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In my blog of 11 August, I said I would write to Jeremy Hunt MP about the use of the NHS by overseas visitors. This is his reply, dated 3 September 2015.

Dear John

Thank you for your letter of 11 August about the use of the NHS by overseas visitors.

There is no provision whereby visitors to the UK can automatically be entitled to free NHS hospital treatment. Anyone who is not ordinarily resident in this country is subject to the National Health Service (Charges to Overseas Visitors) Regulations 2015. The Regulations place a legal duty on NHS hospitals to establish whether a person is ordinarily resident, or exempt from charges, or liable to be charged. Where it is established that charges apply, they cannot be waived for any reason.

Where a person claims exemption from charges under provision of the Regulations, the hospital will ask them to provide documentary evidence to support their claim to free treatment. For example, an overseas student claiming he is here for a three year degree course might be asked to provide documentation to confirm he has leave to enter the UK for that purpose and that he is actually attending the course.

A person who is found liable for charges, or who refused to provide the appropriate evidence to confirm their claim to free treatment, will be asked to pay in advance of receiving any treatment. However, when, in a clinical opinion, medical treatment is immediately necessary it will not be withheld and should go ahead without delay. The NHS is essentially a humanitarian service and no-one in need of immediate treatment will ever be left to suffer just because they cannot pay. Treatment that is not immediately necessary, but otherwise urgent in that it cannot wait until the patient returns home, will also be provided without delay, although hospitals will have time to try to obtain payment in advance. Non-urgent treatment should not be given until the patient has paid in full in advance.

In cases where immediately necessary/urgent treatment is given and the patient is without funds to pay, the hospital should provide only such treatment as is clinically required to stabilise the patient to allow them to return to their own country. This decision will be made locally, based on clinical judgement. This will ensure that the hospital does not incur additional expenditure that it cannot recover, which has a knock-on effect on services that can be provided to NHS patients.

Furthermore, a new health surcharge for non-European Economic Area (EEA) temporary migrants, such as students and workers, who come to the UK for more than six months was introduced on 6 April. This is paid alongside their visa fee.

With regard to your concerns about the European Health Insurance Card (EHIC), the Department of Health takes any case of possible misuse of the EHIC seriously and is continuously working to detect and tackle any suspected fraud. We are currently reviewing the EHIC application progress, and began a major piece of work a few months ago to examine and identify any areas for improvement on all of our administrative systems relating to EEA healthcare payments, including the EHIC. We expect to complete this work by the end of the year.

Entitlement to the EHIC, which provides access to any immediate and clinically necessary state-funded medical treatment in all EEA countries and Switzerland, is based on ‘insurability’ under EU law, not on a person’s nationality. Therefore, as healthcare in the UK is based on residency, it is correct that non-UK nationals, and in some cases their family members, will have a right to a UK EHIC if they meet the UK’s insurability criteria and are not covered by another EEA country. Similarly, there will be UK nationals who carry EHICs from another EEA country because they are insured there, and these people are expected to present their EHIC when accessing NHS treatment in the UK.

The UK reimburses other EEA countries for the cost of providing treatment to people we are responsible for under EU law, irrespective of nationality. In the same way, other EEA countries reimburse the UK for the cost of the NHS providing treatment to people they are responsible for under EU law, including UK nationals insured in another EEA country.

Yours ever

Jeremy Hunt

I have long argued it makes no sense to make energy so dear in the UK that the main industries that need energy leave our shores to burn cheaper fuel somewhere else. That was one of the reasons I did not support Labour’s Climate Change Act, and why I disagreed with the Lib Dem policies on energy under the Coalition which a Lib Dem led DECC championed.

We have seen again recently the damage dear energy does. The mothballing of Redcar steel making is about high energy prices as well as about low steel prices. Many industrial jobs have been lost thanks to the EU/UK dear energy policy.

The decision at Drax to curb its investment in anti Carbon dioxide was a response to this government’s decision to cut back on renewable subsidies. Many have thought it odd that it is environmentally friendly to cut down trees in Canada, ship them across the Atlantic and take them to Drax to burn. Wood after all produces similar CO2 and pollution to coal.

The UK needs to revisit more of its dear energy policies. The march of the makers and the Northern Powerhouse require more cheap energy and more things made in the UK. That does not add to CO2 output worldwide, merely brings more of it home for the goods we intend to consume.

As many of you have pointed out, the UK also needs to adjust its CO2 targets for a rising population.  If we keep inviting in so many extra people CO 2 output will go up.

Yesterday the government published the latest quarterly figures for output and earnings to June 30^th 2015.

