§ Mr. Terry Davis (Birmingham, Stechford)I beg to move,
That this House condemns the new arrangements being made by the Secretary of State for Social Services for charges for National Health Service treatment for overseas vistors; draws attention to the favourable position of visitors from the EEC compared with other countries; doubts that these new arrangements will result in an increased revenue of £6 million per annum for the National Health Service; and considers that the proposed changes will not eliminate racial discrimination in the provision of National Health Service treatment.
§ Mr. SpeakerI have selected the amendment in the name of the Prime Minister.
§ Mr. DavisEveryone is against abuse of the National Health Service or any other part of what it is now unfashionable to call the "Welfare State". However, in deciding what should be done to prevent abuse, we must have regard to three points. First, any special measures must be effective in preventing or detecting whatever abuse may take place. Secondly, the cost of any such arrangements must be reasonable in relation to the revenue that will be generated. Thirdly, such arrangements must not cause unnecessary offence to other people who are entitled to treatment from the NHS without any change at the time of treatment.
First, it needs to be emphasised that we are talking about charges for hospital treatment. This may seem an obvious point, but there appears to be some confusion, extending to Ministers. Indeed, it extends to the hon. Member for Reading, South (Dr. Vaughan) who was, until recently, the Minister for Health. He said during a television interview that this upheaval was taking place because people visit Britain and have glasses or dental treatment on the NHS when they are merely visiting. I do not know what the Minister for Health had in mind when he was talking about his new proposals, but they certainly do not cover that sort of case.
It needs to be clearly and firmly said that many foreigners and overseas visitors are entitled, as of right, to be treated at no charge by the NHS in exactly the same way as any British resident. In the first place, it is residence which matters and not nationality or origin. Many people who are not British citizens are entitled to free treatment by the NHS hospitals and have always been entitled to this free treatment because they live in Britain. They do not have to work here; it is enough to be a resident of England or Wales.
Over the years, other people who are neither British citizens nor residents have become entitled to free treatment as a result of reciprocal arrangements concluded by successive Governments with the Governments of other countries. That was extended automatically in 1973 to all visitors from the Common Market. Of course, there are other overseas visitors who are not entitled to free treatment in hospital under the NHS.
Historically, both Conservative and Labour Governments have allowed visitors from other countries to receive free treatment in certain circumstances. It has been called treatment of immediate necessity for conditions arising, or unexpectedly and seriously exacerbated, while the visitors are in this country. It is not 412 a right for them to receive free treatment under the National Health Service, but it is not an abuse for them to receive free treatment.
If they receive treatment in other circumstances, that is, and always has been, wrong. It is an abuse. In seeking to deal with this abuse, the Government have displayed their usual ineptitude. They are not only trying to stop abuse. They are also restricting the circumstances in which the National Health Service will provide free treatment for some but not all overseas visitors. I emphasise "some" overseas visitors.
The Government's proposals will not affect at least half of the overseas visitors, mainly from the Common Market, to this country. They will continue to receive free treatment in hospitals from the National Health Service. The Government's first mistake was to fail to make any proper estimate of the abuse or the number of people who had previously received National Health Service treatment legitimately and who will be expected to pay in future. It is surely not unreasonable to expect the Government to begin by making an estimate of the numbers of people involved and the cost of their treatment. Instead, Ministers have contented themselves with making a series of unsupported assertions in the House and elsewhere about fairly widespread abuse of the National Health Service by well-heeled foreigners, as the right hon. Member for Wanstead and Woodford (Mr. Jenkin) put it.
It is significant that the only available figures for the numbers of people involved are contained in the report of the working party established by the Government to look into the procedures for these charges after the decision had been made. What do we find? The working party arranged for 8, 152 people to be questioned. These were people who sought treatment at 10 hospitals in England and Wales. The overwhelming majority, 8, 071 out of the 8, 152, were found to be eligible for free treatment without any doubt whatever.
Only 81 people out of the 8, 152, or 1 per cent., needed any further questioning. But this did not mean that 1 per cent. of the people being treated at those hospitals were not entitled to free treatment. On the contrary, the detailed analysis in the report shows that these 81 people included 43 who had lived in the United Kingdom for between one and three years or who were United Kingdom residents working abroad and had returned briefly to this country. Both groups will be exempt under the Government's proposals.
The figure is therefore reduced from 1 per cent. to half of 1 per cent. But the reduction does not stop there. The figure also includes people who had come from the Common Market or from countries with which we have reciprocal arrangements. These people will continue to receive free treatment as overseas visitors. It is not known exactly how many people out of the 8, 152 come into this category because there is some double counting in the analysis provided by the working party. It is, however, known that the 81 people who needed further questioning included 15 from the Common Market, three from Spain, which will shortly join the Common Market, and at least four from countries with which we have reciprocal arrangements.
These 22, at least, out of the 81 people bring the proportion down to one quarter of one half of 1 per cent., or one person in every thousand, who may be liable to be charged. This is before taking account of overseas visitors who have some communicable disease. Heaven 413 knows—certainly the Secretary of State does not—how many people fell into this category. I must stress that these figures show only the number of people—less than one in a thousand—who may be liable to be charged under the Secretary of State's proposals.
§ Mr. Robert Atkins (Preston, North)The hon. Gentleman is probably not aware of a letter written during the period of the previous Labour Government, relating to an inquiry from a doctor, which stated:
It is well aware of the problem of the abuse of the service to which you draw attention.That occurred in October 1978. The previous Labour Government were therefore aware of the problem. Is the hon. Gentleman now seeking to show that it does not exist?
§ Mr. DavisI thought that I had already made it clear that I was not saying that there was no abuse of the National Health Service. I am saying only that it is so minute that it is not worth the trouble of taking these measures. The hon. Member for Preston, North (Mr. Atkins) has referred to a letter written during the period of the previous Labour Government. I recall that when he raised this matter during Question Time the hon. Gentleman flourished a thick file of letters that he said he had received on the issue. The hon. Gentleman never told the House how many of those letters concerned people who will now be charged as a result of the Government's proposal. He never told us how many letters were in the file. He never said how many would be affected by the Government's proposals.
Let him take out of his file all the letters about people who have lived here for more than one year. Let him take out of his file all the letters about people who have come to work in this country. Let him take out of his file all the letters about wives and husbands, sons and daughters, of people who live in this country. Let him take out of his file all the letters about overseas students who have been here for more than one year. Then let him say how many people will be affected by the Government's proposals.
§ Mr. AtkinsThe hon. Gentleman provokes me, although I hope, Mr. Deputy Speaker, to catch your eye later to give more details. The simple answer to the hon. Gentleman is that, in one week, on the very issue to which he refers, I received nearly 300 letters, the vast majority from doctors, nurses and health administrators dealing with the very areas of concern to which he has referred. That figure is reached after taking out all the areas that he has understandably excluded.
§ Mr. Deputy Speaker (Mr. Ernest Armstrong)Order. A number of hon. Members are waiting to catch my eye. This is a short debate. Long interventions, especially from an hon. Member hoping to catch my eye, make for long speeches.
§ Mr. DavisI do not dispute the hon. Gentleman's statement that he has received 300 letters. I question only that this means that there are 300 overseas visitors who have abused the National Health Service. All hon. Members have heard of people who brandish files of letters. We are not impressed by Preston's version of Senator McCarthy.
I stress that these figures show only the number of people—less than one in a thousand—who may be liable to be charged under the Secretary of State's proposals. 414 These proposals involve a change in the rules. It cannot be said that one in a thousand hospital patients are abusing the National Health Service. The Secretary of State will say that the figures are only a guide and cannot be taken as a measure of the abuse that he believes to exist somewhere if only he could find it. He can fairly say that these figures rely on questions and answers and that people may not have answered truthfully.
To be blunt, it is quite likely that people who want to abuse the National Health Service will tell lies, but there is nothing in the proposals to stop that. On the contrary, the report of the working party emphasises that the answers given by the patient should be accepted. There is plenty of room for liars in the new procedure. An overseas visitor liable to pay for treatment can simply lie about the reason for his presence in this country, not tell the truth about the time he has spent here or not tell the truth about whether there is a husband or wife living here. There is nothing to detect these lies. If the new procedure is introduced, it will be totally ineffective in stopping abuse of the National Health Service by overseas visitors. Not only is it ineffective, but I doubt whether it would be cost effective.
One matter that distinguishes the Government is that Ministers of Health may come and go but they all have one thing in common. They are always evasive about money. Wherever we look—the expected reductions in the management costs of the Health Service as a result of reorganisation or the new dental charges that we discussed last week—those Ministers can never explain where they get their figures from. A classic example is that a year ago the Department of Health and Social Security said that the charges would save £5 million. Now the Secretary of State is saying that the figure is £6 million. In the meantime, the Government—under pressure—have extended the categories of people who will be exempt and have dropped the idea of charging for the community services provided by the National Health Service.
How has the Secretary of State calculated his figure of £6 million? So far, he has given only one clue. I understand that when he gave evidence to the Race Relations and Immigration Sub-Committee he said that he had assumed that overseas visitors had a similar usage of hospitals as what he described as the "home population". That is a dubious assumption. It is based on several other assumptions, such as that overseas visitors have exactly the same age and occupation profile and medical histories as the population of England and Wales, which is obviously wrong.
Then there is the assumption that the illnesses experienced by overseas visitors and the treatment received by them are the same as the illnesses of and treatments provided to people who live here. I suspect that that is also wrong. How many overseas visitors have a long period of treatment on a kidney machine, or neurosurgery, or any other expensive treatment? Lastly, there is the assumption that overseas visitors, if they are rot entitled to free treatment, are still going to the National Health Service instead of paying for private treatment.
It is not only a question of the revenue from those charges but a question of cost. How much will the new-fangled system of questioning cost? The working party says that its elaborate proposals could be implemented without any significant increase in administration costs. It then goes on to say that there might be a need for additional 415 staff in some hospitals, but no one knows. The working party's trial involved only the first stage of a proposed two-stage procedure.
A study of its proposals will show that the extra cost depends upon how many people are referred to the untested second stage, but there is no relationship between the costs of questioning all those people and the eventual amounts charged for treating a small minority of them. After the bills are issued, there is also the cost of collection, especially where there is no machinery for collecting charges to private patients. The more that one examines the figure of £6 million, the more doubtful it looks. I hope that the Secretary of State this evening will either explain his estimate or, better still, publish a paper explaining how he has made the calculations.
My third point is the unnecessary offence that will be caused by the interrogation of patients, because under the Government's proposal every patient entering a hospital will be required to submit to questioning. That includes everyone entitled to free treatment, even before they receive any treatment. No one knows how many will then be referred to a more detailed interrogation. From the report of the working party, we know that the second stage will include many people who are entitled to free treatment, including those who give unclear or uncertain answers at the first stage. The Secretary of State insisted that no offence would be given. In his submission to the Sub-Committee, he put great emphasis on the fact that when the working party conducted its trial only 12 people refused to answer the questions.
Typically, the right hon. Gentleman misses the point—in fact he misses three points. First, it was made clear to those taking part in the trial that it was only a trial and that it was voluntary. There is always a better response when people are asked to help in a survey than when they are told that they must answer questions to determine their eligibility for treatment. Secondly, there is no connection between refusal and objection. People may participate in the questioning in a voluntary survey, but that does not mean that they do not object. Thirdly, there was no trial for stage two, with its detailed questions.
In the Labour Party we have a much more fundamental objection. In his statement to the House and submission to the Sub-Committee, the Secretary of State admitted that under the existing rules and guidance there have been several instances in which members of ethnic minorities—people entitled to free treatment from the National Health Service—have been the victims of racial discrimination. What happens is that someone with a black or brown face is asked to produce his or her passport, irrelevant though that is, in order to prove to the satisfaction of the admissions clerk that there is an entitlement to treatment at the hospital.
The Government's answer is to put everyone through the hoop and to question everyone regardless of their ethnic origin. However, the real problem comes after that with stage two and the selection of people who will be subject to further questioning. In view of what has already been established about the way in which some clerks behave towards members of ethnic minorities, the Opposition are naturally concerned that the new two-stage procedure may lead to many more instances of discrimination.
416 The working party says that if someone answers "Yes" at the first stage, which means that he is entitled to free treatment in a National Health Service hospital, no further questions will be asked. In other words, the clerk should accept whatever the patient says regardless of colour or accent—which may mean North Atlantic—and regardless of any suspicions that the clerk may have which may be reasonable or unreasonable, justified or unjustified.
Is that really the Government's position? Will the Secretary of State really issue instructions that if a clerk, for whatever reason, suspects that someone is not telling the truth no further questions will be asked? What will he do if his instructions are ignored? Will disciplinary action be taken? The Opposition will believe that when they see it. Meanwhile, we remain unconvinced that the new procedure of questions for all will stop discrimination against some British citizens and residents.
I wish to put two further points to the House. First, with the new procedure the Government must calculate charges for everything in NHS hospitals. The Opposition have already expressed the view that that may be a paving measure and a way of introducing widespread charges in NHS hospitals, with the intention that eventually everyone will pay. Secondly, a point that has not been brought to public attention is that the Government will not only charge overseas visitors for some treatment of immediate necessity—which was previously provided at no charge—but they will charge overseas visitors for treatment that they would not have had under the present arangements, as I understand them. What is to stop the NHS competing with private medicine? What is to stop NHS hospitals providing treatment for more overseas visitors instead of fewer overseas visitors with the inevitable pressure on hospital waiting lists?
It is no part of the Oppostions's case to say that there is no abuse of the National Health Service. We say that no one knows its extent. The Government have not made any effort to find out and there is no evidence to suggest that it is anything more than minute. The Government are using a sledgehammer to crack a nut.
