Orders of the Day — Overseas Visitors (NHS Charges)

– in the House of Commons at 9:58 pm on 7 February 1983.

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Photo of Mr Alfred Dubs Mr Alfred Dubs , Wandsworth Battersea South 9:58, 7 February 1983

The Government introduced their new proposals to charge overseas visitors for National Health Service treatment at the beginning of October 1982. Those proposals followed several debates and statements in the House and the report of a DHSS working party that looked into the possible working of the scheme, as well as a thorough investigation by the Home Affairs Committee. I also happen to be a member of the Sub-Committee on Race Relations and Immigration, which looked into the scheme in detail.

My main purpose is to raise some of the issues that have come up since the scheme's introduction. It is useful to remind ourselves of the Government's case for introducing the scheme. The Government put forward only two arguments in favour of it. First, they said that it would raise £6 million a year, and they assured us that that was a not inconsiderable sum. Of that, £1 million was to be obtained from fees to be charged for NHS treatment of overseas students in their first 12 months in this country. That came on top of the swingeing fees that overseas students at our universities are charged as a result of the Government's actions.

The second justification put forward by the Government for introducing charges for NHS treatment was that there was abuse of the NHS and that the scheme would somehow lessen or prevent that abuse. Let me remind the House of the opposing arguments, to which I subscribed. The first was that the Government would not in fact raise £6 million by means of these proposals. The second was that there was little evidence of abuse, and that what abuse there was was on a small scale. Thirdly, the whole idea was most unfair to overseas students. Fourthly, the proposals would be seen to be discriminatory against the black population of this country who, although eligible for NHS treatment, might be subjected to a more difficult process of questioning when they went to hospital for NHS treatment. This view of the discriminatory possibilities of the proposals was fully supported by many health authorities which gave evidence to the Home Affairs Select Committee. The fifth argument against the proposals was that they were extremely complicated, would impose an extra burden on NHS staff who had better things to do, and might be applied incorrectly or improperly because of the sheer complexity of the way in which the system should be applied.

In its report, the Select Committee, not surprisingly, divided on party lines. I shall refer in particular to the evidence that the Secretary of State gave to the Select Committee on 1 March 1982. First, he said: I must emphasise that there is nothing in the proposals that I am to do which needs or, I believe, will, increase racial discrimination or tension, as far as that is concerned. Certainly I would do everything in my power to prevent that taking place. That is a fairly clear commitment. Secondly, the Secretary of State said, on the same day: On first hearing that proposition, my aim is to demonstrate to everyone concerned, and to the ethnic minority groups, I suppose, in particular, that this system is fair. Yes, I would be prepared to consider some kind of checking system, if that were thought to be useful. The Select Committee thought that that form of monitoring would be useful, and recommended accordingly.

What has happened since 1 October, when the scheme was introduced? Many of us were interested to know how it was working. So I asked a number of parliamentary questions last December, thinking that I would get some evidence about what was happening. I asked how many overseas visitors had been charged, and what the income had been for each regional health authority. I asked about extra staff having to be appointed to administer the new procedures. I asked whether the new procedures had been introduced in all hospitals. I also asked from which countries the overseas visitors came who had been charged for this treatment. The Minister of Health replied on 9 December 1982: The information sought in these questions is not available centrally".—[Official Report, 9 December 1982; Vol. 33, c. 587.] I asked a further question about a week later as to whether the Secretary of State would introduce a monitoring system, to which the Minister of Health replied: I see no need to do this at present and doubt whether the expense to public funds would be justified".—[Official Report, 16 December 1982; Vol. 34, c. 247.] Finally, today I asked whether the Secretary of State for Social Services was satisfied with these new procedures and whether they were working satisfactorily. The answer came: Yes, so far as I am aware". Those answers are a little surprising, to say the least, in the light of the undertaking given by the Secretary of State when he met the Home Affairs Select Committee. He said that he would take care to ensure that racial discrimination did not take place in administering the scheme and that he would consider a checking system, if that was thought to be desirable. Clearly, it was thought to be desirable. In my opinion, the Secretary of State gave perhaps not explicit but certainly implicit undertakings that he would monitor the progress of this controversial scheme.

