Fourth Standing Committee on Delegated Legislation
Tuesday 5 February 2002
Mr. Nicholas Winterton
National Health Services (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2001
Dr. Evan Harris (Oxford, West and Abingdon): I beg to move
That the Committee has considered the National Health Services (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2001.
Welcome to the chair, Mr. Winterton. I am sure that the Minister is delighted to be here discussing travel plans to the Mediterranean. The order requires scrutiny because it makes a significant change, albeit one forced upon the Government by an adverse ruling in the European Court, and because it raises questions of equity and value for money. As I understand it, the order allows the national health service to pay the travelling expenses of patients who receive hospital treatment outside the United Kingdom and of a companion. I presume that previous regulations allow for the payment of travelling expenses within the UK. As we are talking about the use of public funds, the Government must be clear about the basis on which they make the proposal.
In NHS contracts in general, and in service agreements between Commissioners and hospitals in this country, members of the public, NHS workers, people commentating on the health service and Members of Parliament can examine the figures and prices that are being negotiated to see whether there is adequate value for money. None of that will be possible for patients treated abroad by private companies in secret contracts. It is difficult to tell whether there is value for money and whether the Government, if they are negotiating on behalf of commissioners, or indeed the commissioners themselves, could do better with taxpayers' money.
Resources will have to be spent on providing travelling expenses both for patients and a companion, and that raises further questions. Why have the Government framed regulations that ration patients going abroad for treatment to one travelling companion, paid for under the scheme. The Government are good at rationing, though they usually do it more subtly and secretly and therefore make it a less valid form of procedure. Under the order, quite clearly, people are being rationed to one companion to visit them during their treatment. Of course, they can themselves pay for others to visit them or for their companion to stay longer, but that raises questions of equity. People who can afford a foreign trip for their family or friends will have more support during their treatment than those who cannot. The
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Government should explain why they have decided to set that inflexible ration and what considerations led them to that conclusion.
How can the Government assure us that value for money is being provided when treatments will probably be expensive in comparison with the NHS reference cost? There is also the cost of the travel for the patient and the companion. That adds significant costs and the question is whether funds would be better spent on increasing and releasing capacity in the health service. I understand that capacity is limited. That is why the European Court of Justice has allowed the scheme for patients to travel abroad; it found that patients who cannot get treatment in a European Union country within a reasonable time are entitled to go abroad. However, that does not necessarily mean that the Government should invest resources in scaling up what may be isolated cases. They should ensure that money is invested in capacity in this country.
If the funds to be spent on operations and travel costs for patients and their companions were invested instead in dealing with delayed discharges, for example, more capacity would be released. The Government must explain why they decided to spend money in this secretive way, which appears to be more expensive than building capacity or releasing blocked capacity in the NHS.
The Government may be trying to make a virtue out of a difficulty. They had an adverse ruling and, rather than regret it and hope that only the odd case would be publicised, they decided to make a media affair out of it and sponsor a scheme that focuses on the nine, 10, 12 or couple of hundred lucky patients who, by dint of secret contracts that pay over the odds to private companies in other countries, will be able to benefit.
We all recognise that those patients are the lucky onesno one should deny them treatmentbut those who are not fit enough to travel, who do not live in a geographical area from which travel is straightforward or who do not have the support of a companion who can visit them are unfortunate and will lose out. The Government are building inequity into the system.
Can the Government assure us about value for money and the equity of the arrangements? Why have they chosen the specific conditions set out in the statutory instrument? To some extent, the Government have brought the problem on their own head by their failure to invest early enough in expanding capacity. In all honesty, we cannot use the fact that a few happy patients have finally received treatment in a hospital in France, Germany or Greece as anything other than a damning indictment of the Government's management of the health service, which has brought us to such a state. The term ''national humiliation'' is inappropriate, but the situation is certainly an embarrassment.
The scheme wastes money that could be invested in building or freeing capacity in this country and creates inequity over and above that which already exists. I hope that the Minister will address those points so that we can better judge whether the statutory instrument is adequate.
Tim Loughton (East Worthing and Shoreham): I shall speak more about the regulations than make the general statements of the Liberal Democrat spokesman, the hon. Member for Oxford, West and Abingdon (Dr. Harris). I agree that the regulations require closer scrutiny. The hon. Gentleman said that they are a waste of money, but in the absence of comparative calculations of the cost of sending NHS escapeesas well as companions or relatives who may be accompanying themto the continent rather than treating them in private or not-for-profit facilities closer to their own homes, we do not yet know that.
Will the Minister answer some specific questions? First, why are we debating on 5 February regulations that came into force, under regulation 1(2)(a), on 18 Januarysome three weeks ago? Why were the regulations not timetabled sooner? We saw this coming months ago and expected the Government to provide the meat of the regulations much sooner.
Will the Minister clarify the medical grounds on which companions will be permitted to, and remunerated for, travel to the assigned hospital? Under what special circumstances, if any, can close relatives as well as one companion, accompany the patient, particularly if he is likely to be confined for a long time to a hospital on the continent or in further-flung climes that we have yet to hear about?
Under regulation 3A the health service body has to agree beforehand that a companion can travel, with the qualification ''on medical grounds'', and have expenses paid. What happens if the health service body does not agree, though the patient clearly needs treatment and is exercising his right to seek it at an alternative hospital within the EU because treatment will not be available in a reasonable time in this country?
What special travel arrangements will be provided and paid for in full for those who are unable to hobble off but are badly infirmed and require more specialist transport facilitiesperhaps including ambulancesthat will be much more expensive? What allowance will be granted to health authorities sending off their patients who require such expensive travel facilities? Will a blanket payment be made, or will special allowances take account of the fact that certain patients require more expensive transport? If not, more money will have to be taken out of the health authority's pot to pay for treatment abroad to the detriment of those who stay behind and wave them goodbye. Longer waits for operations here might follow and the people affected might exercise their own right to join the burgeoning queue of people wanting treatment in Lille or Torremolinos.
Will the Minister provide more detail on regulation 7A, which prescribes for the reimbursement of expenses within three months? Journeys abroadwhether on Eurostar, a plane, a boat or whatevercan be expensive, and having to stump up the money without the prospect of reimbursement for three months could be burdensome and deter people from
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taking advantage of treatment abroad. Is there a facility for making payments up front, or at least for reimbursement in less than three months?
Can the Minister provide further detailsthe Secretary of State was quick to dismiss recent press reportson exactly how far afield we are considering sending patients? We know about Lille in France and potential contracts in Germany, and the Minister's officials are considering a large new centre in Greece. Is it true that the Department is also considering facilities beyond the bounds of the European Union, in Malta, Tunisia and Turkey for example, which were mentioned in recent press reports?
In addition, how many EU patients have exercised their reciprocal rights to come to this countryunder the Labour Government for the past five yearsfor treatment and what types of treatment have they received? Has that queue expanded or dwindled?
How long are the arrangements likely to last? As the hon. Member for Oxford, West and Abingdon (Dr. Harris) rightly said, any money sent abroad to pay for operations was good for the patients concerned, and we support their receiving treatment as quickly as possible. However, it is not only an embarrassment but a national humiliation that the treatment cannot be provided in this country. Any money that follows those patients is money that is not invested in health care in the United Kingdom, be it in the national health service or the not-for-profit or private sector. How long are the measures expected to be in force? [Interruption.]