HC Deb 22 February 1982 vol 18 cc593-601 3.32 pm
The Secretary of State for Social Services (Mr. Norman Fowler)

With permission, I wish to make a statement about changes that the Government propose to make in the rules for use of the National Health Service by overseas visitors.

My predecessor told the House last March of the Government's intention to make regulations to provide for charges for hospital treatment for those not ordinarily resident in the United Kingdom. The National Health Service is under pressure, with long waiting lists for some specialties in some parts of the country. It is only fair that people coming from overseas who have not contributed through taxes should be asked to pay for treatment for which our citizens would be required to pay when they were overseas.

We have consulted widely on the proposals and I can now report to the House that, subject to some important modifications, we intend to implement the proposals with effect from 1 October. When our original proposals were announced, two major fears were expressed. First, there was concern that the procedures might be complex to administer. Secondly, there was concern that, contrary to our intentions, the procedures used to identify chargeable patients could give rise to racial discrimination. The Government therefore decided to set up a working party representing a wide range of interests to advise us on how those difficulties might be overcome.

I am grateful to the working party, and copies of its report have today been placed in the Vote Office. The working party found that the present rules are not being administered consistently or fairly. In particular, they believed that there was a distinct risk that checks on eligibility may be being applied by many hospitals in a way which discriminates against members of ethnic minorities living here. I am satisfied that a new system can be introduced which will provide extra finance for the National Health Service, and which hospitals can administer in a way that will minimise the risk of racial discrimination. We therefore accept the working party's recommendation that there should be a standard procedure for checking the eligibility of all new hospital patients, and guidance will be issued to hospitals on the main principles identified by the working party.

However, we propose some further changes in the scope of the scheme. In response to representations that the proposals would bear hard on overseas students here for a considerable period, we have decided that all visitors—including overseas students—should become exempt from charges after they have been here for one year, instead of the three years in the earlier proposals. We also propose that people coming here to work should be fully exempt from the beginning of their stay, as will some visiting dependants of people settled in this country. In other respects the scheme will be broadly the same as that on which we consulted last year. We estimate that the charges will raise about £6 million in a full year. I should emphasise that the money will be available to the district health authorities or boards to finance their expenditure on health care.

Reciprocal agreements with other countries will, of course, be fully honoured. We shall lay regulations before the House in due course. The new arrangements will be publicised abroad so that visitors coming here can take out insurance before they arrive, as we do when we visit their countries.

In making the changes we shall bring our position into line with virtually every other Western country. There is no reason why the British taxpayer should provide free hospital treatment to short-term visitors to this country.

Mrs. Gwyneth Dunwoody (Crewe)

The Secretary of State's bland statement does not hide the fact that the intention behind the introduction of the charges is simply to pander to the most exaggerated prejudices of the Conservative Party. Some detailed matters have not been made clear. For example, the new regulations will depend on the assumption that those who are ordinarily resident in Britain will be excluded. The right hon. Gentleman knows very well that there is no clear legal definition of "ordinarily resident". The matter is already causing difficulty in other Whitehall Departments.

Is the £6 million that the right hon. Gentleman believes that he will obtain from the changes a net saving or a gross saving? It is clear that even the administrative changes that he is proposing will add considerably to the job of admission clerks, even without the difficulties that will arise from their persistent questioning. Is it the intention that DHSS employees will have the right to go direct to the Home Office to check the status of overseas visitors? That would be a most dangerous development which should be strongly opposed.

What is the extent of the abuses on which the Secretary of State has founded this absurd statement? The working party stated at paragraph 34 of its report that it was not asked to quantify the extent of the abuse and could not do so. As there are 12 million visitors to Britain every year, of whom over half will be excluded because they are in EEC or other schemes, how does the right hon. Gentleman expect to gain that amount of money from the imposition of charges?

Will the right hon. Gentleman come clean and make it plain to the House that he intends to provide a system of charging that can be developed in the future so that NHS patients must also pay for treatment? As it is obvious that even now there is no means of recovering private patient costs efficiently, how does the Secretary of State expect to get back any money by this despicable and divisive scheme?

Mr. Fowler

The hon. Lady has asked many questions and made a great number of silly statements. We are talking about more revenue for the National Health Service. I should have thought that even the Opposition would be in favour of that proposition.

The hon. Lady mentioned discrimination. The working party found that the present position—not the position that we are changing to—contained a distinct risk of applying the rules in a way that discriminated against members of ethnic minorities living here. That is dealt with in paragraph 15 of its report. I should have thought that the hon. Lady would want that to be changed.

