§ 7.57 p.m.
§ The Parliamentary Under-Secretary of State, Department for Work and Pensions (Baroness Hollis of Heigham)
rose to move, That the draft regulations laid before the House on 16 June be approved [22nd Report from the Joint Committee].
§ The noble Baroness said: My Lords, I very much welcome the opportunity to introduce the regulations. Their purpose is to reflect a specific recent development in the National Health Service relating to hospital treatment overseas.
§ The Government are committed to expanding the NHS more than ever before to give faster treatment and greater choice to patients. As part of this, we are making further use of spare capacity in overseas health systems in two ways. First, we are bringing overseas teams to England to optimise the use of spare physical capacity where it is available. Secondly, primary care trusts can now directly purchase treatment overseas from some of the best hospitals at affordable prices when they believe that that is in the best interest of their patients. This offers a means of reducing waiting times and extending choice for patients.
§ Several hundred patients have already chosen to go abroad for treatment under these arrangements—mostly to Belgium, Germany and France—for major joint replacements and cataract operations. Those are the two major categories of healthcare abroad. Their experience of the overseas hospitals was very positive, and the Department of Health therefore intends to continue the arrangements. My ministerial colleagues there see overseas treatment as a relatively short-term necessity while domestic capacity is developed, but the option is likely to be needed for some time.
§ Of course, some of those who are waiting for treatment and who are offered the chance of having it overseas will be social security claimants. While waiting, they may not be so ill that they have to claim an incapacity benefit; they could instead be receiving pension credit, income support or jobseeker's allowance. For example, they may be waiting for a hip replacement when their job does not require them to have mobility. The rules for these benefits normally 1093 restrict entitlement when outside Great Britain and so some adjustment is necessary to enable them to make use of these NHS opportunities with the minimum of inconvenience and at no risk to their benefits.
§ We therefore gave a commitment that people claiming any of the three benefits I have mentioned would be able to retain their entitlement when abroad for treatment arranged through the NHS. Pension credit is a new benefit and we were in time to include an appropriate provision in the original regs which came into force last year. IS and JSA are older benefits, which means amending their existing regulations.
§ In the case of JSA, this is quite complicated because in normal circumstances JSA claimants must be in Great Britain, must be available for and capable of work, and must actively seek work each week. Patients who go abroad for hospital treatment would not be able to satisfy any of those four conditions. However, the Jobseekers Act enables circumstances to be prescribed in which jobseekers can be treated as satisfying them, and the existing JSA regs already set out a number of circumstances. For example, jobseekers are treated as available and actively seeking work while engaged in emergency duties for the benefit of others, such as being part-time firemen.
§ These amendment regulations rely on the same powers. First, they treat jobseekers as being in Great Britain when they are temporarily absent to receive hospital treatment provided under the revised NHS legislation. Secondly, they make this an additional circumstance in which jobseekers are treated as capable of work, provided that they have notified the Secretary of State in advance that this is their wish. Finally, the regs make the necessary cross-references so that jobseekers are treated as available and actively seeking work when abroad.
§ The IS rules also require people to be in Great Britain, although a limited exception is made for people receiving medical treatment. As that applies only to people claiming on grounds of incapacity, and then only when the treatment is for the incapacity that caused the claim in the first place, there is a risk that other IS claimants, such as lone parents, could lose entitlement if they took advantage of the NHS's new arrangements. These regs avoid that risk by adding a new circumstance in which all IS recipients can be treated as being in Great Britain, again linking it to the receipt of hospital treatment under the revised NHS legislation.
§ Subject to parliamentary approval of the draft amending regs, we propose to introduce these changes nationally from 4 October 2004. These draft regs ensure that benefit claimants are not excluded or placed at a disadvantage compared with other NHS patients. I can confirm that the Social Security Advisory Committee has decided that it does not want the draft regulations to be formally referred to it. I am also able to confirm that, in my view, these provisions are compatible with the ECHR. I therefore commend them to the House. I beg to move.1094
§ Moved, That the draft regulations laid before the House on 16 June be approved. [22nd Report from the Joint Committee]. —(Baroness Hollis of Heigham.)
§ Lord Higgins:
My Lords, we are grateful to the noble Baroness for that explanation. However, there are one or two points about it that I find a little puzzling. She referred to the type of operation that might be involved as either a joint replacement operation or a cataract operation. I remember, in my former constituency, that we had a rather long waiting list for cataract operations. A hotel was taken over for a week and we cleared the waiting list in a very short time. I gather that the total number of cases we are dealing with this evening is only 850, and presumably not all of those are joint replacements. I therefore find it surprising that cataract patients have to be away for any length of time at all. As I understand it, it is almost a daytrip operation.
§ Perhaps the Minister can give us some idea of the split between cataract and joint operations. If we are going to pay for people to go away and have cataract operations and then bring them back, I should think that it must be much more cost effective to have them done here under the NHS rather than abroad. If it is a major operation abroad, one may deplore the lack of facilities here but understand that it might help to relieve the waiting list situation.
§ I am also slightly puzzled that this arrangement is apparently going out under the National Health Service Act 1977 and the National Health Service and Community Care Act 1990. I thought that the idea that people could go abroad for treatment was a comparatively recent innovation and not covered by legislation as early as 1977 or 1990. Perhaps the noble Baroness can clarify that point.