I would further argue that the Secretary of State has, in the event, not kept the undertakings that he gave to hon. Members. Accordingly, I wrote to all 14 regional health authorities in England putting to them the questions that the Secretary of State was unable to answer because he was not collecting the information. Some of those answers have arrived. Some are still coming in. They cover the three to four-month period since the new charging method was introduced on 1 October. I have done some rough calculations on the basis of the information that I have so far received. I wish, from that point of view, that the debate was taking place in a few weeks' time when I shall have the full results.

The population covered by the regional health authorities that have so far supplied information amounts to about 14·5 million out of a total population in England and Wales of 50 million. I appreciate that one cannot be precise. A heavier weighting in terms of charging overseas visitors arises in the London area. Of the four regional health authorities covering London and the home counties, one has so far replied. The total income obtained by the regional health authorities that have replied, in the three to four-month period, although they did not all give figures for the same period, was £22,000. Even if that figure is multiplied by four on the assumption that their replies related to a three-month period, this gives a figure of £88,000. Projected on the basis of the population for England and Wales, the figure becomes £300,000.

I accept that these figures are not the best basis for making estimates. Even so, the Minister should be concerned that the original estimate of £6 million by his Department is not likely to be met in the first year. There are, of course, teething troubles. It is known that not all hospitals and not all district health authorities are yet operating the scheme. That may be an argument for saying that more money can be expected, although it is not an argument, I believe, from which the Minister will take a great deal of comfort.

In support of the argument that the money will not amount to the sum originally suggested, I should like to refer especially to overseas students. A number of parliamentary questions were asked by my hon. Friend the Member for Crewe (Mrs. Dunwoody) last year about the expected income from overseas students. In March 1982, it was expected that £500,000 would result from Health Service charges imposed upon overseas students who had come to this country at the invitation of the British Government. Given the original estimate by the Department of Health and Social Security that students would contribute £1 million, it can be seen that roughly 50 per cent. comes from those students invited by the British Government.

By December 1982, the Minister for Overseas Development had clearly revised his figures. His reply stated that the likely contribution of the overseas students who came at the invitation of the British Government would be £100,000. On the basis of simple proportions, it is likely that the income to the DHSS from all overseas students will be £200,000. It might be a little more because the Minister added that the overseas students coming under the British Government scheme had had previous health checks, were therefore a bit healthier than the average, and would need less Health Service treatment.

There have been other developments since the scheme was introduced. A judgment by the House of Lords in December is usually referred to as relating to Shah and others. This was concerned at least in part with the definition of the words "normally resident" in this country. That is important, because the definition of who is normally resident arises on this method of charging overseas students. One interpretation of the House of Lords judgment is that "normally resident" has now been defined in such a way as to cover all overses students who would no longer be liable to pay for NHS treatment. I cannot say with utter precision whether the House of Lords judgment will mean that in practice, but it is certainly how it has been interpreted by students and organisations representing them.

There are three particular respects with which we must all be concerned as to how the scheme is now working. First, some people are being charged large sums of money for NHS treatment as a result of accidents that have occurred during a visit to Britain. There was a case in Bradford of an individual, I believe from the Indian sub-continent, who was visiting Britain on holiday. I think that he broke his leg and was charged £7,500 for treatment. It may be that such examples of heavy charges are exceptional— I hope that they are—but it must be a matter for anxiety if people suffer from acidents while visiting Britain and have to pay large sums of money for something which could not be anticipated.

Secondly, it is my contention that some people are being charged incorrectly or out of line with the Government's stated intentions when the scheme was introduced. May I give one example? A woman who had settled here—I cannot give her name, because she would be embarrassed by the publicity—went to the Indian subcontinent and then returned to Britain. I think that at that time her husband was still on the Indian sub-continent. She was pregnant and when she went to the hospital about her impending confinement she was asked about the basis of her stay in Britain according to the form of questioning which is part of the proposals. Because the woman was rather alarmed about the implications of the British Nationality Act 1981—it may have been that she did not understand it fully—when she was asked whether she was staying here permanently she said that she was not sure, although she was settled here and had not been away for two years, so that under the immigration rules she had evey right to stay for the rest of her life. However, because she was disconcerted and ill at ease about the British Nationality Act she was unsure how to answer and she said something about not being quite sure and that she might or might not be going back.

What happened? She has been charged. I cannot understand how that can be an example of other than the way in which these charges have been wrongly applied, even according to the Government's stated intentions and the way in which the Secretary of State described those intentions to the Select Committee on Home Affairs.

