VACCINATION CERTIFICATES (CHARGES) (Hansard, 8 June 1961)

§ Mr. R. W. Sorensen (Leyton)
I wish to raise the question of the charges that can be made by medical practitioners for certifying that they have vaccinated or inoculated a patient. The matter was brought to my attention by a constituent of mine a short time ago, and I was rather surprised that this possibility existed. In other words, although I am certain that the great majority of medical practitioners do not exercise the power, apparently there is a minority who do so exercise this opportunity to make what I can only call petty and mean charges for the small but necessary service which they render in affixing their signature to a certificate to say that they have vaccinated or inoculated their patient.
It is obviously necessary in many cases that individuals who have to go overseas should have certificates of inoculation or vaccination. That has been the case with myself and, I am sure, many Members of the House, but it does seem extraordinary that the necessity of having a certificate to show to the appropriate authorities that the person has been vaccinated or inoculated should nevertheless entitle the practitioner to charge almost any amount he pleases by way, I suppose, of a contract between himself and the patient. I have already said that this applies to only a small minority. Nevertheless it does apply, and it is exercised. That is why my constituent, in great astonishment, wrote to me and then saw me about this matter.
Apparently what happened was this. He was about to go abroad and required to be vaccinated. He went to the doctor and took with him, incidentally, his passport. When he had been vaccinated the necessary certificate was given to him with a request by the doctor that he should pay an amount of 7s. 6d. The same amount, or approximately the same amount, was also asked for for signing the passport or the application for the passport.
In the latter case one can understand that the doctor might well say, "That is beyond my province, and I must make 1547 some small charge," although I think even that rather unwarranted as a matter of principle; but in the case of the certificate of vaccination or inoculation it seems to me quite improper, because the purpose of being vaccinated or inoculated is for the protection of the health of the patient and the people who receive him abroad.
Indeed, one wonders how far this will go. It is possible for medical practitioners to make this small charge. They may even, I presume, charge for usage or share of a surgery. I am quite aware that doctors in some circumstances have been able to charge and still do charge beyond what otherwise is paid to them for medical services, as in the case of certifying mental patients. I must confess my wife was highly amused when at one time, as one of the justices of the peace, she was called upon, as she was two or three times a week, to go along to a doctor and certify with the medical practitioner some unfortunate mental patient and he got two guineas and she received nothing at all.
However, she waived that, and one waives the fact that all of us sign innumerable forms from time to time and would not dream of asking any payment. I suppose we could do so. I suppose one could enter into a kind of arrangement whereby one's constituents, if they wanted any forms signed, would pay, say, on a scale of fees according to the importance of the forms. The idea, of course, seems perfectly ridiculous.
Therefore, I want the hon. Lady to assist if she possibly can in this matter. Indeed, I have had recently evidence of other sorts of charges which seem questionable. I have in my hand a letter from a person who recently reported on this practice of charging for a certificate of vaccination. He said that he discovered that his own son who was to join the A.T.C. went to the doctor, who briefly examined him—it took two or three minutes only—and the doctor said, "This is not under the National Health. There is a charge of 5s." My correspondent says his son had only the residue of his pocket money with him, and said, "Oh, I have only half a crown with me." The doctor replied, "That will do," and accepted the half crown.
1548 This is an extraordinary procedure. I am not doubting that this is quite legal, but if it is, it would seem to be due to an omission, I imagine, from the Acts, and was certainly not intended by the Ministers responsible for the promotion of those Acts.

§ Mr. Speaker
The difficulty about this—I may not have heard enough of the hon. Member's speech—is whether it is possible to arrive at the result he desires without legislation.

§ Mr. Sorensen
I think it is, and I shall endeavour to show that in a moment. I shall not speak for more than a moment longer. I am aware that legislation could meet the situation, but I am proposing another way. The hon. Lady might approach the British Medical Association and ask them to intimate in some way, by circular or otherwise, that it would be highly advisable that no doctor make such charges. That would not require legislation but merely an arrangement between some such body and the Ministry.
I want more or less to leave it there, but I would ask the hon. Lady not to treat this matter as trivial. It may seem trivial, but if I were charged in this way I would most certainly feel indignant at what I could only consider an abuse. This is an abuse, if only by a small number of doctors, and it could be dealt with in the way I have suggested.

