|National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2001
Dr. Harris: The logical extension of that poor attempt is that any scrutiny of a regulation stemming from a European Court judgment will deem those who try to scrutinise it as vehement anti-Europeans. That may be an easy description for the Minister to use to characterise Memberssome make it easier than othersbut taking that argument to its conclusion would lead to an absurd situation.
Mr. Hutton: Had the hon. Gentleman spelled out his position more clearly, Government Members would know whether he was in favour of the regulations. I got the strong impression, as did most Government Members, that he did not think that it was a good idea for us to be doing that. The United Kingdom Government have a treaty obligation to ensure that our legislation gives effect to the two European Court of Justice rulings. I am sure that I am not the only one who got the impression from the Liberal Democrats that they like their pro-Europe leanings, and I am somewhat at a loss to understand why that does not apply today in relation to the two rulings.
Let us inject some reality into the proceedings. The regulations give UK health service bodies the power to pay the travel costs of patients travelling outside the UK for treatment.
Sandra Gidley: I apologise for my earlier misdemeanour, Mr. Winterton.
If I were going somewhere else in the UK for an operation under the choice I will have, I would not think it necessary to take out travel insurance, as most people do when they travel abroad. What would be the position for someone travelling abroad for NHS treatment if they had failed to take out travel insurance? Would they be covered under the NHS, and what advice is being given to those who have already taken part in the scheme?
Mr. Hutton: I am not sure that I quite understood the hon. Lady's question. The scheme would meet the cost of any insurance that a patient took out to cover the cost of their travel abroad to be treated in a European hospital and to oversee any risk of injury during the process of travel, as the cost is associated with travel. I am not sure that I understood her question about whether a patient would be covered if they were injured abroad and they did not have insurance under the NHS. The answer is probably not,
Column Number: 11unless there was some local arrangement to provide the patient with free care. The hon. Lady may want to follow that up in correspondence if she is still unclear about the position.
Without the regulations, patients would have to meet the costs of travelling overseas themselves, regardless of their income, as the NHS would simply not be able to pay for travel beyond UK shores. The regulations are therefore important in helping us to ensure that we meet our European obligations following the EJC rulings last year. If we were to fail to take such action, many patients in England, especially those on low incomes, would be denied the opportunity to travel abroad for treatment if that is what they want to do in the light of the two European Court of Justice decisions. Those who are well off would not be affected. If we took the advice of the Liberal Democrats and rejected the regulations, the less well-off would suffer.
The hon. Member for Oxford, West and Abingdon made a long argument about fairness and equity. I cannot see the fairness, equity or logic of his views on the regulations. In proposing the regulations, our policy is not to discriminate between NHS patients who travel abroad for treatment and NHS patients who are treated in this country. We have treated the journey from the patient's home to the point of departure, which is specified in regulation 2 as the airport, ferry port or international train station, as analogous to the journey from home to hospital, and we have applied the longstanding hospital travel cost scheme rules.
To be clear, patients on low incomes may claim back all or part of the costs of that travel from home to the point of departure. Those who do not qualify may not claim those costs. However, the travel costs will be paid in full from the point of departure to a hospital abroad regardless of patient income but subject to agreement with the health service body concerned. The regulations are consistent with established arrangements for providing health for the cost of travel, and ensure that patients who choose to receive their treatment abroad under the arrangements are no worse off than if they had received their treatment at home in England. I believe that those are the principles of consistency and fairness that the hon. Gentleman was looking for, and they are the right principles to apply in these circumstances.
Regulation 1 explains the coming into force of the regulations and their extent. The regulations cover only England. Except for regulation 5, the changes are subject to the outcome of the debate, but in fact came into effect on 18 January. Regulation 2 defines ''port'' for the purposes of the regulations as
Column Number: 12support or income-based Jobseeker's allowance is automatically entitled to a full refund of their travel costs, as are many people who receive tax credits.
Other people on a low income may make a claim for help; in such cases, there is no restriction on who may claim. The help that they get will be based on a comparison between their income and their requirements. Calculations will be based broadly on income support arrangements; such calculations have been used for a long time and are an accepted measure of low income. Anyone whose income is below the level will get full help; others may be asked to make a contribution to their travel costs from home to their point of departure. Those on low income get help, but others may not.
Regulation 4 introduces new paragraph 3A into the principal regulations. It provides that the NHS will pay the patient's travel costs from the point at which the international journey begins. It would be wrong to pay automatically for all travel costs from the patient's home, as we do not routinely do so for patients who are treated in the UK. Without the regulation, it would not be possible to provide patients on low incomes with a guarantee of help towards the cost of travel to a foreign hospital, which might be hundreds of pounds. In many cases, I expect that the health service body will purchase a package of care that will include the up-front travel costs. The hon. Member for East Worthing and Shoreham made that point. Alternatively, the health service body may agree the mode and cost of travel with the patient in advance.