Thirdly, there have been several instances—I have been given details of at least two—where the sponsor of a visitor to Britain has been forced to sign an undertaking to pay for NHS treatment before that treatment has started. On at least one occasion that undertaking was demanded in what I would only describe as the most stressful of circumstances. When the sponsor's father was on the point of being wheeled into the operating theatre the hospital authorities told the sponsor that he must sign an undertaking to pay. Presumably, the undertaking was for a person who was being treated and could not pay. This is an alarming example of how this particular scheme is being applied.

It is difficult to understand why the DHSS and the Minister are so reluctant to look into the workings of this highly controversial scheme. There was much argument up and down the country about it before it was introduced, and there has been much argument since it has been introduced.

I was in Birmingham last week with the Home Affairs Sub-Committee on Race Relations and Immigration. We were taking evidence on a totally unrelated point, but a black person described a series of events concerning his son who had been subjected to difficult and, in his view, discriminatory questioning in relation to the possible treatment for a broken arm at a hospital in the midlands. Examples of that sort have come to light time and time again. Our black population is very ill at ease and sees that as yet another example of discrimination being practised against them, even when they are absolutely within their rights to go for the Health Service treatment to which they are entitled.

I cannot help thinking that this is a bad scheme. Ideally, it should be withdrawn. It cannot be justified even by the arguments the Government have put forward. At the very least, the Minister owes it to the House and to the people affected by the scheme to ensure that his Department monitors how it is working. His Department should be able to say if the money is coming in, what the difficulties have been, whether the staff are co-operating, how many hospitals are not taking part in the scheme, and what has happened to general practitioners. Labour Members have been forced to accept proposals which they dislike intensely. People up and down the country dislike the proposals intensely, yet there is no way in which we can get the answers to the many questions that we wish to ask about how the scheme is working.

I have written to the regional health authorities and am getting courteous replies from the majority of them. They are giving me the information that I require.

It is absurd that a Back-Bench Member of Parliament should have to write letters to regional health authorities simply to collect information which for a lesser cost the Minister's own officials could collect more easily and could keep collecting at intervals. Members of Parliament could then have information as of right about a scheme that is controversial. Will the Minister consider the plea that he should monitor the scheme so that he can tell the House how it is working, thereby enabling all hon. Members to come to a judgment on whether the Government' s aims for the scheme have been achieved.?

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health) 10:18, 7 February 1983

The hon. Member for Battersea, South (Mr. Dubs) has raised the question of the Government's new scheme for charging overseas visitors who are not ordinarily resident in this country for the hospital services they receive. It is by no means the first debate the House has on the subject. The new scheme that the hon. Member is debating has been in effect only since October last year. The House debated this subject comparatively recently when, following on an Opposition Prayer, it approved the Government regulations. I shall not again give the details of the Government's basic case for introducing the charges.

I remind the House that the principle on which we acted was that we thought it was right that overseas visitors from countries with which we had no reciprocal agreement should pay for their treatment normally by insuring themselves. That is the same basis on which British visitors, when they go to those countries, pay for hospital treatment that they may be unlucky enough to have to receive. I suspect that the bulk of the visitors about whom we are talking come from prosperous countries—American tourists, Australian tourists and visitors from the Gulf—who have a higher per capita income than our own. They also come from countries where British visitors and tourists are expected to insure against the costs of their own treatment.

Someone must pay for the hospital treatment that patients receive. We are generous in the treatment given to visitors in emergency and other circumstances. We freely enter into reciprocal agreements with many countries, but, if the visitor does not pay or insure himself, the British taxpayer must do so. Most British taxpayers would agree that it is perfectly reasonable for visitors to insure so that they can pay for themselves.

I do not believe that we are applying a system that would be regarded as unreasonable by the authorities of the countries from which the visitors come. The aim of the scheme is the perfectly worthwhile one of raising a little more revenue for the NHS. It also puts on a clear footing the longstanding arrangements that have applied to the NHS. Ever since the NHS was created, we have never had a rule whereby overseas visitors were as of right entitled to free treatment.

