NHS: Reciprocal Agreements (Hansard, 14 July 1982)

§ Lord Molloy
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)
My Lords, Her Majesty's Government will continue to consider making reciprocal health care agreements when it is practicable to do so. Although the value and convenience of these agreements is generally acknowledged, experience has shown that new agreements are not always mutually beneficial or feasible.

§ Lord Molloy
My Lords, is the noble Lord aware that I am most grateful for the assurance that he has just given that the Government intend to continue with this principle? Is he further aware that many people believe that if we could increase our fervour for reciprocity in regard to this great principle, which was initiated by this nation, then, particularly in the times in which we live of slaying and maiming, it not only would be of benefit to our nation but could indeed encourage mankind to tread a much saner course than the one it is on at the moment?

§ Lord Trefgarne
My Lords, I hope the noble Lord is right in ascribing the high-powered results from these agreements which he has described, but I think it is important that people who propose to travel abroad ascertain the arrangements which will apply in the countries which they propose to visit. My department issues a leaflet for that purpose, which perhaps I could make available more widely to your Lordships through the Printed Paper Office, which gives particular guidance to almost every country that people are likely to visit, including, of course, the European Community.

§ Lord Auckland
My Lords, would my noble friend not agree that, with the growth of tourism, not only in the more popular countries such as Spain and Portugal, but in the EFTA countries, such as Iceland, it is very desirable for Her Majesty's Government to liaise with the Governments of these countries to see whether some equitable arrangements along similar lines can be made? Is my noble friend aware that this would boost our own exports?

§ Lord Trefgarne
My Lords, my noble friend is quite right. We have agreement, of course, with the European Community. We also have agreements with some 15 or 20 countries outside the European Community. My noble friend mentioned Iceland. I am happy to tell him that we are on the point of concluding an agreement with that country.

Lord Bruce of Donington
My Lords, can the noble Lord give the House some indication as to the endeavours that have been made by Her Majesty's Government to follow up the initiatives which were displayed by the Council of Europe in this regard?

§ Lord Trefgarne
My Lords, I am not quite certain which initiative of the Council of Europe the noble Lord is referring to in this matter. If he would like to give me more details, I will certainly look into it.

§ Baroness Gardner of Parkes
My Lords, following up the questions that he has answered, may I ask the 337 Minister whether the national health card plays a significant role in this matter; and, if so, should our nationals going abroad carry these cards with them? Further, do other countries which have reciprocal arrangements issue similar cards, or in what way do we assess that a patient is entitled to reciprocal treatment on arrival in this country or when residing here?

§ Lord Trefgarne
My Lords, in general, NHS cards do not play a significant role in this matter because they are not a certificate of entitlement to treatment under the National Health Service. They are issued to patients who are included on the list of a particular doctor. As for persons entering this country, again, the card is not, as I say, a certificate of entitlement. That particular matter is determined in other ways.

§ Lord Hatch of Lusby
My Lords, does the noble Lord recall, about two weeks ago, answering a Question put to him by the noble Lord, Lord Kilmarnock, regarding the treatment of foreigners who come to this country, and particularly of foreign students? Is he aware that, quite apart from reciprocal arrangements, there are countries in the world in which British people, and indeed any other foreigners, can go and get some completely free medical treatment—and I am thinking particularly of a country where I spend a lot of time, Zambia—whereas now, under the new Government arrangements, such foreigners and foreign students coming to this country are not given reciprocal arrangements?

§ Lord Trefgarne
My Lords, the question of the Health Service charges for overseas visitors was, as the noble Lord says, discussed in response to a Question from the noble Lord, Lord Kilmarnock, a week or so ago. I am not sure that I have anything to add to the Answer that I gave on that occasion. As for the case of Zambia, the country to which the noble Lord is referring, it is the case that we do not have a reciprocal agreement with that country and therefore the overseas charges regulations will apply in that case.

§ Lord Hatch of Lusby
My Lords, is the noble Lord aware that British people going to Zambia get completely free medical treatment?

§ Lord Trefgarne
My Lords, if there is a case for examining a reciprocal agreement with Zambia, as the noble Lord seems to be suggesting, I shall certainly be willing to do that. Perhaps the noble Lord will be willing to give me more information of the matter he describes.

§ Baroness Gardner of Parkes
My Lords, may I ask the noble Lord to clarify his answer to me as I did not quite understand when he said that anyone possessing a national health card has no evidence of entitlement to treatment? I understood the reverse; that there may be many more people entitled to treatment than those possessing a national health card. Is he saying that national health cards are issued to people not entitled to treatment? Can he amplify the point as to when they are issued (a) to people who were born here or (b) to people like myself who arrived in this 338 country; and what the situation is for EEC nationals who come here to take up employment?

§ Lord Trefgarne
My Lords, I can confirm what I said earlier to my noble friend, that National Health Service cards are not a certificate of entitlement to treatment under the health service. They are normally issued to persons at birth or when they are entered on to a doctor's list. That is not the same thing as determining entitlement to treatment.

§ Lord Molloy
My Lords, is the noble Lord aware that, if we could brush aside much of the bureacracy that is involved in the principle of reciprocity, we would make a big step forward? Is he aware that I am one of those who happens to believe that if when my fellow countrymen went to another country and people from other countries came here and something happened to them, to their families, to their children or to their relatives, they received the treatment which any human being should be given, and there was no question of asking whence they came but to help them overcome either grief or pain, when such people returned to their countries and our people come back to our country, it would increase the feeling that we are all of one great race and make a contribution to achieving world peace?

§ Lord Trefgarne
My Lords, I can assure the noble Lord that he is pushing at an open door in this matter. We certainly accept the merits of these agreements where arrangements can be made. One of the difficulties is that many other countries do not have the comprehensive health service that we have and therefore a reciprocal agreement is not really possible. It is possible, however, to have a limited reciprocal agreement of some sort—for example, the sort of agreement that we have with some of our dependent territories—where primary health care is really the only thing immediately subject to the agreement. Perhaps that may be a possibility in the case that the noble Lord, Lord Hatch, raised.