Examination of Witnesses (Questions 540
- 559)
TUESDAY 27 APRIL 2004
RT HON
CHARLES CLARKE
MP, RT HON
JOHN HUTTON
MP AND MR
CHRIS POND
MP
Q540 Chairman: I can see how an ID
card might greatly simplify the job of a college in deciding whether
to give somebody a place in the college and help you ensure that
EMAs go to people who are entitled to them or student loans. I
cannot quite see how an ID card helps with the issue of whether
students continue to attend a college.
Mr Clarke: I would not like to
claim that that is a substantial element of it, it is not, but
simply ensuring the people who are there are entitled to be there
is a part of the process which might be necessary. You are quite
right, Mr Denham, it is not a central part of the argument which
I would advance.
Q541 Chairman: Mr Hutton, could I
move on to you with the equivalent set of questions. At the moment
am I right in saying that there are no identity regulations relating
to someone's access to primary care or their ability to register
with a GP?
Mr Hutton: Yes, that is right.
Q542 Chairman: Do you have any intention
of changing the legislation so that somebody who registers with
a GP does have to establish their entitlement to do so irrespective
of whether an ID card is going to be used for that?
Mr Hutton: Yes, we do. I am concerned
that there is scope for potential abuse here. As members of the
Committee will know, in December we confirmed our plans to change
the legislation around access to secondary care to close what
we thought were loopholes in the 1989 regulations[2]
and I announced then that it was our intention to operate a similar
regime in relation to primary care. I think we will be in a position
to start the consultation on those changes in the next couple
of weeks and obviously we will keep the Committee informed of
that.
Q543 Chairman: What implications
does that have for the way people working in primary care are
expected to work, people who have never been asked to take responsibility
for checking somebody's identity or entitlement?
Mr Hutton: These options will
be set out in the consultation paper itself. Basically what we
want to do is to minimise the bureaucracy on the front-line primary
care staff. I do not believe it is their job to enforce these
regulations in that sense. I think the primary burden of enforcement
should fall properly on the NHS itself, on the primary care trusts.
We will canvass a number of options in the consultation paper
on how we can minimise the bureaucratic burden of front-line staff,
but it is not part of our plans—and I hope this will be
confirmed shortly—to pass the principal obligation to police
such a system directly on to receptionists or GPs or practice
nurses, I do not believe that is part of their job description.
Q544 Chairman: Do you have any idea,
even a ballpark figure, of how many people might be registered
with GPs who are not entitled to be registered because it is unfair
in relation to status, they are illegal immigrants?
Mr Hutton: I wish! I do not. What
is true, and this is one of the odd things about the registered
primary care population of late, is that there are more people
registered with a GP than are living in this country. That is
partly because of the fact that records are not up-to-date, people
move and change their GPs and sometimes their records are slow
to reflect that. All I can say to the Committee is that anecdotally
during the course of my job as minister responsible for primary
care I meet people in primary care, particularly receptionists,
practice managers, who say to me that there is a significant amount
of abuse going on, but unfortunately I cannot quantify that. The
same is true in relation to secondary care, lots of figures have
been chucked about. In relation to hospital care, we have never
separately recorded or asked the NHS to keep information on the
number of foreign nationals who are receiving treatment or the
number of foreign nationals who are entitled to free care under
the exemptions in the regulations and for perfectly good reasons.
If they are exempt from charging they are just like ordinary NHS
patients and they will be in the statistics for the numbers who
were treated. We have just started a study in relation to secondary
care to try and bottom out these figures because it is obviously
not satisfactory. We are asking 12 NHS trusts across the country
to participate with us in working to quantify some of the costs
and that study will look at people from the accession countries
as well as people who are regarded in the process as health tourists.
I hope that will help us put some figures onto this subject. In
relation to both secondary care and primary care, all I can say
to the Committee is that I am convinced there is a significant
problem because that is what the NHS tell me is going on, but
very unfortunately I cannot say and it is costing the taxpayer
and the NHS so much money. Lots of figures have been chucked about,
but, honestly, Chairman, there are no reliable figures that I
can bring to the Committee today.