The hon. Lady mentioned abuse. We know that the present system is not being enforced, because that is what the working party says. We know that it opens the door to abuse. Complaints from inside the National Health Service are made year after year. I am concerned not only with abuse but with raising money for the National Health Service for short-term visitors to Britain. Basically, the question is "Who pays—the taxpayer or the insurance company of the overseas visitors?" I see no reason why the British taxpayer should pay.

Several Hon Members

. rose

Mr. Speaker

Order. I remind the House that we are to have a half day's debate on the arts and that there is much interest in it. We must not be too long on the statement.

Mr. A. J. Beith ( (Berwick-upon-Tweed)

Does the Secretary of State realise that, even with the welcome concessions in this version of the proposals, there will still be a huge disparity between the treatment of overseas students, many of whom are from the poorer countries, and the treatment of students from EEC countries? Does he recognise that, when added to the burden of the high fees that they now have to pay, this is a further disincentive to students from poor countries to come to Britain?

Mr. Fowler

As the hon. Gentleman recognises, we have made important concessions to overseas students. We do not want to penalise them. On the other hand, I do not believe that any Government have recognised that overseas students are a special case for completely free National Health Service treatment. I think that the balance that we have struck in the proposals is right. When the hon. Gentleman examines the proposals in more detail I am sure that he will support us.

Mr. Robert Rhodes James (Cambridge)

Is my right hon. Friend aware that his decision on overseas students' charges is absolutely right? Will he accept the gratitude of those of us who have made representations for the positive manner in which he has responded to them?

Mr. Fowler

I am grateful to my hon. Friend. We have made a further concession in respect of general practitioner treatment. The Government have made a resonable response to the conern about overseas students.

Dr. M. S. Miller (East Kilbride)

Is the right hon. Gentleman aware that this shameful decision is another way in which this country's prestige is being eroded by this Government? Is he aware that it is a question not simply whether we can make any money out of the proposal—and I doubt whether we can make any—but whether the principle involved since the inception of the Health Service is being eroded by the right hon. Gentleman to an extent that lowers the esteem in which we are held by the world?

Will the £6 million saving which the right hon. Gentleman thinks he can achieve be at the expense of asking the British people to carry identity cards with them if they consult another doctor in another area? Even if that derisory amount of money were to be lost to the Health Service, would it not be an inexpensive advertisement for the good name of Britain?

Mr. Fowler

The hon. Gentleman is wrong in principle and in practice. The powers date back to 1949. Guidance was issued in 1963 that, in principle, short-term visitors should be private patients. There is absolutely no question of people carrying identity cards. The hon. Gentleman speaks glibly about £6 million being a trivial amount. I have no doubt that that reflects his colleagues' view, but I do not take that view. About 5 million short-stay visitors come to Britain each year from non-EEC countries or countries without reciprocal arrangements. If the Opposition's concept of the National Health Service is that it is a free service for anyone who enters the country, they are sadly out of date.

Mrs. Jill Knight (Birmingham, Edgbaston)

Is my right hon. Friend aware that for years the British taxpayer has been longing for a Secretary of State with the courage to take the step that he has just announced? Is he further aware that many visitors to these shores—particularly from America and Canada, some of whom are extremely wealthy—have for years thought it incredible that we are so lunatic as to offer them a completely free Health Service when they are capable of paying for it and when the ordinary British taxpayer, who is paying for it, has to be denied because of shortage of cash?

Mr. Fowler

I am grateful to my hon. Friend. I am sure that she is right. We are asking visitors to insure for hospital treatment if they fall ill here. That is precisely what we are expected to do if we go to their countries.

Mr. Laurie Pavitt (Brent, South)

Will the Secretary of State answer the question about the £6 million? Is it net or gross? How many interviews of out-patients and inpatients take place annually? He has that figure in his statistics. What additional work load will there be, and what will be the increase in public expenditure as a result of employing more people in the National Health Service to monitor the scheme? Will there be any net saving?

Does the Secretary of State recall that this was known as the "Good Samaritan" policy? When he says his prayers tonight, will he read the Good Samaritan parable once again?

Mr. Fowler

I shall take the hon. Gentleman through the estimates of costs. We are talking about 5 million visitors. My predecessor gave a figure of about £5 million. That has been up-dated to allow for inflation, but the concession that we are making will also cost money. It is unlikely that the amount that we shall receive back from hospital services will be less than £6 million. The estimated cost of acute hospital services is about £3 billion a year.