As to the other changes, the Secretary of State has failed to explain how he calculated that his new procedure will earn £6 million for the National Health Service over and above the cost of questioning every patient who goes into hospital and the cost of setting up the machinery to collect the charges. Finally, the new procedure will do nothing to eliminate racial discrimination in the National Health Service. For all those reasons, the Opposition condemn the new arrangements.
§ The Secretary of State for Social Services (Mr. Norman Fowler)I beg to move, to leave out from "That" to the end of the Question, and to add instead thereof:
this House welcomes a commonsense and fair measure to raise extra income for the National Health Service from charging overseas visitors for hospital treatment, which lifts the burden from the British taxpayer and avoids the possibility of racial discrimination in the present hospital admission procedures.Perhaps I may start with an agreed basis of facts, because of course there are some facts that cannot be denied. They are not the invention of the Common Market, which is mentioned in the Opposition's motion, nor of my Department. I suggest that there are three such facts.417 The first is that the number of overseas visitors to this country now totals about 12 million a year, and about 5 million of them are not covered by reciprocal health agreements.
The second fact is that, unfortunately, some of these visitors who come to this country fall ill and receive hospital treatment. The third fact is that the hospital treatment that they receive costs money.
I suggest that the initial question is who should pay for this treatment. That basically comes down to whether the British taxpayer should pay, or the foreign visitor—or, to be more accurate, the insurance company covering the foreign visitor.
The Government's starting position is simply that we see no reason why the British taxpayer should pick up the bill in these cases. Even less do we see any reason for that when, if a British resident goes to a country that is not covered by a reciprocal arrangement, he will have to pay.
We should be under no illusion about this. If a British resident goes to the United States, Australia, Canada, Nigeria or Japan, falls ill and requires hospital treatment, he will be charged. We are suggesting that if an American, Australian, Canadian, Nigerian or Japanese comes here, he, too, should be charged. We suggest that the cost should not fall on the British taxpayer and that before coming to this country visitors should be warned of the position and insure against the risks. In other words, we are bringing our position into line with that in those countries.
The position that we are changing—I was not clear having listened to the hon. Member for Birmingham, Stechford (Mr. Davis) whether he was defending it—is completely indefensible, because the present procedure is ramshackle and haphazard in its application. It is indefensible, because for those very reasons it can lead to the possibility of discrimination on racial grounds. The question is, therefore, whether any other objections in principle or practice stand in the way of this common sense move.
As to the principle, we should remember that the power to charge overseas visitors was not invented by this Government. It was contained in the National Health Service (Amendment) Act 1949. That Act gave the Government power to make regulations to charge persons not ordinarily resident in Great Britain. It is basically that power, introduced by a Labour Government, that we shall be using, and we shall be using it for the very clear reasons set out in the report of the working party that was set up in July 1981 to consider the position.
The setting up of that working party and the report that it has presented show the care with which we have approached this question. The working party contained representatives from throughout the Health Service and from other organisations, such as the Commission for Racial Equality. It examined the present system and ways of making the suggested new system work.
There is a procedure for overseas visitors. It was introduced under guidance issued in 1963 and it has remained the policy ever since, including during the period of the Labour Government. In brief, it lays down that short-term visitors should be private patients, but with a number of exceptions. Emergency treatment is free, and that includes treatment arising from an accident or an illness contracted here. Whatever the intention may have 418 been, there is no question but that the present system does not work, and if one reads the working party report one sees that there is no way of reaching any other conclusion.
A special study was set up at four hospitals, and the conclusions are set out in paragraph 13 of the report. It found, first, that the checks made on patients to establish illegible overseas visitors were infrequent and irregular; secondly, that the registration of patients was largely carried out by clerical officers, many of whom were not aware of any restrictions on NHS treatment of overseas visitors—that does not sound to me to be a system that is working well—and, thirdly, that patients were often questioned about eligibility only if they had given a foreign place of birth or address or were of foreign appearance.
That is the system that has been examined by the working party and which the Opposition are apparently defending. Those findings were confirmed by a further questionnaire to hospitals and health authorities, and left the working party in no doubt that the present position was unsatisfactory. It is unsatisfactory for a number of reasons: because the intention of the 1963 guidance is clearly being defeated, because the system is wide open to abuse, and because it can lead to discrimination.
On the question of discrimination, it is worth looking at what the working party said:
Because the checks currently used by many hospitals appear to be based on little more than intuition of hospital staff that a patient may not be resident in this country, there is a distinct risk that they may be being applied in a way which discriminates against members of ethnic minorities living here. We therefore feel that there are strong arguments for laying down a uniform procedure for establishing a patient's eligibility and that this procedure should be administered universally".The next logical step in the view of both the Government and the working party was to consider whether the proposed new system could work. The working party had already said that hospitals gather a considerable amount of personal detail about a patient entering hospital and thatMost staff involved in the registration of patients thought it would be feasible to include in the hospitals' current registration procedure some additional questions to determine eligibility, providing the questions asked were simple and unambiguous".The working party then tried out a simple questionnaire at each of 10 hospitals. The questions were designed to check on residence in this country, and the conclusions of the study were again quite clear. They were that, on the evidence of the trial, the procedure could be used to establish rapidly and unobtrusively the prima facie eligibility of the great majority—8, 071 out of 8, 152—of patients.The questionnaire also established that most hospitals felt that this part of the procedure could be implemented—this is important—without additional staff being employed. It found that staff reaction was generally favourable, and most staff, including doctors, have been willing to co-operate. It also found that very few—precisely 12—patients out of the 8, 152 had objected to answering the questions.
§ Mr. Michael Meacher (Oldham, West)The right hon. Gentleman knows that the working party said that extra staff were needed for stage 2 of the procedure. Does he propose to make extra funds available for extra staff? If not, what is his estimate of the cost of transferring existing staff from other more worthwhile duties?
§ Mr. FowlerIn respect of stage 1, there is no dispute about extra staff being required. That is what the working party found. As to stage 2 it may be that in some hospitals some extra administrative effort will be required. Given the growth in administrative and clerical staff over the last two or three years, that should be catered for in the present resources of the NHS. There is no indication that the additional administrative effort will outweigh the gain to the National Health Service.
Following the questionaire, the working party proposed a registration procedure which would be simple to administer and, equally imortant, would reduce the risk of discrimination. The working party commented, and I am sure that this will be accepted by members of the Select Committee:
No procedure can be totally discrimination-proof and a lot can depend on the attitude of staff and the way in which the questions are asked. The recommended procedures would, however, include a number of important features which we believe will greatly reduce the possibility of discrimination.We have adopted the procedure recommended by the working party. It should go on record that there is little or no discrimination in the NHS. However, the new system, with its universal challenge, reduces the risk of discrimination.Basically, a two-stage process is proposed. At stage 1, the admission clerk will ask a number of general questions of everyone. The questions will establish whether the patient has lived in this country for 12 months. That is the basic test. These questions will be added to the admission questions, which are asked in any event.
Only if he answers "No" to those questions will the patient go to stage 2, where he will be questioned by more senior staff on his eligibility for free treatment. The working party found that in its trial only 1 per cent. of patients went to this stage, and of course some of those would be covered by reciprocal arrangements. I have already told the Select Committee that is considering the issue that detailed guidance will be sent to hospitals on the handling of these cases in stage 2 and, further, that guidance will be circulated in draft to the ethnic community organisations. There will be an opportunity for the House to debate the regulation in a few months' time when it is laid before the House, and when the manual of guidance will also be available. We are aiming to raise additional resources for the Health Service.
§ Mr. Alan Clark (Plymouth, Sutton)Although no one will accept the extraordinary slur on overseas visitors that has been put about by the Opposition, which is that they would universally claim eligibility, it is valid to ask what precautions have been taken to guard against dishonest answers to the questionnaire.
§ Mr. FowlerThe first aim will be to ensure that the country of origin, for example the United States or Australia, is aware of the new situation and to ensure that those who come here on holiday or on business are aware of it and take out insurance in exactly the same way as United Kingdom residents would do when visiting the United States or Australia.
There must be a balance in stage 1. The advantage is that stage 1 avoids discrimination. If, after answering stage 1, it becomes evident to one of the hospital staff—we are not advocating that the staff should seek out this information—that the person concerned is not a resident 420 of the United Kingdom, but comes, for example, from the United States and is returning there, he will be referred to the stage 2 procedure.
§ Mr. Alan ClarkIs the stage 2 procedure excluded automatically, as has been alleged by Labour Members?
§ Mr. FowlerIt is not. However, if the suspicions of the hospital staff were raised, the issue would be referred to the stage 2 procedure and those questions would be asked.
§ Mr. Alexander W. Lyon (York)rose—
§ Mr. FowlerI give way to the hon. Member for York (Mr. Lyon).
§ Mr. Alexander W. LyonThe right hon. Gentleman told the Select Committee that if the answer to any of the questions was "Yes" there would be no further questions at stage 1, and that only if a suspicion arose later, perhaps in the course of treatment, would the matter be taken further. He said that if somebody said "Yes", there would be no automatic reference to stage 2.
§ Mr. FowlerThat is right. The admission clerks will not have the power to cross-question. If someone lied at stage 1 and that became clear to the hospital staff at a later stage, it would be unreasonable for the staff to turn their back on that. That would be farcical, and so the issue would be referred and further inquiries would be made. Surely that is nothing but a commonsense arrangement. If the process leads in that direction, the patient will be questioned by more senior staff on his eligibility for free treatment.
We are aiming to raise money for the Health Service. Surely that deserves the support of the entire House. The money will go to the service. The original estimate of revenue of £5 million was made by my predecessor and was based on 1979–80 prices. The working party did not quarrel with that estimate. We have uprated the estimate to £7 million in taking account of the increase in inflation. We have deducted £1 million for the concessions that we have made, notably to overseas students.
The figures can be presented in another way. The cost of acute hospital treatment—this may come as a surprise to those Labour Members who laugh—is £3 billion a year. If the costs of treating visitors were only 0.5 per cent., that would raise about £15 million. A figure of 0.5 per cent. would raise £7½million. That range would be entirely consistent with all the figures and examples that the hon. Member for, Stechford has given. I have never sought to say that £6 million is anything but a modest estimate.
I suspect that the difference between us is not so much over the estimate as on the principle. The Government believe that it is reasonable to seek and encourage ways to supplement public spending on the National Health Service, which is now over £12 billion a year. That is why we welcome the £52 million a year that is going to the NHS from private practice, and that is why it is condemned by the Opposition. That is why we welcome the £20 million that is coming this year from the sale of surplus land. We want to see that full potential realised. This is money that goes to the Health Service and goes direct to patient care.
The motion complains that preferential treatment is to be given to EEC visitors needing hospital treatment. The hon. Member for Stechford did not make a great deal of that. That was probably because the hon. Member for 421 Crewe (Mrs. Dunwoody), who leads for the Opposition on these matters, drafted the motion and is not present for the debate.
§ Mr. Terry DavisAs the right hon. Gentleman has referred to my hon. Friend the Member for Crewe (Mrs. Dunwoody), he might mention that she is not here because she is ill.
§ Mr. FowlerI understand that and make no criticism. It is not controversial to say that the hon. Lady feels strongly about the EEC. I assume that that is one reason why preferential treatment for EEC visitors is mentioned in the motion, but did not play a large part in the hon. Gentleman's speech.
The Opposition might have added the names of the countries with which we have reciprocal agreements under which we treat one another's citizens on the same basis. That arrangement is like the arrangement with the EEC. It is fair to the taxpayers of all the countries concerned. There is the additional point about the European Community arrangement. We inherited from the previous Government an arrangement under which EC countries allowed short-term visitors the same treatment as for their insured population, but only to employed people covered under our social security system. It is this Government who have succeeded in negotiating the inclusion of the self-employed in that scheme—something that will help to balance the arrangements. The previous Government failed to achieve that.
Another major point that should be understood is that we have made a number of important concessions from our initial proposals. Initially, the period of residence was to be three years. We have reduced it to one year. That is a major concession for overseas students. The position is even more favourable for students with regard to general practice. Provided that they are staying for more than 12 months, treatment is free from the beginning. Visiting dependants—spouses and children of people settled in this country—will be exempted.
We have made every effort to meet the legitimate concern that has been expressed. We have devised a scheme which is administratively simple, which minimises the chance of discrimination and which raises money for the National Health Service. Above all, the public will regard the scheme as fair and will be unable to understand the view of the Opposition that the British taxpayer should shoulder the financial burden of paying for the medical expenses of overseas visitors. It is a sensible and commonsense measure. I hope that the House will reject the Opposition's foolish motion.
§ 8.3 pm
§ Mr. Laurie Pavitt (Brent, South)Anyone who has served on hospital or regional hospital authorities will recognise that the Secretary of State is learning rapidly, but, unfortunately, without a great deal of understanding.
I wish to refer to the £3, 000 million for acute surgery. The right hon. Gentleman knows as well as I do that for 30 years overseas visitors who have needed medical treatment have paid fully. The abuse is only a small one. From the figures given by the London teaching hospitals, the right hon. Gentleman will know that the proportion of overseas patients who fail to pay their bills is minute compared with the number of British private patients who fail to pay.
422 I wish to confine my remarks to about 10 minutes, so I cannot demolish as many of the right hon. Gentleman's arguments as I would have liked.
After his statement on 12 March 1981, the right hon. Gentleman's predecessor had second thoughts. I am surprised that, after the working party, the Government have gone ahead with the scheme. It seems that they are obsessed with emotive dogma, out of touch with practicality and ignorant of NHS realities.
An excellent leader in The Guardian on 23 February was headed "Fowler's Potty Plan". Since then, like most hon. Members, I have had a chance to study the Red Book of the working party report. The Guardian leader could have been three times as long with the factual material which emerges from the report and which shows how ridiculous the proposal is in a comprehensive National Health Service costing £12 billion a year.
