HC Deb 13 February 1968 vol 758 cc1303-12

Motion made, and Question proposed.

That this House do now adjourn.—[Mr. McBride.]

11.38 p.m.

Mr. Julian Ridsdale (Harwich)

This is a simple case concerning a constituent of mine, David Belsham of the Post Office, Wivenhoe Cross, a railway draughtsman, who, when he was on holiday last year in the Netherlands, most unfortunately caught polio. During the 11 weeks he was in hospital in the Netherlands, the National Health Service was unable to help him in any way, either by helping him to pay his hospital bill, or, during the time he was abroad, allowing him any sickness benefit. I am glad to say that the British Legion and other voluntary organisations were most generous in helping to pay the hospital bill, as his father was in the Services. The question which I am raising this evening is that of the payment of sickness benefit while a person is abroad and, in particular, whether anything should be done to give sickness benefit to David Belsham.

I am sure that it cannot be underlined enough and brought home to the public enough that the Health Service at present applies to the United Kingdom only and that we do not have many reciprocal arrangements with other countries for health services. Where such arrangements do exist, even with the Continent of Europe, they are very limited. This underlines the importance of individuals making private insurance arrangements wherever possible when they travel abroad.

I hope that the Minister will do his best to bring this home to the public. This case underlines the importance of this. There is a reciprocal agreement for social security between the United Kingdom and The Netherlands, but this provides only that when a national of say, the United Kingdom goes from the U.K. to The Netherlands, after having fallen sick in the U.K., he shall remain entitled to receive a sickness benefit under British legislation as if he was in this country, providing that he gets permission from the Minister before his departure.

Here is the rub. The agreement makes no provision for anyone if they are taken ill, for instance in The Netherlands, or anywhere else. It is thus a very narrow reciprocal agreement. I only hope that we shall hear from the Minister that he realises its shortcomings, and is endeavouring to get agreements such as this re-negotiated as soon as possible, and extended, because one day soon, and perhaps sooner than later, we shall be joining the E.E.C.

Do such other arrangements exist already with the E.E.C. countries and the Free Trade Area countries? As we are likely to get still closer to the Continent, surely it is reasonable to take steps to see that at least in cases such as Mr. Belsham's, where serious illness has been contracted while abroad and help is really needed, sickness benefit should be paid? Why is it not possible in special cases, such as this, to make provision, so that sickness benefit is paid?

I agree that there has to be supervision over claims for sickness benefit. I know that this is usually carried out by an officer from the Ministry of Social Security, or by the regional medical officer of the Ministry of Health. Why is it not possible to make some different arrangement in cases where serious illness is contracted abroad? I am surprised to learn that nothing has been done in this respect, either, for instance, to make it possible for someone from the embassy to do checking similar to that done by the Ministry of Social Security, or to get a doctor from the country where the illness occurs to sign an appropriate certificate.

The sum for sickness benefit in Mr. Belsham's case is not very large. It is£4 a week for 11 weeks—£44. The Minister keeps saying how much he sympathises with Mr. Belsham's case, but he can do nothing. Is that really so? Is he so much in the straitjacket of his own Regulations that he cannot escape from them? Why cannot he say that this is clearly wrong, as it is, and that he will pay this and get the Regulations altered? Surely it is in his power to do this? Does he expect: me to accept the statement contained in his letter of 19th October last, when he said: Doctors in this country know what is required by way of a certificate of incapacity for work for the National Insurance Acts, but we should not expect doctors in other countries to be aware of the requirements in this respect, or to know the criteria used here for judging incapacity for work. Surely this is complete nonsense. Why cannot doctors in other countries know, in exactly the same way as our own doctors, the requirements of the National Health Service, and when a person is seriously ill?

I am certain that something should be done to help Mr. Belsham. I feel that I am being fobbed off with a lot of inept Ministerial excuses. In the cause of common sense, I ask the Minister to let my constituent have the£44 sickness benefit. The poor man was on his back in an iron lung during the 11 weeks that he spent in hospital in the Netherlands. Surely this is a time when the Minister should show that he is in charge of events and that, where there is a wrong, he can put it right.

The regulations imprison the Minister almost as if he was in an iron lung himself. Why cannot they be amended and brought up to date? Surely he can pay the£44 to my poor constituent for his sickness benefit.

11.45 p.m.

The Joint Parliamentary Secretary to the Ministry of Social Security (Mr. Norman Pentland)

I have listened carefully to the hon. Gentleman's short speech, and, if I say once again that I am sympathetic to the case of his constituent, I hope that he will not take it amiss and think that I am trying to fob him off because of any straitjacket of regulations in which I might find myself.

As he has said, in July of last year, Mr. Belsham, who is now aged 19, went on holiday to Germany. On the way back, on 30th July, he was taken ill. He was admitted to Arnhem Municipal Hospital, in the Netherlands, and found to be suffering from poliomyelitis. After some two months in Dutch hospitals, he was flown back to this country and, on 4th October, admitted to Notley Hospital. I want here to pay tribute to the skill and care of the doctors and nurses in the Netherlands when this young man was in their charge.

On 5th December, Mr. Belsham was transferred to the Passmore Edwards Rehabilitation Centre at Clacton, where he stayed until 12th January, 1968. I am glad to say that, on 22nd January, he was able to return to work with British Railways.

National Insurance sickness benefit was paid to Mr. Belsham from 4th October, 1967, to 21st January, 1968, but could not be paid for any earlier period because he was absent from this country and not covered by ally of the exceptions from the general rule that sickness benefit is not payable abroad.

I should make it clear at once to the hon. Gentleman that neither my right hon. Friend the Minister nor I have any discretion in this matter. Much as we have every sympathy for Mr. Belsham and his mother in the plight in which they find themselves, the regulations do not allow payment of sickness benefit during the period of Mr. Belsham's illness and treatment in the Netherlands. A reciprocal agreement is a two-way matter. We cannot impose our will upon any country when we try to reach these reciprocal agreements.

Mr. Ridsdale

Is the Minister considering amending these very unsatisfactory reciprocal agreements?

Mr. Pentland

I am coming to that, but I want to get on record as much as I can about these types of cases.

I must emphasise that there are and always have been good, reasons for the general disqualification for receiving sickness benefit abroad. The disqualification is necessary because of the difficulties of obtaining satisfactory medical evidence of incapacity for work and of checking on incapacity while a person is abroad.

In this country, sickness benefit is paid not for illness as such, but for illness which causes incapacity for work and a claim that a person is incapable of work must be supported by continuing medical evidence of incapacity. This evidence takes the form of medical certificates issued by registered medical practitioners under rules which, as the hon. Gentleman will probably know, are laid down in the Medical Certification Regulations which, I might add, have been reviewed by the National Insurance Advisory Committee on more than one occasion recently.

I must make it clear that medical certificates do not give automatic title to sickness benefit. They are prima facieevidence of incapacity for work and in the event of there being any doubt about incapacity for work, these certificates are part only of the evidence which is put before the authorities who are responsible for deciding whether there is incapacity in the particular case. Other evidence may include the report of an independent medical practitioner to whom the claimant has been referred by the Ministry, because the Ministry can exercise control over claimants for sickness benefit in this country, as the hon. Gentleman recognised during the course of his speech.

One of the justifications for the procedures for claiming sickness benefit and exercising control over claims is that these procedures apply to all claimants in this country without fear or favour. But a person who is abroad is generally unable to produce the same sort of continuing medical evidence of incapacity for work which a claimant in this country is required to produce in support of his claim for sickness benefit. Moreover, he also escapes the checks on incapacity for work to which everyone in this country who claims sickness benefit is subject.

Therefore, these requirements being so, we have to think very carefully before we make concessions for some people which we are not prepared to make for others. But we have made concessions where we can be reasonably satisfied about continuing incapacity for work and can afford to relax or dispense with the normal checks. Provided we are satisfied that a person is incapable of work before he leaves this country, we are prepared to allow him to go abroad temporarily for treatment for that incapacity—for example, respiratory tuberculosis. He must, however, produce satisfactory evidence that while he is abroad he receives the appropriate treatment. We are also prepared to allow someone who has been sick for a long time—for at least six months—to go abroad for a temporary period. In this type of case the patient has been incapable of work for so long that it is reasonable to relax or dispense with the checks which we would normally have applied to him.

The disqualification may also be modified if a reciprocal agreement on social security is concluded with a foreign country. Apart from what might be referred to as domestic agreements of this kind with the Governments of Northern Ireland. the Isle of Man and the States of Jersey and Guernsey, reciprocal agreements covering sickness benefit have been made during the 20 years of operation of the present National Insurance Scheme with 19 countries, including the Netherlands. But, here again, it would be a mistake to suppose that because a reciprocal agreement has been concluded with another country all restrictions on the payment of benefit in that country are thereby lifted. One of the purposes of our agreements is to enable people to qualify for short-term benefits under the legislation of the country where they are at the time when they need the benefit.

Turning to the reciprocal agreement that we have with the Netherlands, which the hon. Gentleman is concerned about, it may assist the House if I give a brief account of what that agreement actually does in the field of sickness benefit for persons going from this country to the Netherlands. First, it safeguards the insurance position of British employees sent by their employers to work in the Netherlands. Broadly speaking, a British employee taken ill during the first six months of any such period of employment would be covered for British sickness benefit. Secondly, it preserves the right of existing beneficiaries in this country to continue to receive sickness benefit while in the Netherlands. All that is necessary is that the claimant must obtain the consent of his local national insurance office before he leaves this country. Thirdly, it helps any chronically sick person who has received over a year's sickness benefit in this country, to qualify for further sickness benefit while in the Netherlands. Finally, for insured persons from Britain who are working in the Netherlands, the agreement allows British insurance to be taken into account to satisfy the conditions for Netherlands sickness benefit.

I need hardly add that this brief account of what the Netherlands Agreement does is by no means exhaustive. Many other benefits are covered, and I should stress that the agreement is reciprocal and extends to people coming to this country from the Netherlands the same sort of facilities that I have described.

As I said in my reply to the hon. Gentleman's Question on 29th January, it is estimated that the number of people who received benefit last year by virtue of the agreement was of the order of 700. The number of employed persons who remained insured under our legislation while working in the Netherlands was about 500.

The House will, I know, share my sympathies—and I make no apology for saying this again—with the plight of this young man who was stricken down with such a serious illness while on holiday in a foreign country, but, as I have said, unfortunately his case is not covered by any of the exceptions to the general rule about disqualification for absence abroad, and no discretion exists to modify that rule without a change in legislation.

This is where I come to the valid point made by the hon. Gentleman. In some of our more recent agreements—for example, Cyprus, Malta, Germany, the Scandinavian countries—and this brings in at least one E.E.C. country, and some E.F.T.A. countries—the Minister has power to pay sickness benefit in the other country at her discretion. I assure the hon. Gentleman that when there is an opportunity to amend the Netherlands Agreement my right hon. Friend will try to negotiate arrangements which will give her a similar power to that in the agreements which she has with the countries I have mentioned.

I conclude by emphasising, as the hon. Gentleman quite properly did, that when holiday makers from this country fall ill while they are on holiday abroad it seems to me that the main problem is not the withholding of the cash sick ness benefit, but the fact that the National Health Service is not available abroad, which means, in a case like Mr. Belsham's, that very heavy bills for hospital treatment and other incidental services may be incurred.

My right hon. Friend the Minister of Health makes every effort to encourage holiday makers to take out policies of insurance against the risk of being taken ill while abroad. Such advice is included in a leaflet issued with every passport, and is well publicised in the Press, on television, and on the radio, but from the many sad cases which come to the Ministry—such as this one—it is clear that the advice that is tendered by the Minister of Health is not taken as seriously as it should be by thousands of people who take their annual holidays abroad.

Although I am unable to give the hon. Gentleman the satisfaction that he would like in this individual case, I am sure that he has served a useful purpose in raising the matter tonight.

12 m.

Dr. M. P. Winstanley (Cheadle)

I am sure that the House will fully accept that the Minister was sincere in offering his sympathy to the hon. Gentleman's constituent in the predicament in which he finds himself. If he needs any convincing that the present regulations need altering, he need only read his own speech. He enumerated many compelling reasons why we should amend them.

I intervene, first because I have had a constituent in a similar predicament. I had to refer to the Parliamentary Secretary the case of a nurse working in a hospital who went on a convalescent holiday to the Republic of Ireland on the advice of a consultant. She had the same problem. While the Minister was not able to do anything, the hospital management committee was able to make an ex-gratiapayment which put her position in order, but did nothing to alter the general regulations. Since then I have felt this, as much as does the hon. Membre for Harwich (Mr. Ridsdale), who has raised the matter.

The second reason I rose was to give the Parliamentary Secretary an opportunity to correct or expand on an answer he gave. It appeared to me, and I am quite sure that he was unwitting in this, that he was misleading us about the present regulations, under the National Insurance Acts. He gave as a principle reason why it was impossible to pay to people in other countries that it was difficult to obtain satisfactory medical evidence of their incapacity. He later explained that it was impossible to pay benefit without the statutory medical certificate. I am sure that he knows that that is not so.

There is provision in the Act, and always has been, for people in certain circumstances, which we would not like to be too common, to produce other than ordinary medical evidence. There are some Christian Scientists who will not have a doctor within miles and have been able to produce other evidence which satisfies the Minister or her Department that a person is incapable of work because of sickness.

There are quite often examples, in that Department, of cases in which evidence has been provided by a clergyman, by neighbours or by an official of the Ministry. I agree that this is not the kind of procedure which we would like to become general, but I am sure that the Parliamentary Secretary will agree that there are circumstances in which a person, surely without premeditation, becomes ill abroad. That also will not be very general. If the Minister can make exceptions for people here who for their own good reasons cannot or will not produce a certificate, I would have thought it possible for the Department to make exceptions for others who, not from choice, find themselves in a similar predicament on holiday abroad.

It is true that there is that provision, and that it is acted on from time to time. I would not lend myself to a campaign to alter the regulations so that this becomes general, but it is important that these payments should be applicable to and available to our citizens wherever they happen to be.

I encourage progress in the development of reciprocal schemes with other countries, for social security, medical treatment and so on. Obviously these are developments we all want to encourage, but until other countries have made social security provisions on the same lines, I see no reason why our citizens when abroad should be penalised.

I fully support the Minister in any efforts he is making to arrive at more satisfactory reciprocal arrangements with a large number of other countries, but, until he is able to arrive at such arrangements, I ask him to look again at the regulations to see whether it is possible in future cases such as that brought forward by the hon. Member for Harwich to have a different attitude without it being necessary to amend the present regulations.

Question put and agreed to.

Adjourned accordingly at six minutes past Twelve o'clock.