Dr. Brian Mawhinney (Peterborough)

Does my right hon. Friend accept that his statement will be welcome, not least because it will be seen to be fair to the British taxpayer and to the ethnic minorities? Will he consult his right hon. Friend the Foreign Secretary to ensure that the 5 million people who might be affected by the scheme are informed of the need to buy insurance before they come to Britain so that we can avoid the difficulties of people trying to beat the system by claiming ignorance?

Mr. Fowler

My hon. Friend makes an important point. The scheme will not come into effect until 1 October. Therefore, holiday visitors this summer will be covered by the present arrangements. After that influx, the new system will come into being. We shall, of course, make the new position clear to the public overseas through all means open to us.

Mr. William Hamilton (Fife, Central)

Will the Minister confirm that there is no evidence whatever of extensive abuse of the National Health Service by foreign visitors? If he has evidence, will he please publish it? Is he aware that every trade union in the National Health Service is violently opposed to the principle that he has annunciated? Will it not mean that extra staff will have to question and cross-examine every patient, including psychiatric and mental patients? Is it not an absolute disgrace?

Mr. Fowler

There is no reason why extra staff should be taken on for that purpose. When the hon. Gentleman has had the opportunity to study the working party's report, he will see that that is so. It is important for the House to understand that the working party has established that the scheme is feasible, can work and will raise extra money for the National Health Service.

Mr. Hamilton


Mr. Fowler

The hon. Gentleman says "Rubbish", but I urge him to read the working party's report and to look objectively at the evidence. He will then see that his fears are, as usual, misplaced.

Mr. Toby Jessel (Twickenham)

Is my right hon. Friend aware that the British people will be glad that from now on they will be expected to provide a National Health Service and not an international health service?

Mr. Fowler

The British public will welcome this common sense move. I think that they will be puzzled by the Opposition's attitude and by the way in which they apparently regard this common sense way of getting new funds for the National Health Service.

Mr. David Ennals (Norwich, North)

Is not this scheme, as with the cuts in overseas aid and the increases in overseas students' fees, a further mean-minded way of alienating people and creating administrative problems that will mean that there will be no saving from this wretched act?

Mr. Fowler

No; the right hon. Gentleman is wrong. When he reads the working party's report, he will find that the estimates that I and my predecessor have set out are broadly confirmed by the working party's estimate of the money that will be raised. I hope that the right hon. Gentleman will recognise that the change from three years to one year is an important concession for overseas students. We have also made further concessions for general practice treatment. This is a reasonable response to their concern, and I hope that they will see it as that.

Mr. Mike Thomas (Newcastle upon Tyne, East)

Is the right hon. Gentleman aware that the Social Democratic Party does not lay at his door the cheap charge of racism that has been laid by the hon. Member for Crewe (Mrs. Dunwoody)? However, is he convinced that the scheme will produce real cash benefits for the National Health Service? If it does, will the savings exceed the benefits of good will to overseas students—for whom the charge for the first year seems ridiculous—good race relations, the treatment of communicable diseases and voluntary psychiatric treatment, the latter being an area in which it is very much in the public's interest that even overseas visitors should receive adequate treatment?

Mr. Fowler

The last two categories in the hon. Gentleman's question are covered in the exemptions that we shall be bringing forward. I thank him for his initial comments.

The hon. Member for Crewe (Mrs. Dunwoody), who is the Opposition's spokesman on these issues, was completely wrong when she asked the first of her questions. The working party's report shows that the present procedure is racially discriminatory, but that is the procedure that the hon. Lady is defending. Paragraph 39 of the report confirms that there are savings to be made and that the estimate that we have made of the savings is about right.

Several Hon. Members


Mr. Speaker

I shall call the hon. Gentleman for Northampton, South (Mr. Morris), but before I do so I tell the House that I shall not call questions on the Secretary of State's statement one second after 4 o'clock. To allow questions to continue after 4 o'clock would not be fair to those who wish to participate in the debate that RS to follow.

Mr. Michael Morris (Northampton, South)

Is my right hon. Friend aware that his practical approach to the problem is very much welcomed by the public? Is he confident that the loophole of temporary registration with general practitioners is covered by the report that he has received? While he is in a tidying-up mood for mutual health care, will he examine the arrangements within the EEC, where the system is not working as well as it should be?

