§ Motion made, and Question proposed. That this House do now adjourn.—[Mr. Peel.]
§ 9.50 p.m.
§ Mr. Donald Wade (Huddersfield, West)
In raising the problem of British subjects taken ill abroad, I should like to say at the outset that I am well aware of the value of our consular services. There are many occasions on which the British consul is of great value to British subjects when they find themselves in difficulties, and with the increase in the number of people going abroad for their holidays, this may create a growing problem for our consular staff. I recognise that, and I would do all that I can in my power to urge those going abroad, either on holiday or on business, to safeguard themselves so far as possible against the hazards of living or travelling abroad.
At the moment, many people are looking at attractive brochures and beginning to make their plans for the summer holidays. They are enjoying in anticipation happy days in the sunshine in some foreign country, but it is as well to remember that when going abroad one does not leave behind the ordinary risks of life, and these risks may be greater rather than less.
For that reason I would advise everyone to take out some kind of insurance against illness or accident. For example, one can take out a policy covering oneself against medical expenses. I believe that £100 is the normal cover, but it 1039 could be more. One can also take out a personal accident policy, and the insurance companies which deal in motor insurance will no doubt advise on policies covering the risk of accidents on the road.
I think that one has to recognise that there are exceptional misadventures against which one cannot expect people to insure, or at any rate which people do not normally anticipate. As a result of falling ill, a British subject may find himself in a very serious predicament and involved in expenditure far beyond his means. That situation may arise from the heavy cost of a long spell in a foreign hospital, or from the equally heavy cost of transport home.
I propose to illustrate this with some specific examples, because I think that it is better to deal with particular cases rather than generalities. The three examples which I intend to refer to tonight are of people stricken with polio when abroad. This happens to be a subject about which I have some knowledge.
The first case is that of Bryan Thomas, whose parents live in my constituency. I shall give only a brief résumé of the facts. He is a young school teacher who was educated at Huddersfield College and Leeds University. He was teaching at the East Ham Grammar School. At the end of July last year he went on holiday to Rome via Strasbourg. He arrived in Rome on 9th August and shortly after his arrival became ill. Polio was diagnosed and he was taken to the Policlinico Hospital in Rome. On 18th August the British consul cabled Bryan's father informing him of his son's illness, and Mrs. Thomas flew out to Rome the same evening. Mr. Thomas, senior, who is a Post Office employee and is due to retire this year, borrowed the money to enable his wife to go out to Rome.
As a result of this unfortunate attack of polio, Bryan Thomas was paralysed and had to be put in an iron lung. His mother remained in Rome and visited him daily. The hospital charges, which included the cost of an English night nurse, were £38 a week, a staggering amount for a family of modest means.
But even more serious was the problem of getting the boy home. The longer he remained in Rome the greater 1040 the amount of the hospital charges which would have to be met. On the other hand, the cost of transport was prohibitive. Bryan's mother was extremely worried, as I learned when I was approached by his father, who was even more worried when I received a letter in reply to one that I had written to the Foreign Office, informing me that the Italian doctors had said that Bryan might have to remain there "for weeks or even months". The letter that I refer to now is dated 1st October, 1963—and Bryan had already been there since August.
I will not trouble the House with the full story of my correspondence with the Foreign Office, the numerous telephone calls, and the efforts made to bring Bryan home. At first I was advised that it would be essential to have a British iron lung flown out if Bryan was to be brought back to England, and that the cost would be about £1,000. Later I learned that he could be brought home with the aid of a Cuirass respirator—which, for technical reasons, makes the journey easier—but that it was still essential that he should be brought back by aircraft and that a medical team should be flown out. The most up-to-date figure that I now have for the cost involved in this journey is approximately £550—not as much as the original forecast but nevertheless a considerable sum.
The point is that no progress could be made until the money was raised or promised. Somehow the cost had to be guaranteed before the Foreign Office could ask the Air Ministry to go ahead with the arrangements. I shall always remember one entire day that I spent at the telephone, trying to find a solution and knowing all the time how worried Bryan's parents had become. Meanwhile, I learned that Bryan was getting depressed, and that this was adversely affecting his progress.