Q545 Chairman: I will come back to
you in a moment, but, going back to Mr Clarke, Mr Hutton has told
us that the NHS is conducting a study of 12 trusts to try and
get an idea of the scale of the problem. Have you considered doing
a similar exercise looking at 12 FE colleges or 12 universities
or a mixture of the two to try and identify the problem?
Mr Clarke: We have considered
it. We have actually decided that the stage before that is to
get to a proper system of accreditation of the colleges which
actually exist in this country. We obviously know of all the publicly
funded colleges immediately in our database systems and there
is a range of other institutions as well. We would be ready to
conduct a particular analysis of people who are coming into publicly
funded colleges who are not entitled along the lines of what Mr
Hutton has suggested, but it has not been something we have hitherto
given priority to. As I said in my earlier answer to you, I do
not think this is a major case for ID cards. The major case is
simply having one simple system of identification, Mr Hutton's
argument of a simple test of identification by front-line staff.
Q546 Chairman: But you would not
be closed to the idea of it?
Mr Clarke: Not at all. In fact,
subject to my considering it a little bit, I could say to you
now that it is something which it would be worth doing and we
would be ready to do it.
Q547 Chairman: Mr Hutton, if I can
go back to you, one of the obvious areas of concern in the past
is so-called `health tourism' which can come in a variety of forms,
but particularly the idea that people can access quite expensive,
particularly hospital-based treatment without establishing their
entitlement or without them being properly charged for the service.
It is a slightly different issue from the issue of when they are
illegal immigrants registering with a GP. Do you have any idea
of how big that problem is and whether the NHS has got better
at routinely identifying who is required to pay?
Mr Hutton: I think that the problem
is not uniform across the NHS certainly. I think the problem of
so-called health tourism, which I accept and acknowledge is a
real problem, is concentrated, I would say, in most of Britain's
urban centres, particularly in big cities like London, and there,
I think, there is a higher awareness and I think a more effective
attempt by front-line NHS staff to properly enforce the regulations
that we recently changed. However, if you were to ask me whether
there is a similar approach towards identification and establishing
entitlement in every NHS trust, I would say no, I do not think
that is the case.
Q548 Chairman: You are obviously,
from what you are saying, determined to tighten up on these eligibility
issues in any case under your own timescale. What assessment have
you made of how helpful an ID card would be as opposed to simply
imposing better administrative arrangements using the current
forms of identity in private care and hospitals?
Mr Hutton: Well, our general view
in relation to ID cards is that it would represent a very, very
straightforward way and, therefore, a very helpful way and I think
a more efficient way for the NHS to establish entitlement to free
NHS care. It is the case of course that you can have entitlement
to NHS care, but not an ID card and it is perfectly possible that
you could have an ID card, but not be entitled to NHS care. I
think the point is that on the production of an ID card, those
issues would be established by checking the data on a national
data register. At the moment NHS organisations have a variety
of mechanisms and ways of establishing identity, such as passports
and visas, and because there are some exemptions in relation to
people who are here on the grounds of employment in the UK, evidence
from their employer that they are working legally here. Now, none
of those really addresses the issue of identity fraud and there
are genuine issues there and I think from a logical point of view,
if there is an ability with one swipe of a card to have current,
up-to-date information of a person's residency and immigration
status, their current address and so on, that simply would make
the job of the NHS, I think, much more straightforward. I would
not be able to say, Chairman, that we have quantified the value
of that more straightforward check in cash terms and I think it
would be a very difficult thing to do. I think our position is
a very simple one. The NHS has always had a set of rules applying
to it about who is entitled to free-at-point-of-use healthcare.
