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Healthcare: Reciprocal Arrangements

Volume 620: debated on Thursday 14 December 2000

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3.16 p.m.

What steps they are taking to ensure that the United Kingdom's reciprocal healthcare arrangements with other countries are in practice fully reciprocal.

My Lords, the arrangements give travellers healthcare on the terms available to the host country's own people. As countries have different healthcare systems, variations in benefits provided are inevitable. Overall, however, the Government believe that the present arrangements provide a reasonable outcome for the people of this country.

My Lords, if it were a truly reciprocal arrangement, surely it is wrong that if we fall ill in France, we have to pay 25 per cent of the costs of treatment whereas if a Frenchman falls ill in England, he receives that treatment totally free of charge? Furthermore, will the Minister confirm that in April of this year, a certain London psychiatric hospital stated that it thought that 20 per cent of its beds were being utilised by foreigners?

My Lords, I know that various allegations have been made over the years. I have yet to see hard conclusive evidence that that is so.

On the substantive point raised by the noble Lord, it is true that, for example, France and Belgium require a personal contribution of respectively 30 and 25 per cent of costs from patients in many cases. But there are also examples of UK citizens receiving more favourable treatment in other EEA countries than they would from the NHS; for example, prescription charges are lower in several countries, and access to dental treatment and physiotherapy is immediate and free in Germany. The EEA countries and those with which we have a bilateral agreement number over 50. To negotiate NHS-type provision for people in those countries and vice versa would be a bureaucratic nightmare. Although in some cases, UK citizens may be disadvantaged, surely the arrangements represent a sensible and reasonable outcome.

My Lords, is not part of the problem with this issue of so-called "health tourism" that it is possible for a visitor to this country simply to lie when he is asked whether he has lived here for more than certain length of time? Is the Department of Health considering some form of smartcard identification system which could weed out people who were trying to abuse the system?

My Lords, although allegations have been made, hard evidence is very difficult to find. Hospitals are asked to ask all patients whether they are ordinarily resident in the UK. If they are not ordinarily resident, further questions may be asked to determine whether they are liable to be charged for using the NHS.

I accept that the guidance currently issued to the NHS on how to deal with the kind of issues which the noble Earl mentioned may well be in need of updating. That is being done at present. When that work is completed, we shall issue it to the health service. If there are specific problems such as those which the noble Earl mentioned, I hope that we can deal with them. Overall, I believe that the general arrangements that we have in place are very sensible.

My Lords, is it not the case that sometimes the provisions are too fiercely enforced against British citizens who return to this country? When charity workers who have worked abroad for a temporary period in Asia or Africa return here, they are not eligible for National Health Service treatment except in the case of an emergency. Will the Minister undertake to look at that matter as part of a revision of the Patient's Charter to see whether that unfair provision can be mitigated?

My Lords, I am grateful to the noble Lord for advance notice of that Question. People who work abroad, either for the UK Government or in employment that is financed in part by the Government, retain their entitlement to free hospital treatment. That would include anyone recruited to work abroad under the British volunteer programme. In addition, people who have lived in the UK for 10 years and who are now employed by charitable organisations abroad outside that category may retain their entitlement to free treatment for at least five years and perhaps for longer, depending on their individual circumstances. If there are specific issues that the noble Lord would care to bring to my attention, I shall investigate whether there is a problem in the way in which the regulations are drawn at the moment.

My Lords, will the noble Lord reflect on the fact that the French system, which, as I understand it, applies equally to their own citizens as to citizens from other countries in the European Union, has a great deal of merit? As the Government grapple—not with a great deal of success—with the problems of the National Health Service and with the financing of it, there may be some merit in looking again at the French system as a model that we may follow.

My Lords, it is unusual for the Benches opposite to propose France as the model that we should follow. I do not agree with the noble Lord. I believe that the essential components of our National Health Service—a service that is free mostly at the point of delivery and funded out of general taxation—is the right one. I do not accept the points that the noble Lord makes about our stewardship of the NHS. We are bringing in extra staff; we are building many new hospitals; and under the NHS Plan we shall make the service truly great again, underpinned by the enormous extra resources that we are committing to it.

My Lords, following the Question posed by my noble friend, what happened to the European health card which was intended to facilitate the reciprocal arrangements throughout the European Union?

My Lords, I am not sure what the noble Baroness means by a "European health card".

My Lords, there were proposals for a health card, a smartcard, that could be used throughout the European Union. It would enable people to be recognised as having particular health conditions and it would make for easier understanding of the system in the countries concerned.

My Lords, I am grateful to the noble Baroness for that explanation. I am not aware of progress in relation to a smartcard, but I shall certainly find out whether any progress has been made. However, I am certain that generally the arrangements between countries in the EU are working fairly well in relation to reciprocal healthcare. Where there are problems, for example, with the administration of E111 forms, this Government are always prepared to take up individual cases with the country concerned.