I rarely bore the House with figures, but I must do so now to show how the Secretary of State's calculations are way out of touch with those of hospital administrators. The Department has ordained a 10 per cent. cut in administrative costs this year from 1 April in the hope that the money can be used for medical care. However, the action that the right hon. Gentleman announced will destroy the endeavour. It is diametrically opposed to the aim.
Let me quote figures from the central Middlesex hospital, which is my local hospital. Hon. Members can translate the figures to hospitals in their constituencies. The statistics will be comparable. In 1981 in-patient admissions were 17, 492, and new out-patient admissions were 24, 918. I am dealing only with the first stage of questioning in these proposals. I am informed that if the admissions officer spends only two minutes per patient, on those figures the total time taken is 177 working days, or an additional 1, 414 hours.
Nationally, administrative excess costs would be astronomical. In 1980, 6, 808, 000 in-patients were admitted and interviewed. There were 20, 145, 000 new out-patients. I emphasise that that is new-out-patients and not out-patient attendances, for which the figure was 56 million. In a parliamentary answer I was told that it is estimated that, for the year after October 1982, the figures will be 5¾ million new in-patients and 8 million new outpatients. What miracles have happened so that there will in the coming year be less call on the NHS to that extent?
Let me again do the arithmetic. At two minutes a time, on stage 1, we get 900, 000 hours. With a 40-hour week, that would mean 450 more administrators. I will not come to stage 2, when there is a much greater need to spend time but for which no estimate is possible. However, the Government declare that they want fewer administrators, with more money spent on the practicalities of medical care and treatment.
I weary of reminding the House that one in three of the patients at the central Middlesex hospital has a black face. The Committee for Racial Equality condemns these changes. It states:
This is not the time to impose further stress on the ethnic minorities in this country.The working party report to which the right hon. Gentleman referred states:No procedure can be totally discrimination-proof and a lot can depend on the attitude of staff and the way in which the questions are asked. The recommended procedure would, however, include a number of important features which we believe will greatly reduce the possibility of discrimination.423 Anyone who knows Brent, Brixton or Toxteth is aware that the Government are perpetrating the greatest nonsense ever. The changes may rationally or intellectually be seen as improvements, but my black people will feel certain that they are racial discrimination, even though they are carried out in the gentlest possible way. Unemployment in my area has doubled, and 80 per cent. of the unemployed school leavers from some schools are black. This is not the time to make changes that they may seem to be discriminating racially.
§ Mr. FowlerThe hon. Gentleman is making a serious charge. He has read the report and will have seen there the point about the prospect of discrimination in the present procedure. What is his solution for that?
§ Mr. PavittUnder the present procedure, the situation in, for example, Sutton Coldfield is different from that in central Middlesex. Most hospital workers are understanding and compassionate. They are not governed by DHSS circulars. The way in which these matters are dealt with now does not alter the fact that it will be compulsory to ask that question at stage 1. The result will be more of what happened at St. Stephen's, Fulham a year ago. Echoes will go right through the black community that this is prejudicial against ethnic minorities. That will be the accepted belief. The extra responsibility that will fall on the new district health authority, which will be formed in only a fortnight's time, is a nonsense in health administration.
For Brent, the real cuts in NHS expenditure on RAWP figures this year will entail a shortage of £280, 000 for development and a loss of 1.7 per cent. or £¾ million for growth. The right hon. Gentleman knows that that is because the north-west Thames area has a growth rate of 0.03 per cent., for historical reasons. The Government are passing the buck with regard to the nurses' pay award. Almost before the district health authorities have their feet under the table, they may have to find 2½ per cent. of the award which is to be transferred from national to district level.
The Government pursue what seems to be a rational approach, but they have no understanding of people, health or the realities of the situation. This is an example of the type of dogma that the Government pursue. I shall pray for the sanity of the newly-appointed district health authority finance officers who will have to try to cope with the Government's mental deficiency.
§ Mr. John Page (Harrow, West)I am sorry that it is impossible for me to agree with the hon. Member for Brent, South (Mr. Pavitt) whose sincerity in activities relating to the Health Service is known and apprecated by all. I hope to deal later with some of the illogicalities in his speech.
I congratulate the Government on introducing the new plan. I have been advocating its like for the past 25 years. Indeed, I discussed it at my original selection committee at Eton and Slough. That explains my—unnatural, I hope—ego-tripping in tabling an amendment of congratulation to the early-day motion in the name of the hon. Member for Crewe (Mrs. Dunwoody).
I wish that my hon. Friend the Member for Sowerby (Mr. Thompson) would finish his conversation with my 424 right hon. Friend the Secretary of State. I am about to be frightfully nice to my right hon. Friend, and I do not want him to miss the bouquets. My right hon. Friend's speech was devastating in its logic, transparent in its common sense and remarkable in its sincerity. Perhaps he will give me a job. Those who have had the opportunity of listening to my right hon. Friend's speech need no further explanation of the Government's case. Therefore, I shall deal later with something completely new.
The Opposition are wholly out of step with public opinion on this matter. From time to time, we all say that our views are supported by public opinion but I have heard no such claim in the two Opposition speeches so far. I believe that the public entirely support the Government's view on this matter. [Interruption.] My constituents are great travellers and very cosmopolitan in attitude. They love to welcome overseas visitors to Harrow—one of the most beautiful suburbs of London—but they resent seeing them getting something for nothing, whether it be in health services or London transport fares.
The hon. Member for Birmingham, Stechford (Mr. Davis), in his rather ranting speech, did not deny that there are abuses. If there are abuses, surely it is right for the Government to do something about them. It was only at the end of the hon. Gentleman's speech that we discovered the real reason for his strong opposition. He resented the idea that anything whatever in the National Health Service should be paid for in any way. The sacred cow must not be touched—even to dress its wounds.
The most absurd criticism was that the new scheme might make race relations more difficult. I agree with my right hon. Friend the Secretary of State that the new scheme will improve race relations by changing the present procedures, which are worrying to many people. The idea that the Health Service might put off people who come a long distance, especially those with black faces, is ridiculous. If they have paid £100, £200 or even more for an airline ticket, an extra £5 for insurance is negligible, and it is a wise and sensible step to take in any case.
Under the new stage 1, I hope people will be required to know their national insurance number. I wonder how many hon. Members present today know theirs. I hope that my right hon. Friend will feel that now is the time to tighten up this aspect of Health Service administration.
I make one personal comment which I hope will be treated as privileged. Twenty years after my wife left Cambridge and we had a fairly large family, she received a letter from a Cambridge doctor saying that he was retiring and that her card would be transferred to another doctor. I suppose that that old boy had been drawing his basic fee on my wife's name for 20 years. I do not resent that, but I wonder how many hundreds, thousands or even hundreds of thousands of duplications of health cards there are in the country. [HON. MEMBERS: "Was she black?"] My wife is not black. She is not even a Red Indian—thank goodness.
I turn to the important, positive and absolutely brand new part of my speech. I draw attention to recommendation 792 of the Council of Europe, passed on 18 September 1976, recommending
the institution of an international medical credit card".It may surprise some Labour Members to know that I was chairman of the Social and Health Committee at the time it was published, but it may not surprise them to know that our activities were often more social than they were healthy. That recommendation was introduced by Mr. 425 Cordle, our colleague and former Member for Bournemouth, East. [Interruption.] We should give credit where credit is due.I ask my right hon. Friend the Secretary of State to give that recommendation his full consideration, because it is a gem that will make him even more famous than he is now if he adopts it and gets it through during his tenure of office. The idea is that throughout the 21 countries of the Council of Europe those who go abroad should have a medical credit card similar to Diners Club or American Express, or whatever the hon. Member for Isle of Ely (Mr. Freud) thinks is the most trendy credit card to brandish about these days. With this card in one's pocket, whenever one went through the Council of Europe countries—and it could be extended to other countries in Eastern Europe with which there are reciprocal arrangements—any payment for medical or hospital treatment could be dealt with on a credit card basis. I am sure that hon. Members have either personal or constituency experience of the difficulty of making a claim after returning from a holiday, when one has been ill, and having to go through the tedious formalities. If this went through, in future, in, I hope, every country of the world ultimately, an internatinal medical credit card could be used. Many of the expensive and useless procedures could be got rid of. Reciprocity is not enough. We need a simpler way of dealing with these charges.
I ask my right hon. Friend the Secretary of State—I shall send him a copy of the recommendation—to get some of his officials to examine it and to have discussions with insurance companies to see whether such a credit card could be instituted. If so, it would be something of which we, if we initiated it, could be justly proud.
§ Mr. Clement Freud (Isle of Ely)I shall not pursue the points made by the hon. Member for Harrow, West (Mr. Page) other than to mention that the idea of a medical credit card—when credit card companies demand 5 per cent. of the action, which would be £300, 000 plus administrative costs—would just about wreck the savings occasioned by the measure.
The hon. Member for Harrow, West began by congratulating the Secretary of State. I begin by commending the Opposition on the motion, which has great relevance. This evening we are being asked to approve or disapprove the abandoning of what has always been the pride of our National Health Service: the giving of free medical aid to those in need of it. We are asked to do this to save what, by all accounts, is a piddling sum of money—£6 million—and if the Secretary of State estimates that it is £6 million the sum is likely to be rather less, because Government estimates in matters like this are always on the high side.
I contend that the savings that will be achieved by asking each patient who comes to a hospital a question which must take 20 seconds per patient will be erased by the administrative costs. We know what will happen. Over the months hospital officials will become bored with asking patient after patient the same question, to which they will receive the same reply—"Yes." Eventually they will confine their questioning to people of whom they are suspicious, such as black people or anyone with a foreign accent.
If the Minister says that at a cost of £9, 000 per constituency one can conduct the questioning and 426 requestioning and then follow up suspicions that the first answer might not be the right answer, I should like to know how. How can all that extra work be done at so little extra cost? I do not believe that it can. For this doubtful benefit, we would lose our reputation as a generous and caring nation that worries about the health of its own and other people and provides a cure when needed.
The Secretary of State should aim at reciprocity with other nations. That would be more sensible than what is being done. It would certainly be infinitely more sensible than introducing a credit card system. It might be sensible, certainly in the case of Nigeria, if people who come here are compelled to take out insurance before they leave their native shores.
I am concerned about three fundamental aspects. First, I am concerned about overseas students. They are deeply worried. An overseas student, particularly if he is here on a short, sharp course lasting only a year, has enough on his plate. If he is made to pay for medical services. he might not go to a doctor when he should. The danger to him and the country would be substantial.
Racial discrimination has been mentioned. It will continue to be mentioned. That problem will be accentuated as the scheme progresses. The change in the system will deter early diagnosis. If there is no free Health Service, people will not go to a doctor when they should and short-term savings to the Health Service would become counter-effective because of epidemics.
My right hon. and hon. Friends take pride in our National Health Service, as I hope do many Conservative Members. We want no diminution of it. If there were genuine savings we might approve, but I do not believe that an arguable £6 million in a budget of £3, 000 million is a genuine saving. This minimal proposed saving has no overall relevance and will harm our reputation. My right hon. and hon. Friends and I will vote with the Opposition.
§ Mr. Robert Atkins (Preston, North)The abuse of the National Health Service by foreign tourists came to my attention in July 1979 when my little girl was ill and was taken to hospital, where she stayed for a couple of weeks. I discovered that the poor child next to her in hospital was of Iranian origin at the time when her country, sadly, was facing difficulties. I was moved to inquire about her position in relation to fees and other expenses.
I did not think a great deal of it, but I tabled a parliamentary question. I set out not to provoke publicity, but to seek information. Some publicity followed the tabling of the question and the answer. My mail bag expanded. I do not have to tell hon. Members that when one's mail expands to five or six letters on a subject one takes serious notice.
As a result of that I asked another parliamentary question and received a further answer. I also did a brief radio interview on the "Today" programme. Within about 10 days I had received an enormous amount of correspondence—nearly 300 letters. The vast majority of them were from doctors, nurses and administrators within the Health Service. They are the people—Labour Members may deride this, either indirectly or directly, in the context of this discussion—who face the realities of the problem day by day and know what is going on.
I want to answer some of the unpleasant and unmerited attacks and smears by Opposition spokesmen, whatever party they represent, because I believe that the sensible 427 decision taken by my right hon. Friend to do something about this anomaly stands happily on its own and does not merit the attacks that have been made.
It is instructive to consider the position of the Labour Government over this issue. One of my doctor correspondents sent me a copy of his correspondence in pursuit of this matter in the summer of 1978. He received a variety of replies over a period of time. First, he received a letter from the right hon. Member for Lewisham, East (Mr. Moyle), the Minister responsible for this matter in September 1978, who said:
I do not consider it likely that there is improper use of the NHS by foreign visitors, nor is it as large a problem as my correspondent believes or that there is abuse on a massive scale.That was the view of the then Minister, despite the evidence that was being accumulated.In a further letter in October 1978 he said that he was well aware of the problem to which my correspondent had drawn his attention only a month previously. He went on to say that under section 121 of the National Health Service Act 1977, which substantially embodied the provisions of section 17 of the National Health Service (Amendment) Act 1949, passed by a Labour Government, Ministers were empowered to make regulations under which charges could be levied on persons not ordinarily resident in Great Britain for certain services in particular circumstances as might be provided. However, no such regulations were made. That is instructive.
In May 1979, just before the general election, in a further letter from the same Department—although not from the Minister—the point was made that if it did happen that a patient from a country without reciprocal health arrangements ended up in an NHS hospital that was not authorised to treat private resident patients under section 65 of the National Health Service Act 1977, neither the hospital nor the consultant who treated that patient would have any authority to charge the patient.
In other words, there was no real attempt by the Labour Government to face their responsibilities—responsibilities which I readily admit to the hon. Member for Brent, South (Mr. Pavia) I did not know a great deal about until I tabled the parliamentary question as a matter of interest, and as a result of the response from the people who actually know the subject at first hand. I recognise that the hon. Gentleman is well informed on matters relating to the National Health Service, but I suggest that there are people working within the Health Service at all levels who have a different view from his, and I would seek to substantiate that view.