There have been difficulties enforcing those rules and I think
that is a common reality actually and we have a choice. We either
have rules and we try to properly enforce them or we have completely
open access. Now, of those two options, I am pretty sure where
the public would be and I am afraid to say that probably at the
moment, and this is why we are enthusiastic about ID cards, I
do not think I could say to the Committee with confidence that
the system we have currently got in place is the best that we
could have. I do believe very strongly that the ID card will help
the NHS to properly police the rules that this House has set and,
in the process, it will be able to make sure that the resources
that we have allocated in the NHS are used for the purposes for
which they have been voted and are not wasted and misused. Therefore,
I believe very strongly that it is going to be of benefit to the
NHS, logic and commonsense dictate that that is so, and we will
obviously have to look very carefully at the emerging technology
and the biometric identification systems that come through the
testing phase and also obviously the take-up of ID cards amongst
the public as a whole. As we come to make the sort of decisions
about what IT investment we need to make to support all of this,
clearly there will be a cost, but I think it comes back, Chairman,
to this very simple argument that we have got rules and we should
enforce them, but at the moment I do not think we can enforce
them with the degree of confidence that I and I think many others
in this House would like to be reassured about.
Q549 Chairman: Mr Pond, if I turn
to you. Most, as I understand it, benefit fraud is actually for
doing things like working and not declaring it, co-habiting and
not declaring it. What proportion of the fraud which your Department
faces comes from people who are actually not the person they say
they are when they make a claim?
Mr Pond: Well, Mr Denham, there
are two forms of identity fraud which we are seeking to tackle.
One of course is, as you say, people pretending they are somebody
they are not and the other is people taking on other people's
identities. Now, together we would estimate that at the moment
about £50 million is lost to the taxpayer in identity fraud.
Now, in the context of the overall benefits budget and in the
context of £2 billion which we lose in fraud each year and
which we are reducing quite effectively, that is a relatively
small amount currently, but we believe that over time it could
become more significant as we clamp down on other forms of fraud,
such as methods of payment fraud, and the organised criminals
who enjoy that sort of activity may have to move elsewhere, and
identity fraud is a potential area. I have to say as well that
whilst we think that much of that £50 million is a potential
saving through the introduction over time of identity cards, perhaps
an equivalent amount in other forms of benefit abuse could also
be tackled through the introduction of that sort of system.
Q550 Chairman: Could you say just
a little more about the amount?
Mr Pond: Yes, we have broken down
the figures as best we can, although I have to say these are early
days and it is because much of the evidence is based on regional
benefit reviews and because, by definition, identity fraudsters
keep as much as they can under cover that it is difficult to estimate
the total amount, but we estimate that the reduction in fraudulent
claims using false identities costs something between £40-45
million. A reduction in general benefit fraud through additional
information on addresses and foreign travel potentially is available
if we had a more effective ID system of about the same amount,
£40-45 million again, and then administrative savings of
around £8 million. That does not include potential savings
to local authorities through, for instance, an easier process
of verifying identity for claims such as Housing Benefit and Council
Tax Benefit.
Q551 David Winnick: Mr Pond, you
are not telling us, are you, that unless the identity card project
goes ahead, you are not able to do anything whatsoever about the
sums of money which are being lost?
Mr Pond: No, I am not saying that
at all, Mr Winnick, and, as you know, we are very vigilant in
trying to make sure that we do drive down fraud in every possible
way in the benefit system, and we do have at the moment quite
a wide range of methods of establishing somebody's identity, which
of course is a requirement before the claiming of benefit. At
the moment we require people to come along with as much information
as they can to establish their identity. Of course if they have
a passport, that is helpful, but we might also look at work permits,
letters from employers or contracts, payslips, evidence of actively
seeking work, marriage or birth certificates, deed polls, a long
list of documents which we might require. Now, the advantage both
to ourselves and also to our customers is that if we had an identity
card, that whole process would be both more secure than it currently
is and probably a lot more convenient for the customer as well
as for us.
Q552 David Winnick: So on the basis
that any compulsory card is not likely to come in before 2013,
you are clearly confident that the sums of money which are being
lost to the public are being tackled?
Mr Pond: Yes, I am very confident
of that, Mr Winnick, and we do favour, we are very much in favour
of the idea of an identity card, but we also favour its gradual
introduction to make sure that the processes are properly in place
and that our customers, many of whom are very vulnerable, are
not going to lose out in this process. However, I do believe that
there are real benefits for many of those customers as well perhaps
in identifying those who are entitled to benefits, but not claiming
them presently and who we may be able to contact through this,
but in the process of the take-on of identity cards, we will continue
to drive forward on identity fraud and all other fraud.
