NHS Treatment: Overseas Visitors (Hansard, 20 July 2004)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)
My Lords, existing guidance to general practice on these matters is set out in health service circular 1999/18. That makes it clear that if GPs do not wish to accept overseas visitors as NHS patients, they can offer to treat them on a private paying basis. The Government are currently consulting on proposals to clarify the rules in this area. Revised guidance will be issued to explain any changes that are made to the rules after the consultation ends on 13 August.

§ Baroness Boothroyd
My Lords, I am delighted to hear of the consultation process, although I am sad to say that the GPs with whom I have spoken are not aware of it. Is the Minister aware of the claim made by GPs at their recent conference that one in 10 patients is not entitled to NHS care? Does he agree that general practitioners are the gatekeepers of the NHS, without the time or the resources to ascertain the eligibility of visiting tourists?
Would he consider that until such time as we are issued with identity cards, we insist on holiday insurance that covers healthcare for every overseas visitor who does not fall within the eligibility rules? Would that not have the two-pronged effect of reducing pressure on our health service and at the same 88 time lessening the need to recruit professional health personnel from overseas countries whose need is often greater than our own?

§ Lord Warner
My Lords, there are a number of strands to the noble Baroness's questions. As regards the suggestion that one in 10 patients on GPs' lists are not entitled to NHS care, it was in fact one general practitioner at the BMA conference who said that, who happens to be based in Gants Hill, Essex. We have no reliable data on the number of overseas visitors registered with general practices but, as I said, it is open to doctors now, under the current guidance, not to accept people where they have good reason to believe that they do not live in their practice area and to deal with them on a private, fee-paying basis.
Given that we have started a process of consultation, it would be premature to pre-empt that consultation by deciding how we are going to tackle this problem. Out of that consultation will come further guidance for general practice to bring it more in line with the guidance that has now been reissued to hospital services. Under the new system, essentially, the burden of proof will be on the person presenting himself or herself for registration to declare and demonstrate unambiguously that they are eligible for free NHS primary medical services.

§ Lord Peston
My Lords, can my noble friend enlarge on what seems to me to be a fantasy land? Most of us when we try to visit our general practitioner get to see a receptionist, who then quotes a date a month or five weeks ahead when we might be fitted in. I know that all these overseas visitors are diabolically clever, but how do they manage in their short visits to get to see a GP at all?

§ Lord Warner
My Lords, I know how lit my noble friend is; he may not have been to his GP lately and may not have noticed that we have speeded up access to general practitioners. It is one of the many achievements within the NHS that is to the Government's credit. Of course, when the new arrangements come in—we are not reorganising general practice—it will be for patients to present themselves and, as I said earlier, to convince the practice that they are eligible for free NHS care.

§ Baroness Thomas of Walliswood
My Lords, when answering the first Question the Minister told the House that the Government do not know the size of the burden placed on GPs at present. Is it not rather important to know that before you start instructing GPs how to handle what might be quite a minor problem? If further guidance is issued, is it not important to ensure that it does not result in an additional administrative burden upon GPs, who are already extremely overburdened with administration? Finally, is there not a risk that persons of ethnic minorities who live in our country might constantly be checked for eligibility?

§ Lord Warner
My Lords, I pay tribute to the work done by GPs. As the House knows, the Government 89 have increased the number of general practitioners so that the burden is more evenly spread. We are conducting a survey to ascertain whether there is a problem in this area. It is important that we amend the guidance because it contains some ambiguities. It is important that the guidance on free NHS primary care is aligned with the new guidance on the entitlement of overseas visitors to hospital services.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that many people with HIV come from abroad, develop AIDS and stay on? Will GPs be given extra funds to cope with these people?

§ Lord Warner
My Lords, I would suggest that that is a little wide of the scope of the Question. As the noble Baroness may know, the Cabinet Office is currently reviewing imported infections and immigration into the UK. We await the result of that review, which will be made available publicly in due course.

§ Lord Tomlinson
My Lords, does my noble friend agree that today he has announced another survey and reported to us on further consultation? Can he tell the House the state of play of the consultation that is already taking place in relation to entitlement cards, which was announced with a great flourish some months ago? If we had entitlement cards, would not that relieve general practitioners of any kind of administrative burden being put upon them?

§ Lord Warner
My Lords, the Government are still working in this particular area. Although, again, it is a little wide of the scope of the Question, I shall make further inquiries and write to my noble friend.

§ Lord Walton of Detchant
My Lords, can the Minister confirm that short-term visitors to the UK who are taken ill during a holiday or a short-term visit are entitled under the law to free treatment, both by general practitioners and in hospital; but that people coming here specifically for medical treatment and investigation at hospitals must be private patients? To avoid any kind of misunderstanding, can the Minister clarify the position of overseas students from outside the European Community and their entitlement to medical care in the UK?

§ Lord Warner
My Lords, it is true that the NHS remains a humanitarian service and that treatment will be provided free of charge where, in the professional opinion of a healthcare clinician, it is an emergency or immediately necessary. Nothing in the consultations will change that. As I said earlier, the arrangements in relation to primary care will be brought into alignment with the new hospital charging regulations, which came into operation in England on 1 April. We want to ensure that the same conditions apply. Essentially, they will require people to be ordinarily resident in this country. There will be a number of exemptions, and I 90 believe that students will form a part of those exemptions. I shall confirm that in writing to the noble Lord.

§ Earl Howe
My Lords, what is the scale of the problem that the Government are seeking to solve?

§ Lord Warner
My Lords, as I said in reply to an earlier question, we are conducting a survey to establish precisely the scale of the problem. But we know, and there have been concerns expressed, that the guidance issued in 1999 is not as clear as it might be. It is important that we amend that guidance to bring it in line with the new hospital charging regulations, which, as I said, were brought into operation on 1 April. We are undertaking consultation to achieve that end.