I come now to the solution of this case. Eventually I was able to arrange with the National Fund for Polio Research to underwrite the cost, although the amount at that time was uncertain. The British Polio Fellowship, in co-operation with the Huddersfield Polio Fellowship, undertook to raise the necessary funds to meet both the cost of transport 1041 and the hospital charges. I should like to pay tribute to the trouble taken in making the arrangements and, in particular, to the Royal Air Force in flying Bryan Thomas home. A medical team was flown out and an aircraft was diverted specially to Rome in order to bring him back.
He is now in hospital in Sheffield, and I understand that he is making slow but satisfactory progress. Both he and his parents were very thankful that he was able to get back, and since his return there has been a most generous response to the appeal made by the British Polio Fellowship, The whole cost of the hospital charges and transport will be covered, and I am grateful to the individuals and organisations who have helped in this way. The only reason I do not mention names is that I am afraid that I might leave somebody out. I stress, however, that great gratitude is felt for what has been done. But it is fair to point out that if no one had taken up the case Bryan might still be in hospital in Rome, with the bills continuing to mount. There is apparently no Government fund, or intergovernmental arrangement, for dealing with this kind of situation.
Since the Bryan Thomas case, two other cases have been brought to the attention of the British Polio Fellowship, and it has been able to come to the rescue. The Reverend David Howe was returning from Spain with two friends when he taken ill in Tours, in France. A very severe form of polio was diagnosed, and his widowed mother flew out to Tours. At first Mr. Howe was too ill to be flown home. In this case the hospital expenses amounted eventually to £400, and the estimated cost of bringing Mr. Howe home was about £500. This is a very substantial sum for anyone to have to raise. Someone heard of the British Polio Fellowship and, through the aid of the Consular Department of the Foreign Office and the Royal Air Force, transport arrangements were made.
§ It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed. That this House do now adjourn.—[Mr. Peel.]1042
§ Mr. Wade
A guarantee was given by the Fellowship. A medical team was flown out, and, in December last, Mr. Howe was brought back to England.
The third case is that of a Mr. Turner, a business executive in his late twenties. He contracted polio in Singapore. He was out there with his wife. Like Mr. Howe, he had a widowed mother in this country. I need not go into all the details. A friend heard of the Polio Fellowship, which got in touch with the Commonwealth Relations Office. Again, a guarantee was obtained. The C.R.O. approached the Air Ministry, and Mr. Turner was flown back to London by the Royal Air Force. Perhaps I should explain that one reason for using the Royal Air Force is that it is better equipped for bringing home a polio victim.
What worries me is that there could well be other British subjects who have been taken seriously ill abroad and who do not know of any voluntary body which might be willing to assist with the extremely heavy cost of hospital and transport charges. What happens then? I do not know.
Reverting to the case of Bryan Thomas, I find that, whenever I mention it to people, they say something to this effect, "It is a mercy flight. Surely, the R.A.F. would be only too willing to do it free. "I do not know the answer to that. Presumably, the Minister has to consider the interests of the taxpayer. But, be that as it may, there are three other relevant questions.
First, if there is delay in bringing a patient home, while those concerned wait until the money has been found or a guarantee is obtained, may not this, in some cases, have serious consequences for the health of the patient? Second, what happens if a patient has no money and no relatives who can help? Does he just have to stay indefinitely in the foreign country, and, if he is in a fee-paying hospital, is he turned out, or what? Third, is this not the kind of circumstance in which there ought to be reciprocal arrangements at inter-Governmental level?
I have been examining the existing reciprocal arrangements. I understand that, if a British subject is taken ill in New Zealand, Denmark, Norway, Sweden or Yugoslavia, whatever the 1043 purpose of his stay, if his need for treatment arises during his visit, he is eligible for treatment under the particular country's national health service. Presumably, this does not cover any fee-paying hospital, and there is no provision for transport home.