Q553 David Winnick: Of course you
are working on the basis, Minister, are you not, as indeed all
ministers must be in this regard, that once the card comes into
being, if it does come into being, there will be no fake cards
and the criminal gangs will not be able to reproduce cards, and
you are working on that assumption of course?
Mr Pond: Yes, we have to be aware
that there are limits obviously to the security even of this system.
What we are also aware of is the fact that it is going to be a
lot more secure than the systems that we currently have in place.
Q554 David Winnick: If I could come
to you, Secretary of State, you told the Chair that you are a
keen advocate, though you did not use exactly those words, of
the ID card. I take it that you are one of the more enthusiastic
members of the Cabinet in favouring the scheme?
Mr Clarke: I would not like to
make any comparative comment. `Keen' is a word I try to use to
describe myself in many different circumstances, so yes, I am
keen to improve the way in which we operate in the ways which
I have set out, but I am not going to get into a league table,
and you know how my Department has got different views about those,
of Cabinet members' keenness.
Q555 David Winnick: I think that
since this Select Committee has been looking into all aspects,
there have been reports in the press, and they may be totally
inadequate reports and I think that may well be the case, but
there seems to have been an ongoing debate in the Cabinet more
public to some extent than normally happens when Cabinet decides,
a more grown-up approach and that Cabinet members understandably
have different views about the desirability of an ID card.
Mr Clarke: The reports in the
press, Mr Winnick, are correct insofar as they describe me as
generally a supporter of the ID card proposition both in general
and in particular in relation to my Department for the reasons
which I have set out. I do think we are having a grown-up debate
about it as a matter of fact, and it is easy to turn it into great
pros and cons, but the kind of considerations that my colleagues
have been expressing here are the kind of considerations that
I have been generally supporting.
Q556 David Winnick: No Secretary
of State, if there is perhaps a division in the Cabinet on an
issue, could have given a better answer.
Mr Clarke: I am very grateful.
I am trying to improve my technique!
Q557 David Winnick: I am sure the
Prime Minister would be equally impressed! You did say, Secretary
of State, that the central argument is not one about how it affects
your Department. That is not the main argument, is it?
Mr Clarke: No, but I do believe
we are moving into a situation in public services, like education,
where we are trying to focus much more on the support which the
system can give to an individual learner and the various projects
which I have described about the Unique Learner Number Project
and the way in which we view post-16 education and so on are designed
to get a system which gives the individual more identity and more
focus in the way that a service like education provides and, in
that, it is important to know about an individual and their achievement
to be able to do that. The example which I give sometimes, which
Mr Denham will be very familiar with, is education support to
people within the criminal justice system, prisoners and so on,
that often there is a dotting around as people are moved. If you
have a central identity saying this is how we can move and take
things forward, it can make a big difference. A different type
of example is people moving from primary to secondary school where
there is often a complete break at that point and some people
are actually lost out of the system sometimes in tragic circumstances.
I think that kind of development is the way that society is moving
and I basically welcome that, and the ID card is something that
will help in that.
Q558 David Winnick: Yes, it will
help and you are keen, as you have been telling us, but in no
way trying to put words into your mouth, the problems which you
face, which do not seem to be quite the same as in social security,
are not problems which could not be resolved to a large extent
without an ID card? You are in favour of an ID card for all kinds
of other reasons, are you not?
Mr Clarke: That is broadly true,
Mr Winnick, that it is not a central issue for my Department.
On the other hand, it is also true that in each of the four areas
that I identified, there are important benefits. One which I have
not talked about is the one of the Children's Services passport
and, subject to what Sir Michael Bichard is going to report following
the tragedies at Soham, the fact is that the whole operation of
the Criminal Records Bureau, the need to have protection for children
from people working around them in a proper way, is an important
and an increasingly important element of their security there,
so there is an important security element which an ID card, in
my opinion, would help. Now, could we solve it without an ID card?
Well, yes, we could make a good stab, but I believe we would make
a better stab if we had an ID card than not.
Q559 David Winnick: So that is where
the debate continues, Secretary of State?
Mr Clarke: Indeed.
2 Note by witness: The National Health Service
(Charges to Overseas Visitors) Regulations 1989. Back
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