§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
The first point in reply to the hon. Member for Leyton (Mr. Sorensen) is that doctors are under no obligation to provide these certificates, as he is aware. The legal position is that Section 33 (2, d) of the 1946 Act, as amended by the Schedule to the 1949 Act, provides for regulations to be made. …for the issue to patients or their personal representatives by medical practitioners providing such services as aforesaid of such certificates as may be prescribed, being certificates reasonably required by them under or for the purposes of any enactment. The Minister has no power to prescribe certificates not required for an enactment, and I am advised that the International Sanitary Regulations, 1549 adopted by the World Health Organisation, under which international vaccination certificates are provided as evidence of vaccination, cannot be regarded as an enactment for the purposes of the National Health Service Acts.
The present legal position with regard to these international certificates is that they may be required by persons leaving this country as evidence of vaccination against smallpox, cholera or yellow fever, on entry to another country which makes this requirement. The International Sanitary Regulations adopted by the World Health Organisation do not make this requirement compulsory for persons leaving this country. The choice therefore lies with the foreign Government. There is no statutory provision in this country to require those leaving the country to be vaccinated or inoculated or to obtain a certificate that this has been done. An amendment of the National Health Service Acts would be necessary to require doctors to provide these certificates free of charge.

§ Mr. Sorensen
The fact remains that if I go overseas I require certificates to say that I have been vaccinated and inoculated. I can go to my doctor for vaccination or inoculation; surely it is possible, without legislation, for the appropriate medical authority to advise the practitioners who perform these small operations to remit the certificates without charge.

§ Miss Pitt
The short answer is that the doctor is not required to provide this under his terms of service. Therefore, the answer to the hon. Member's point is that it is for the doctor to decide what charge, if any, he shall make. It is a private transaction.
The hon. Member thought it was not intended that this should be the case when the National Health Service Act was passed. The answer clearly must be that it was the intention, because such certificates are not required for the purpose of any enactment, and that was specifically laid down. The present position with regard to the Service is that under some 23 different enactments the Regulations now specify 13 different purposes for which certificates are prescribed for free issue.
The main purpose for which doctors are required to provide free certificates are: to substantiate claims for various 1550 financial benefits such as National Insurance, industrial injury, family allowances, National Assistance and pensions of various types; to establish a patient's unfitness for such purposes as jury service and registration as an absent voter, fitness for analgesia in childbirth, or pregnancy for the purpose of obtaining welfare foods; or to authorise sight tests under the supplementary ophthalmic services; and there are others.
It is difficult to see grounds for Parliament placing a duty on the profession to provide free certificates which it does not see fit to require the public to obtain. If a doctor is asked to certify that these procedures have been carried out for the benefit of someone going abroad and in respect of one of his National Health Service patients he may make a charge for so doing. Whether he does so or not is entirely a matter between him and his patient. There is no evidence to show that these arrangements involve any hardship to those people who must have international certificates because they choose to go to a country which will not admit them without one, and this issue of certificates must be regarded as being for the private convenience of the patient.
The hon. Member asks how far the process goes. Under his terms of service a doctor may not make a charge to a National Health Service patient for any medical attention and treatment which he gives to him. Treatment is defined in the Regulations to include the issue of certificates for the prescribed purposes, being medical certificates reasonably required under, or for the purpose of, any enactment. A doctor is at liberty to charge for any service which he gives which is not treatment as defined.
Finally, the hon. Member put a suggestion to me and asked whether it was not possible for my right hon. Friend to come to some kind of voluntary arrangement with doctors to provide this type of certificate free, but I am clear that the answer is "No." My right hon. Friend is not required to make any provision for this kind of certificate. If he were so required, it would need power given by Parliament to impose what would be an obligation on the doctor. There is no such power 1551 and the provision of such a certificate is a private transaction between the doctor and the patient.

§ Mr. Sorensen
Before the hon. Lady sits down, may I press the point that the great majority of doctors make no charge whatever and would not think of doing so? Is it not possible for the Minister not to require a doctor not to charge but to advise, or secure the co- 1552 operation of the British Medical Association to advise, doctors not to charge in the same way as indeed most doctors do not charge?

§ Miss Pitt
No, Sir. This does not come within my right hon. Friend's province.