25 March 2013

Mr Frank Field (Birkenhead) (Lab) (Urgent Question): To ask the Secretary of State for Health what moves the Government intend to take to prevent the national health service becoming an international health service.

The Secretary of State for Health (Mr Jeremy Hunt): The current system of policing and enforcing the entitlement of foreign nationals to free NHS care is chaotic and often out of control. At a time when we are having to face the challenges of an ageing society, it places a significant and unjustified burden on our GP surgeries and hospitals and may well impact on the standard of care received by British citizens.

As the Prime Minister said earlier today, the Government are determined to ensure that anyone not entitled to receive free NHS services should be properly identified and charged for the use of those services. Currently, we identify less than half of those who should be paying and collect payment from less than half those we identify.

We also have some of the most generous rules in the world on access to free health care. Our rules allow free access to primary care for any visitor to the UK, including tourists, and free access to all NHS care for foreign students and temporary visitors. But ours is a national, not an international, health service, so last year, under my predecessor, we began a wholesale review of the rules and procedures on charging visitors for NHS care, with a view to making the regime simpler, fairer and easier to implement. In particular, we focused on who should be charged and how the rules can be applied and enforced more effectively. We have examined the qualifying residency criteria for free treatment; the full range of other current criteria that exempt particular services or visitors from charges for their treatment; whether visitors should be charged for GP services and other NHS services outside hospitals; establishing a more effective and efficient process across the NHS to screen for eligibility and to make and recover charges; and whether to introduce a requirement for health insurance tied to visas.

The initial phase of the review has concluded and we will shortly start a consultation on a range of options, including plans to extend charging to some visitors and temporary residents who were previously exempt so that the default qualification for free NHS care would be permanent, not temporary, residence; ending free access to primary care for all visitors and tourists; introducing a prepayment or insurance requirement for temporary visitors to pay for NHS health care; and improving how the NHS can identify, charge and recover charges where they should apply. We will retain exemptions for emergency treatment and public health issues.

We will work closely with medical professionals, NHS staff and partner NHS organisations during the consultation and then seek to introduce agreed changes as quickly as possible. We will need to take a staged approach, because some changes are likely to require primary legislation before they can be introduced, which will take longer to put in place. However, some changes can be made immediately, and we should proceed with those as quickly as possible.

Mr Field: I thank the Health Secretary for his reply. If he wants us to take him seriously, will he today give a commitment in respect of the directive his Department issued just as the House was rising for the summer recess, compelling doctors, if they have vacancies, to admit all those who have been in the country for 24 hours or more, including illegal immigrants? Will he ensure that someone in the NHS—not doctors—works out whether or not a person is entitled to claim, and will he implement such proposals forthwith?

Mr Hunt: The directive to which the right hon. Gentleman refers was issued by an independent NHS body, not my Department. The sorry truth is that it is consistent with the current rules on access to primary health care, which is what we believe is wrong. I think that one of the big problems in the current system is that we have free access to primary care for anyone visiting the UK, however short their visit is. Through that access to primary care, they get an NHS number, which should not entitle them to free care but is often treated by hospitals as such. That is what we have to put right. He is absolutely right that we need a system that properly identifies whether people should have care that is free at the point of access without impinging on the ease of access for British citizens, which is one of the things they treasure most about the NHS.

Source: Hansard, HC Debate, 25 Mar 2013, Column 1291