NATIONAL HEALTH SERVICE (RECIPROCAL ARRANGEMENTS) (Hansard, 24 March 1964)

§ Mr. David Gibson-Watt (Hereford)
I am glad to be able to make a short speech tonight on the Adjournment with regard to the problems of one of my constituents. This is a matter of great importanec to my constituents, Mr. and Mrs. Bowen, of 28 College Road, Hereford. The issue is that Mrs. Bowen had a grave accident in the United States which resulted in medical charges which she and her husband find themselves unable to pay.
The object of my speech is not to ask Her Majesty's Government to raise the money in any way; indeed, I should be out of order if I were to suggest that. But I want to draw attention to the very different systems which apply in this country and the United States respectively to pay for injured visitors, and to show what can happen as a result. This is Mrs. Bowen's story: in June, 1963 the Bowens left the United Kingdom to visit their daughter in Idaho. 425 Their daughter is married to a Mr. Harold Bergendorf.
They travelled in a K.L.M. air liner, chartered by the G.I. Brides and Parents Association. The Bowens took out an insurance policy with the Railway Passengers Assurance Company, of London, for a premium of £6 6s. 9d. for two-and-a-half months, which was the length of their intended stay. The total liability for medical expenses did not exceed £100. For personal accident and total disablement there was to be a sum payable of £10 a week, for partial disablement £4 a week—both for a period of up to 100 weeks' benefit. I have been in touch with the insurance company, and in my view it has done well and is still doing well in meeting its commitments with regard to Mrs. Bowen. The point is that the Bowens were adequately insured and had taken proper precautions before leaving this country.
When they landed in New York in the K.L.M. air liner there was some form of bumpy landing, as a result of which Mrs. Bowen suffered a serious internal injury. She was rushed to hospital and there, as a result of a number of operations—and extremely great medical care was taken of her—her life was saved. The Bowens say that the landing was bumpy, but in any case, whether it was or not, it was a most unlikely and unfortunate injury. No one else in the aircraft was hurt.
Mrs. Bowen was in hospital for eight weeks and had four major operations and was in an oxygen tent for three weeks. Her recovery was remarkable, and nobody can say enough for the attention she had in the American hospital. But the outstanding bills now amount to 9,500 dollars, or about £3,000, of which 4,400 dollars have been loaned by the Mormon Church. The son-in-law, Mr. Bergendorf, is a member of that church, but he will have to pay back the money. Mrs. Bowen is now back with her husband in Hereford.
It is fair to say that neither Mr. Bowen nor the son-in-law is in a position to find a sum of the order that I have described. Mr. Bergendorf describes himself as just an average working man, and Mr. Bowen is an egg delivery man in Hereford. It appears that Mr. Bergendorf has behaved in a wonderfully generous and helpful way to his mother- 426 in-law. Perhaps not many sons-in-law would have done so well. But who will pay that £3,000? I understand that the Bowens have taken the matter up with K.L.M. and the airline's solicitors in New York, but they are not prepared to admit any liability.
I do not say that there was negligence on the part of the airline. I am not in a position to know whether there was or not. I do not know whether Mrs. Bowen's seat was properly adjusted or whether the stewards on board carried out their job properly. I merely state that K.L.M. refuses to pay.
Had Mrs. Bowen been an American citizen and the position been reversed. her medical bills here would have been all paid by the National Health Service. It is a matter of sadness to me that over a matter of this sort the systems which apply in this country and in that of our great ally, the United States, are so different and that the system in America does not cover unfortunate incidents of this sort. Is it not possible to instigate a system which would cover them? If this cannot be done at present, as seems clear from the Answer which my hon. Friend who is to reply to this debate kindly gave to a question by me on this subject on 27th January, it seems that the situation exists in which only the rich can visit America and the poor cannot. That is a situation which is bad for allies as great as ourselves and America who have such a close understanding.
I think something could be done to see that this difficulty is removed. People of all walks of life and all sizes of income should be able to visit one another in their respective countries. I do not believe that people understand how many citizens of this country have married and are living in the United States of America and that a great many Americans have married and are living in this country. Perhaps I am making a constituency point, but Hereford has given some good things to the United States over past years. We have given her some of the finest cattle in the world. Is it asking too much that, in his usual generous way, Uncle Sam should reach out a hand of generosity to the Bowens of Hereford and people like them in future and arrange a special way of paying for such accidents, 427 for no action would be more appreciated. Generosity in small things is as attractive in a country as in a human being.

§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I can well understand why my hon. Friend the Member for Hereford (Mr. Gibson-Watt) has sought to ventilate the sad experience of Mrs. Bowen and her family. We can all sympathise with them in the difficult circumstances they encountered at a time when they must have been looking forward eagerly to a family reunion.