In the case of Belgium, France, West Germany, Luxembourg and Holland, British subjects employed there are eligible for treatment under the country's national health service, but British subjects on holiday or in transit are not eligible, and, again, there is no provision for fee-paying hospitals or for transport home. In Italy, there is no reciprocal arrangement for health benefit, although British subjects who are both employed and insured in Italy are eligible for treatment under the Italian health service. If a British subject is taken ill on holiday in Italy, he should, no doubt, get in touch with the British consul, but, as I have explained, no fund is available to help him and, if a loan were made, I understand, no part of it would be met by our own Ministry of Health.
Obviously, there are some very large gaps in the health benefits which a British subject may expect to obtain when abroad. Could not an effort be made to negotiate reciprocal arrangements to deal with the exceptional cases, covering both medical expenses and the cost of transport home? If thought fit, it could apply only to expenditure above a specified sum. Many foreigners benefit from our own National Health Service. I do not object to this, but it seems only reasonable that we should try to negotiate some improved benefits in return.
Meanwhile, I wish to put forward a practical suggestion. The cases to which I have referred have shown that there are some voluntary bodies wishing to help, if they are asked to do so; but they cannot do anything if they do not actually know of the cases. Could not a list be compiled of organisations willing to help either on account of the nature of the ailment or because of the occupation of the patient? If some arrangement could be made whereby a voluntary body was informed this might prove very valuable. I suggest that the Ministry of Health be asked to compile a list, and the Foreign Office and the Commonwealth Relations Office should be responsible for the distribution of the 1044 information. I do not think that this would involve any great administrative work and I think that it would be well worth while.
I hope that my suggestion will be considered and in any case I trust that, as a result of my raising the subject, other unfortunate British citizens who may in future be taken ill in some foreign country far from home will reap some benefit.
§ 10.6 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I am sure that the House and the Joint Parliamentary Secretary will agree that the hon. Member for Huddersfield, West (Mr. Wade) has raised an extremely important subject. I agree with a great deal of what he said at the outset. It is, of course, wise for any British subject going abroad, either on business or for a holiday, to take out an insurance policy. But we may all know of cases where illness has followed, and involved a person in expense far beyond what even a prudent person would have been likely to cover by an insurance policy.
The hon. Member outlined three particular cases. They were sad examples, all involving polio, but for that reason all the cases were in a sense fortunate in that a particular voluntary body, the Polio Research Fellowship, was able to help and refund part, if not all, of the expense incurred. But every hon. Member at some time or other must have had a case of a constituent who found himself in some difficulty of this kind and faced with expense totally unexpected and beyond his capacity to meet.
I appreciate that there are great difficulties for the Minister. There is no provision in the National Health Service Act for meeting expense incurred outside the British Isles by a citizen of this country. As the House will know, and the hon. Member for Huddersfield, West reminded us, for some time the National Health Service Act has offered facilities for foreign visitors to this country who fall ill.
I well remember the late Aneurin Bevan explaining the motives which led him to include this provision in the original legislation. He said that the reasons were two-fold. He thought it a simple good-neighbour policy. At the same time, he said that he hoped that it 1045 would encourage other countries to offer similar facilities to British citizens living and travelling abroad. I know that over the last 15 years or so there have been efforts to bring about these reciprocal arrangements. On the whole, the results have not been very encouraging. The hon. Member for Huddersfield, West listed the reciprocal arrangements which have been achieved. But even these do not give the same facilities as are available to the national of the country concerned and they do not meet the bill. They do not constitute genuinely reciprocal arrangements.
I wish to ask the Parliamentary Secretary a question which is additional to those asked by the hon. Member for Huddersfield, West. I wish to know whether any attempts have been made to negotiate an agreement with a foreign country which did offer to the British visitor the same sort of facilities that a national of that country would obtain if he fell ill in this country. The difficulty is that almost no country offers its own citizens anything like the benefits that we offer our citizens under the National Health Service. Although I do not think that any hon. Member would want to curtail the benefits we offer, we think that the time has come after 15 years to get a slightly better quid pro quo than successive Ministers of Health and successive Governments have been able to achieve in the past. I hope that we shall have a few encouraging words from the Parliamentary Secretary.
