Party political knockabout on overseas visitors
Authors: W. Russell
Journal: BMJ (1982)

When a politician cites something as evidence to support a contentious case he is putting it is always worth going back to his source just to make sure he is telling the whole truth. There was an intriguing illustration of how a source may be  during the rather heated party political knockabout in the Commons that followed the announcement by Mr Norman Fowler, Social Services Secretary, of the new scheme to charge overseas visitors for using the NHS (27 February, p 682). The scheme, which will come into operation from 1 October, is expected to bring in ?6m a year, a sum that will go to the district health authorities or boards to finance health care. The scheme is the second version tried by the Government. The mark one version announced last year was strongly criticised, and as a result a working party was set up to try to solve the difficulties. Justifying his decision to introduce charges the Minister insisted that the report showed the present procedures used to establish eligibility to be racially dis? criminatory. This system, he complained, was the one that Mrs Gwyneth Dunwoody, Labour's health spokesman, had been defending. It sounded like the argument that clinched his case. But that was not quite what the report said. Earlier in the row, when he was sticking more closely to his brief, Mr Fowler said that the working party had found that the present position contained a   of applying the rules in a way that discriminated against members of ethnic minorities living  Now that is not quite the same as saying that the rules were racially discriminatory. Nor is it exactly in context?politicians love to claim that they have been taken out of context, so it is not surprising if occasionally they reverse the process. To supplement the field study carried out at four hospitals a questionnaire was sent out to which 20 replies were received. The answers showed that the present arrangements for establishing eligibility varied from place to place, tended to be applied somewhat haphazardly, and were based on the intuition of hospital staff concerned rather than any clearly defined local guidelines. The working party decided, therefore, that clearer guidance was needed, irrespective of the Government's present proposals to introduce NHS charges, because the rules were not being enforced consistently. The point is that if the present rules were enforced consistently on the basis of proper guidance the distinct risk that they may be being applied in a dis? criminatory way would not necessarily exist. Under the system that will start in the autumn all visitors, including overseas students, will be charged for NHS hospital treatment during their first year here. In the previous proposals they did not get exemption until after three years. People coming here to work will be exempt from the begiruring of their stay, as will some visiting dependants?wives and children under 18. In most other respects the new scheme is the same as the one on which the Government consulted. Mr Fowler said that in making the changes the Government was bringing Britain into line with virtually every other Western country, and that there was no reason why the British taxpayer should provide free hospital treatment to short-term visitors to this country, who are said to number around five million a year. Britain has about 12 million foreign visitors annually, but the seven million others are covered by reciprocal health agreements. One of the arguments made on behalf of the parliamentary process is that MPs by questioning Ministers find out things and this acts as a check on the executive. On the evidence of the inquisition that followed Mr Fowler's announcement this is far from the case. It proved to be a rowdy swapping of party political points, with Conservative backbenchers congratulating the Minister?at last a Secretary of State with the courage to take this step which will delight the British taxpayer?while Labour backbenchers warned that it was all a diabolical plot to edge us one step nearer having to pay for NHS treatment too. Dr Maurice Miller, Labour MP for East Kilbride, a former medical practitioner in Glasgow, summed up the Opposition attitude when he warned Mr Fowler that this shameful decision was another way in which the nation's prestige was being eroded by the Government. Will the ?6m saving be at the expense of asking the British people to carry identity cards with them if they consult a doctor in another area ? he asked.