NHS: Proposed Charges to Overseas Visitors (Hansard, 8 June 1982)

§ Lord Kilmarnock
My Lords, I beg leave to ask the first 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, we believe that the likely extra costs of the new arrangements will be minimal, and this view is endorsed by the report of the working party which was set up to advise on the practicability of our proposals. The basis for this conclusion is the fact that only a tiny proportion (less than½ per cent.) of patients will be asked more than one extra question.

§ Lord Kilmarnock
My Lords, while thanking the noble Lord for that reply, may I ask whether he is aware—he has referred to the working party scheme —that it will require a special interview with an administrative grade officer and not just a clerical grade officer, and whether he expects no extra cost to arise from that? Furthermore, is he not aware that the working party stated, in paragraph 39, that in their opinion those hospitals where a large number of patients were liable to proceed to Stage 2 interviews would be likely to have to take on additional staff whom the working party were unable to quantify; and is this a satisfactory basis for a comprehensive scheme?

§ Lord Trefgarne
My Lords, the second interview to which the noble Lord referred in the first part of his supplementary question I would say only applies to a tiny percentage of the patients, and in our view the additional staff that may be required is minimal. I said this in my original Answer. I stand by what I have said: that the number of extra staff and hence the cost of the new scheme will be very tiny.

§ Lord Wells-Pestell
My Lords, can the noble Lord indicate to the House what would be the position of overseas students in this particular matter?

§ Lord Trefgarne
My Lords, in general, overseas students will be regarded as visitors, and therefore liable to pay the cost under this scheme; but certain transitional arrangements are being agreed and these 96 will be published in regulations which will appear very shortly.

§ Lord Harmar-Nicholls
My Lords, is my noble friend aware that, whatever the cost, far too many people have clear examples of this service being abused for us to allow it to continue without being dealt with in some way?

§ Lord Trefgarne
My Lords, when the health service was set up in 1948—I think that was the time of the first legislation and there was subsequent legislation in 1949—it was clearly intended for the people of the United Kingdom, and not visitors.

§ Lord Molloy
My Lords, may I ask the Minister if he could explain to the House what is the position of those visitors to our country where their nations have reciprocal arrangements to tie in with our National Health Service, so that they receive certain benefits freely in this country and Britons visiting their countries equally may have free service?

§ Lord Trefgarne
My Lords, I can confirm that those visitors from countries with whom we have reciprocal arrangements—there are a number of them—will be exempt from charges.

§ Lord Avebury
My Lords, what is the position of students here on scholarships, particularly British Council scholarships, whose grants at the moment cover fees payable to the universities and the bare cost of their living expenses, but which do not take into account the burden of any additional medical expenses that may arise from this scheme?

§ Lord Trefgarne
My Lords, students from overseas will be regarded as visitors for the purpose of this scheme, but we hope that they will see fit to take out appropriate insurance to cover their medical costs.

Lord Wallace of Coslany
My Lords, is the Minister aware that when the National Health Service was brought in it was not just a question of covering British people; the principle was that anybody taken ill within our shores would receive adequate medical attention irrespective of his or her means or colour? Are not the Government going contrary to the general spirit of the original health service? I would ask the noble Lord why the Government will not drop this scheme, which will cause a great deal of difficulty for the hospital administrative staff, while there is a danger of racialism creeping in, however unintended it may be.

§ Lord Trefgarne
My Lords, I fear that the noble Lord is mistaken. The 1949 Act which amended the 1948 Act took powers to make these charges by virtue of regulations which were authorised under the 1949 Act. Those regulations have not yet been implemented but we are now doing so.

§ Lord Wells-Pestell
My Lords, may I ask the noble Lord whether he will give the number of people who are likely to be affected by this scheme, in view of the widespread belief that a great deal of abuse is going on? May the House have the department's figure?

§ Lord Trefgarne
My Lords, I am not quite sure what figure it is that the noble Lord is seeking, but there are very many millions of visitors each year—I think in excess of 10 million—and it is thought that these regulations would apply to the bulk of them.

§ Lord Avebury
My Lords, can the Minister say how students can take out the insurance that he recommends if their grants from the British Council or other sources are not increased to enable them to do so?

§ Lord Trefgarne
My Lords, I imagine that the cost of insuring for a year, say, will be of the order of £100. I would not wish to minimise that amount for students who are here on grants from the British Council or elsewhere, but it is the case that most of those people would have to bear medical costs if they were at home, anyway.

§ Baroness Masham of Ilton
My Lords, may I ask the Minister whether those people who are not covered by insurance and who come from overseas and have emergency problems will be covered free of charge?

§ Lord Trefgarne
My Lords, there will be no question of assessing the patient's ability to pay before offering treatment.

§ Lord Stewart of Fulham
My Lords, is it not a fact that the bulk of the health service is paid for not out of insurance but out of taxation? Therefore a foreign visitor starts to pay for it every time he has a drink or buys a cigarette or anything which is subject to VAT?

§ Lord Trefgarne
My Lords, the noble Lord is partially correct. It is true to say that the health service is, generally speaking, funded from the main body of taxation, although there is an element from the national insurance contributions as well.

§ Lord Molloy
My Lords, is the noble Lord aware that the principle of reciprocity which originated in the Council of Europe was agreed among nearly 18 European nations and was looked on as a remarkable, civilised advance? Is the noble Lord now saying with regard to those arrangements that they will be dishonoured by this Government?

§ Lord Trefgarne
No, my Lords; quite the contrary. All the reciprocal arrangements—and there are, so far as my memory serves me, about 20—will be honoured in full, including the special arrangement with countries of the European Community.

§ Lord Kilmarnock
My Lords, is the noble Lord aware that the Secretary of State said in another place that it is unlikely that the amount we shall receive back from hospital services will be less than £6 million? What weight is to be attached to the word "back"? Who is to get the money? Can the noble Lord assure the House that this is not simply a backdoor cut in National Health Service funding?

§ Lord Trefgarne
My Lords, indeed I can. The 98 purpose of this scheme is essentially to recover the costs from patients who are not eligible for the free health service. That is why it has been brought forward at this time.

Viscount St. Davids
My Lords, will the noble Lord not rejoice with me that it is now possible to charge overseas visitors for this service, wheras under previous Administrations it was always stated that the cost of collecting this money was far more than the sum collected? Is he able to tell the House what has changed which makes it now possible to collect this sum? That would be extremely interesting.

§ Lord Trefgarne
My Lords, the noble Viscount will recall that there was a working party set up to look into this matter, and the new element, I suppose, is the report of that working party, which indicates, as I have said, that, whatever was thought previously, the costs of collection are now thought to be minimal.