Regulation 4 allows the travel costs of a companion to be met by the NHS when it is necessary on medical grounds. The issue of funding the cost of a companion's travel is not new but arises in connection with hospital travel costs in the UK. We have simply carried over the arrangements for travel by companions in the UK and applied them to the European scheme, because we want consistency between the arrangements for patients in the UK and for patients who travel abroad. Ultimately, the issue will have to be sorted out at a local level by the trust, the patient and their family. The term ''medical grounds'' clearly means that the hospital, the general practitioner or the consultant in charge will have a say in the decision. Usually, there is agreement about such matters. That is the only way such issues can be effectively and fairly addressed.
Regulations 6 and 9 make consequential amendments to ensure that claims for payments can be made under the new system. In regulation 7, we have made special provisions for the Isles of Scilly. Regulations 5 and 10 are not directly about treatment abroad but have been included to avoid making another set of regulations within the next few weeks to amend the principal regulations. Regulation 5 increases the weekly income level at which individuals receiving tax credits are entitled to full remission of charges; for example, in relation to prescriptions and payment of expenses for travel from home to hospital in the UK. Obviously, income limits must be kept under continuous review.
Column Number: 13The regulations will provide further help to people receiving tax credits for the costs of NHS prescriptions and dental treatment. That is right; I thought that the hon. Member for Oxford, West and Abingdon would have supported those changes, at least. Sadly, he did not refer to them in his remarks.
Regulation 10 makes a small change to clarify that only full-time students are entitled to NHS charges certificates, which will relate to the full academic year. Other students will not be affected by the changes and will continue to receive certificates according to their varying periods of part-time study.
As I said, the regulations are principally designed to make technical changes to the existing hospital travel cost scheme and to make important changes that will benefit people on low incomes. Without the regulations, we could not implement effectively the rulings of the European Court of Justice last July and fulfil our obligations under the treaty of Rome. For those reasons, I hope my hon. Friends will support the regulations.
In response to the wider points about and criticisms of the changes and patients' right to seek health care abroad, we must accept, because of the European Court rulings, that this is the right interpretation of health service legislation in this country. It is wrong to caricature the arrangements as an underhand way for the Government to reduce average waiting times for patients in the UK; that is simply not true. We are investing huge amounts of additional resources to improve NHS capacity to treat patients locally, close to home, where most patients wish to be treated. The programme of investment to build up NHS capacity will continue and will not be compromised in any way by the need to make changes to the hospital travel cost scheme so that patients can receive treatment abroad. The Government's clearly stated objective, which my hon. Friends support, is not incompatible with the changes that we are making to the regulations, which have been made necessary by the European Court rulings.
Let me make it clear to the hon. Members for Oxford, West and Abingdon and for East Worthing and Shoreham that we do not view these pilot schemes and the wider access to treatment options abroad as a solution to the problem of long waiting times for treatment on the NHS. People wait for scandalously long periods to receive treatment on the NHS. The Conservatives set a maximum 18-month waiting time for treatment, but never met that target during their entire period in office. Not once in their 18 years in office did they meet that target, yet they have the gall to criticise the Government for the way in which we are trying to manage the national health service and reduce patient waiting times.
This scheme is not the solution to the problem of capacity or the problem of long waits for NHS patients across the country. It is the solution to long waits for some patients. For that reason, we should not shrug our shoulders, walk away and say that we are not prepared to spend the money.
Column Number: 14The hon. Member for Oxford, West and Abingdon and others expressed concern about the cost of the pilot schemes. We cannot make detailed prices available for individual operations as he requested. The information relates to one specific provider, a hospital in Lille, and is specific to the cost quoted and charged by that unit. It has always been the policy of successive Governments not to release information that would identify individual providers in that way. We do not intend to do that.
The costs are generally comparable to those of purchasing in the UK private sector. The hon. Member for Romsey (Sandra Gidley) asked about wider access to choice being implicit in the European Court of Justice rulings. As more patients exercise choice we shall get a better deal overall for patients, as the scope of the pilots rolls out across the rest of the national health service.
Purchasing treatment overseas opens up new capacity in some cases. It avoids putting yet more pressure on conditions in this country. For all the reasons given by the hon. Member for Oxford, West and Abingdon and on which he has reportedly made his views clear on a number of occasions, it is a sensible thing to do. It reflects the reality of our legal situation and provides a solution in some cases to the long wait people are unfortunately enduring under the national health service.
|©Parliamentary copyright 2002||Prepared 5 February 2002|