Healthcare (International Arrangements) Bill

Debate between Lord O'Shaughnessy and Lord Thurlow

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[Lord Thurlow (CB)]

My Lords, it is a pleasure to welcome the noble Baroness, Lady Blackwood of North Oxford, and I congratulate her on her fine maiden speech. She has certainly hit the ground running by going straight on to the Front Bench. I thank the Library as well for its excellent briefing for this debate.

I laud the efforts of the Government to recreate or replicate the pre-Brexit arrangements within the EEA and EU, while anticipating the future. It is of course of mutual benefit to EEA citizens as well—the noble Lord, Lord O’Shaughnessy, referred to this. But given our apparent failure to collect our share of the cost inflicted on the NHS, in my opinion those countries would be mad not to agree. Given the important comments on Henry VIII powers raised by the noble Lords, Lord Foulkes and Lord Marks, and particularly by the noble Baroness, Lady Barker, I should declare my membership of the Delegated Powers and Regulatory Reform Committee. We were not preparing furniture for throwing through the windows.

My concern is the failure to accurately calculate the cost of our great national health services as supplied to foreign nationals. The current arrangement with the EU and the EEA allows for a reconciliation on a pro-rata basis for cost recovery—quite right, very sensible and fair. However, it is evident that we in UK cannot work out how much those users from overseas—possibly not those carrying the appropriate cards—cost the NHS. It appears that there is no universal, accurate mandatory recording system in place at the point of delivery.

In my local hospital, which is a very large NHS one, to try to set about recovering costs, people walk around with clipboards inquiring of people in the hospital who have not given the necessary data information on arrival, trying to find out where they have come from and whether or not they are entitled. It is ridiculous. You can imagine the success rate of the people with the clipboards, trying to find out information from those who are not entitled, in particular from those who know they are abusing the system. There have been attempts to improve these systems, but we see continued—extensive, probably—financial shortfall in this area, partly from Europe and particularly from those outside the European Union.

We proudly boast that our great NHS is free at the point of delivery. It certainly is; it appears to be free for the whole world. There have been attempts to overcome this unintended anomaly, but hospitals and others are reluctant debt collectors; they are, after all, in the healing business, not the banking business. We need to design a system that works without asking the health industry to collect the money. An ID system that works and is not easily abused must be capable of simple introduction—they seem to do it elsewhere very effectively.

I was going to refer to statistics. We have heard a lot about the number of UK residents living in Europe, the number of retirees living in warmer climes, those who use medical services in continental Europe because they have been referred, and so on. But the fact is that there are apparently some 3 million EU nationals living in the UK, and 1 million British nationals living in the EU. Yet we recover only 10% of what they recover. I do not get the arithmetic. I am sure I will be corrected—

[Lord O'Shaughnessy]

I can tell the noble Lord the reason for that. It is fantastic to hear somebody from the Cross Benches supporting the efforts that the Government have been making for cost recovery, because it is not always a popular topic in this House. One of the main reasons is that if you are here for six months or if you have made your home here, wherever you are from, you are counted as ordinarily resident and are therefore entitled to free care. That is a founding principle of the way the NHS is set up, and the reason for the discrepancy that the noble Lord talks about. It is not a failure to deliver costs—it is an entitlement that anybody from any country has if they are counted as ordinarily resident under the law.

[Lord Thurlow]

I thank the noble Lord for his clarity.

Health tourists are a different category. The BMJ reported 18 months ago that in the year before, some 50% of births at a particular London hospital were to mothers not entitled to NHS services. I realise that this is a completely different category, but health tourism is something we are all aware of. The estimates I have read of the cost of this to the NHS vary from £300 million to £500 million; a senior doctor at a London hospital estimates that the figure is well over £1 billion. There appears to be a well-organised shuttle service of sorts from west Africa, giving access to those who can afford the service, no doubt for a great price. Are our doors really that wide open to this abuse of taxpayers’ money?

Why my interest? I am not a ranting, Brexiteering, screaming far-right nationalist, I promise you. I am doing this as a taxpayer and we, the legislature, owe a duty of care to all British taxpayers and citizens. The Second Reading is the first opportunity for us to debate the key principles and the main purpose of the Bill and to flag up concerns. To read that the cost of the mix of inefficiency and fraud may cost the NHS only £300 million or £500 million is insulting. Just try getting that out of the Treasury for your next worthy project. Does the Inland Revenue stop chasing us when it gets down to the last £300 million? We are all taxpayers, all paying for this shortfall.

In 2014, the visitor and migrant NHS cost recovery programme was, I believe, implemented. It sought a target, for some reason, of £500 million per annum. To do this, it wanted to improve existing charging systems, laying a health surcharge on non-EU citizens. This Bill provides an opportunity to redress this programme and so support the principle of fairness by ensuring that those not entitled through treaties pay for their care. It requires that the particulars of NHS access entitlement must be made completely clear to foreigners as they arrive in the UK, to avoid confusion for both patients and service providers.

In our great liberal democracy I could easily be perceived as a bogeyman or pariah—no one else has raised these points before in this debate. Please do not do that. It is taxpayers’ money; it is hard cash. We have a duty, as I have said, to stamp out abuse. Please do not turn a blind eye to this shameful state of affairs. The UK is not a rich country at the moment. We are doing our best to recover from the great recession of 2008 to 2012. We had austerity—closing rural schools and closing or reducing hundreds of other public services. Yet we appear to waste hundreds of millions of pounds because this is in the “too difficult” category. At the least, we could let DfID pay for the illegal health tourists through the aid budget. After all, it is foreign aid.

We must create an effective system to record the origin of unentitled users of the NHS, and allow for the accurate reconciliation of costs as the system is set up to do. To stop health tourism, users must pay. It is not a job for medical practitioners, but we have hospitals staffed by highly paid administrators. If remedied, hundreds of millions of pounds could be added to the funding of the NHS. Why is cost recovery not more effective and what, if anything, is being done to radically overhaul the system which allows this shameful waste of taxpayers’ money?