Mr. Fowler

I shall be happy to consider the latter point. We shall be advised to bring general practitioners' practices into line with the hospital service. We are suggesting that overseas students who plan to be here for more than one year should go on to the list straight away. That is a concession for overseas students.

Mr. Bob Cryer (Keighley)

If the Minister is seeking to save money, why does he not investigate the abuses of National Health Service consultants when they are working for private patients? Would not that be a more fruitful method of seeking to save money than embarking on the scheme that he has outlined, which is bound to lead to apprehension among racial minorities? Will he assure the House clearly and categorically that the scheme is not laying down a basis for universal National Health Service charges?

Mr. Fowler

This is entirely geared to and intended to meet one aspect of the National Health Service. I give the assurance that the hon. Gentleman seeks. The working party did not inquire into abuse. It merely considered whether the proposed system would be feasible. That was the whole point of the working party. It reported that the scheme was feasible and could be introduced. That is why the report is important.

Mr. Robert Atkins (Preston, North)

I congratulate my right hon. Friend on this long-overdue requirement for the National Health Service, which is one that I and many of my hon. Friends have been pressing upon him since September 1979. If he wishes to present evidence to the Opposition, may I refer him to the many hundreds of letters that have been received on this issue, the vast majority of which have come from doctors, nurses and administrators in the National Health Service, that point to the abuses within the system? Is the £6 million to which he has referred anything like the sum lost by the Labour Government's refusal to implement sections 65 and 121 of the National Health Service Act 1977?

Mr. Fowler

It would be difficult to estimate the cost of the Labour Government's refusal to implement those sections. I know of my hon. Friend's concern about the matters that are covered by the scheme and I am aware of what he has done in this sphere. Many of the complaints about abuses within the system have come from inside the National Health Service, and that is an added reason why the system should be changed.

Mr. Alfred Dubs (Battersea, South)

Is the right hon. Gentleman aware. that many of us are still not convinced by his reasoning that leads him to think that savings will be made on the estimated scale? A year ago the DHSS estimated that there would be a saving of about £5 million if people were charged who had been in the country for up to three years. I am thankful that the Minister has reduced that period to one year. Nevertheless, he says that the saving will be £6 million. He explains that by talking about the effect of inflation. Is he aware that there are serious doubts in the House and among many people who work within the National Health Service that the scheme will cost more to administer than it will produce by introducing charges?

Mr. Fowler

I reject that. In my view, the saving is unlikely to be less than £6 million. I think that £6 million is a modest estimate of the saving to the National Health Service. I sought, in answering a previous question, to set out the reasoning that led us to arrive at the figure of £6 million. I believe that there is a saving to be made, and we would be foolish to turn our back on such a saving to the NHS.

Mr. Teddy Taylor (Southend, East)

My right hon. Friend seems to have indicated that all Common Market visitors will be entirely exempt from the extra charges. Will the exemption apply also to the overseas territories of France? If so, does he agree that it will be daft to give complete exemption to all visitors from French Guyana while making those from British Guyana liable for the full charges?

Mr. Fowler

I shall consider the detail of my hon. Friend's question. Reciprocal arrangements exist for EEC countries but it will be necessary in countries such as Australia, where there are no reciprocal arrangements, to make arrangements for insurance. If my hon. Friend or I were to visit Australia, we would be advised to make insurance arrangements.

Mr. D. N. Campbell-Savours (Workington)

Will the introduction of this measure have any effect on RAWP or on Government allocations to regional health authorities? When the right hon. Gentleman spoke of an increase in savings from £5 million to £6 million, he referred to inflation. Is that the level of inflation that he believes has been inflicted on the National Health Service by his Government in the past 12 months?

Mr. Fowler

If the hon. Gentleman had listened to what I said, he would have heard me say that it was over the past two years. The resources will go to the district health authorities, and the authorities will be able to use them in their own areas.

Mr. Frank Dobson (Holborn and St. Pancras, South)

Will the right hon. Gentleman bear in mind that his Department issued a press statement that suggested that one way of verifying whether people were eligible would be to ask them to show their passports? Will he confirm that it is no longer the intention to ask black or brown British citizens to show their passports? Will he confirm also that he will resign if any of those citizens are asked to produce their passports?

Mr. Fowler

That is not the intention. The situation that the hon. Gentleman is seeking to describe is the present one and not the position to which we are moving. In any case, we have to move from the present racially discriminatory position.