 

The UK economy is now producing 6% more than at the peak in early 2008 before the crash. The USA is producing 10% more, the EU just 1% more and Japan has the same output as Quarter 1 2008.  The UK recovery has been a steady one since 2009. The last annual figure shows growth of 2.4% , after 2.9% for calendar 2014. GDP per head is also now a little higher than at the pre crash peak, and rose by 1.9%  comparing the second quarter of 2015 with the same quarter the previous year. Japan’s stagnant output since 2008 is partly owing to population decline.

 

The best news in the figures is the growth in incomes and real incomes.  Compensation for employees is up by 4.7% in the last twelve months (Q2 2015 over Q2 2014), and real  disposable incomes rose by 2% just between the first and second quarters of 2015.  A greater feeling of job security for many, coupled with increases in earnings, is allowing service sector expansion and more retail purchases.

 

The figures once again remind anyone interested in the reality that public spending continues to rise. Government spending is up 0.4% on the previous quarter and 1.6% over the last twelve months, in real terms. The balance of payments improved sharply in the second quarter after a weak first quarter. Exports were up, imports down, and the current account deficit narrowed from 5.2% of National Income in the first quarter to 3.6% in the second.

 

Whilst the overall money supply figures show a small contraction in money, and no growth in lending to finance a recovery, the picture is of 4% growth in money (M4) adjusted for other financial corporations as the Bank of England likes to do. Lending taking out the other financial corporations was up by 2.3%. The Bank regards this narrower measure as a closer proxy for the real economy.

 

All this points to a steady performance. There is no great inflation threat as higher wages are coming at a time when productivity is improving as well, whilst the prices of imports and commodities remain weak.

It would be good if the political debate and interviews could be based around this factual portrait of the UK economy based on the official figures. More needs to be done to boost output, real wages and productivity. High energy prices remain a big problem, but we have a good base for further advances in employment and living standards.

Labour’s slogan from yesterday is one Conservatives can welcome as well. What was odd about the conference was the statement that Labour will not now stoop to personal abuse, and will debate in a grown up way. This was juxtaposed in the same speech with old anti Conservative rhetoric that was harsh and untrue. We had to listen to the lie that Conservatives seek to “protect the few  and to tell all the rest of us to accept what we are given.” That was a bit rich, when this government is all about getting more people out of low income and off benefits, by creating the conditions for more jobs and for better paid jobsand encouraging more home ownership.  One of the main themes of today’s Conservatives is to boost real wages and the productivity which underwrites them. Working smarter for more money is exactly what we are striving to achieve for the many.

I like the idea of a grown up debate. Could we start by all using the true figures of public spending, which show modest real growth in public spending over the last five years? Can we acknowledge that real wages are now rising and  more people are in work? Could Labour understand that demanding more homes for people whilst  demanding more migrants come to the country makes it difficult for housebuilding to catch up? Do they accept that more homes are now being built than in the later years of their government?

A grown up debate means recognising that  both Conservatives and Labour want higher living standards for all, and proper care and support for those who cannot support themselves. The arguments about means are important and can be fierce. Doubting people’s aims is not part of a new politics, but part of the old negative spin politics that many dislike, and which gets in the way of understanding.

I thought the bits of the speech that Mr Corbyn borrowed from Mr Heller were well written, but displayed their age from the pre kinder politics era. If you want a new kind of politics, it helps to write it in your own words and show us how it can be done. As readers here know, I seek to avoid abuse and dishonest statements of the attitudes and actions of others.

Labour’s patriotism is said to be British. Labour does not know where England is, and has a suite of policies to split it up and deny us a voice. When this morning the BBC analyst linked Labour’s patriotism to England it must have been a mistake. Others called it British nationalism. No one seemed to remember the UK is our nation state.

 

I will only believe Labour has changed from disliking England trying to stifle us when they change policy on England, devolution and regions. As Lord Mandelson wisely observed, the use of the patriotic words is just spin.

Not so long ago the Coalition government wanted us to vote for a war against President Assad of Syria. They were right that he is an unpleasant dictator, using excess force against his own citizens and failing to unite his country behind him. Some of us declined to support, on the grounds that many of Assad’s enemies were also people of violence, unlikely to bring good and fair government to the citizens of Syria. We did not wish to help bring down Assad by force, only to see something worse take his place. Without a strong moderate opposition and a winning political strategy for after the bombing it was difficult to endorse military action.

Now we read that the USA is thinking of co-operating with Russia, a power traditionally friendly to Assad and an opponent of extreme ISIL and related factions who oppose the Syrian regime. Mr Cameron says he still wishes to see Assad replaced if the west intervenes more on  the side of the current Syrian government against the ISIL and related insurgency. I can understand why.

This viewpoint requires more thought over who could replace Assad, how they could create a m0derate and effective government for Syria and how they could find some unity of purpose between moderate Sunni, Shia and Kurdish factions. The Kurds in the north will be looking for an independent Kurdish state. The Sunni groups will want reassurance that any new Syrian government will be fair between their interests and those of the Shia groups. None of this is easy politics.

