My Lords, official warnings of the mounting crisis in the National Health Service are coming thick and fast. Last week, the Government said that the NHS could break down if we continue to run an international service open to all comers from other parts of the world. At one o’clock this morning, the body responsible for the NHS in England published its report, A Call to Action, saying that it is about to run out of cash and may need a minimum of another £30 billion a year by 2020. The royal medical colleges believe that 20 hospitals may have to close to prevent financial ruin. In short, the NHS is fighting for its life. Painful though it is, I welcome this outburst of reality. I only regret that it has taken so long.
There is a culture of denial and indifference in this country that allows serious problems like this to reach a crisis point before we face up to them. Too often, those in authority react by creating new organisations that do not work, prattling about lessons being learnt when it is clear that they are not being learnt, and hunting for culprits who pass the buck to others, who say they did not know anyway.
Last week’s report by the Department of Health breaks new ground. It points to the chaos in our hospitals and GP surgeries caused by overseas visitors who are not entitled to use the NHS, yet do so and avoid payment for their treatment. We do not know how much this racket costs. Ten years ago, a document produced by CCI legal services estimated that between £50 million and £200 million is lost every year through under or non-recovery of charges applicable to overseas visitors. We have never known the true cost because successive Governments did not want to know, and said so. Serious though this issue is, I believe that we have almost advertised our willingness to be taken for an international trolley ride.
I take no pleasure in saying that this is not hindsight on my part. In this House on 9 December 2003, I asked how the Government intended to strengthen the regulations to prevent overseas visitors unlawfully obtaining free national health treatment. My question fell on stony ground. I was told that we must not get this out of proportion, that it was best left to local authorities to decide who should or should not be charged and that no data were collected centrally. I was astonished to learn that this important information, costing the country millions of pounds, was not among the information that hospital trusts must yield to central authority.
Six months later, on 20 July 2004, I tried again and said that GPs have neither the time nor the resources to decide which foreign nationals were entitled to free treatment. I suggested a system of compulsory health insurance. After a lost decade, that is one of the options in last week’s consultation paper. The noble Earl, Lord Howe, may remember the exchanges that we had with the Minister responsible at the time, who said that the NHS was “a humanitarian service” and talked about a Cabinet Office review into the problem of seriously sick migrants. Today, 32 diseases qualify for free diagnosis and treatment, regardless of a person’s nationality or conditions of stay here. That does not count sexually transmitted diseases and HIV treatment, which also qualify.
Some say that we can easily afford to run the world’s most generous health service and dispute that it is exploited or defrauded on a significant scale. They are living in a land of make-believe. Professor Meiron Thomas, a cancer specialist, has first-hand evidence. He tells a different story, as do those of us in this House with friends in the medical profession who have experience of tourists who exploit the system.
Doctors rightly have the last say on whether patients need emergency care, but the parameters have surely become too wide. One hospital I know routinely gives free dialysis to foreign nationals on the grounds that their condition would worsen without it. Dialysis can cost more than £30,000 per patient a year. How long can this go on? Under the NHS tariff, private outpatients are charged £250 a visit, in-patients pay £500 a day and a normal pregnancy costs £3,000—with complications, this can rise to £9,000.
Insiders know what goes on. The Health Secretary says that fewer than half of overseas visitors who should pay are charged and that fewer than half of
those who are charged pay up. Fraud specialists report a trail of false addresses, false identities and untraceable patients.
The current guidance to GPs and hospitals shows why the system never worked. This document runs to 89 pages. Last year alone, there were seven revisions of it. What are doctors supposed to do if they suspect a bogus patient and read on page 9 that they should consult a lawyer if they are unsure of their obligations, or that, before refusing a patient, they must sign a statement that reminds them of the Human Rights Act 1998?
The NHS is bleeding and needs emergency treatment. The dream of free universal care from the cradle to the grave lasted from 1948 to 1951, but the NHS survived and it is time to face reality. The fraudsters who exploit it have had more than their fair share of our resources, our doctors and our hospitals. We can no longer deny what we know to be true. It is time to say: enough.
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