NHS: Health Tourism

Earl Howe Excerpts

Monday 28th May 2012 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what is the cost to the National Health Service of international health tourism, and whether the Home Office has consulted the Department of Health on appropriate assessments of likely health needs or conditions before issuing visas to visitors to the United Kingdom.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, estimated written-off debt for NHS treatment provided to chargeable overseas visitors in 2010-11 was £14 million. However, this will include debts for visitors requiring unexpected treatment as well as those actively seeking NHS treatment to which they are not entitled. On 21 May, the Home Office announced the introduction of pre-entry screening for tuberculosis for long-term migrants from countries with high TB incidence. The department and the Health Protection Agency worked with the Home Office to review current arrangements.

[Baroness Gardner of Parkes]

That is a considerable increase. In his Written Answer last year, the noble Earl gave the figure for the previous year as under £7 million, so the amount has doubled. I do not know whether the £14 million includes the previous £7 million, but obviously the amount is growing. In the same Written Answer, he said that the Home Office was now consulting. On screening—for TB, for example—does the visa application ask applicants to declare any pre-existing medical condition, as is the case in many overseas countries?

[Earl Howe]

My Lords, the Home Office, with our agreement, drew up a list of high-risk countries where TB was prevalent. In those countries, if someone seeks a visa to come to this country for six months or more, they will have to undergo TB testing. Questions on other medical conditions are not relevant in this context. We do not screen for other things. TB is an exceptional case because it is an airborne disease and poses a public health risk.

[Lord Kakkar]

My Lords, what assessment have Her Majesty’s Government made of potential future health tourism from eurozone countries facing imposed austerity measures and cuts to their own local healthcare provision?

[Earl Howe]

The best answer I can give the noble Lord is that this entire area of health tourism is one which we in the department are looking at extremely closely. A review has been carried out by officials and Ministers are considering the recommendations flowing from that. It is a complex set of issues but clearly the context to which the noble Lord rightly refers will need to come under the spotlight.

[Lord Roberts of Llandudno]

My Lords, if this is devolved to Scotland, Northern Ireland and Wales, how are the Government relating this particular problem to the Assemblies and the Parliament?

[Earl Howe]

My Lords, we are in constant contact with our counterparts in the devolved Administrations. The policy adopted in England need not necessarily be replicated in those Administrations but we seek to keep officials in those parts of the country fully informed as we go forward.

[Baroness Boothroyd]

My Lords, when I travel abroad on holiday, which I am happy to say I do quite often these days, I have to carry health insurance and it is quite expensive. Because of my age and various other problems I have to take it out each time I go on holiday. I will not tell you how many times a year that is. What happens in reverse when people come here on holiday? Is it required of them to carry health insurance in case they have any problems here?

[Earl Howe]

The rules are complex, depending on whether the person is from the European Union, where certain rules apply, or from other parts of the world. There is no mandatory requirement for people to carry health insurance unless there is a transparent medical need when they enter the country. For example, a heavily pregnant woman might be asked to produce proof that she could pay for treatment if giving birth was likely. There are clear rules for NHS trusts where a patient who is chargeable presents. The trust must seek either to secure payment before treatment or to bill the person immediately afterwards.

[Lord Foulkes of Cumnock]

My Lords, in answer to the question asked by the noble Lord, Lord Roberts of Llandudno, the Minister rightly described the situation as it currently is. Is the Department of Health doing any study into the disaster that would happen in terms of healthcare between Scotland and England if Scotland were to separate from the rest of the United Kingdom? If it is not doing a study, why not?

[Earl Howe]

My Lords, were that situation to occur, the issues arising from it would be little different from the issues today in that health is already devolved. However, I cannot speculate on whether there would be a different policy on immigration in Scotland compared to south of the border as we are really not in that territory yet.

[Lord Swinfen]

What checks are actually carried out to ensure that patients are entitled to free National Health Service care?

[Earl Howe]

My Lords, it is incumbent on NHS trusts when a patient presents directly to them to ensure that the person in front of them is entitled to NHS care, and they have various means of doing that. However, primary care in this country—care delivered by GPs—is not subject to any checks of that order.

[Baroness Farrington of Ribbleton]

My Lords, would somebody from anywhere in the world who had a British passport be entitled to NHS treatment were they to be in this country at the time of need?

[Earl Howe]

My Lords, the answer is no because the entitlement to NHS care is and always has been dependent upon an ordinary residence test, so that the mere possession of a UK passport does not necessarily indicate that a person is ordinarily resident.