As my hon. Friend pointed out, this raises the question of reciprocal health service agreements between this country and others. Perhaps it would help if I first explained what the position is in regard to such arrangements. From the Government's point of view we would regard it as ideal if we could have complete reciprocity with every country so that our citizens and theirs need have no fears of the financial consequences of injury and ill health while travelling abroad. Our policy, therefore, is to conclude reciprocal agreements wherever possible, but the difficulties which face us in seeking to attain this desirable end is that very few countries provide a health service comparable to ours.
Most countries relate their health service arrangements to insurance contributions which cannot easily be extended to citizens of the United Kingdom travelling abroad. We have, however, so far established reciprocal arrangements covering medical treatment for any United Kingdom citizen living in or visiting Denmark, Sweden, Norway, Yugoslavia and New Zealand, where in general the conditions are similar to those in our own National Health Service. More limited agreements have been made for citizens of the United Kingdom who are living abroad and are insured under local schemes, with France. Belgium, Luxembourg, Italy, Israel, Malta, the Netherlands, Switzerland and the Federal Republic of Germany.
The arrangements which operate in most other countries are limited for specific groups of insured persons and their dependants who must satisfy pre- 428 scribed conditions. I am sure that my hon. Friend will appreciate that overseas bodies providing insurance cover of this kind could not reasonably be expected to afford more favourable treatment to British visitors than they do to their own compatriots who do not satisfy the prescribed conditions. In short, this is another reminder of the value to the British people of our own free National Health Service.
Since my hon. Friend first raised the case of Mrs. Bowen, I have had very full inquiries made into the details, and the information that I have is that she left this country on 18th June last year with her husband to visit her daughter, Mrs. Bergendorf, living in Pocatello, Idaho. As my hon. Friend has said, Mrs. Bowen travelled in a K.L.M. aircraft on charter to the Transatlantic Brides and Parents Association. It is alleged that the aircraft made a clumsy landing in New York, as a result of which she was thrown forward against her seat belt, rupturing her oesophagus, suffering, as my hon. Friend has described it, serious internal injury.
A family friend who met Mr. and Mrs. Bowen at the airport arranged for her to be seen immediately by his personal doctor and she was admitted to hospital in New York for surgical treatment. According to Mrs. Bowen's son-in-law, Mr. Bergendorf, in a letter which he wrote to my right hon. Friend the Prime Minister on 6th March, the bills for hospital and surgical treatment amounted to 9,500 dollars which he was arranging to meet from his savings and by various loans. Information has been received more recently from our Consulate-General in Seattle that the hospital bill was reduced to 3,500 dollars and that this was paid by Mr. Bergendorf from money advanced by his church against his undertaking to repay. It appears that surgeon's bills amounting to about 2,000 dollars may still be unpaid. The figures which my hon. Friend has quoted may not, therefore, be completely up to date; but I recognise that this does not affect the substance of his comments tonight.
Mr. Bowen returned alone to this country last August. Mrs. Bowen was not well enough to accompany him, but she returned last month. Her unused return fare was forfeited and the cost of her fare was met by her husband and 429 son-in-law. I believe there may have been some misunderstanding as to the possibility of our consular officials in the United States being able to help Mrs. Bowen, and I should like to clarify the position on the basis of the information that I have been given.
Our consular posts at New York and Seattle received no request for financial assistance from Mr. or Mrs. Bowen. Mr. Bowen's passport, which was issued jointly for himself and his wife, was amended by the Consulate-General in New York to allow him to return home alone. But I am assured that Mr. Bowen made no request for any other kind of assistance at the time that he applied for his passport to be amended. Subsequently Mrs. Bowen applied to the Consulate-General at Seattle for a passport in her own name. A letter from her daughter, Mrs. Bergendorf, covering the passport application, mentioned her mother's illness but not the question of her medical expenses.
Later, as a result of a newspaper report about Mrs. Bowen, the Consulate-General asked her whether she was experiencing difficulty in returning home. She told them that she was not planning to return for the time being since she had not fully recovered from her illness. The Consulate-General told Mrs. Bowen that although they could not assist with her medical bills in New York, she should not hesitate to get in touch with them if there was any other way in which they could help. I am informed that Mrs. Bowen has filed a claim for compensation against the airline. She was advised by lawyers in New York and they told our Consulate-General there that in a hearing in the Supreme Court of Queens County, New York, the airline had successfully invoked the Warsaw Convention, claiming non-jurisdiction.