It was unfortunate that the hon. Member for Birmingham, Stechford (Mr. Davis) said that I was being McCarthyite in the way that I raised these matters. I shall not take issue with him over that, because I do not think he really believes it. However, the Opposition say that, if nothing else, this system enhances racialism. I resent that slur. Many of my right hon. and hon. Friends will resent that suggestion. I served for nearly 10 years on the London borough of Haringey, which has similar problems to those in the area represented by the hon. Member for Brent, South, and I also served on the executive of the community relations council. I did an enormous amount of work with my hon. Friend the Member for Hornsey (Mr. Rossi) in that area, where there is a substantial immigrant population.
428 When I became the candidate for Preston, I sought to represent a constituency with a large Asian population. As most hon. Members would do in those circumstances, I have done an enormous amount of work to represent my constituents' interests. So racist am I that I was one of those Conservative Members—I make no play of this, but merely record the fact—who did not support the Government on the immigration rules. I am not one of those who can be accused on my record, actions and words of being a racist in intent. I resent the slur being put about that anyone who supports such changes is a racist.
The provision merely rectifies an anomaly that leaves us out of line with almost every country in the free world. This action does not in any way represent an attack on the Good Samaritan policy that all hon. Members broadly support. I refer to the policy of dealing with emergencies first and subsequently asking for any financial contribution that can be made. That occurs in almost every country in the free world. We could still carry out such a policy.
Judging by some of my correspondents' experiences of the system of retrieval under the Labour Government's rules, the form E111 procedure was, according to all accounts, something of a comic performance. In addition, it was often difficult to get money out of embassies, which denied any knowledge of citizens who were supposed to be in their care. However, we can retrieve some of the finance if we accept the Government's rules and proposals.
It has been suggested by the Labour and Liberal Parties that there is no abuse or that it is too small to worry about. My constituents in the North-West—and I am sure that this is true of my hon. Friends' constituents—do not consider £6 million as too small a sum to worry about. Britain has been in trouble because not enough people worry about sums such as £6 million. It does not matter whether the sum is £6 million, £60 million or £100, 000. If the situation is wrong, we should do something about it.
§ Mr. Edward Lyons (Bradford, West)Is the hon. Gentleman in favour of charging foreigners for entry to our museums and art galleries? What about the subsidy of several million pounds a year to Covent Garden? Americans take great advantage of that and pay half the value of the full ticket. Does the hon. Gentleman want to try to save some of that money, too?
§ Mr. AtkinsI do not wish to be drawn on a separate argument, but my brief reply is that I am in favour of charges for museums and galleries. Money raised from outside users will go much of the way towards making our museums and art galleries more efficient and effective. However, given the time constraint I do not wish to take up that separate argument.
The Opposition misjudge the situation if they believe that there is no public concern, particularly among the medical profession, about the abuse that has occurred in recent years. I shall refer to some of the correspondence that I have received, but which I did not seek to provoke. Heaven alone knows that we have enough constituency problems every day without having to cope with such enormous amounts of correspondence. Of nearly 300 letters, the vast majority came from doctors, nurses and administrators. I shall make that point over and over again, because it bears repeating.
The first letter was sent by a lady in South London, who is involved in administering an ante-natal clinic in a hospital. She wrote: 429
One person came from Ghana. She was given an indefinite stay but went home and then came back to this country in March 1981. Her baby is due now and she says she has no money. She says she does not intend to stay here for good and will be going home in about two years. She also said that seeing as she used to live here she is entitled to maternity grant and benefits".The same lady mentioned another case and wrote:A lady from Nigeria came here seven months pregnant. At the same time she is only staying a year on her passport. Surely she got pregnant in her own country and none of them are working. Why shouldn't she pay for her confinement".My hon. Friends may think that that is a fair point.Another letter comes from a different part of the world, Yorkshire. The problem is not confined to London, where the tourists are. The correspondent wrote:
I met a young Cypriot in a cafe, who informed me that her two brothers are staying in Harrogate at the moment and that she is going to Harrogate in May in order to have her second baby. How can this be, except as I suspect, by false pretences?Then there is the case in another part of London of a lady who came from the Ivory Coast. She stayed until June 1980 and went home for three months. She then came back to this country in October 1980. The Home Office allowed her two months' stay. She came to the ante-natal clinic in November this year, having got herself pregnant. So it goes on.I have a letter from a senior nurse in another part of London, who said that
not only do women come here from abroad to have their babies either privately or in the NHS obstetric units, but they all receive at least one visit from the Health Visitor 10 days after the birth—in my experience they rarely leave Britain before the baby is one month old".Now I have a classic example. It is from a higher clerical officer in an ante-natal clinic. She writes:A couple from Brazil came over on passports stamped for 6 months. He was a private paying student, and she was five months pregnant. When told that they were not entitled to national health and that they would have to pay, the husband argued most strongly, saying that when you come to England you do not have to pay. However, he paid for a few visits and then produced a letter from his embassy saying that they were going to employ him, but would not say for how long. When I phoned the Department of Health and Social Security they said that there was nothing we could do and that they could have the baby here free of charge. They agreed with me that something fishy was going on but there was nothing that could be done. When I told the husband that they would not have to pay after all, he laughed and said we were an easy touch. He then asked for a refund on the payments he had already made.I have given only a tiny slice of the correspondence that I have received.
§ Mr. Alexander W. LyonI hesitate to intervene on every case, but in most of the cases that the hon. Gentleman has mentioned the person was entitled to be here and to receive free treatment under the immigration rules. In the last case, if the Brazilian embassy's letter was correct and the man had been employed here, or had entered into employment, the DHSS advice was correct. The man is entitled to free medical treatment, and will be entitled to it under the rules that are being put forward.
§ Mr. AtkinsI am sure that the hon. Gentleman does not fail to recognise that the people concerned realised that they were out to "con" the British taxpayer. They themselves recognised that fact, as my correspondence suggests. If they recognised that, surely that is clear evidence. [Interruption.] It is no good Opposition Members shouting and shrieking. They know full well that they are wrong and that they made a mistake which they are trying to get out of.
430 I received a letter from a senior doctor in Leicestershire, who said that he was closely connected with a situation where a Portuguese resident was brought to this country with serious leg trouble, which he believed was gangrene. The man was admitted to a National Health hospital and had a leg amputated. A temporary artificial leg was fitted, and the man duly returned home. Some months later, again he visited the area on holiday, and had a final artificial leg fitted, again under the National Health Service, entirely free. These letters are from doctors, administrators and nurses who know what is going on. They recognise that this is an abuse. On this issue the British public are much more sound than the Opposition, whether Labour or Liberal.
Here is a letter from another doctor in Sheffield:
I have … personal experience of a patient presenting himself at Heathrow from Hong Kong without having had a chest X-ray and was found on X-ray at Heathrow to have open tuberculosis. He was immediately admitted to a NHS hospital, and subsequently treated at great expense for the next two years".
§ Mr. Edward LyonsThe hon. Gentleman has just quoted a case from Hong Kong. Before that, he quoted a case from Portugal. Is he aware that there are reciprocal arrangements with both those countries, and that in future, after these regulations, those people will still be entitled to have that treatment? One example that the hon. Gentleman gave concerned a person who was permanently settled here. Under the new regulations, all those people will remain entitled to the same treatment as before. Will he deal with people who will not be entitled to treatment?
§ Mr. FowlerThere is no reciprocal arrangement.
§ Mr. AtkinsAs my right hon. Friend has rightly said, almost inaudibly, there is no reciprocal arrangement with Portugal or Hong Kong. The hon. Gentleman is wrong.
§ Mr. Edward Lyonsrose—
§ Mr. AtkinsI cannot go on giving way. Other hon. Members want to speak and they may get a chance if hon. Members stop intervening. [Interruption.] I am sorry to confuse right hon. and hon. Members opposite with the facts. They may not like them, but people throughout the country are recognising what is happening. [Interruption.] I resent interventions which suggest that anything to do with Portugal or Hong Kong involves racism. The hon. Member for Walsall, North (Mr. Winnick) is the sort of person who stirs up racism. I take it ill from him—
§ Mr. John PageHe has just come in.
§ Mr. AtkinsHe has just come in, as my hon. Friend says.
I may bore hon. Members opposite by quoting from letters from people who care. We are not talking about the average anonymous letter or the concern of people at different levels. I am quoting letters from doctors, nurses and administrators, the people who are running the National Health Service. Labour Members, with their bleeding hearts on their sleeves, pretend that they care more about society than anyone else. The letters that I am quoting are from people who face the problem at first hand and know what is going on. Opposition Members ignore at their peril—and peril it may be—what these people are saying.
One could delay the House for a long time on this, but I do not intend to do that. I conclude, therefore, by referring to two or three other letters that I have received. One, signed by eight nurses in a hospital in London, says: 431
Most people that I work with, in five different clinics, feel very strongly about this issue, particularly since if we or our children apply for such a service abroad we invariably must pay for it.Point proven.A letter from another doctor says:
We must surely be bonkers. When are we going to wake up to the situation in this country? When our people go abroad and unfortunately have to go to hospital, especially in America, we have to pay. So why are we being so soft on people coming here?Finally, in this context I quote from a doctor who has spoken to several people in the family practitioner committee. He said that in the Bristol area the medical profession would back me in my campaign—I am sure they will back my right hon. Friend—all the way. Indeed, the British Medical Association issued a statement when the matter was raised originally, in which it said that it backed the campaign. It said:Our policy is that payment should be enforced for medical services provided in this country for visiting nationals of those countries with which we do not have reciprocal arrangements.The British Medical Association and its official representative body believed that there was abuse about which something had to be done.The examples that I have given are only a tiny minority of the letters that I have had from people working in the Health Service. If they do not serve to show that there is substantial public and medical concern about the abuse to support what my right hon. Friend is doing, I do not know what more is required. The Labour Party has misjudged the mood of the nation, as it so often does. This is a necessary rectification of an anomaly which annoys many people in the medical profession and in the country as a whole. I therefore warmly welcome what my right hon. Friend is doing.
§ Mr. Alfred Dubs (Battersea, South)The hon. Member for Preston, North (Mr. Atkins) referred to several examples of abuse. If he will refer to schedule 3 of the circular sent out by the DHSS last year, he will see that on the list of countries for whose citizens treatment will be provided is Portugal—along with Austria, Bulgaria, Czechoslovakia and so on. In that respect at least the hon. Member was misinformed, because we have an agreement with that country.
§ Mr. William Hamilton (Fife, Central)And Hong Kong.
§ Mr. John PageWould the man from Portugal be able to have his amputation and false leg free?
§ Mr. Alexander W. LyonYes.
§ Mr. DubsI had said hardly more than one sentence before giving way.
The statement at the beginning of schedule 3 is:
Treatment of immediate necessity provided in respect of nationals of, and citizens of the United Kingdom and colonies resident in the following countries and territories".Over many years we have heard many stories of what has happened to United Kingdom visitors to countries such as the United States. There have been depressing stories of treatment being refused until the individual concerned could produce enough money to pay for it. Over many 432 years we have prided ourselves on having a better system—treating people on the basis of their need. We have said that we shall not engage in hassles over whether they have enough money to be entitled to such treatment.If the Secretary of State's proposals are implemented—I hope that they will not be—a different situation will prevail in the National Health Service. For example, a student from another country—say, Bangladesh—might be knocked down by a motor car and taken to hospital. As an emergency case, he can have treatment free of charge, but if he needs further treatment in the hospital—perhaps for a broken leg needing inpatient care—he will have to pay for it. If he cannot pay, is he to be discharged while still requiring treatment, or will some other arrangement be made?
The Government's reasons for their policy are, according to the Secretary of State, the saving of £6 million, the provision of what the right hon. Gentleman calls a fair system, and the lessening of alleged abuse. I believe that those of us on the Labour Benches broadly agree that the scheme is wrong in principle. It is a departure from the basis of a free NHS; it introduces a major element of discrimination against people who are not white; and in any case it will not save £6 million.
I agree that the stage 1 questions to be asked are innocuous enough. If the intention is carried out, they will be asked of everybody entering hospital for treatment. The sting is in stage 2. We do not know what the stage 2 questions will be. Naturally, there is apprehension about how stage 2 will work. The Secretary of State has cleverly introduced the scheme, but has left us all wondering what stage 2 will be all about. When we asked the right hon. Gentleman in the Select Committee on Home Affairs, he could not say, but he told us that he would present his proposals later.
In 1978 the Department of Health and Social Security looked into the matter. After all, the idea of charging is not new. It concluded:
it is likely that the administrative cost of making the additional inquiries necessary would be as great and probably greater than the revenue which would be received from charging visitors for the cost of emergency treatment.That was the view of the Department advising the Secretary of State four years ago. When the point was put to the right hon. Gentleman in the Select Committee, he repliedWe have made a better assessment now and our figures are more accurate.What is the basis of that "more accurate" assessment that has been made more recently? The first part of the assessment is the survey carried out on behalf of the working party, to which reference has already been made. The survey found that, of 8, 152 people going for hospital treatment, 81 would have been suitable for possible further questioning if the stage 2 questioning had been available. Despite the complexity of the analysis, despite the figures and despite the detail, there is no table in the report showing how many of the 8, 152 would be liable to pay under the new arrangements. We have various tables that tend to confuse rather than to clarify. It is clear that at least half of the total of 81 would not be liable to pay on the criteria that they were working abroad as United Kingdom residents, and were returning to or living in the United Kingdom for a year.433 Another set of criteria relates to the urgency of the need for treatment. There are about 44 people in that category. However, we cannot make a cross-reference between the two groups.
A third group consists of people from countries where they normally reside. Although it is clear that 15 individuals come from countries with which we have reciprocal agreements, it may well be that many of the others come under different categories.
