§ 7. Mr. Graham Brady (Altrincham and Sale, West)
If he will make a statement on sending NHS patients for treatment in overseas hospitals. 
§ The Secretary of State for Health (Mr. Alan Milburn)
Following rulings of the European Court of Justice, I announced in August that NHS health authorities and trusts could commission treatment for their patients overseas. Three areas in southern England are working through the legal and practical issues involved, with the aim of offering, by the end of the year, treatment abroad to those patients who want it. I shall publish guidance for the NHS based on the experience in those three sites.
§ Mr. Brady
I am grateful to the Secretary of State for his response. He will know that in the Salford and Trafford health authority, the proportion of patients waiting more than a year for NHS treatment has doubled compared with four years ago. In that situation, he must know that his announcements have raised the expectations of many people who are waiting for treatment, sometimes in severe pain. When will he bring forward clear guidelines that will say under which circumstances and criteria people will be entitled to treatment overseas?
§ Mr. Milburn
I did say when. Three sites are currently working through the issues because, as the hon. Gentleman will be aware, we want to get this right. Patients who want overseas treatment will be able to go abroad—I repeat: patients who want that; there should be no question of sending patients abroad against their wishes. Not only will such an alternative be offered according to clinical need and a proper assessment of the patient's need, but that person will have to want to go abroad for treatment.
707 It would be a disaster to send patients abroad and to find, for example, that the taxpayer was not getting good value for money and, more important, the patient was not receiving the highest standards of care. That is why we are working through the three pilot sites. I hope that we will be able to make the offer to patients by the end of this year, with a view to issuing guidance early in the new year to the NHS based on those patients' experiences. I think that that will be helpful.
Incidentally, on the numbers who are liable to take advantage of such an option, my view is—other hon. Members may have a different opinion—that what most patients want, as the hon. Gentleman has rightly said, is the choice of good-quality local care based in their local hospital, and falling waiting times. Indeed, in the past year, the number of in-patients waiting more than a year for treatment has come down by 13 per cent.
§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)
Is my right hon. Friend aware that one of the best ways of making a clinical assessment is to talk to and listen to the patient? Will he give an undertaking that no one will be offered care in a country where there are not sufficient doctors and nurses capable of performing that task? Will he also ensure that anyone receiving treatment abroad has a clear pattern of after-care, should that be needed, under post-operative treatment?
§ Mr. Milburn
My hon. Friend makes a very good and telling point. It would be extremely foolish, as the hon. Member for Altrincham and Sale, West (Mr. Brady) seemed to be suggesting, to rush into such arrangements. We have to get them right to ensure not only that patients are fit and well enough to go abroad to be treated, but that they receive the appropriate support and after-care that they need in the country of treatment and once they return home. Those issues have to be worked through properly.
I give my hon. Friend the assurance that she seeks on her first point. As she is aware, spare capacity is available in Germany, France and elsewhere, and we are looking to those countries so that we can treat what I believe is a minority of NHS patients, but that choice should be available to as many NHS patients as possible.
§ Peter Bottomley (Worthing, West)
Does the Secretary of State recognise that there are plenty of patients in West Sussex and west Surrey—where one in 10 of those awaiting in-patient treatment are waiting more than one year—who would welcome not only the possibility of going abroad, but the opportunity to be treated in the Durham health authority or by his own authority, where the number of those waiting more than one year is almost nil? Such postcode delays could be sorted out without worrying about languages or going abroad. What is he going to do about that, and when will he do it?
§ Mr. Milburn
That is a perfectly reasonable suggestion and, as the hon. Gentleman is probably aware, we are exploring ways in which we can make more choice available to patients. He is also quite right that waiting times vary in different parts of the country; even in London, the average in-patient waiting time varies from seven weeks in one hospital to 23 weeks in another. Very often, patients are locked into a contract with their local hospital that the local primary care group or primary care trust has negotiated. Although GPs have the right to refer 708 to other areas, it is important that they should exercise that right in a more proactive manner. We are investigating whether it is possible to extend more choice to patients, precisely to enable them to take advantage of the shorter waiting times available in some hospitals.
On travel, the hon. Gentleman will be aware that, certainly in constituencies in southern England, geographical proximity is an issue. It makes sense for patients in Kent, for example, to travel to northern France rather than northern England. Although I know that geography is not necessarily the hon. Gentleman's strong point, I should have thought that even he would be able to distinguish his Arras from his Elmet. For the avoidance of doubt, one place is in northern France and the other is in west Yorkshire.
§ Caroline Flint (Don Valley)
I welcome my right hon. Friend's proposals to seek any opportunity to ensure that people in this country receive the treatment that they deserve. We will have to use whatever stop-gaps are necessary to deal with the 20 years of decline. In examining how the system might operate, will he consider issues such as travel to the destination, necessary support care during travel and especially the cost of travel? I should not like people on lower incomes to feel that they could not take advantage of the system because they might have to bear the burden of travel costs.
§ Mr. Milburn
I strongly agree with my hon. Friend. As she is aware, the question asked by the hon. Member for Altrincham and Sale, West raises difficult and complex issues. The NHS already operates a scheme for patients, and particularly for low-income families, who need to travel to hospital, whether it is a local or more distant one. It seems obvious that we have to be able to extend the benefits of that type of scheme to those who might be travelling abroad for treatment. We have to assess that issue properly. Crucially, we also have to ensure that not only patients going abroad for treatment but their carers and families are offered appropriate support. We are seeking to address precisely those issues in the three pilot areas. Based on that experience, we shall be able to issue the appropriate guidance to the national health service.
§ Dr. Evan Harris (Oxford, West and Abingdon)
If the initiative or stop-gap is to be taken seriously, it is the Government and not guinea pig patients on the south coast who must answer the questions. If patients have to pay for their own and their families' travel, where will be the fairness for those who cannot afford to pay? If the health authority or PCT pays for travel, how will value for money be delivered?
If things go wrong, whom will the patient be able to sue, or—a more appropriate question for the Secretary of State—whom will the Government blame? How can informed consent be given and received in a foreign language? How will the Government feel if overseas trusts and providers advertise for British nurses and doctors to go and do the work?
Is not the very fact that we are even considering this an indictment of the Secretary of State's management of the health service, and a sign that he has failed to deliver?
§ Mr. Milburn
The hon. Gentleman began by asking good questions—precisely those to which we seek 709 answers. Believe it or not, it is not easy. I know that the hon. Gentleman thinks that it is easy, and that a magic wand can be waved to solve every problem in the national health service; but this is not the Harry Potter appreciation society. Difficult decisions are involved. Perhaps at some point even the Liberal Democrats will have to make a difficult decision.
§ Mr. Milburn
Well, let us hope not.
Issues of standards, negligence and informed consent are precisely the issues that must be worked out. With regard to standards, we are exploring whether it would be possible to accredit certain overseas care providers, perhaps with the involvement of the Commission for Health Improvement as the independent inspectorate of the NHS. As for negligence, complex legal issues need to be considered. It is right for us to do that in conjunction with primary care trusts, which, after all, will be the fulcrum of the health service that we want.
The hon. Gentleman is right about the difficulties involving languages and informed consent. We will have to provide not just support enabling patients—and their carers and families—to travel, but language support, if the system is to offer genuine choices.
The hon. Gentleman made a wider point about this being, somehow or other, all the Government's fault. He must realise that, as we said a year or more ago in the NHS plan, turning around the NHS will mean a long hard struggle. He knows as well as I do that the service suffered decades of neglect and underinvestment. We are putting that right, and we will continue to do so, because we have put the money in.