We tried to estimate the amount that would be raised following the introduction of a charging scheme. We used a figure of £6 million, which the hon. Gentleman will find was something of a guesstimate, although I always personally felt that that was an underestimate of the sum that could be raised for the NHS. A figure of 0·25 per cent. of services charged for would produce £7·5 million. We suspect that £6 million is, therefore, a reasonable expectation, although we have no means of knowing for sure, and I doubt whether the hon. Gentleman has any basis for knowing at this stage what exactly a full year will produce.

If we get £6 million or anything like it, that will be a welcome addition to NHS funds. The Government have steadily increased expenditure on Health Service provision of all kinds, but the hon. Gentleman would be among the first to argue that we could spend additional money in a perfectly worthwhile way. I therefore cannot understand why foreign visitors from countries with which we have no reciprocal agreement should not make a modest contribution to their own care when they are taken into hospital and are able to pay.

The hon. Gentleman has consistently been a critic of the scheme. He has been against it from the word go and has always thought that it should never have been introduced. He has sought evidence to show that he was right, that the scheme is not working and that all his fears have been justified. He has asked parliamentary questions to discover whether in the first three months of operation there is evidence to support his criticisms. The answer to his inquiry is, first, that we are not collecting centrally the informatiion he wants and, secondly, that it is far too early in the lifetime of the scheme to check any sensible statistics because the information is not readily to hand.

Not every district health authority has introduced the new procedures at the same time. In October last year, we were in the middle of the NHS pay dispute, which was a much higher priority on management and staff time. Most authorities now have the scheme under way, but it has been introduced at a time when the number of foreign visitors is very small. I also hope that those authorities are not devoting undue effort to checking the working of the system and collating the statistics.

I hope that they are ensuring that the guidance is followed properly, fairly and consistently, but I have no intention of organisng a massive statistical collecting operation, which would merely impose a high administrative cost. I cannot imagine that most regional health authorities have the spare management time to indulge in a close scrutiny of the monthly revenue returns from district health authorities. We have, however, asked health authorities to keep a separate record of any complaints arising from the scheme. We wish to be informed of these and in due course will ask for a return, but it is far too early to do so yet.

As for income from the scheme, figures for the first six months will emerge in autumn 1983. As I have said, however, I do not expect those figures to be fully representative, as the scheme was slow to get under way in some areas and the figures will relate to a period in which the number of foreign visitors was at its lowest.

Therefore, I do not believe that it is justified at this stage to start collecting the detailed statistics that the hon. Gentleman requires or to reach any sensible conclusion about how the scheme is working in practice and how much revenue it is likely to raise.

The hon. Gentleman raised some specific and important points about events since the scheme was introduced and the way in which it has worked so far. He referred to the House of Lords decision in the case of Shah and others regarding the residential status of certain overseas students. I accept that there may be implications for the guidance that we have issued about charging of overseas students.

The legal basis on which overseas visitors may be liable to hospital charges depends upon whether they are "ordinarily resident" here. That has always been the term used in legislation governing the National Health Service. Their lordships actually considered a definition of "ordinarily resident" in the case in question. They rejected the "real home" test which had been used in the past and referred instead to the purpose of living in a particular place. The definition that they preferred comes from a judgment of Lord Scarman to the effect that a person should be judged as ordinarily resident here when, having regard to the purposes for which he is living here, he can be regarded as having established a sufficient degree of continuity to be properly described as settled". That is one random quotation from a judgment that the hon. Gentleman has studied. We must study it and consider its relevance to the guidance that we have issued and the practice that we have been following in relation to overseas students. I do not, however, accept the claim that some have been quick to make that all students are now exempt. To take an obvious example, I do not think that a person who comes here for a short language course in the summer could be regarded as ordinarily resident. Nevertheless, we may have to reconsider our advice about students. We shall try to clarify matters for health authorities as quickly as possible if we decide that the legal position established by the House of Lords requires a change in our guidance.

The hon. Gentleman described some cases in which he had been involved. For understandable reasons, he did not give names, and he gave inadequate information for me to respond to those cases. I am aware of one or two cases in which there were difficulties, but they did not match the information that he gave. If he will write to me about those cases, giving the names and details in confidence, I will give specific answers to the points that he raised on behalf of the complainants.

Photo of Mr Terry Davis Mr Terry Davis , Birmingham Stechford

If my hon. Friend the Member for Battersea, South (Mr. Dubs) wishes to send copies of his correspondence to me, I hope that the Minister will do me the same courtesy, as I am very interested in the allegations of discrimination. My right hon. and hon. Friends have brought other cases to my attention and I hope that the Minister will entertain those, too on a confidential basis.