§ The Minister for Health (Mr. Kenneth Clarke)The hon. Gentleman has obviously gone into the details. Therefore, he will know from the tables that 12 Americans are identified. I am trying to understand his position. Is he saying that there is something wrong in American tourists, admitted to hospital, paying for their treatment out of insurance policies that they would presumably expect to take out and that it is wrong not to expect the British taxpayer to pay for those Americans' appendicitis or other hospital treatments? Why is he so root and branch against what seems to be a perfectly sensible proposition?
§ Mr. DubsI shall deal with that point in a moment. I was seeking to test the proposition that the Secretary of State put forward: that a careful assessment showed a saving of £6 million, from the introduction of the scheme. Despite the detailed tables in the report, it is still impossible to deduce how may individuals will have to pay under the new arrangements. There cannot be many, or the Secretary of State would have been the first to present such information.
As the Minister said, the table includes 12 people from the United States. Even if every one of those had to pay, that is still only 12 out of 81 from an overall total of 8, 152. The least we could have expected from an investigation based on interviewing over 8, 000 people would have been an indication of the numbers liable to pay. That is the one figure on which the Secretary of State could have based his assesment of £6 million, but that figure does not appear.
Therefore, the Secretary of State, in a document prepared by his Department, presented to the Select Committee an alternative based on the ratio of visitors from countries with which we do not normally have reciprocal agreements as the total number of hospital patients in Britain. The document states:
Since records do not show present use of hospital services by visitors, one can only assume usage similar to that of the home population; the estimate of £6 million annually has been derived from that.That is a rough and ready estimate. There is no supporting evidence to show the intervening stages and whether any assumptions were made about the nature of the treatment, which would exclude certain people under psychiatric treatment and so on. It is a hit and miss basis for arriving at a figure of £6 million.The Secretary of State told the Select Committee that, of the £6 million, £1 million would be obtained by charging overseas students. There is not a shred of evidence in the report of the working party or in anything else that has come from the Secretary of State, the Minister or the DHSS to support claim that one-sixth of the total that the Health Service will allegedly obtain will come from students. More supporting evidence would be necessary for that.
Without any knowledge of how stage 2 will operate, we clearly cannot say whether it will be discriminatory. For 434 the life of me, I cannot understand how we can have stage 2 questioning without there being an element of discrimination in the way that it will be applied. The overwhelming view of National Health Service bodies and others, which gave evidence to the Select Committee, is that there is a danger that the new tests will be seen as discriminatory.
The Brent health district said:
Our experience suggests that the mere process of assessing eligibility is looked upon as discriminatory notwithstanding the fact that all patients are expected to submit to the test.That is a reference to stage 1, let alone what happens under stage 2.The Kensington, Chelsea and Westminster area health authority stated:
However carefully the rules are applied, distress and offence will inevitably be caused to some patients who are in fact entitled to treatment.The TUC made a similar comment. The Association of Community Health Councils expressed concern, as did the West Midlands regional health authority. So did the Commission for Racial Equality. One could go on referring to various organisations and bodies, many of them directly concerned with the day-to-day administration of the National Health Service, which believe that the effect of the proposals will be discriminatory.The next problem is the burden on National Health Service staff in administring what will prove to be a very complex system. It is not merely a matter of saying—however the details of stage 2 are worked out—that certain groups will be exempt and then discovering whether people fall into those groups. There is, for example, the question of refugees. It is by no means clear whether we are talking about people who have been granted refugee status or people who have come to this country and are applying for refugee status. What will happen to people waiting for the Home Office to confirm whether they are refugees?
Many people, who are subject to the immigration rules, have a complicated immigration status. It is difficult enough for experts in immigration law or for hon. Members, at their surgeries, to resolve the immigration status of some people who come to us for help in certain matters. Yet some of the complexities will be applied to discover whether people are exempt from the charges inherent in the new procedure. The difficulty of applying the system and the need for Health Service staff to understand it fully and to have special training makes me wonder whether the whole thing is worth while.
Another problem is what will happen to students, liable in the first year to pay, who go into hospital before they have been here a year but are not sent the bill until after the year has elapsed. They will presumably have to pay because they were ill before qualifying. There may be a large number of borderline cases. Will a person who applies for refugee status, becomes ill, and is then given refugee status get his money back retrospectively? Will he have to pay? The scheme will be difficult to apply.
Another difficulty is the sort of evidence that might be necessary. The Secretary of State has at no time denied that passports might not be helpful in enabling people to establish that they are exempt from the need to pay. It is a very short step from that proposition to the one that people will feel pressurised to produce their passports. The Minister shakes his head. People will feel that it is much 435 easier to come along with their passports. There will be an implicit and insidious pressure for people to come along with their passports.
The DHSS accepts the passport as evidence of entitlement to supplementary benefit. It maintains that this is part of the procedure that is supported by the Secretary of State. Many hon. Members know of constituents, fully entitled to supplementary benefit, who, having been abroad for a short period, have to go through the business of producing their passports to establish their entitlement to supplementary benefit.
§ Mr. Alexander W. LyonWith respect to my hon. Friend, no one is bound to produce his passport. Home Office Ministers have made clear on several occasions that for no purpose whatever is anyone bound to produce his passport. At the moment people are not bound to produce passports for treatment in the National Health Service, but some are being asked to do so. It is this development that hon. Members now fear will be extended more widely.
§ Mr. DubsI thank my hon. Friend for that intervention. Nevertheless, letters from Ministers at the Department of Health and Social Security about passports have certainly not repudiated the practice whereby, in some instances, DHSS officers have asked for passports.
§ Mr. Kenneth ClarkeThe manual of guidance, on which my right hon. Friend said that we shall be consulting, will be issued to officers carrying out the Secretary of State's questioning. It will tell them not to ask for passports. The reason for that, apart from the sensitivity of the subject, is that it does not have much relevance. Nationality will not determine entitlement to treatment. The questions will be aimed at where the man has been living and, if he has been here for less than a year, what he is here for. That is hardly likely to be racially discriminatory. As we see from the answers, we are likely to get places such as Wyoming or Adelaide as the person's residence, and then the insurance company will pay the bill.
§ Mr. DubsI understand what the Minister has said. If that is an assurance that passports will never in any circumstances be asked for as a test of eligibility for Health Service treatment, we have not so far received such an assurance from the Secretary of State. It is helpful to have that assurance from the Minister.
§ Mr. William HamiltonI have a document from the Association of Scottish Local Health Councils, which states:
The DHSS has stated that it sees no reason why people should not be asked to produce passports since there is no requirement to carry identity cards in the United Kingdom.That is on the matter that we are now debating.
§ Mr. DubsThat was my understanding of the position. I hope that we can have some further clarification of it. Certainly the Minister has made the position a little more clear than it was up to now. I hope that it represents a change of heart by his Department. If so, he is to be congratulated on having brought it about. It certainly removes one of the main anxieties—although not the only one—about the way in which this procedure will be applied.
There are obviously political disagreements between the two sides of the House on the principle of the matter. 436 It has not been shown convincingly that we can avoid the new practice being discriminatory or being seen to be discriminatory, especially against people whose skins are not white. It would be far better for the Government to say that their policy is to extend the number of reciprocal agreements, so that we in turn can provide free NHS treatment to visitors from abroad, and that the main thrust of our policy should be to try to achieve similar benefits for British people when they visit other countries. I hope that the Minister and the Secretary of State will think again and decide in the end not to introduce this proposal.
§ Mr. Deputy Speaker (Mr. Bernard Weatherill)Order. Before I call the next speaker, it may be for the convenience of the House if I say that I am informed that the winding-up speeches will begin at 9.35 pm and there are a number of hon. Members who wish to speak.
§ 9.8 pm
§ Sir William van Straubenzee (Wokingham)I shall respond to what was clearly a message and therefore make only a short speech. I appreciate that the debate is about the whole range of charges in the National Health Service for overseas visitors. However, I wish to concentrate my few remarks upon one section.
I have listened to most of the debate and have missed only one speech, about which I am sorry. It seems to me that there is more agreement than might otherwise have been supposed. There is agreement that there is some abuse, but there is probably disagreement about how much. I see the hon. Member for Birmingham, Stechford (Mr. Davis) nodding agreement. There is disagreement about whether an additional inflow of £6 million is worth it or whether that will happen. I take the view that many small savings or additional inflows is a valuable way of assisting the funding of the National Health Service and other matters about which I cannot talk this evening.
From my modest experience as a constituency Member, I know that few matters arouse more passionate hostility and anger among perfectly decent people who do not have an ounce of prejudice in their veins than the feeling of misuse of the NHS, as they believe, with the occasional actual example, by those who come from abroad. We are not talking about a free Health Service. Our constituents are paying considerably and so are their employers. We owe it to them to be extremely careful.
The group on which I wish to concentrate is overseas students. The Minister for Health's assumption of his new office gives enormous pleasure to many of his hon. Friends who admire his qualities. To him I say that I am extremely grateful for the advances that have been made insofar as they affect overseas students. I have always deeply felt that there is nothing less than a moral duty on a rich nation, which we still are in world terms, to share part of its education heritage with students from other parts of the world, preferably countries that are less well off, but also countries that as well or better off. I was therefore troubled about these charges as first proposed because they were an additional burden on the students I have in mind.
In general terms, for many years I have always doubted whether our previous system of financing overseas students was sufficiently discriminatory. I believe that, arising out of recent changes, we shall be able to make great improvements, particularly as we can afford more. 437 I rejoice in the fact that a student enrolling for a course lasting longer than one year will now have his medical treatment from his doctor, and other than in the first year his treatment in hospital, provided. My hon. and learned Friend must understand that many people welcome that. They are grateful for it and appreciate the care and attention that I personally know Ministers gave to this problem.
We are not completely home and dry. I would not expect us to be so until we finally see the form of the regulations that will be laid before the House. Let me illustrate the sort of thing that we must try to hammer out. It was referred to briefly by the hon. Member for Battersea, South (Mr. Dubbs). I confess that I am not clear, if I were an overseas student and required, in week 50 of my first year, hospital treatment which extended two weeks into my second year, whether I would have to pay for only two weeks or for the four weeks. I simply use the four-week illustration for ease of example. Obviously the period could be considerably longer.
My right hon. Friend fairly made the point that we would be expecting overseas visitors—in that, he must have included overseas students—to rely increasingly upon insurance cover for this liability, just as all hon. Members do when they visit countries with which we do not have a reciprocal arrangement. I do not expect my hon. and learned Friend to reply to this detailed point. I ask him to do no more than bear it in mind when he hammers out the details. I am concerned about this because insurers are at work on policies, and in the student world there is an intelligent operation run by Endsleigh Insurance which will be known to several hon. Members.
I have made careful inquiries and I believe that the company can—I truncate an elaborate matter—produce a group policy to cover this year, for £75 outside London, and £100 for inside London. [Laughter.] I do not know why hon. Members laugh. Many of us have a common interest in these matters. When considering the large sums spent by students—often at considerable sacrifice—on travel, fares and caring for themselves when in this country, that is not a massive additional sum. We must be reasonably practical even when we care deeply about a subject. I do not regard the premium as unreasonable, but it could be reduced.
The National Union of Students receives a great deal of stick—regretfully, often from the Conservative Members. I know that in matters political that stick is justified. However, for many years I have said, and will continue to say, that on matters technical relating to students the NUS can be extremely effective. Tonight's debate is, in part, a reflection of that.
The union's representations to my hon. and learned Friend and my right hon. Friends and their predecessors have been extremely responsible, well researched and technically competent. When my hon. and learned Friend replies, I hope that he will agree to listen to narrow, technical representations which might make all the difference, from whatever reputable source, and I hope that he will include Government Back Benchers.
The hon. Member for Battersea, South is right in saying that there are matters of definition and precision on which it would be enormously helpful to have more clarity.
I am happy to be making this representation to my hon. and learned Friend because he will remember that we first met when he was a distinguished officer of the Federation of Conservative Students. That illustrates how old I have 438 become. I am extremely sorry that his successor generation—the leadership, not the rank and file—of that splendid organisation takes such a narrow dog-in-the-manger view of its wider responsibilities to students in the National Union of Students, although we shall no doubt get that right.
I believe that my right hon. and hon. Friends on the Front Bench have materially helped in this sphere. I fully understand the problem of the one-year course students. I believe that examination will prove that a large proportion of them are studying languages. In many sub-degree courses—often overlooked in regard to overseas students—where qualifications are being obtained, the course is longer than one year. Even so, I hope my hon. and learned Friend will be receptive to representations.
My hon. and learned Friend has received a great deal of criticism, —I am not noted for saying in a smarmy way that I think my leaders are doing splendidly, though generally I do—but I say without equivocation that we have taken a great step forward and I, for one, am grateful.
§ Mr. Michael Meacher (Oldham, West)I hope that the hon. Member for Wokingham (Sir W van Straubenzee) will forgive me if I do not take up his remarks on overseas students. Time is pressing and I wish to advance a rather different argument.
The central issue is the Government's motives and intentions, because it is difficult to take the Govermnent's claims at face value. There has been a great deal of discussion about the benefit of saving £6 million. If that were really the issue, the smallest attack on the black economy, which is now costing Britain between £3, 000 million and £4, 000 million a year—that is the official estimate—would provide a flow of funds for the National Health Service hundreds of times greater than the Government's puny measure.
There is no evidence of extensive abuse of the NHS by foreign tourists coming to Britain only for NHS treatment. The hon. Member for Preston, North (Mr. Atkins) quoted the results of an entirely unstructured sample that was totally unrepresentative, and the Minister knows that. The official survey suggests that in more than 99 per cent. of such cases there was no abuse. My hon. Friend the Member for Birmingham, Stechford (Mr. Davis) has shown that the degree of abuse, as reflected in the official survey, is a tiny fraction of 1 per cent. In those circumstances, how can the Government justify introducing an eligibility test for everyone applying for NHS treatment to winkle out a minuscule number of foreign tourists, a fraction of whom might be abusing the NHS?
