Hospital Authorities: Contracts Overseas (Hansard, 27 March 1991)

§ Lord Johnston of Rockport
My Lords, at the request of my noble friend Lord Thorneycroft, I beg leave to ask the Question standing in his name on the Order Paper. The Question was as follows:

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, in my reply to a Question on 27th February, I said that health authorities here have no powers to enter into contracts directly with overseas providers for the treatment of patients ordinarily resident in England and Wales. That remains the case.

§ Lord Johnston of Rockport
My Lords, I thank the Minister for that Answer. Perhaps I may ask three short questions. In view of the fact that health authorities do not have powers to make general contracts for the treatment overseas of patients, what is the likelihood of the European Community seeking recourse to the International Court of Justice to reverse this decision? Secondly, in the past people from abroad have made good use of our health scheme in obtaining spectacles, teeth and much medical aid for little or no cost. Is it not time that the tables were reversed so that hospitals may reduce their waiting lists? Finally, how do such arrangements apply to the private sector?

§ Baroness Hooper
My Lords, as yet, no concrete proposal has been received from a health authority. If ever we receive one we shall of course study all the legal implications. We already follow the procedures of the European Community social security regulations, which enable the competent authorities in member states to authorise individual patients entitled to health care in their member states to receive treatment in another, subject to certain conditions. This is known as the E112 procedure. The competent authority in the United Kingdom is the Department of Health. Almost 300 cases were so authorised in 1990. There is nothing to stop any individual choosing to seek private treatment, as with the much publicised case of Mr. Robert Davies. The private sector providers of health care are free to set up in business on either side of the Channel.

§ Lord Bottomley
My Lords, is the Minister aware that a sister associated with the London Hospital is present today especially to hear the Answer to this Question? I cannot talk to her about her views until afterwards but, if they coincide with my own, she will have thought the reply pretty appalling.

§ Baroness Hooper
My Lords, I regret that I did not quite take the point of the noble Lord's question.

§ Lord Carter
My Lords, is the noble Baroness aware that there is some confusion over this issue? Can she be absolutely clear that a health authority which has opted out or a hospital with trust status is not allowed to have a contract with an overseas hospital to provide treatment? Is she aware that recently on television the director of the Boulogne General Hospital said that fleets of ambulances were ready, a helicopter was available for urgent cases, a chef had been trained to prepare English breakfasts and that the doctors had undergone a two-year English language course in order to be ready for this eventuality? The hospital was offering the chance for people to go over on the ferry, have the operation and return the same day. Is the Minister saying that the 1070 health authority concerned—the Medway Health Authority—is not allowed to enter into a contract with the Boulogne General Hospital?

§ Baroness Hooper
My Lords, I can only repeat that local health authorities have no powers to contract outside of the United Kingdom. As a consequence of the previous Question tabled by the noble Lord, Lord Carter, on 27th February, I understand that the health authorities which have been considering this possibility have, for the first time, realised that they may be considering something that would be ultra vires.

Lord Winstanley
My Lords, as far as concerns contracts, am I right in thinking that this country has a continuing obligation to provide medical care under the National Health Service for citizens from the European Community as and when the need arises? I believe that the Minister's previous answer confirmed that fact. II I am correct, can she tell us how the balance now stands? For example, are we doing more for them or are they doing more for us?

§ Baroness Hooper
My Lords, there are two ways in which we provide treatment for residents of other member states within the European Community. One way is under the emergency treatment arrangements; that is, the so-called E111 arrangements whereby anyone who is travelling abroad who has an accident is entitled to be treated in the other country and arrangements are ultimately made for the payment of costs. The other way comes under the El 12 procedure to which I have already referred, whereby individual cases for treatment can be referred overseas by the Department of Health on individual application. I believe that the balance is about even.

§ Lord Mancroft
My Lords, can my noble friend confirm whether any hospital authorities have contracted out to the voluntary and private sector for specialist treatment as they are entitled to do? If not, can she say what the department is doing to encourage them to take out such contracts?

§ Baroness Hooper
My Lords, as my noble friend well knows, government policy is to encourage co-operation between the National Health Service and the private sector, especially when that involves a cost-effective way of providing or extending services. So long as there is no prejudice to NHS services, local health authorities are able to enter into contractual arrangements to meet the needs of their patients. Further, they have a discretion as to what use is made of independent health care facilities. We are aware of many such arrangements which already exist.

§ Lord Waddington
My Lords, I am extremely sorry to be so heavy handed this afternoon, but I am told that I ought to intervene at this stage; otherwise there will be less than five minutes left to deal with the last Question on the Order Paper.