I believe that the Minister inadvertently misled the House when he said in opening that the situation is still that the National Health Service provides generous treatment in emergencies. Certainly, treatment in accident and emergercy departments is still free. If an overseas visitor needs treatment for emergencies, such as a broken hip that requires treatment in an ordinary hospital ward, that visitor is charged—even though it is an emergency. I know of several accidents involving broken bones where visitors have been charged substantial sums for treatment in hospital. That is a change arising from the Government's new regulations. Previously, the treatment would have been free, which was the policy of all Governments.

I understand the Minister's problem in answering questions on revenue. As he said, the scheme has been operating for only a short time and there are not many foreign visitors at this time of year. When will it be sensible to give a better idea of the annual income from the scheme? Will he please drop his statement that my hon. Friend the Member for Battersea, South is asking for a massive collection of statistics? He is asking only for a simple accounting report. The income is supposed to be accounted, and will be a separate item in the accounts. It should be relatively easy to provide an inexpensive report.

Will the Minister consider the costs? My hon. Friend rightly concentrated on the aspects of racial discrimination, about which the Opposition are worried, but we also wonder whether the revenue will justify the cost of the administration and clerical work involved. If the Minister is so confident that the revenue will be about £6 million, which will more than compensate for the cost of the scheme, will he refer the matter to the new team established under the leadership of Mr. Griffiths? One of its terms of reference is to consider the effective use and management of manpower in the NHS.

Will the Minister say a few words about the position of general practitioners? Is the circular ECN 473, which was issued in 1964, still applicable?

Photo of Mr Ernest Armstrong Mr Ernest Armstrong , North West Durham

Order. That was one of the longest interventions that I have heard. The hon. Gentleman had already addressed the House. He should ask for the leave of the House if he wishes to make a second speech.

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

It was a long intervention. I had not realised that it would be quite so long, and did not note every point. I shall try to remember them and cover them in a way that allows me to return to my thread in answering the hon. Member for Battersea, South.

I have already covered the point about revenue. I said that in the autumn of next year we expect to produce the returns for the first six months. That will be subject to the proviso that some districts did not introduce the scheme quickly because of other problems. Also, the first six months will be winter months.

I decline to introduce any system of monthly returns that would be administratively expensive. We rely on the report of the working party—which recommended a scheme of administrative costs. It contained some administrators from the NHS and also representatives of ethnic minorities. Paragraph 38 of the report concludes: Our proposals should be capable of being implemented by health authorities without any significant increase in administrative costs, and while in certain areas additional staff may be required to operate it, this should only be in hospitals where the additional income may be expected to exceed this cost. I have not yet received any information to show that that advice and prediction have gone wrong. I am not aware of anyone having engaged additional staff. If we do attain anything like our modest estimate of income, it will far outweigh the administrative costs.

The hon. Member for Birmingham, Stechford (Mr. Davis) mentioned advice to general practitioners. We are considering that question and will issue advice in the not too distant future. It follows naturally from our view on charges for hospital service that we should examine the long-standing circular issued to general practitioners to ensure that it complies with the law, is defensible and does not give rise to unnecessary difficulty for family practitioner committees, doctors and chemists. With regard to copies of the correspondence and the types of cases that have been cited, I shall reply to the letters that the hon. Members for Battersea, South and for Stechford sent me. We all accept that we are dealing with the names of the patients confidentially unless the patient has indicated otherwise.

I shall examine the case of the lady who came here to have her child. An error may have been made. We wish to detect it if one has been made. Nevertheless, as a general proposition, if, having followed our procedure, a hospital concludes that a woman is not normally resident here but has come here for the express purpose of giving birth to her child, quite a few ordinary British taxpayers will complain. They will maintain that, if we have no reciprocal arrangement with that country, there is no earthly reason why she should not pay for the treatment if she regards NHS treatment for the delivery of her child as so superior to that of the country from which she came. If she is normally resident, or the birth is premature or unexpected, other considerations of course arise.