In 1973 the Department of Health and Social Security found that the sum spent on treating visitors was only about £1 million. That was a fraction of about one-twentieth of 1 per cent. That is almost exactly what £6 million is as a fraction of £12 billion, which is the total annual cost of the NHS now. Even that figure included the cost of treating those covered by reciprocal health agreements, which are perfectly legitimate.
The administrative costs of the Government's scheme would most certainly exceed the net savings in preventing abuse. The working party estimated that the saving might be £5 million. It would be wrong to take that as a firm figure. It is uncertain what the saving will be. The working 439 party did not know how many persons might be deterred and how many persons might opt for private treatment, for example.
An offsetting factor is the extra cost of staffing. When I intervened in the Secretary of State's speech to advance that argument he gave an extremely unsatisfactory answer. He said that no extra staffing would be made available. However, there will be the hidden cost of transferring staff from other more worthwhile duties to implement the scheme. The scheme will involve the printing and distribution of manuals, the training of staff to use them and the printing of a vast number of extra forms. That is a curious thing for the Government to be doing when we bear in mind their concern about unnecessary official forms.
What is the Government's estimate of the total offsets? That is the relevant figure if we are to judge the real gain, if there will be one. Given that there is clearly negligible abuse and little or no net savings, what is the Government's motive? Several reports have appeared, which have not been denied, that the Government are continuing to seek ways of changing the structure of the NHS so that it rests on an insurance basis. The Government have expressed a general desire to privatise up to 25 per cent. of the NHS. Against that background it is difficult to avoid drawing the conclusion, whatever protestations may be made by the Secretary of State, that the Government's real intention is to lay down an administrative framework and to pave the way for setting up a National Health insurance scheme.
Once we have administrators checking every patient's eligibility, there will be nothing simpler than to set them to check on every patient's health insurance. A health insurance scheme could then be introduced at low cost. The Government could come to the House and say "It will cost the taxpayer hardly anything."
We are opposed to this mean-minded and petty proposal, partly because of this clear ulterior motive, but there are several other objections to the scheme. The scheme will force NHS staff into the role of immigration officers. As an hon. Member sponsored by the Confederation of Health Service Employees, I assure the Secretary of State that that is unacceptable to members of that union and, I am sure, to other NHS unions.
Paragraph 39 of the working party report states that extra staff would be required for stage 2. The Secretary of State made it clear that he would not provide extra funds. What is certain is that shortage of time and the unpleasantness of the task will lead to corners being cut in asking questions. The people who will bear the brunt of the questioning will be those with black or brown faces, with odd sounding names or with funny accents. The Secretary of State's suggestions that there will be no increase in discrimination in the National Health Service is ill founded.
§ Mrs. Elaine Kellett-Bowman (Lancaster)Paragraph 39 of the report states clearly that
there should be a net gain to the NHS.Would the hon. Gentleman regard that as inconsiderable?
§ Mr. MeacherWhether there is a net gain depends on the offset of the savings. It is our view that the offset of 440 any savings is likely to exceed what are alleged to be the gross savings. The proposals will be an adminstrative nightmare.
§ Mrs. Kellett-Bowmanrose—
§ Mr. MeacherEvery patient will have to be checked. That will include psychiatric and geriatric patients who make up the majority of those who enter NHS hospitals.
Just for amusement I shall quote an extreme case, which will show the absurdity of the proposals. It is suggested that all cases of sexually transmitted diseases caught in Britain should be tackled free, while cases imported by the visitor should be charged. How on earth does one tell the difference? I do not have to tell the Minister that germs do not come to Britain carrying flags and passports.
§ Mr. Kenneth ClarkeThe hon. Member has produced at least six inaccuracies in the past five minutes. His last statement is wrong. Treatment of communicable diseases will be free. It does not matter where they have been contracted.
The hon. Gentleman referred to racial discrimination. The only people who will be asked stage 2 questions will be those who have said that they do not live in Britain, or have not lived here for long enough, or who arouse suspicion. In a city such as Nottingham there would be more questioning at a hospital of someone with an Australian accent who has got through stage 1 than there is likely to be of any person who has an Indian face. An Indian is more likely to live in Nottingham than anyone with a strong Australian or American accent. The hon. Gentleman's proposition that this is likely to lead to the questioning of immigrants is preposterous, and is likely to set off completely false fears.
§ Mr. MeacherThe hon. and learned Gentleman is wrong. If the Secretary of State is not prepared to make available extra funds and staff, there will be corner cutting in the asking of questions. Everyone will not be subjected to this procedure. It will apply, as the Minister for Health said significantly, in cases where there are suspicions. Those suspicions will depend, at least partly, on the colour of face, on accents and on other such matters.
The Government have claimed that emergency treatment will be available free to everyone. That is not the case. Only treatment in casualty and out-patient departments will be free. What will happen with emergency in-patients? Presumably, when serious cases are admitted as in-patients—as, indeed, almost all are—they will be charged at the full private rate. If that is the case, it suggests that the Government have been exceedingly misleading in suggesting that emergency treatment will be free.
Information is to be sought from the Home Office via the DHSS where there is doubt about a patient's immigration status. That could have an extremely serious effect. In certain cases it could lead to unwillingness to seek medical treatment where it was clearly needed. If a person was carrying a highly infectious disease, the implications would be extremely dangerous for the individual and for the population in general. It is a serious loophole in the proposals.
The Government claim that people who are not eligible for treatment can take out health insurance or go private, but DHSS Ministers should not be in the business of 441 boosting profits for private medical or insurance companies. If foreign tourists still use NHS facilities, how will simply paying for them reduce NHS waiting lists?
The Government should not expect NHS staff to do their dirty work in cracking down on immigration—that is what is about—or in reducing eligibility for NHS treatment. It is a mean-minded, petty, nasty little measure. It will not reduce racial discrimination in the NHS. It will produce negligible—if, indeed, any—net savings. It could lead to infectious illnesses remaining untreated. I hope that the House will decisively reject it.
§ Mr Alexander W. Lyon (York)In the Select Committee on Monday the Secretary of State refused to accept that £6 million was peanuts. He said that a responsible Government must consider sums of that magnitude seriously. On Wednesday, the Secretary of State for Defence, when asked about £12 million for territorial divisions, said that that sum was peanuts. It depends on one's view.
Why are the Government so concerned, considering the small saving? The only enlightenment came from the hon. Member for Preston, North (Mr. Atkins). The fiasco arises because he visited his daughter in hospital and asked questions about a patient in a neighbouring bed. We have had a build-up of popular opinion. The hon. Gentleman read out letters. People have written to him about cases, 90 per cent. of whom were eligible for free treatment, even under the old rules, and about the same proportion of whom would be eligible under the new rules. Ninety per cent. of the cases were wrongly perceived because the patients were of foreign extraction. The reaction is prejudice against their treatment.
That is the danger, above all, that worries me about the proposals. However carefully conceived stage 1 is, stage 2, which we know nothing about and which the Minister has refused to tell even the Select Committee about, will animate the prejudice against people of foreign extraction. I do not wish to pay that price to collect £6 million.
I object to the proposal on principle. My hon. Friend the Member for Birmingham, Stechford (Mr. Davis) said that there was some abuse in the proposal. The original concept of the NHS was that it would be wholly free to all, including visitors. In 1949, Nye Bevan introduced an amending Bill, because pressure had been put on him. It was put forward in the context that there would be regulations, but they were never introduced. Over the years people have tried haphazardly to implement the 1949 legislation.
In such a situation, one cannot tell people that there are rules, that for them to be treated is against those rules, and that they are therefore abusing the system. There is an abuse of the system only if people consciously try to defraud it. The Government may try to clarify the situation by introducing rules, and there might be an abuse of the system thereafter, but the Government cannot depend upon past abuses when rules have never existed.
In 1963, a circular was issued, but it has never been enforced in practice. Now every patient going into hospital will have to be asked questions. When that has been done, it may be possible for someone to study the answers and decide whether a patient is trying to deceive the NHS. The scale of the problem will therefore increase.
The hon. Member for Preston, North having returned, I can tell him that the Select Committee has a mass of 442 evidence from hospital administrators throughout the country. Only a few suggested that a scheme of this type was needed. The great majority said that if there was anything that they could describe as an abuse, it was on a small scale. It is, therefore, nonsense for us to take the risk—and there is a risk, whatever the Government say—of exciting racial antagonism at this difficult time merely to make a saving that the Minister cannot prove of about £6 million.
§ Mr. Terry DavisI shall be brief to allow the Minister as much time as possible to reply.
I shall deal first with the point made by my hon. Friend the Member for York (Mr. Lyon) about whether there is any abuse of the NHS. I refer my hon. Friend to what our hon. Friend the Member for Waltham Forest (Mr. Deakins) said on 8 November 1978. He explained that if visitors came to this country specifically for treatment, then unless they were within one of the categories where free treatment is provided—if they came from Common Market countries or those with reciprocal arrangements—they would be abusing the system.
I did not say that the hon. Member for Preston, North (Mr. Atkins) was racialist. I said that he was engaged in McCarthyite tactics by brandishing a file of 300 letters. As I listened to some of those letters, I formed the same opinion as my hon. Friend the Member for York. Most of those people were entitled to free treatment under the NHS and will still be entitled to it under the proposed arrangements.
There is a reciprocal arrangement with Portugal. I understand that a reciprocal arrangement with Hong Kong is about to come into effect. The gentleman from Brazil is also entitled to free treatment under the Government's proposal. A letter from the Brazilian embassy stating that he is to begin work here is sufficient. When the hon. Member for Preston, North advanced those as examples of abuse he confirmed my earlier comment.
The hon. Member for Preston, North also said that £6 million is not a small sum. He is making the same fundamental mistake that has been made by all Conservative Members. There is no truth in that figure. There is no evidence to suggest that the cost of the abuse of the NHS is £6 million or any other figure. No figure has been given. The £6 million is the Government's estimate of the revenue that could be obtained as a result of changing the rules for people who are entitled to free treatment under the present arrangements.
When I asked the Secretary of State how the £6 million had been calculated, he referred the House back to the original estimate of £5 million provided by his predecessor. That is no answer. The House and the country should know where the £5 million came from. We have had no answer from the Government. I hope that we shall get one.
As for overseas students, it has not so far been mentioned that one fifth of overseas students in this country are paid for by the Foreign Office, so one fifth of the expected £1 million revenue will still come from the British taxpayer. Indeed, the cost will be more than the £200, 000 for the cost of treatment, because insurance premiums will have to be paid by the Foreign Office, so the taxpayer will be contributing to the profits of the insurance company.
443 The Minister pointed out in an intervention that among those 81 people who seemed to need further questioning in the working party survey were 12 Americans. He asked whether my hon. Friend the Member for Battersea, South (Mr. Dubs) thought that those 12 American tourists should pay for their appendicitis operations. He made two assumptions. We do not know whether they were tourists, nor do we know for what conditions they were being treated in National Health Service hospitals.
The Minister cannot tell us whether they had lived in the United Kingdom for more than one year. He cannot say whether any of them were American students who had been studying at college or university here for more than a year. There is no proof that there were 12 Americans covered by the survey who would not have paid charges in the past but who would pay charges in the future. The Minister does not know whether they were treated for measles or food poisoning. Perhaps they were all tourists suffering from food poisoning, for which treatment will be free under the Government's proposals.
§ Mr. Kenneth ClarkeOnly as out-patients.
§ Mr. DavisThere will be no charge for out-patients who go to accident or emergency departments, but there will be charges for patients admitted to hospital as a result of accidents. In other words, if an overseas visitor is involved in a car accident and suffers a cut face, he will receive free treatment whatever his origin, but if he is so seriously injured that he is unconscious and is taken to hospital with broken legs or a fractured skull the Government want to charge him for the treatment. The more seriously a person is injured, the more likely he is to be charged by the Government.
The Government should concentrate on concluding reciprocal arrangements with other countries. In 1978, we were told that the Labour Government had begun such discussions with the American and Canadian Governments. What has happened to those discussions in the past three years?
I am prepared to agree that there may be some abuse, although we do not know how much. We know, however, that there are other abuses. If the Government are so concerned about abuse of the Health Service, what are they doing about the abuses for which there is evidence? For example, the Government's own auditors have found abuse by consultants in the Greenwich and Bexley area health authority who have been charging private patients for National Health Service facilities but not passing the money on to the NHS. That is the kind of abuse that the Government should tackle.
§ The Minister for Health (Mr. Kenneth Clarke)I well understand that there may be concern about the apparent complexities of this issue, in view of the wide range of visitors who come here, but I think that the Opposition have gone in not just for misunderstanding complexities, which at times is understandable and which I might presume myself, but for absurd exaggeration of their case. By the time we reached the speech of the hon. Member for Oldham, West (Mr. Meacher), the whole exercise was supposed to be a sinister plot to abolish the 444 free Health Service for British residents—having heard on the way about a new drive against illegal immigration, new attempts to undermine race relations and so on.
As my right hon. Friend the Secretary of State said in opening the debate, this is a perfectly commonsense measure which does not give rise to any of those fanciful fears and will be widely appreciated by the British public once it is understood. It has one simple aim, which should command universal support, and that is to obtain more resources for the National Health Service. It is not a vast amount of money, but the National Health Service is not so awash with money that £6 million can be lightly waved aside as the Opposition did.
That worthwhile, modest sum will be achieved by introducing arrangements whereby certain treatment for short-term overseas visitors—the bulk of whom are usually described as tourists—should be paid for by their insurance companies, assuming that they take out an insurance policy, and not by the British taxpayer. That seems a sensible proposition.