§ 10.10 p.m.
§ Mr. A. E. Oram (East Ham, South)
I support what the hon. Member for Huddersfield, West (Mr. Wade) has said and thank him, in particular, for having raised the case of Mr. Bryan Thomas. I feel involved in this case, because Mr. Thomas was at the time of his illness a teacher at the East Ham Grammar School and many people in East Ham and the Borough Council have joined in the charitable funds to which the hon. Gentleman referred. We are glad to know that there has been a sufficient response to cover all the expenses involved. My hon. Friend the Member for East Ham, North (Mr. Prentice) and I were in correspondence with both the Foreign Office and the Air Ministry about the great difficulty in this case. We were 1046 glad that the expense turned out in the end to be rather less than we feared at one time.
Nevertheless, the points raised by the hon. Gentleman are most important. He put forward some practical suggestions. I hope that the Joint Parliamentary Secretary will be able to give a very sympathetic reply to the points which have been made. I want to put forward one argument in my own behalf. We as a country accept responsibility for the safety of or citizens in civil disturbances overseas. It seems to me that there is a parallel between the calamity of very serious canes of illness—I do not mean every ordinary illness, but serious illnesses such as that suffered by Mr. Bryan Thomas, who was struck down with polio—and the calamity of a civil disturbance. I hope that we shall get a sympathetic reply from the Government to the very formidable case put forward by the hon. Member for Huddersfield, West.
§ 10.12 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
First, I would like to thank the hon. Member for Huddersfield, West (Mr. Wade) for giving us the opportunity this evening to consider a question which is of widespread interest to people everywhere. Indeed, I welcome the opportunity to clarify what I recognise is a complicated matter. It might be helpful first to look at the arrangements which we provide for visitors to this country, as there is a great deal of misunderstanding on this subject and also because it has some bearing on what I shall say later.
Steps are taken at all the ports of entry to prevent people who are not resident in this country from entering purely for the purpose of taking advantage of the National Health Service. There have been cases of people being turned back. In other cases people have given an undertaking to pay for treatment. The House may like to know that hospital authorities have been advised of the arrangements they should make for the treatment of visitors from overseas. However, if a visitor to our shores has the misfortune to fall ill, we act on the Good Samaritan principle: we provide treatment. I cannot think that anyone would wish it otherwise. Admittedly it is not possible 1047 to identify precisely those cases where treatment has been provided on this basis, and we cannot estimate the precise cost. There is no reason to believe that it is really substantial. Hon. Members will see that it is not practice—as some people still seem to imagine—to provide unrestricted services for anyone who may come to this country. This is a fact which ought to be more widely known and I welcome this opportunity once again to make the position clear.
The hon. Member for Huddersfield, West and the hon. Member for St. Pancras, North (Mr. K. Robinson) raised the question of reciprocal arrangements with other countries. Those who are familiar with this queston will be aware that the Government are anxious to improve and extend these arrangements. Perhaps I should explain that reciprocity agreements stem normally from the desire to get arrangements to cover insurance benefits in the widest sense, and the major part of this interest centres on cash benefits.
It may not be generally known that in most countries other than the United Kingdom medical treatment is an insurance benefit available only to insured persons and their dependants, and for these reasons it is my right hon. Friend the Minister of Pensions and National Insurance and not the Minister of Health who normally negotiates reciprocity agreements and who, when he can, includes in his negotiations arrangements for medical and other treatment as well.
Let me make it absolutely clear that the Government are anxious to make reciprocal arrangements for medical treatment wherever possible for our nationals abroad, but as I think hon. Members recognise, we are faced in this connection with a major difficulty in that very few countries provide a health service comparable to ours. Most of them have systems of insurance instead, which cannot easily be extended to visitors from the United Kingdom.