Photo of Mr Alfred Dubs Mr Alfred Dubs , Wandsworth Battersea South

Our immigration rules are extremely complicated. The lady in question was settled here, had lived here without any restrictions and had gone back to the Indian sub-continent for a while. I think that her husband was working there. On her return to Britain, she faced these difficulties. As she had been living here for some years and was settled here, I do not think that the ordinary British taxpayer would feel that she was not entitled to NHS treatment.

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

As, I think, we have agreed, the catch is whether the lady was ordinarily resident here. The hon. Gentleman said that she may have given some ambiguous or inaccurate replies to questions because she was worried on other counts. If, on examination of the facts, it appears that she was legally entitled to free treatment, we shall reconsider the case.

Other cases have been raised, such as those of people who have suffered accidents here and received emergency treatment. It remains the case that no charge is made in the accident and emergency department. Anyone admitted following a road accident or some other unexpected emergency is exempted, but he can be liable for charges thereafter when admitted for in-patient treatment.

That is not so startling or unjust. When a British person goes abroad—to the United States, for example—if he is wise—and we recommend it—he insures himself for hospital fees as he will be charged if he needs hospital treatment. We are trying to treat our visitors in exactly the same way as the British visitor is treated in the countries in question. I accept that we should be sensitive and sensible about the way in which the charges are collected. Sponsors and relatives may be asked to pay charges, but the first consideration will be that the proper treatment should be given.

We have no intention—we will try to protect against it and I do not think that it happens now—of going over to what occasionally happens in other countries whereby people who need emergency treatment are not admitted and dealt with because consideration is being given to whether they will be able to pay for the treatment. Our guidance is quite clear. We say that the procedures adopted must accord with normal principles of patient care. If staff have any reason to think that medical attention is required without delay, then that must take priority over enquiries into the patient's liability to charges or his ability to pay. Those are the words of our circular. We have given clear guidance that should enable people to deal with accident victims sympathetically.

The final allegation is the most serious one that the hon. Member for Battersea, South made. He said today, as he has said in the past, that somehow the regulations and the policy that we have introduced are intended to be racially discriminatory. I shall not labour all the arguments that I used when the regulations were introduced, except to remind the hon. Gentleman that one of the reasons why we felt that it was necessary to tidy up the long-standing arrangements was that the working party, which included representatives of ethnic minorities, found that in practice the old system could easily become or seem to be racially discriminatory.

I quote from the working party's report when it studied how the old system, which some people want to go back to, was working. It said that the old system was so haphazard that it came to the conclusion that because the checks currently used by many hospitals appear to be based on little more than the intuition of hospital staff that a patient may not be resident in this country, there is a distinct risk that they may be being applied in a way which discriminates against members of ethnic minorities living here. Because the old system had the risk of being racially discriminatory in practice, we thought that it was necessary to bring in a new system and to avoid any danger of racial discrimination.

The hon. Gentleman has been supporting a most unfortunate organisation that is campaigning on the subject up and down the country, which calls itself the No Pass Laws to Health Campaign, a particularly ridiculous title, which I am afraid is used by a body that sends out fairly ridiculous propaganda, which, if read, would give the impression to many black and Indian residents that they were likely to be discriminated against when they went to hospital. The propaganda is based largely on almost direct misquotation or misrepresentation of the contents of our circular and the procedures being used. I will quote from one of its circulars, which was issued at the time of a conference addressed by the hon. Gentleman. It said that we were bringing in new regulations and that— This means that if you are black or have a 'foreign sounding' name or accent, you may well find it more difficult to get NHS treatment because you may be asked to prove that you are entitled to it. As I am sure the hon. Gentleman knows, every instruction given to health authorities and everything in the guidance is designed to ensure that the exact opposite is the case. That is a good description of the previous arrangements, which the Government have ended and which we have sought to clarify. The new arrangements ask exactly the same questions of people whatever their origin in the first instance by a sifting process, and thereafter questions are asked sensibly according to a set pattern that avoids the risk of any impression of racial discrimination. For instance, we expressly ruled out requests for passports, except for EC nationals and others trying to prove quickly that they are entitled to be treated on a reciprocal basis because of agreements with their countries.

