House of Lords
Tuesday, 9th December 2003.
The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.
Prayers—Read by the Lord Bishop of Salisbury.
NHS Treatment Charges for Overseas Visitors
Baroness Boothroyd asked Her Majesty's Government:
- How they intend to strengthen the charging regulations for overseas tourists who unlawfully obtain free medical treatment from the National Health Service; and who is involved in the consultation on this issue.
The Parliamentary Under-Secretary of State, Department of Health (Lord Warner): My Lords, the recent public consultation involved a wide range of organisations and individuals, including NHS interests. More than 100 responses have been received and the Government are considering a number of possible changes to tighten the arrangements for charging overseas visitors for NHS hospital treatment.
Baroness Boothroyd: My Lords, I appreciate the Minister's response. Does he agree that as well as strengthening the charging regulations for tourists using the NHS, debt recovery must also be considered? Is he aware of the document produced by CCI legal services, which estimates that,
- "£50–200 million is lost to the NHS every year through under or non-recovery of NHS charges applicable to overseas visitors"?
Lord Warner: My Lords, I am aware of that document, but we do not necessarily agree with the figures in it. The noble Baroness must also understand that collecting debt has a cost. The cost of collecting debt must be proportionate to the debt to be collected.
Lord Renton: My Lords, have the Government managed to estimate how many people from overseas come here simply to obtain medical treatment?
Lord Warner: My Lords, it is, and has been since the beginning of the NHS, the responsibility of local health services to decide whether or not someone is exempt from NHS costs. It is for the overseas visitor manager to
collect those costs locally. As successive governments have devolved that authority to the local level, we do not collect data on it centrally.
Lord Taylor of Blackburn: My Lords, do the Government intend to extend our reciprocal agreements with any of the new entrants to the European Community?
Lord Warner: My Lords, I do not presently have the details of countries with which we have reciprocal agreements, but I am happy to make inquiries and write to my noble friend.
Baroness Thomas of Walliswood: My Lords, is the Minister aware of recent research that shows that in HIV clinics in parts of the country—London and Manchester, I think—those who arrived to be tested had fallen ill, been discovered to be HIV-positive when they became pregnant, or were those whose partners had died? I should add that none of those people was an illegal immigrant. What light does that throw on the accusation that people are coming in as illegal immigrants from various countries where serious diseases are rife to use our services and endanger our public? Do the Government intend to test those who legally enter this country from countries where HIV or TB, for example, are rife? Would that fall within the bounds of the Human Rights Act 1998?
Lord Warner: My Lords, the Government are currently reviewing imported infections and immigration into the UK. That review is being conducted by the Cabinet Office. I cannot throw any more light on the issue until the report is available, but I understand the points made by the noble Baroness.
Lord Campbell-Savours: My Lords, is not a little help on the margins for those in need from abroad a small price to pay when we are prepared to strip much of the underdeveloped world of its best doctors?
Lord Warner: My Lords, we have always made clear that where urgent treatment is needed either to save life or to prevent the condition becoming life-threatening such treatment should not be refused or delayed simply because there are doubts about whether the patient is chargeable. The NHS remains a humanitarian service.
Lord Roberts of Conwy: My Lords, if the noble Lord does not accept the figure of £200 million cited by the noble Baroness, Lady Boothroyd, what figure for the cost is acceptable to the Government?
Lord Warner: My Lords, the Government have kept inflation under control; the noble Lord's figure seems to have quadrupled since the noble Baroness asked her supplementary question. I ask him to consider that.
Lord Harrison: My Lords, is it not a credit to this country and a comfort to overseas tourists who come here as genuine tourists and do not deliberately fall ill
that we provide healthcare for them should they fall ill? Is that not also a help to our tourist industry, which at present is in deficit in terms of overseas tourists coming into the country compared with those who leave to go as tourists to other countries within the European Union?
Lord Warner: My Lords, I thank my noble friend, who introduces a sense of proportion to the issue. As my noble friend Lord Taylor said, we have reciprocal arrangements with many countries through which British tourists also benefit when they fall ill abroad.
Lord Peyton of Yeovil: My Lords, does the Minister understand that his answer to my noble friend Lord Roberts of Conwy was a marvellous example of what an answer ought not to be?
Lord Warner: My Lords, I thought that it was not bad, given that it was on the spur of the moment.
Lord Hunt of Kings Heath: My Lords, does my noble friend not agree that there is a risk: either one introduces a wholly bureaucratic process whereby everyone using the NHS must prove their entitlement to treatment, or NHS staff use very subjective judgments, including race and language, which could lead to problems of people who are legitimately entitled to NHS treatment being challenged? Surely we should be very careful before we go down that route.
Lord Warner: My Lords, my noble friend is right. We acknowledge that there are loopholes; that is why we have had this consultation exercise. But it is very easy to exaggerate the number of loopholes and make the exercise over-bureaucratic. I am grateful to my noble friend for his balanced observations.
Baroness O'Cathain: My Lords, when the Minister replied to the noble Baroness, Lady Boothroyd, about the debt of £50 million to £100 million—I shall not over-exaggerate it—he said that the Government did not "necessarily agree" with the document. Do they not necessarily agree because they thought that the data in the document were fallacious, or did they just not like the message?
Lord Warner: My Lords, we are always interested to hear messages, however unpalatable. This is a listening Government, as I have said previously. But we had questions about the methodology in that piece of work.
Earl Howe: My Lords, will the Government publish the responses to the consultation before any further regulations on the subject are laid?
Lord Warner: My Lords, I am sure that the Government will make known the drift of those comments and observations during the consultation process when they make known their decisions on the exercise itself.
Alcohol Harm Reduction Strategy
2.45 p.m.
Baroness Masham of Ilton asked Her Majesty's Government:
- When they will introduce a strategy to tackle alcohol-related problems.
Lord Warner: My Lords, the Prime Minister's Strategy Unit has already published an interim report on the evidence that it has examined relating to the development of an alcohol harm reduction strategy for England. A cross-government strategy involving a wide range of interests will be published in 2004, when implementation will commence in line with the NHS Plan.
Baroness Masham of Ilton: My Lords, I thank the Minister for his Answer. Is he aware that, because there has been for some time a drugs strategy, it has been a great problem to treat people with severe alcohol problems, particularly in prisons? Does he agree with me that joined-up government is needed, because alcohol abuse covers so many different departments, including the Home Office and those responsible for health, education, sport, roads and many others?
Lord Warner: My Lords, the noble Baroness is quite right. That is why the alcohol harm reduction strategy is being conducted through the Prime Minister's Strategy Unit, which has great expertise in cross-governmental issues and problems.
Baroness Goudie: My Lords, we are aware of the cost to the health service of alcohol-related illnesses. Will the Government's strategy team consider making the same restrictions on alcohol advertising as on smoking advertising?
Lord Warner: My Lords, the role of alcohol advertising in harmful consumption was highlighted by a number of respondents to the joint Department of Health/Strategy Unit consultation. That issue will be carefully examined as part of the Strategy Unit's work to develop a strategy.
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