Friend the Member for Kidderminster, but that I was grateful to him for raising this matter because it allowed me to ventilate what I believe to be a truly shocking personal case. It enables me to ask if it is possible—and we can all agree, I know, that we have the good will of the Parliamentary Secretary—to see if we can increase the degree of reciprocity, and that is all we want.—[HON. MEMBERS: "Hear, hear."]—There is obviously very great agreement on that point, and I think it is a very good thing.
What I am saying in effect is that it is shocking to find that foreigners can come 172 into this country and get treatment when they are on holiday—and I agree and accept it—when our people who go abroad are unable to get it. It is that which is shocking, and it is also shocking to think that if this wife of my constituent was still a national of what was formerly her own country, she could have got that treatment, and, further, that she could have got it if she had been in this country. It is simply because she went abroad to visit her mother, a perfectly proper, natural and right thing to do, that she and her husband have got into these great financial difficulties.

§ Mr. Nabarro
It is all very fine talking about reciprocal arrangements, but we have had ten years of this, and it is going to take another sixty or seventy years at the present rate of progress before we get proper reciprocity.

§ Mr. du Cann
I do not think my hon. Friend the Member for Kidderminster should complain here, because we have an excellent Parliamentary Secretary and a first-class Minister——

§ Mr. Nabarro
I quite agree.

§ Mr. du Cann
—and I am quite certain that the very fact of ventilating the matter tonight will lead them to consider the matter and do what they can. I am sure that we have their good will in the matter. I hope, however, that the Parliamentary Secretary might be able to hold out some hope this evening of an improvement in the situation.
Personally, I intend to take up this particular constituency case, as I think we should, with the authorities of the country concerned. I think this is a two-way movement when we have these individual cases, such as have been mentioned by the hon. Member for Cardiff, West (Mr. G. Thomas) and the hon. Member for Kidderminster. When we have these cases, it just is not good enough to write a letter to the Parliamentary Secretary asking what can be done about it. One has to try to do something in the other country concerned as well. I myself propose to do what I can to bring pressure to bear on the authorities of the country concerned, because I do not believe that it is in the interests of our relations with that other country if there are items of disagreement of this sort. I therefore propose to do what I can in 173 that connection, but I hope that the Parliamentary Secretary may be able to hold out some hope for us this evening.

§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
I apologise for intervening now, but I have a good deal of ground to cover in my reply; otherwise, I should have liked to have listened to any other contributions that might have been made.
I congratulate my hon. Friend the Member for Kidderminster (Mr. Nabarro) on raising this subject, this knotty problem which has actually cropped up in many forms since the National Health Service was introduced. I find myself in a slightly anomalous position, being caught, as it were, in the cross-fire between both back benches, and having a good deal of sympathy with almost everything that has been said by almost everybody who has spoken, and in particular, having much sympathy with all that my hon. Friend the Member for Taunton (Mr. du Cann) said; but I will come to that case later.
I am fully aware of the resentment felt in certain quarters at foreigners being entitled to benefit from the National Health Service without apparently contributing to our revenue. It is a quixotic practice and difficult to justify in all circumstances, but tonight I should like, as far as I can, to try to clear up some misunderstandings about what the volume of this traffic is and what the possible costs have been, and also to deal with the difficulties which would be attendant on making regulations under the National Health Service (Amendment) Act, 1949, which allowed the Minister to make charges not to foreigners but to … such persons not ordinarily resident in Great Britain as may be prescribed. That goes a little wider than the term "foreigner" in the sense in which my hon. Friend used it. I am not expressing any opinion whatsoever on the merits or otherwise of making such regulations.
My hon. Friend talked about foreigners. I am concerned with non-residents—nontaxpayers, if hon. Members prefer the term. They include not only foreigners but also Commonwealth citizens, those from overseas Colonies, citizens of the Irish Republic, and United Kingdom citizens 174 resident abroad but here on holiday or on leave. These categories of people have a very important bearing on the practical problem, which would arise if we did introduce regulations, in discriminating between residents and non-residents. That is one of the minor administrative difficulties which crop up.
My hon. Friend gave his version of the figures involved. We are all of us in a slight difficulty about them, because there are no exact figures. Of the 1,200,000 he mentioned I am told that about 800,000 stay less than six months, and it is estimated that the average stay is about two weeks. Compared with the rest of the population, that number is equivalent to about 12,000 bed-days at any given time. The total cost might be roughly £60,000. However, these are estimates and are entirely conjectural.
I have had given to me some very interesting figures which have been brought out by the London Executive Council, which has produced figures for some years. These figures are for the quarter ended 30th September, 1955. The important thing to remember is that that is the quarter when most overseas visitors are here, and that that is the part of the country which is most affected because 90 per cent. of travellers to Britain come to London. The analysis shows that in any one quarter in the London area about 14,000 temporary residents are treated, of whom fewer than a quarter are from abroad. About 3.000 are people from overseas.
It is interesting to examine these figures further. There are, to give the exact total in the last year for which figures are known, 3,273 people from overseas using the health services in the London Executive Council's area during that quarter. Of the five nationalities which head the list three are Commonwealth. Australia heads the list, followed by the United States, followed by the Irish Republic, South Africa and Canada in that order.
I hope that the House will realise the implication of those figures, that in proportion to the number of tourists Canadians and Australians are probably using the health services to a far greater extent than any Americans or any other foreigners whatsoever. On the basis of the figure we have here we reckon that the outside estimate of the cost of all 175 non-residents using the National Health Service is probably £150,000. That is the outside estimate.