The hon. Members for York (Mr. Lyon) and for Birmingham, Stechford (Mr. Davis) seemed to imply that we should run some kind of international free Health Service, regardless of the figures in the report. They never gave a clear answer to my question: if a Texan oil man comes here and is taken ill with appendicitis, do the Opposition believe that the British taxpayer should pay, or that an American insurance company should pay? We say that an American insurance company should pay, and I think that most people would agree with that.
Nevertheless, the Government believe that if this matter is not handled carefully odd difficulties will arise, as in some of the cases that have been described. For that reason we have taken particular care on the subject of racial discrimination. The Opposition missed the point that one of the things that the working party uncovered was that the existing arrangements give rise to serious risk of racial discrimination. Those arrangements were tolerated by the previous Government, and the Opposition wish to leave them alone, despite their present and proven risk of racial discrimination. We have devised arrangements that will avoid that risk. To accuse my hon. Friend the Member for Preston, North (Mr. Atkins), or my right hon. Friend the Member for Sutton Coldfield (Mr. Fowler), or myself, or any other hon. Member who has spoken in the debate of being in favour of racial discrimination is absurd and insulting.
My hon. Friend the Member for Wokingham (Sir W. van Straubenzee) was concerned about students. The Government were also worried about the effects of the original proposals on students. That is why we have gone so far to make considerable concessions and we will meet all the costs of students, except for their first year hospital charges. My hon. Friend the Member for Wokingham appreciates, as the hon. Member for the Isle of Ely (Mr. Freud) does not, that students coming here on long-term courses could go on to their general practitioner's list and obtain medical treatment. I accept the point made by my hon. Friend the Member for Wokingham about those on short-term language courses, and shall examine it.
It should be taken for granted, although it is not, that we will ensure that patients are not refused treatment for accidents or emergencies and that they will have free out-patient treatment. We shall also give free treatment for communicable diseases, wherever they have been contracted. The spirit that has been described as the "spirit 445 of the Good Samaritan" should exist within the National Health Service. That will be retained intact and is not threatened by our proposals.
In short, the British taxpayer will say "What a sensible way of getting a few million pounds extra for the NHS. Why on earth was this not done before? What on earth are the Opposition getting so excited about? Why do they feel it is so easy to waive aside this sum of money?" My right hon. Friend explained how we arrived at this sum of money. It is not a precise estimate; nobody has ever said that it is. However one arrives at it, and my right hon. Friend gave two methods of doing so, it seems to be about right and is probably a slight underestimate.
The Government accept that we are probably talking in terms of only about 0.5 per cent. of the patients in hospitals. Those patients are included in the 4.6 million people who come to this country in any one year—short-term overseas visitors who are not covered by European Community or reciprocal agreements. I shall not relate the arguments advanced by my right hon. Friend, but the figure of 0.5 per cent. gives about £6 million, which will be new income for the National Health Service and will go to the district health authorities.
That sum of £6 million was described by the hon. Member for the Isle of Ely as "piffling" and by the hon. Member for York as "peanuts". In the context of the National Health Service it is neither piffling nor peanuts. If Opposition Members wish to know, I can give a few examples of why we are so concerned about £6 million. It would enable the NHS to treat 8, 000 more acute patients, or provide 200 hospital new beds, or run 40 body scanners for a year, or provide 400 new residential places for the elderly, or 350 new residential places for the adult mentally handicapped, or new residential places for mentally handicapped children. That is not piffling and the British public will not appreciate why the Opposition are not interested in that, but prefer to provide free treatment for Australians who are involved in road accidents in this country, rather than looking at the kinds of facilities that £6 million could provide.
The hon. Member for Isle of Ely said that the administrative costs would outweigh all this—
§ Mr. Edward LyonsThe Minister refers solely to Australians and Americans, but what about the large number of elderly persons coming to visit ethnic minorities in this country and to see their children and grandchildren? Many of them will be too old to come with any insurance scheme and cannot be insured. Is not the proposal an attempt to raise money mainly from elderly people in the Third world, and not from Americans, Europeans and others, who will come insured?
§ Mr. ClarkeFor some reason, hon. Members who are interested in race relations keep trying to make that case. I do not mind their being so sensitive about race relations, but they have chosen the wrong subject. The nationalities that emerged in the working party report were American, Australian and Nigerian. Dependants of people resident here will be exempt from the arrangements when they are here. We are talking about £6 million and about charging short-term visitors, who will probably be tourists.
Administrative costs have been criticised. Comments have been made about the administrative complexities and the dangers that could arise. The administrative costs were estimated by the hon. Member for Brent, South (Mr. 446 Pavitt). He said that he did not usually go in for figures. There was a flaw in his figures. He made the preposterous suggestion that the three simple questions in stage 1 questioning would take two minutes to administer. The questions will be put mainly to ordinary British residents, who will answer "Yes. Yes. Yes." The 20 seconds suggested by the hon. Member for Brent, South were wildly divorced from reality.
The working party membership included senior National Health Service administrative officers who have expertise in the subject. On the basis of their inquiries it was decided that stage 1 with the three simple questions, would require no extra staff. They decided that stage 2 could be implemented without any significant extra cost. The only increase in cost would be for hospitals with a large number of overseas visitors—such as some of the London hospitals—where additional costs might be involved. We are talking about perhaps half a staff post. The £6 million that we hope to gain vastly outweighs any administrative costs.
The administrative process has been attacked in various ways on the basis that it will be racially discriminatory. It is suggested that it might allow COHSE members to use it as a new drive against illegal immigration.
The hon. Member for Stechford described the first stage as being the interrogation of patients. We are talking about adding three questions to the existing process for registration at a hospital. We are asking difficult questions such as "What is your name? What is your address? What appears to be the matter?" Other questions are also asked when a person is registered for hospital treatment. Three additional questions are to be asked. Almost all the patients will find them straightforward. The clerical officer will not be allowed to challenge the answers. He will merely record the answers. There is no question of cross-examination.
As the working party report shows, the bulk of the answers will be "Yes. Yes. Yes." Only a few people will move to the second stage. Most of them will be Americans, Australians or Nigerians, who will cheerily say "No". The only question required at that stage will be "Where do you live?" An address in Wyoming, for instance, will be given and arrangements will be made to collect money through an insurance company. Most people admitted to hospital will have taken the prudent step of taking out insurance.
There might be some difficult cases. There might be language difficulties and some people will be from the ethnic minorities. Most of the people questioned at the second stage will say that they have not been living in the country for the requisite period. The people from countries with reciprocal agreements and from the European Community will be identified. Only a few of the others are likely to give rise to any difficulty.
As I have said, Conservative Members are highly sensitive—as sensitive as the other Opposition Members—to any suggestion that will introduce racial discrimination into any aspect of the Health Service. We have become particularly sensitive because it was Conservative policy which threw up the evidence that there is racial discrimination in the existing arrangements which the Opposition want to keep going and keep sacrosanct.
We have, therefore, decided that to make sure that there will be no difficulties, a clear manual of guidance will be issued for the more senior staff carrying out the second 447 should not do. That will be before the House, because we will be consulting widely upon it. The regulations on which the whole thing is founded will be before the House and we will consult bodies such as the Commission for Racial Equality, representatives of ethnic minorities, and so on, to make sure that we do not introduce any racially discriminatory procedure. There is really no reason at all why we should, because all that the second stage will be seeking to establish is the residence of the person in question and how long he has been here. If he has been here for less than 12 months we need to establish why he is here. If he is here to work, and in the one or two other cases that have been described, he will still get treatment free.
The hon. Member for Stechford was quite right. Nationality does not have any bearing on eligibility for National Health Service treatment in Britain. Therefore, there is no point in asking for somebody's passport, because in most cases his nationality will not be relevant. I repeat what I said to the hon. Member for Battersea, South (Mr. Dubs) that the manual of guidance will contain instructions to people carrying out the second stage that they are not to ask for passports and people are not to be required to produce them.
That again will be an improvement on the present position, which is being defended by the hon. Members for Battersea, South and for Stechford. The working party discovered that misguided staff have been left so much in the dark by the Labour Party in their previous years of administering the present system that they are asking for passports.
The present system, for which the Labour Party was responsible and is now defending, is largely administered on the intuition of the administrators, who often do not understand the rules. They tend to question people who give foreign addresses or who have a foreign appearance, and that must mean that they are largely questioning black or brown people. Our manual of guidance, which the Opposition are resisting and which presumably they are about to vote against because it is part of our policy, will for the first time establish—unless the Opposition are successful—that people are not to ask for passports when deciding elegibility.
§ Mr. DubsWill the Minister concede that there is not one member of the Labour Party who has ever defended a system that demands the production of passports as a test of eligibility for Health Service treatment?
§ Mr. ClarkeI accept that no member of the Labour Party has done that deliberately. Every member of the Labour Party who has spoken in this debate has done so by accident, because the Opposition are defending the present position. What we are putting forward is a system with a manual of guidance which says that it is not to happen. It may be that there is a dawning of understanding and we are coming so close to each other in principle that the Division need never happen.
During the last two minutes let me try to make that clear by getting away from the fanciful fears that I have largely answered by illustrating what will be the actual situation that these rules will produce. They will change the situation of tourists in this country. That is the largest group of people who will be affected. Tourists will ask 448 their travel agents about the health arrangements of the United Kingdom.
At the moment they get a pleasant surprise, because they are told that the chances are that it will be free in Britain, unlike anywhere else in the world. They will in future take out an insurance policy, just as we do when we go to America or Australia. That is a sensible arrangement. We will table the regulations to introduce the scheme soon. We hope to introduce it in October, so as not to surprise this year's summer visitors. We hope that the £6 million extra for the Health Service will be wisely spent by the health authorities.
§ Question put, That the original words stand part of the Question:—
§ The House divided: Ayes 226, Noes 295.