In his negotiations with other countries the Minister of Pensions and National Insurance has been able to make full reciprocal arrangements covering medical treatment for all United Kingdom citizens, whether resident or tourist, with Denmark, Sweden, Norway, Yugoslavia and New Zealand. Local conditions 1048 are, of course, applied in these arrangements, but they do not differ widely from those which we enjoy under our National Health Service.
Agreements covering health benefits for United Kingdom citizens resident abroad and insured under local insurance schemes have been made with France, Belgium, Luxembourg, Italy, Israel, Malta, the Netherlands, Switzerland and the Federal Republic of Germany. Some of these agreements cover also British workers who remain insured in the United Kingdom while they are employed temporarily in those countries. The stumbling block in the way of negotiating reciprocal agreements for medical treatment more widely has been the lack of a health service comparable to our National Health Service in many other countries.
Most countries outside the United Kingdom which do not have a comprehensive service like ours provide medical treatment, often limited in scope and duration, for specific classes of insured persons and their dependants, who have to satisfy certain conditions, for example as to their financial contributions, which are laid down by local insurance institutes working within a national frame work.
Most systems of medical benefit abroad do not automatically cover holiday-makers and tourists. Hon. Members will appreciate that we cannot expect insurance institutes abroad to treat visitors from the United Kingdom more generously than they treat their own people, and arrangements of this kind form no part of our National Health Service. The National Health Service is not organized by insurance institutes of this kind and the Minister has no power under the National Health Service Acts to reimburse the costs of any treatment provided outside the Service either at home or abroad.
The hon. Member for St. Pancras, North asked me whether any attempts have been made to negotiate an agreement which afforded our people who might fall ill abroad the same degree of service that they would have had if they had fallen ill at home.
I know that the hon. Gentleman will understand when I say that I cannot answer that question authoritatively to night because negotiations for these 1049 reciprocity agreements are carried out not by the Minister of Health but by the Minister of Pensions and National Insurance. It is an interesting point and I should like to go into it myself. If I can get any useful information I hope that he will be content if I write to him.
We can, therefore, only get reciprocity of treatment in those cases where the other country regards it as practicable to provide a service without regard to insurance criteria and without claiming reimbursement of costs. This applies to the Scandinavian countries, New Zealand and Yugoslavia. In other countries with which we have limited agreements—France and West Germany for instance—this is not practicable but reciprocity applies to certain classes of people such as those who go to these countries to work, whether they become insured persons or remain covered by the British scheme of insurance.
My right hon. Friend has not the power to pay medical expenses incurred outside the National Health Service here or abroad. His duty is clearly laid down in Section 1 of the 1946 Act. It is to…promote the establishment in England and Wales of a comprehensive health service designed to secure improvements in the physical and mental health of the people of England and Wales.It might be argued that he should take power to pay for treatment abroad but he has not got that power at the moment. We must recognise that this would, in effect, be comparable to paying for treatment given in this country outside the Health Service. It would be illogical for him to meet the costs of one and not of the other.
Moreover, I suggest that, under an arrangement of this kind, there would be virtually no control over the amount involved and therefore no protection for the British taxpayer. One could well imagine the reaction of Parliament to any suggestion that the Exchequer should meet whatever costs might be involved by anyone who chose to go overseas to any country in order to obtain medical treatment.
The hon. Member for Huddersfield, West referred to three cases where people who had gone abroad had the misfortune to be taken ill while overseas, I have studied the details and agree broadly with the facts as he stated 1050 them. In all three cases the unfortunate traveller was stricken by poliomyelitis and consequently needed to be transported home by air with specialised equipment.
In each case the Royal Air Force, using its own special techniques, flew the patient home safely. It was arranged that on arrival admission should be made without delay to a National Health Service hospital. In each case the cost to the individual was kept to a surprisingly low level, bearing in mind what the commercial fare would have been. To have brought these people home by civil aircraft would have meant chartering an aircraft.
The House will recognise from what I have said that when a British subject travelling abroad is stricken with poliomyelitis the Government accept the special nature of the difficulties arising and readily give assistance in bringing the patient safely home.