In contrast to what the No Pass Laws to Health Campaign says, our guidance says: Ministers would find it totally unacceptable for the process of establishing identity to impose a special burden of proof on any group of people living in this country. It is important that the selection of patients for detailed inquiry must not be influenced by the personal characteristics of the patient—such as colour, accent or name. We have had no complaints about racial discrimination arising from the regulations, as far as I am aware. The whole point of our guidance was to avoid any impression of racial discrimination being caused because the working party found that the old system was giving rise to just those dangers in practice. It is the old system to which the hon. Gentleman appears to want to go back. The new system is designed to avoid those dangers.

With regard to alarm being created among members of the ethnic minorities, alarm is not created by the Government or by anyone who has read our circular. If there is any, it is being caused by ridiculous and unhelpful campaigns such as the No Pass Laws to Health Campaign. It seems to me that the people behind the campaign are trying expressly to raise fears among the immigrant population that it will be discriminated against, by deliberately misrepresenting the terms of the policy, the way in which it is being applied and the advice that is being given by the Government.

Photo of Mr Alfred Dubs Mr Alfred Dubs , Wandsworth Battersea South

The Minister said earlier that I had alleged that the Government were deliberately introducing a racially discriminatory scheme. I was doing nothing of the sort, although I said that one consequence of the scheme would be that it would discriminate against black and Asian people.

I shall refer the Minister to a point made by the Secretary of State about passports. The Secretary of State gave evidence to the Home Affairs Sub-Committee on Race Relations and Immigration. He was asked about his assurances that passports would not have to be produced under the stage 2 procedures. He said: No, because what I have said on passports is that it may well be for the convenience of the individual—if, for example, he comes from an EEC country—actually to establish, from his entitlement to free treatment, that he is a resident of Denmark or he is a resident of West Germany. Therefore, as in all things, I think that commmon sense has to be applied. Although the Secretary of State quoted the EC as an example of from where a resident might be asked to produce a passport, he did not say that passports would not be asked for from people of other countries. The basis of the No Pass Laws to Health organisation was the fear that passports would be required before health service treatment was given free-of charge.

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

Passports are relevant at stage 2, because they can be helpful for someone who comes from an EC country or some other country which has a reciprocal agreement. The quickest way for a visitor to prove that he is a national of a country which has such an agreement is to produce his passport.

Our guidance expressly sets out that, apart from those countries, passports are not be be requested, precisely because we responded to fears expressed before the scheme was introduced that people would be worried that it was part of an enquiry about their immigration status and so on. Passports, apart from this, are not particularly relevant because access to free hospital services depends upon ordinary residence and not upon nationality or immigration status.

If I misquoted the hon. Gentleman when I said that he was suggesting that we were deliberately introducing racially discriminatory legislation, I apologise. He has not done so in his speech. However, he has appeared on the platform of the No Pass Laws to Health organisation helping to support its campaign. It is distributing leaflets typeset by an organisation called Bread 'n Roses (TU) of 30 Camden Road, London. It is being printed by Community Press (TU) in St. Pauls Road, London. I do not know whether that is a printing press of which the Labour party approves or disapproves. The hon. Gentleman knows perfectly well the scurrilous nature of the literature being distributed by the organisation. I shall quote one paragraph: We can guess from what already happens in hospitals that ethnic minority people will be singled out for more careful questioning and will be more likely to experience delays before getting treatment. White people will not meet the same barriers. Anyone, including the hon. Gentleman, who has seen our regulations and our guidance knows that their tenor and terms are designed to ensure exactly the opposite. The same questions are asked of everyone regardless of race, accent, name or anything else.

We are laying down a clear procedure that avoids the danger described in that leaflet, which existed before the Government acted. It is irresponsible to suggest that the new arrangements, which are designed to reduce the risk of racial discrimination, are causing greater racial discrimination. The campaign is not helpful.

I apologise to the House if I have used, even shortly, the basic arguments put forward in earlier debates about the scheme. They were accepted by a majority in the House. It is a common sense reciprocal arrangement giving some overseas visitors the same treatment that British visitors would expect in civilised countries abroad where one expects to insure and pay for treatment.

It is far too soon to have details of how the scheme is working in practice. It would be absurd to make detailed checks at this stage. We shall eventually have figures for the income and we shall monitor carefully any complaints that arise, including those raised by hon. Members.

I believe that a disproportionate amount of fuss is being made about a commonsense improvement to a long-standing legal position on entitlement to Health Service treatment. If it produces a little extra income for the National Health Service we should all agree that it is a good thing because the Health Service can use all the revenue that it obtains.