§ I understand the arguments on income support, but I am rather more puzzled by the question of the jobseeker's allowance. If a jobseeker is abroad, he is not able to seek a job. We are effectively deeming him able to do so. Can the noble Baroness remind me whether the job-seeking operation is a continuous operation or whether it matters if there is a slight drop in the payment of the jobseeker's allowance while the person concerned is abroad? I do not recall.
§ Baroness Hollis of Heigham:
My Lords, when the noble Lord uses the word "operation" does he mean a medical operation or the operation of JSA?
§ Lord Higgins:
Both, my Lords. As the person is clearly not available for work and is not seeking work in the period when he is abroad for the medical operation, I am not clear why he should continue to have jobseeker's allowance. I can see that he might require income support, but I do not see why he needs jobseeker's allowance.
§ I have always understood very clearly that, on the whole, the taxpayer does not have to pay twice for the same thing. We have previously debated whether 1095 people's benefits go on while they are in hospital. I am not clear why in this case a jobseeker should continue to get jobseeker's allowance if he is abroad having this operation. Similarly, I am not clear why he is able to obtain accommodation in the overseas hospital and transport costs—for both of which, presumably, the British taxpayer is paying—while being paid his income support or jobseeker's allowance. There appears to be a duplication, and that would seem to breach what I had always understood to be a fairly basic rule, that one does not pay twice for the same thing.
§ I do not want to weary the House longer. However, it seems that this particular proposition, which appears to operate on an extraordinarily small scale—less than 1,000 per year all told—leads to so many complications. Given the Chancellor's Statement earlier today, one would have thought that it would be possible to increase resources in the NHS without the necessity for these regulations and the arrangements that flow from them. I would be grateful if the noble Baroness could clarify those points.
§ Lord Addington:
My Lords, I thank the Minister for introducing the regulations. I have one small quibble. Straightaway, she put a bullet through the one fox that runs around this subject; that is, why we must go abroad for such services. The Minister said that that was unfortunate and that, although we currently have to do so, the hope was that the situation would improve in future. In truth, that is the real political point. The NHS does not currently have enough resources. We can later argue about organisation and funding. However, it would be rather unfair to have a go at the Minister in that regard because she does not have responsibility for those matters.
§ If we do have to go abroad, the regulations are absolutely vital. If people lost certain benefits that they were on, we could damage, for instance, their status, their ability to maintain a home and so on. We have argued about hospitals; if they lost such rights, that could be crippling. If we have structural problems that require people to go abroad for treatment, we must allow those people to maintain their benefits and income stream so that they do not end up losing housing and so on. The Merits of Statutory Instruments Committee, on which I sit, said that the regulations were not worthy of the special attention of the House, and I have no intention of breaking with its views.
§ Baroness Hollis of Heigham:
My Lords, I shall do my best to answer the questions raised. I am grateful for the response of noble Lords, which was one of puzzlement rather than hostility or dispute.
§ The noble Lord, Lord Addington, was absolutely right; I entirely agree with him. The noble Lord, Lord Higgins, referred to the figure of 850; of that, perhaps two handfuls of people are on JSA or IS. By definition, 1096 they will probably be over the pension age. Older people tend to need help with cataract problems or have hip replacements. Frankly, it is not worth the hassle of trying to get them on to a different benefit for three, five or 10 days, or for a fortnight. Currently, one can be on JSA for up to a fortnight with temporary sickness and on IS for up to four weeks. For the most part, that should cover such situations anyway. We do not want people who might have follow-up problems—through anaesthesia, for example—to be caught and find, while they are in Belgium or France, that their benefits had run out. We do not expect many people to be affected.
§ We hope and expect this to be a sharply diminishing problem. Whereas in March 2002 the maximum inpatient wait was 15 months, by March 2004 it was down to nine months. That is a function of the length of waiting times. For people who so choose, they may prefer the option of speedier treatment by going to Belgium, Germany or France to waiting for local treatment, particularly in the south-east. Guy's and St Thomas's conduct bulk purchases on behalf of those scattered individuals.
§ The noble Lord was absolutely right: increasingly, the NHS is bringing doctors to the UK, particularly for cataract treatment, for example. That is a more cost effective and desirable route in the eyes of many patients. Three-quarters of referrals abroad have, I believe, been for orthopaedic cases, which require bed space and recovery time in a way that cataract surgery often does not. Again, we hope to bring the figure down sharply. We hope that there will be a diminishing use of overseas resources. For the time being, it a sensible way to use surplus capacity of a very high standard abroad at broadly comparable costs. I believe that that adds to patients' choices.
§ I hope that I have addressed all the queries raised by noble Lords. If I have overlooked any, I invite them to nudge me. Basically, we are dealing mainly with elderly patients and we do not expect more than a couple of handfuls to be on benefit. We do not believe that it is worth trying to alter benefits during the short time of interruption. If people return and need an extensive period of convalescence, they would go on to incapacity benefit anyway. If a short temporary period is involved, it is simpler and cleaner merely to treat the person as though they were having NHS surgery at home. Effectively, that is all that we are doing. It seems a sensible, non-bureaucratic way of coping with what we hope will be a temporary response to a temporary problem.
§ Baroness Andrews:
My Lords, I beg to move that the House do now adjourn during pleasure until 8.33 p.m.
§ [The Sitting was suspended from 8.11 to 8.33 p.m.]