§ Mr. Osborne
A year?

§ Mr. Vaughan-Morgan
A year.
The figures are very interesting. They range from 339 Australians to two from the Fiji Islands. I think that that will provide a check to the wild rumours that sometimes circulate about the volume of this traffic and the amount that is involved, but I should like to go a little further.
Two kinds of treatment are involved when one is considering the National Health Service. First, there is accident or emergency. I think that the debate has shown that all of us would far and away prefer to continue on what has been called the Samaritan principle. After all, "hospital" and "hospitality" are almost the same word. While I would not go as far as to say that it was necessary as a good advertisement for the tourist traffic, which the hon. Member for Cardiff, West (Mr. G. Thomas) suggested and which, I thought, a rather specious argument, it is a principle that we ought to accept.
I join with hon. Members on both sides of the House in wishing that there was more reciprocity. It is one thing to lead the world, but it is much more consoling if others are following a little nearer behind. While I would not be so pessimistic as my hon. Friend the Member for Kidderminster, I would say frankly that very little progress has been made.

§ Mr. Nabarro
That is what I was saying.

§ Mr. Vaughan-Morgan
We shall have reciprocity with Sweden when the treaty is ratified, and we have a treaty with Norway awaiting signature. My hon. Friend gave figures for other countries. He was slightly inaccurate on one point. We have reciprocity with all the Channel Islands, except Sark.

§ Mr. Nabarro
The countries, which my hon. Friend has just mentioned, where there is or is to be some sort of reciprocity are Norway, with a population of 3 million, and Sweden, with a population 176 of 7 million, but what about the really populous countries such as Western Germany, with 57 million, and France with 42 million? It is the people from those countries who are coming here and getting the service, and it is about those people that we ought to be doing something.