In the case of Mr. Thomas, the Royal Air Force flew out to Rome a specialist aero-medical team with respiratory equipment weighing 700 1b. The patient and his mother were brought home safely. I am advised that there was no delay in his case in the sense that as soon as we were told that he could be moved the financial guarantee was forthcoming. The transport and medical arrangements took some seven to ten days to plan.
The hon. Gentleman asked what would happen if the patient could not pay. We repatriate over 3,000 distressed British subjects every year, a proportion of whom are sick and ill. If there is no money we take a signature and bring them home but, of course, each case has to be judged on its merits.
I should like to look into the hon. Member's suggestion about the compilation of a list of voluntary bodies and see what we can do. I fully recognise that the need to meet substantial charges of the order the hon. Member mentioned can present a great problem to the individual concerned.
We are all indebted to the hon. Member and his associates in the British Polio Fellowship for their generous help to those affected in this unhappy way. They may be assured that the Government will continue to give help wherever 1051 the need arises and the Royal Air Force with its great fund of technical expertise in these difficult cases will play its part. More than that I do not think it reasonable to expect us to do.
I should like the House to consider for a moment the scale of the problem. Over 4 million Britons are now going abroad every year mainly for pleasure, partly for business. Their numbers are increasing. Travel agents estimate that they are increasing by about 7 per cent. per year. Thus, we can expect that the numbers of those who fall ill or have accidents while abroad will increase; certainly they will not diminish. We are already responsible for repatriating a large number of distressed British subjects. Quite apart from the additional financial burden which would fall on the Exchequer, the administrative burden of repatriating great numbers of sick or injured travellers who at present take care of themselves would impose an intolerable and unreasonable strain on the resources of the Foreign Service.
Where should we draw the line? Suppose a British tourist injures himself while practising a dangerous sport in some country where we have not negotiated a reciprocity agreement. Should he be brought home at the taxpayer's expense? Suppose an export salesman is taken ill in similar circumstances and is not covered by insurance by his firm. Should the cost of bringing him home be borne by the taxpayer? One has only to ask such questions to underline the difficulties.
We all feel sympathy for anyone who suffers the misfortune of being taken seriously ill while abroad. I have said that the Government are anxious to make reciprocal arrangements wherever possible with the health services of other countries. I look forward to the day when travellers will be able to move freely across the world without having to concern themselves about difficulties which might arise should they fall ill. Such a desirable state of affairs, however, is still a very long way off. In the meantime, there is clearly scope for the kind of voluntary help which in this case has been given so freely and so generously.
1052 This does not mean that nothing can be done now. On the contrary, as the hon. Member recognises those wishing to travel abroad ought to make prudent arrangements to ensure against the risks in foreign travel, among which are the high costs which may be incurred in illness or accident. In many foreign countries the normal scales of medical fees and hospital charges go far beyond what we in this country can possibly imagine, and intending travellers should be alerted to this. The Government do what they can to draw people's attention to the problem. With every British passport there is issued a pamphlet entitled Essential Information for travellers. This specifically draws attention to the fact that the National Health Service does not extend overseas. It states that:Treatment under the National Health Service is available only in the United Kingdom. You are therefore advised in your own interests to take out a comprehensive insurance policy before leaving this country. This should cover medical and hospital treatment in case of illness or injury, the loss of money or effects, and death.I have made inquiries and I am told that it is becoming standard practice for travel agencies to include in their quotations for tours the cost of a comprehensive insurance policy which includes among its benefits cover for medical expenses incurred up to a limited amount. I understand that it is also quite common for travel agents to supply their clients with proposal forms which they can use if they wish to increase the amount of cover provided by the basic package deal insurance arrangements.
I am glad of this opportunity to urge anyone who may intend to travel abroad to ensure that he has protected himself against the risk of accident or illness. This is a course which I have always taken myself, and I am sure that hon. Members will join me in stressing the importance of making sensible insurance arrangements in these circumstances.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock