§ 1.17 a.m.
§ Mr. Ray Carter (Birmingham, Northfield)I did not anticipate earlier this evening having to wait quite so long for the Adjournment to come. It is a little late. As a consequence, the debate will not get the publicity a subject like this obviously deserves, but I am hoping that at least some of the media will take note of it; namely, the reciprocity of the regulations which now apply to this country upon our entering into the European Economic Community on 1st January.
A number of regulations immediately applied to us, and our nationals became subject to certain possibilities within the Community. Three of the regulations—1408/71, 574/2 and 878/73, the last two the implementing regulations—came into effect at that date. They are about arrangements by which nationals of the various EEC countries can obtain in other EEC countries medical and health facilities. The introductory booklet, SA 28, issued by the Department of Health and Social Security gives a very good account of these regulations.
In brief, they can be summarised as they are in the third paragraph of the introduction:
Persons covered by the Regulations who are on holiday or otherwise stay temporarily in a Community country will be entitled to medical treatment for sickness or accidents which require urgent attention on the same basis as insured nationals of that country.The last part of that paragraph is particularly important because there were certain exclusions affecting Britain upon entering; self-employed people were specifically excluded, as were the unemployed, and students, and other groups of people who were in normal forms of employment.My interest in this subject was raised by a constituent of mine who got in touch with me after discovering, purely by chance, that this regulation was now in force and was reminded by the person she was going to visit in France, who happened to work in the Embassy in Paris, that she should go armed with the certificate which would entitle her, if she became ill or had an accident, to treatment as a national while in France.
446 Her experience was that the local health and social security office knew nothing about the regulation, far less about the form, and advised her to go to the central office in Birmingham. She went there, and, after some search, a form CM 1 was produced. This was filled in in accordance with the document SA28 from which I have quoted, and she was then issued with certificate E111. Armed with this, she was able to go to France and was fortunately not ill. Had she been, she could have presented the certificate to the doctor and the various health departments and have been reimbursed for any expenses she might have incurred.
I took the matter up because she felt that not enough was known about the scheme and because I did not know enough about it. Further investigation on my part exposed what I now believe to be, and what is proved to be, a series of failures on the part of the Government properly to communicate to the public the fact that the scheme now exists and that there has been a great deal of incompetence by bureaucracy and other bodies should be responsible for bringing to the attention of the public, and of the travelling public particularly, the entitlements which they have now acquired as rights consequent upon our entry into the EEC.
There also appears to be a considerable amount of cheating by travel firms, insurance companies and other bodies responsible for administering the affairs of the travelling public.
I shall deal with the failures one by one and first with the publicity campaign, which, by any standard, has been quite appalling.
Hardly anybody in the city of Birmingham alone knows anything of this scheme. When my constituent went to the central office in Birmingham, she was told that only nine people had had the good fortune to know of the scheme and gone to that office and applied for the form CM1 to get the certificate E111.
When one considers how much the Government spent on their campaign throughout the country to convince people of the need for Britain to enter the EEC and become a fully participating member, there has been a paucity of effort in bringing home to the British public the 447 benefits which were held out to them and of which they should have been made fully aware as soon as we became members on 1st January.
An excellent article was written by Mary Kenny of the Evening Standard.
She made the round of travel firms and tried to find out from them precisely what they might know about this facility which would remove some financial burden from the travelling public who before 1st January would have had to take out insurance. She inquired at Clarksons precisely how it was informing its customers of the new arrangement. All she got from it was a bemused "What?" from the other end of the telephone line. She went to Thos. Cook and Son, Ltd. which one would have thought, with its long history and background in these matters, would know a good deal about the regulations. It might have known, for the agent of Cook's replied that it was not normal practice at Cook's to tell travellers about this unless they inquired.
It seems clear to me, coming as that does from Cook's, one of the great reputable travel concerns, that a number of people in the travel industry are hanging on to business to which, frankly, they have no entitlement. Undoubtedly they have large contracts with the insurance companies and get a commission on every premium that they are able to secure for an insurance company. Maybe, as the Cook's agent said to Mary Kenny, it is for purely economic reasons that they do not tell the travelling public precisely what their new rights are. When he replies the Minister must deal with that point. Why are premiums still being collected for health and medical insurance when there is no need to do so.
Why are self-employed persons specifically excluded from the scheme? On the Continent in the original Six all health schemes are contributory. The employee pays a certain sum into the national health and insurance fund. The Six insisted as part of our terms of entry that our self-employed people should be excluded from the new reciprocal arrangements. That is deplorable because for years foreigners have been able to come to this country and enjoy the full benefit of our health facilities.
448 As I read from the introductory pamphlet, every country in the enlarged Community has to provide the visitor from another member country with the same facilities as it accords its own citizens. That means that any self-employed person from France coming to Britain will be able to get treatment and facilities here which a self-employed United Kingdom citizen cannot obtain in France. I should like to be told that I am wrong, but I doubt that I am. I suspect that, as has always been the case, the Ministry does not attempt to recover expenses because of the cost of trying to do so.
That is a particularly important part of the criticism I level at the Government for the way they have handled these matters. There are about 5 million people in this country who are self-employed, or the dependants of self-employed persons, who are now specifically excluded from the arrangements. It means in effect that there is a form of double taxation. These people are paying through direct taxation a contribution towards the upkeep of a free health service, yet when they travel abroad they are having to take out private insurance cover.
For those people lucky enough to have discovered the facility which now exists, filled out the form CM 1, read the introductory pamphlet, got a certificate and gone on their holiday to one of the other countries of the Nine, what kind of treatment can be expected when they fall sick, break a leg or have some other accident? I have been given the clear impression by one or two correspondents that they do not receive helpful treatment when they get abroad. On the contrary, it seems that the medical professions in one or two countries, and bureaucracy generally, try to get out of the commitment which is clearly laid upon their countries and them as doctors or officials of ministries. I am sure that they know that Britain fully lives up to its commitment relating to the EEC. Indeed, we go far beyond that and care for citizens of other countries who come here temporarily and fall ill.
Travelling is increasing all the time. On the figures which I have been able to obtain, almost 5 million people a year visit the EEC. I imagine that a large 449 proportion of that number will have an accident—for example, a fall—and require medical attention. They might have a skiing accident, a road accident or a stomach upset. In that event they will need help of some kind. Clearly, the travelling public to the EEC alone should be made fully aware of their new rights as from 1st January.
This is no small matter for a family of five or six travelling abroad. The insurance cover which is now demanded by insurance companies varies from £1 to approximately £2.50 for a fortnight's holiday on the Continent. If we multiply that by 5 million it will be seen that there is a fair turnover for the insurance business. No wonder that there is an attempt, at least on the part of travel organisations and the insurance industry, to hang on to what must be a fairly lucrative form of business for them.
I remind the Minister of the Government's promise to the British people when the prospect of entry was held out to them. It seems, at least on the first time of asking, that those benefits are not immediately forthcoming.
I remind the Minister that we are now in the height of the holiday season. There is still time for a large part of the travelling public to save money which they need not spend. The Government should make a massive attempt to inform the travelling public of their new rights. I could deal with other rights which they now have relating to social security, industrial injury benefit and a whole range of other benefits, but there is not time to do so. The insurance companies should be immediately tackled and asked precisely why they are taking premiums from persons for coverage which strictly they do not require. The travelling organisations should be asked—certainly Cook's and Clarkson's—why they are taking insurance premiums which are not strictly needed.
I hope that some attempt will be made to discover from the people who have filled in the form and received a certificate what their experience was on the Continent when they had to avail themselves of the new facilities—namely, when they had to go to a doctor and ask for help or when they had to go to hospital to receive treatment for an injured limb. Let us find out how they fared. Let us 450 discover whether their experience was satisfactory and whether the certificate met with an instant reception from officialdom and from the medical profession within the EEC.
These are questions which should be answered. Indeed, really they should never have had to be asked, because the Government, as from 1st January last, should have carried out a massive campaign of advertising, informing the insurance companies of the new regulations and what they were expected to do. Even at this late stage, there is an opportunity for the Government to retrieve the situation and inform the travelling public of the new regulations and facilities.
§ 1.35 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)I very much welcome the subject which the hon. Member for Birmingham, Northfield (Mr. Carter) has chosen for the debate because it gives yet a further opportunity for increased publicity in an area where I share the concern he has expressed that there should be as wide and full a programme of publicity as can be managed. The publicity we want to give is at least one of the most important early benefits which we have derived from our membership of the European Economic Community. The Migrant Workers Regulations, which came into operation in the United Kingdom on 1st April, provide for the retention of the social security rights of citizens moving from one country to another, very much on the lines of the bilateral reciprocal arrangements that preceded our accession. The medical treatment benefits which the regulations make available to people travelling or working in the other new member States are new and represent a net beneficial increment to our nationals. This is a genuine gain to the majority of our people visiting or working in other countries of the EEC.
The benefits provided are emergency medical treatment for people on holiday or temporary visits in other Community countries, and medical benefits on the same terms as the nationals of the country concerned for any of our nationals permanently residing in another Community country. The treatment is not necessarily given completely free, and I 451 hope that the hon. Gentleman will remember that when I come to a later point about insurance cover. In some countries it is free and in others the patient pays a proportion of the cost in exactly the same way as the nationals of that country.
Another point which the hon. Gentleman fairly made was that the logic of the scheme is that visitors, always a tiny minority in the population of any given country, receive benefits as they would be provided to the nationals who are in the majority and not in respect of the services which are available to the visitors in their own homes. There is not an unreasonable logic behind that approach, although it necessarily is the case that some visitors will derive benefits which are not exactly the same in each country because the pattern of policies adopted in member States is clearly based on their own democratic choice of the systems they prefer. This is part of the agreement between the nations.
Unfortunately, these benefits are not available to everyone, although they are to most. Those covered are employed persons and their dependants, retirement pensioners and widow beneficiaries and their dependants. The self-employed are not included, for reasons I shall come to, but I assure the hon. Gentleman that it is our intention to do all we can, from our position of strength within the Community as a full member, to secure an extension of the provision for the self-employed.
There is now a long-term trend within the older Community countries towards the inclusion of the self-employed categories within the national insurance schemes. It is far from fruition and fulfilment of our standards, but it is a movement which is now under way. We shall push against this open door.
It is necessary to produce evidence of entitlement to medical treatment benefit. That is done through the issue of an entitlement notice, Community form E111. Application for this should be made at a local national insurance office on our domestic United Kingdom form CM1. I echo what the hon. Gentleman said about the holiday season being in full spate. Intending travellers should 452 make application as soon as possible when they know they will be going. I am grateful to the hon. Gentleman for enabling me to remind those who are going on holiday to EEC countries later this year to make application through CM1 for the relevant Community form E111 as soon as possible and certainly in good time.
I apologise to the hon. Gentleman for not having replied to his letter of 11th June. I was about to send a reply when I learned that he had secured the debate. I thought it would be better to postpone the letter and write immediately afterwards.
I should like to explain why the self-employed and non-employed sections of the community are not covered by EEC regulations. Basically, it is because the regulations are made under Article 51 of the Treaty of Rome, which relates to the movement only of employed persons within the Community. From a positive point of view, over 90 per cent. of our people benefit under the new regulations, whilst no pre-existing rights were removed from any class of our people, including the self-employed. The self-employed continue to benefit from the bilateral agreements on social security which already existed with each of the other member States. Except in the case of Denmark, these do not cover health care for visitors, but it is our intention to do all we can to extend coverage from 90 per cent. of our people to the full 100 per cent.
I should like to say something about publicity. In October 1972, in preparation for our entry into the Common Market, the Government undertook a publicity campaign. As part of that campaign they prepared a booklet "Europe—a checklist" as a guide to sources of information and advice on EEC matters. This checklist included references to medical treatment in EEC countries for both workers and visitors going to another Community country, and was widely distributed to firms, trade and professional associations, libraries, local authorities and the like. At the same time, my Department issued a Press notice giving details of the new facilities and the availability of the leaflet SA26 entitled "Social Security and the EEC".
453 At the time of our entry on 1st January this year, a letter was sent to the Association of British Travel Agents giving details of medical care arrangements under the EEC regulations and suggesting that travel agents should hold a supply of our application forms CM1 for a certificate of entitlement, E111, and the explanatory leaflet SA28 from which the hon. Gentleman quoted. The Association of British Travel Agents undertook to advise its members accordingly. Other tour operators have taken part in this arrangement.
I will now say a word or two about private insurance. Although some free medical care may be available in Community countries—and there are payments to be made either in full for the self-employed or partially for those in the employed category—most people still wish to take out adequate private insurance cover for such items as holiday cancellations, personal injuries, hotel expenses arising from sickness, loss of belongings, repatriation and a host of associated problems arising from serious illness. It goes much beyond the limited definition of medical cover.
Most insurance policies are of the package type covering a whole range of benefits negotiated by tour operators and believed to be relatively cheap in comparison with similar coverage which might have to be taken out by an individual. It must obviously remain the responsibility of the traveller to make up his mind what cover he requires. He can always opt out of insurance if he does not want it. But there are benefits for him even if he comes within the employed category if he falls ill in a Community country where payments ale normally necessary for a proportion of the charge. However, the policy of private insurance companies is not a matter in which I can intervene. There is no evidence of deliberate misrepresentation or of cheating, which was the strong word which the hon. Gentleman used.
We have found the Association of British Travel Agents very co-operative, and several tour operators have taken the 454 trouble to provide the explanatory leaflet that we have made available. A letter was also sent to the Confederation of British Industry suggesting that the larger employers at least might like to hold supplies of the application form and leaflet. In the same month the Citizens Advice Bureaux produced a circular dealing with the United Kingdom's entry to the EEC and mentioning the new regulations on medical benefit.
The arrangements in question first operated from 1st April 1973 and, with this in mind a more detailed Press notice was issued on 28th February to the national Press and to travel agency periodicals and other holiday magazines giving details of the new arrangements and indicating that application forms and the leaflet SA28 dealing specifically with medical treatment for holiday makers and other temporary visitors to countries of the EEC would be available from any of the Department's local social security offices and from any employment exchange. These give detailed information country by country on the procedure to follow in order to obtain treatment under the regulations.
At the time that the regulations came into force, key radio and television programmes were circularised and an announcement was made on the radio's Government information spot. A further Press notice was issued on 30th March which resulted in substantial Press coverage on 1st April, the day the regulations came into effect
My right hon. Friend replied to two Written Questions on the new arrangements, the first from the hon. Member for Farnworth (Mr. Roper), which was published in the OFFICIAL REPORT of 29th January 1973——
§ The Question having been proposed after Ten o'clock on Tuesday evening, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at thirteen minutes to Two o'clock.