§ Mr. Vaughan-Morgan
With all respect, they are not. I agree with my hon. Friend's argument but not with its basis. I want reciprocity, but we do not want to single out the countries that he has mentioned, because their nationals are not among the largest classes of those using the Service.
I turn now to the crux of the grievance—the alleged use of the hospital services for expensive operations and the dental and ophthalmic services for costly work. I think that the House knows, and the country should know, that steps are taken to see that these privileges are not abused and that those who come here for the express purpose of free treatment are prevented from doing so as far as we possibly can. All aliens coming into the country are interviewed, or can be interviewed, at the port of entry by immigration officers. One of the purposes is to satisfy the authorities that they are not coming here to exploit the Service. If there is reason to think that they are, those concerned are either not allowed entry into the country or the appropriate authorities are warned that they should be treated as private patients.
It is of interest to note that last year about 1,000 foreigners were dealt with under this procedure. What I have said does not apply to "non-alien nonresidents"—and I apologise for the phrase. It does not apply to Commonwealth citizens, but persuasion is used to achieve exactly the same end—I think with some success. If there is any exploitation of the dental or ophthalmic services we have to remember that a substantial charge is made and delays may be involved in securing and completing treatment, which really makes it available only for long-term visitors. But I agree that the occasional loophole exists. What I have described is the informal machinery which we have to prevent exploitation, but I must admit that it is informal and incomplete.
177 Why have we not used the powers under the 1949 Act? It is entirely for administrative reasons. First, it would be necessary to define "non-residents". That is not insuperable. The definition would presumably also have to cover "non-alien non-residents". It would involve extended controls at the ports and introduce a new principle with a significance far beyond this debate. If we exclude non-residents from entitlement to the Health Service we impose upon doctors, dentists and hospitals the responsibility of discovering whether a patient is entitled to receive treatment. Either the patient must produce something such as an identity card, or a very unwelcome burden is placed upon the practitioner to decide.
How does he decide? By the patient's name, his accent or his looks? Think of disputes that might arise with a British subject in agony, with a foreign name or accent, who had lost his card. When a foreigner has been pinned down under the surgical knife, how is it to be discovered whether he is a Swede or a Norwegian? When he is on the operating table, how is it possible to tell whether he comes from Sark or anywhere else? It is quite impossible.
Even if all that could be solved, owing to certain existing international treaties it would be necessary to find out whether the patient was a merchant seaman, or was suffering from an infectious disease because, if so, he would be entitled to the Service free. If we are to make regulations we must make sure that they are watertight and that they work. They must not cause unnecessary trouble to those affected, they must not exclude those legitimately entitled, and they must not be expensive.
Does my hon. Friend want to bring back the identity card? If he does, it will cost £1 million, and that would be a very costly sledgehammer for such a small nut, and I do not think that anyone is more enthusiastic than the hon. Member for economy. These are the real difficulties which are constantly in our minds.
I should like to quote some words used by the right hon. Member for Ebbw Vale (Mr. Bevan) on 19th October, 1949, because they are still very relevant. He said: 178 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."—[OFFICIAL REPORT, 19th October, 1949; Vol. 468, c. 638.] We wholly accept that principle. I recognise entirely the exacerbation which the present position causes. Despite the fact that the problem is not as large as has been suggested, and that the solution is not easy, it is very much in our minds.

§ Mr. Wedgwood Benn (Bristol, South-East)
I am extremely grateful to the Parliamentary Secretary for sitting down in time to allow at any rate one hon. Member to point out that the argument of the hon. Member for Kidderminster (Mr. Nabarro) has been totally destroyed. He knows as well as I do that there was never anything practical in what he had to say. He reduced the cost of the Service to £575 million net, and I do not dispute that, but he did not say that every foreigner who comes to this country pays tax. He pays it when he buys cigarettes, and he pays it in bus fares. He pays all the indirect taxes exactly as do residents of this country. Therefore, for all practical purposes the foreigner makes a substantial contribution, and he benefits from the Health Service only if he needs it. It is very unlikely that many foreigners come here for that specific reason.
There was never any real case behind the hon. Member's speech, and the Minister's speech will be of enormous use to all of us in future in dealing with the irresponsible arguments advanced by the hon. Member for Kidderminster. I am grateful to the Minister for destroying the hon. Member's argument. This was really an attempt by the hon. Member to build up hatred against foreigners, particularly Americans, who have subsidised the Government since they have been in power. It is very unworthy of the hon. Member, although I fear that it is typical of him and several of his hon. Friends who think like him. If the Hungarian refugee cannot get a job, the hon. Member thinks that he should pay for medical attention. The hon. Member's argument gives us an insight to his principles and those of many who think like him. My hon. Friends are extremely grateful to the Minister tonight.

§ Mr. T. L. Iremonger (Ilford, North)
The speech of the hon Member for Bristol, South-East (Mr. Benn) has been characteristically mean and bitter. The House has been very dissatisfied and disappointed to hear the rather complacent attitude which the Minister has taken——