The court held, apparently, that it had no jurisdiction and that, since Mrs. Bowen's ticket for the return journey had been issued in London and this was the place of final destination, jurisdiction properly lay with a British court. I understand that the Ministry of Aviation has confirmed, orally, that such a claim could be made in this country. Accordingly, Mrs. Bowen would be well advised, if she wishes to pursue her claim in this country, to seek proper legal advice, but I am unable to say 430 whether, in fact, she has taken steps to do this and I know that my hon. Friend will appreciate that I cannot comment on that aspect of the case.
That, then, is the background to the matter. Before I say any more, I should like to endorse what my hon. Friend has said about the generosity and helpfulness of Mrs. Bowen's family and the church which rallied to their help in time of need. I understand, however, that if the family had not been willing and able to arrange for, and meet, the cost of private treatment, Mrs. Bowen could have been taken to a municipal hospital as an emergency case, where charges are based on financial circumstances and the ability to pay. The charges for essential treatment can be waived in cases of destitution, and these facilities are available to alien visitors without funds as well as to American citizens.
I am told that these hospitals have an excellent reputation and that the best New York doctors give their services to them without charge if the circumstances justify such action. Normally, it is not expected that British visitors would find themselves in such straits since, before leaving this country, they are warned by the Consular Department of the Foreign Office, by the United States Consulate, by travel agencies, and by organisations sponsoring trips to the United States, that the National Health Service operates only in this country and that they should, therefore, take out fully adequate insurance cover before leaving.
I have here a booklet entitled "Essential Information for Citizens of the United Kingdom and Colonies who intend to travel Overseas", a copy of which is issued with every British passport. This makes the position absolutely clear and perhaps I may quote some relevant passages. Under the heading "Insurance", it is stated in bold type that Foreign travel entails the risk of incurring unforeseen expenditure as the result of accident or other mishaps. You are strongly advised in your own interest to insure against the various risks which are inherent in foreign travel, including illness, theft or loss of possessions, injury, or death". Under the heading, "Illness and Accident", it is stated that Treatment under the National Health Service is available only in the United Kingdom. 431 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. Such policies can be obtained from most travel agencies or insurance companies, brokers or agents. If you do not do this you will probably be personally responsible for all medical or hospital expenses which you may incur in foreign countries, with the exception of Denmark, Norway, Sweden, and Yugoslavia, where certain benefits are available, subject to the conditions referred to below. Later on, the booklet states, The Ministry of Health has no power to pay for treatment obtained outside this Service, whether at home or abroad. As my hon. Friend indicated, the Association sponsoring Mrs. Bowen's visit insist on its customers insuring to cover minimum medical expenses of £100 and this, of course, Mrs. Bowen did at the cost of £3; but the Association also strongly recommends its customers to insure for increased benefits, as it warns them that £100 will cover only minor ills.
I cannot stress too strongly the importance of intending travellers making adequate insurance arrangements. I have said before in this House, and I say again, that in many foreign countries, the normal scales of medical fees go far beyond what we in this country can possibly imagine and those intending to travel abroad should be fully alerted to this fact. So far as the Government are concerned, we draw the attention of travellers to this in the way I have described, and I am grateful to my hon. Friend for giving me the opportunity to emphasise this point again tonight.
Another cost which can arise, and did in this case, is the inability of the traveller to return on the specified flight. Here again, it is possible to insure against this. I know it is very easy to be wise after the event—

§ Mr. Gibson-Watt
Hear, hear.

§ Mr. Braine
—but, as I have said, I hope that a debate such as this will bring it home to people that the risks do exist and that it is wise to insure against them.
As an additional safeguard against the risk that an alien may find himself unable to meet his obligations in the United States, immigrant and visit visas to that country are granted only to persons who can produce proof of adequate means of subsistence, or whose visit is sponsored either by an American firm or institution or an American resident. I think that is the answer to the point my hon. Friend made about the rich and the poor. In Mrs. Bowen's case this is what happened, and, as I have said, full credit should be given to those who have made the very considerable effort needed to meet the bills.
I have seen the most reasonable letter which Mrs. Bowen's son-in-law sent to my right hon. Friend the Prime Minister, and I must say I am shocked at the statement in that letter that the airline concerned has not replied to letters sent to it. I trust that it will not be out of place for me to express the hope that if responsibility does rest with the airline—and as my hon. Friend said, it is not for us to pronounce on that—a satisfactory outcome to this unhappy story will be secured.
I am, therefore, grateful to my hon. Friend for raising this matter and providing us once more with an opportunity to bring home to intending travellers the importance of making really adequate insurance arrangements to cover this sort of contingency.