451| Division No. 94] | [10 pm |
| AYES | |
| Abse, Leo | Dunn, James A. |
| Adams, Allen | Dunnett, Jack |
| Allaun, Frank | Eadie, Alex |
| Alton, David | Eastham, Ken |
| Anderson, Donald | Edwards, R. (W'hamptn S E) |
| Archer, Rt Hon Peter | Ellis, R. (NE D'bysh're) |
| Ashley, Rt Hon Jack | Ellis, Tom (Wrexham) |
| Ashton, Joe | English, Michael |
| Atkinson, N. (H'gey) | Evans, loan (Aberdare) |
| Bagier, GordonA.T. | Evans, John (Newton) |
| Barnett.Guy (Greenwich) | Ewing, Harry |
| Barnett, Rt Hon Joel (H'wd) | Field, Frank |
| Beith, A.J. | Fitch, Alan |
| Benn, Rt Hon Tony | Flannery, Martin |
| Bennett, Andrew (St'Kp'tN) | Fletcher, Ted (Darlington) |
| Bidwell, Sydney | Foot, Rt Hon Michael |
| Booth, Rt Hon Albert | Ford, Ben |
| Boothroyd, MissBetty | Forrester, John |
| Bray, Dr Jeremy | Foster, Derek |
| Brown, Hugh D. (Provan) | Foulkes, George |
| Brown, Ronald W. (H'ckn'yS) | Fraser, J. (Lamb'th, N'w'd) |
| Brown, Ron (E'burgh, Leith) | Freeson, Rt Hon Reginald |
| Buchan, Norman | Freud, Clement |
| Callaghan, Jim (Midd't'n&P) | Garrett, John (Norwich S) |
| Campbell, Ian | George, Bruce |
| Campbell-Savours, Dale | Gilbert, Rt Hon Dr John |
| Canavan, Dennis | Ginsburg, David |
| Cant, R. B. | Golding, John |
| Carmichael, Neil | Grant, George (Morpeth) |
| Carter-Jones, Lewis | Hamilton, James (Bothwell) |
| Cartwright, John | Hamilton, W. W. (C'tral Fife) |
| Clark, Dr David (S Shields) | Hardy, Peter |
| Cocks, Rt Hon M. (B'stol S) | Harrison, Rt Hon Walter |
| Cohen, Stanley | Hart, Rt Hon Dame Judith |
| Coleman, Donald | Hattersley, Rt Hon Roy |
| Concannon, Rt Hon J. D. | Haynes, Frank |
| Conlan, Bernard | Healey, Rt Hon Denis |
| Cowans, Harry | Heffer, Eric S. |
| Cox, T. (W'dsw'th, Toot'g) | Hogg, N. (EDunb't'nshire) |
| Craigen, J. M. (G'gow, M'hill) | HomeRobertson, John |
| Crowther, Stan | Homewood, William |
| Cryer, Bob | Hooley, Frank |
| Cunliffe, Lawrence | Horam, John |
| Cunningham, DrJ. (W'h'n) | Howells, Geraint |
| Dalyell, Tam | Huckfield, Les |
| Davidson, Arthur | Hughes, Mark (Durham) |
| Davies, Rt Hon Denzill (L'lli) | Hughes, Robert (Aberdeen N) |
| Davies, Ifor (Gower) | Hughes, Roy (Newport) |
| Davis, Clinton (Hackney C) | Janner, Hon Greville |
| Davis, Terry (B'ham, Stechf'd) | Jay, Rt Hon Douglas |
| Deakins, Eric | Johnson, James (Hull West) |
| Dean, Joseph (Leeds West) | Jones, Rt Hon Alec (Rh'dda) |
| Dixon, Donald | Jones, Barry (East Flint) |
| Dobson, Frank | Jones, Dan (Burnley) |
| Dormand, Jack | Kaufman, Rt Hon Gerald |
| Douglas, Dick | Kerr, Russell |
| Dubs, Alfred | Kilroy-Silk, Robert |
| Duffy, A. E. P. | Lambie.David |
| Lamborn, Harry | Rooker, J. W. |
| Lamond, James | Roper, John |
| Leadbitter, Ted | Ross, Ernest (Dundee West) |
| Leighton, Ronald | Rowlands, Ted |
| Lestor, MissJoan | Ryman, John |
| Lewis, Arthur (N'ham NW) | Sever, John |
| Lewis, Ron (Carlisle) | Sheerman, Barry |
| Litherland, Robert | Sheldon, Rt Hon R. |
| Lofthouse, Geoffrey | Shore, Rt Hon Peter |
| Lyon, Alexander (York) | Short, Mrs Renée |
| Lyons, Edward (Bradf'dW) | Silkin, Rt Hon J. (Deptford) |
| McDonald, DrOonagh | Silkin, Rt Hon S. C. (Dulwich) |
| McKay, Allen (Penistone) | Skinner, Dennis |
| McKelvey, William | Smith, Rt Hon J. (N Lanark) |
| MacKenzie, Rt Hon Gregor | Snape, Peter |
| McNamara, Kevin | Soley, Clive |
| McTaggart, Robert | Spearing, Nigel |
| McWilliam, John | Spriggs, Leslie |
| Marks, Kenneth | Stallard, A. W. |
| Marshall, D (G'gowS'ton) | Steel, Rt Hon David |
| Marshall, DrEdmund (Goole) | Stewart, Rt Hon D. (W Isles) |
| Marshall, Jim (Leicester S) | Stoddart, David |
| Martin, M (G'gowS'burn) | Stott, Roger |
| Maxton, John | Strang, Gavin |
| Maynard, MissJoan | Straw, Jack |
| Meacher, Michael | Summerskill, HonDrShirley |
| Mellish, Rt Hon Robert | Taylor, Mrs Ann (Bolton W) |
| Mikardo, Ian | Thomas, Dafydd (Merioneth) |
| Millan, Rt Hon Bruce | Thorne, Stan (Preston South) |
| Mitchell, Austin (Grimsby) | Tilley, John |
| Mitchell, R.C. (Soton Itchen) | Torney, Tom |
| Morris, Rt Hon A. (W'shawe) | Urwin, Rt Hon Tom |
| Morris, Rt Hon C, (O'shaw) | Varley, Rt Hon Eric G. |
| Morris, Rt Hon J. (Aberavon) | Wainwright, E. (Dearne V) |
| Morton, George | Walker, Rt Hon H. (D'caster) |
| Moyle, Rt Hon Roland | Watkins, David |
| Mulley, Rt Hon Frederick | Wellbeloved.James |
| Newens, Stanley | Welsh, Michael |
| Oakes, Rt Hon Gordon | White, Frank R. |
| O'Neill, Martin | White, J. (G'gow Pollok) |
| Orme, Rt Hon Stanley | Whitehead, Phillip |
| Owen, Rt Hon Dr David | Whitlock, William |
| Palmer, Arthur | Wigley, Dafydd |
| Park, George | Williams, Rt Hon A. (S'sea W) |
| Parker, John | Williams, Rt Hon Mrs (Crosby) |
| Parry, Robert | Wilson, Gordon (Dundee E) |
| Pavitt, Laurie | Wilson, Rt Hon Sir H. (H'ton) |
| Pendry, Tom | Wilson, William (C'try SE) |
| Powell, Raymond (Ogmore) | Winnick, David |
| Price, C. (Lewisham W) | Woodall, Alec |
| Race, Reg | Woolmer, Kenneth |
| Richardson, Jo | Wright, Sheila |
| Roberts, Albert (Normanton) | Young, David (Bolton E) |
| Roberts, Allan (Bootle) | |
| Roberts, Ernest (Hackney N) | Tellers for the Ayes: |
| Roberts, Gwilym (Cannock) | Mr. Hugh McCartney and |
| Robinson, G. (Coventry NW) | Mr. James Tinn. |
| NOES | |
| Aitken, Jonathan | Boyson, Dr Rhodes |
| Alexander, Richard | Braine, SirBernard |
| Alison, Rt Hon Michael | Bright, Graham |
| Amery, Rt Hon Julian | Brinton, Tim |
| Aspinwall, Jack | Brotherton, Michael |
| Atkins, Robert (Preston N) | Brown, Michael (Brigg&Sc'n) |
| Atkinson, David (B'm'th, E) | Browne, John (Winchester) |
| Baker, Nicholas (N Dorset) | Bruce-Gardyne, John |
| Banks, Robert | Bryan, Sir Paul |
| Beaumont-Dark, Anthony | Buck, Antony |
| Bendall, Vivian | Budgen, Nick |
| Benyon, Thomas (A'don) | Bulmer, Esmond |
| Benyon, W. (Buckingham) | Burden, SirFrederick |
| Best, Keith | Butcher, John |
| Bevan, David Gilroy | Cadbury, Jocelyn |
| Biffen, Rt Hon John | Carlisle, John (LutonWest) |
| Biggs-Davison, SirJohn | Carlisle, Kenneth (Lincoln) |
| Blackburn, John | Carlisle, Rt Hon M. (R'c'n) |
| Bonsor, SirNicholas | Chalker, Mrs. Lynda |
| Boscawen, HonRobert | Channon, Rt. Hon. Paul |
| Bottomley, Peter (W'wich W) | Chapman, Sydney |
| Churchill, W.S. | Howell, Rt Hon D. (G'ldf'd) |
| Clark, Hon A. (Plym'th, S'n) | Howell, Ralph (N Norfolk) |
| Clark, Sir W. (Croydon S) | Hunt, David (Wirral) |
| Clarke, Kenneth (Rushcliffe) | Hunt, John (Ravensbourne) |
| Clegg, SirWalter | Hurd, Rt Hon Douglas |
| Cockeram, Eric | Irving, Charles (Cheltenham) |
| Colvin, Michael | Jenkin, Rt Hon Patrick |
| Cope, John | JohnsonSmith, Geoffrey |
| Cormack, Patrick | Jopling, Rt Hon Michael |
| Corrie, John | Joseph, Rt Hon Sir Keith |
| Costain, SirAlbert | Kaberry, SirDonald |
| Cranborne, Viscount | Kellett-Bowman, MrsElaine |
| Critchley, Julian | Kershaw, SirAnthony |
| Crouch, David | Kimball, SirMarcus |
| Dean, Paul (NorthSomerset) | King, Rt Hon Tom |
| Dickens, Geoffrey | Knight, MrsJill |
| Dorrell, Stephen | Knox, David |
| Douglas-Hamilton, LordJ. | Lamont, Norman |
| Dover, Denshore | Lang, Ian |
| Dunn, Robert (Dartford) | Langford-Holt, SirJohn |
| Durant, Tony | Latham, Michael |
| Dykes, Hugh | Lawrence, Ivan |
| Eden, Rt Hon Sir John | Lawson, Rt Hon Nigel |
| Edwards, Rt Hon N. (P'broke) | Lee, John |
| Eggar, Tim | LeMarchant, Spencer |
| Elliott, SirWilliam | Lennox-Boyd, HonMark |
| Emery, Sir Peter | Lester, Jim (Beeston) |
| Eyre, Reginald | Lews, Kennelh (Rutland) |
| Fairbairn, Nicholas | Lloyd, Ian (Havant& W'loo) |
| Fairgrieve, SirRussell | Lloyd, Peter (Fareham) |
| Faith, MrsSheila | Loveridge, John |
| Farr, John | Luce, Richard |
| Fell, SirAnthony | Lyell, Nicholas |
| Fenner, Mrs Peggy | McCrindle, Robert |
| Finsberg, Geoffrey | Macfarlane, Neil |
| Fisher, SirNigel | MacGregor, John |
| Fletcher, A. (Ed'nb'ghN) | McNair-Wilson, M. (N'bury) |
| Fletcher-Cooke, SirCharles | McNair-Wilson, P. (NewF'st) |
| Fookes, Miss Janet | McQuarrie, Albert |
| Forman, Nigel | Madel, David |
| Fowler, Rt Hon Norman | Major, John |
| Fox, Marcus | Marland, Paul |
| Fraser, Rt Hon Sir Hugh | Marlow, Antony |
| Fry, Peter | Marshall, Michael (Arundel) |
| Gardiner, George (Reigate) | Mates, Michael |
| Gardner, Edward (S Fylde) | Maude, Rt Hon Sir Angus |
| Garel-Jones, Tristan | Mawby, Ray |
| Gilmour, Rt Hon Sir Ian | Maxwell-Hyslop, Robin |
| Glyn, Dr Alan | Mayhew, Patrick |
| Goodhart, SirPhilip | Mellor, David |
| Goodhew, SirVictor | Meyer, Sir Anthony |
| Goodlad, Alastair | Miller, Hal (B'grove) |
| Gorst, John | Mills, Iain (Meriden) |
| Gow, Ian | Mills, Peter (West Devon) |
| Grant, Anthony (Harrow C) | Miscampbell, Norman |
| Gray, Hamish | Mitchell, David (Basingstoke) |
| Greenway, Harry | Moate, Roger |
| Griffiths, E. (B'ySt.Edm'ds) | Molyneaux, James |
| Griffiths, Peter Portsm'thN) | Monro, SirHector |
| Grist, Ian | Montgomery, Fergus |
| Gummer, JohnSelwyn | Moore, John |
| Hamilton, Hon A. | Morgan, Geraint |
| Hamilton, Michael (Salibury) | Morris, M. (N'hampton S) |
| Hampson, Dr Keith | Morrison, Hon C. (Devizes) |
| Hannam, John | Morrison, Hon P. (Chester) |
| Haselhurst, Alan | Mudd, David |
| Hastings, Stephen | Murphy, Christopher |
| Havers, Rt Hon Sir Michael | Myles, David |
| Hawksley, Warren | Neale, Gerrard |
| Hayhoe, Barney | Needham, Richard |
| Heath, Rt Hon Edward | Nelson, Anthony |
| Heddle, John | Neubert.Michael |
| Henderson, Barry | Newton, Tony |
| Heseltine, Rt Hon Michael | Nott, Rt Hon John |
| Hicks, Robert | Onslow, Cranley |
| Higgins, Rt Hon Terence L. | Oppenheim, Rt Hon Mrs S. |
| Hogg, HonDouglas (Gr'th'm) | Osborn, John |
| Holland, Philip (Carlton) | Page, John (Harrow, West) |
| Hooson, Tom | Page, Richard (SW Herts) |
| Hordern, Peter | Parkinson, Rt Hon Cecil |
| Parris, Matthew | Stanley, John |
| Patten, Christopher (Bath) | Steen, Anthony |
| Pawsey, James | Stewart, A. (ERenfrewshire) |
| Penhaligon, David | Stewart, Ian (Hitchin) |
| Peyton, Rt Hon John | Stokes, John |
| Pink, R.Bonner | Stradling Thomas, J. |
| Pollock, Alexander | Tapsell, Peter |
| Porter, Barry | Taylor, Teddy (S'end E) |
| Powell, Rt Hon J.E. (S Down) | Tebbit, Rt Hon Norman |
| Prentice, Rt Hon Reg | Temple-Morris, Peter |
| Price, SirDavid (Eastleigh) | Thatcher, Rt Hon Mrs M. |
| Prior, Rt Hon James | Thomas, Rt Hon Peter |
| Proctor, K. Harvey | Thompson, Donald |
| Pym, Rt Hon Francis | Thome, Neil (IlfordSouth) |
| Rathbone, Tim | Thornton, Malcolm |
| Rees, Peter (Dover and Deal) | Townend, John (Bridlington) |
| Rees-Davies, W. R. | Townsend, Cyril D, (B'heath) |
| Renton, Tim | Trippier, David |
| RhodesJames, Robert | Trotter, Neville |
| RhysWilliams, Sir Brandon | van Straubenzee, Sir W. |
| Ridley, HonNicholas | Vaughan, DrGerard |
| Ridsdale, SirJulian | Viggers, Peter |
| Rifkind, Malcolm | Waddington, David |
| Rippon, Rt Hon Geoffrey | Waldegrave, HonWilliam |
| Roberts, M. (Cardiff NW) | Walker, Rt Hon P.(W'cester) |
| Roberts, Wyn (Conway) | Walker, B. (Perth) |
| Rossi, Hugh | Walker-Smith, Rt Hon Sir D. |
| Rost, Peter | Wall, SirPatrick |
| Royle, SirAnthony | Waller, Gary |
| Sainsbury, HonTimothy | Walters, Dennis |
| St. John-Stevas, Rt Hon N. | Ward, John |
| Shaw, Giles (Pudsey) | Warren, Kenneth |
| Shaw, Giles (Scarborough) | Watson, John |
| Shelton, William (Streatham) | Wells, Bowen |
| Shepherd, Colin (Hereford) | Wells, John (Maidstone) |
| Shepherd, Richard | Wheeler, John |
| Silvester, Fred | Whitelaw, Rt Hon William |
| Sims, Roger | Wickenden, Keith |
| Skeet, T. H. H. | Wiggin, Jerry |
| Smith, Dudley | Williams, D. (Montgomery) |
| Speed, Keith | Winterton, Nicholas |
| Speller, Tony | Wolfson, Mark |
| Spence, John | Young, SirGeorge (Acton) |
| Spicer, Jim (WestDorset) | Younger, Rt Hon George |
| Spicer, Michael (S Worcs) | |
| Sproat, Iain | Tellers for the Noes: |
| Squire, Robin | Mr. Anthony Berry and |
| Stainton, Keith | Mr. Carol Mather. |
| Stanbrook, Ivor |
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 32 (Questions on amendments) and agreed to.
§ Main Question, as amended, agreed to.
§
Resolved,
That this House welcomes a commonsense and fair measure to raise extra income for the National Health Service from charging overseas visitors for hospital treatment, which lifts the burden from the British taxpayer and avoids the possibility of racial discrimination in the present hospital admission procedures.
-
c452
- STANDING ORDER NO. 40 (COMMITTAL OF BILLS) 73 words c452
- SPECIAL STANDING COMMITTEES 473 words