Any UK bombing campaign would need to be planned in conjunction with troops from other countries on the ground. It would need help on the ground with identifying and checking targets to avoid loss of life of non combatants. It is difficult to see what extra the UK can bring to the long, vicious and tortuous Syrian civil war. UK forces should only be given tasks to do where there is a high chance of success and where their legal status is clear – unless our home country is under direct attack when you defend it come what may.

Meanwhile the US rhetoric towards Mr Putin has changed. He was a pariah when he exploited the western mistakes in Ukraine to take Crimea illegally. Now he is seen as a useful partner in Syria. He has been a critic of past western interventions which have so far failed to create peace and stability in several countries of the Middle East. Let’s hope this change of atmosphere between the great powers produces diplomatic and political initiatives that can achieve something in the cauldron that is Syria. This is a civil war that cannot be won by killing more people – it needs a political strategy for better government.

 

On Saturday evening at the Cambridge Union 200th anniversary debate on the EU there were signs of things to come. The pro EU side was to comprise 2 former continental senior politicians, and one unelected UK pro European in the Lords, with just one MP.  One of the 2 continentals pulled out at the last minute. Clearly there is a problem finding people prepared to argue the pro EU case. The anti EU side fielded two MPs who have been Cabinet Ministers , a senior businessman and the Deputy Chairman of UKIP.

The pro EU side had to argue that the EU was a success. Not a difficult task you might have thought if you believe in it and want a united Europe. Instead they conceded that the Euro was a shambles and implied the UK was right to be out of it. They accepted it was causing economic damage in much of the EU. They volunteered that the borders and migration policy had failed and needed radical change.

Rather as communists used to argue in the days of the Soviet empire, who always said when we criticised the Soviet system that it was not proper communism as they wanted it, they held up a view of an ideal EU. The EU they sought was  quite unlike the EU we currently have. In a sign of how the stay in side may argue in the referendum  it appears the pro side will join in with all the Eurosceptic criticisms of the current EU. They conceded the EU was too regulated, that it was doing economic damage, and that it did not control its borders. Their main argument was that we now have peace in Europe. When we pointed out NATO, US forces present for much of the post war period and the outbreak of democracy in Germany account for that, they agreed they were important. When asked about the violence  and conflict in the Ukraine and the Balkans a few years ago, they  disagreed on the EU’s unhelpful role.

None of them owned up to the 5 Presidents report, none set out a vision for a united Europe, none had the courage to explain why political union was essential to the project. What are they ashamed of? Why can’t they speak out for the United States of Europe which they must secretly want? I will go on reminding people the EU is on a wild ride to political union. Will none of the pro EU people in the UK defend it?

 

The audience who included various people who worked for EU and government institutions or in EU law, voted strongly in favour of the EU.

Hard on the heels of Nissan announcing a five year investment plan and a new model for Sunderland comes Vauxhall’s statement of its continued enthusiasm for plant and investment in the UK, with a new model here.

The BBC Today programme made as little progress in trying to persuade Vauxhall they should leave the UK if we leave the EU, as they did with Nissan. Vauxhall pointed out that they have an important car market in the UK that they wish to sell to. They argued that they assume there would be a satisfactory trade agreement with the rest of the EU if the UK decides to leave.

I am still waiting for the Today programme to ask about some of the advantages to business and voters of leaving the EU. It would be good if they abandoned their attempts to talk business people into wanting to cancel their links and investment with the UK were the UK to decide to vote to leave the EU. The BBC still seems reluctant to grasp that business invests in many countries all round the world that do not join the EU but trade very successfully with it.

The  campaign to get business to make the case to stay in the EU is not going well. Polls of smaller businesses shows over 40% wanting to leave, and more bigger businesses accepting they can prosper here out or in. Of course it should not primarily be a decision for business or about business. It is far wider, a matter of who governs and whether we still have a UK democracy. There is now comment from Greeks and commentators that the Greek election was largely irrelevant, because whoever won has to follow EU policies. The UK as a non Euro member is not in such a chronic position, but there are an increasing number of matters that a UK election cannot change thanks to our EU membership.

This evening I will be moving the motion in Middle Temple Hall in London for the 200th anniversary Cambridge Union debate. We will be debating the failure of the European Union. The debate starts at around 8 pm.

 

The VW clever computers helped engines pass the US exhaust tests. Now VW has apologised and thought better of such intelligent engineering, recognising that passing the tests was only meant to be an indicator of how  a vehicle would  perform when being driven on normal roads.

This tussle between manufacturer and regulator is one of many that occur when regulators demand certain performance, and when there are varying ways of conforming to the letter of the law. Many think companies should observe the sprit of the test and rules. Others blame the regulator for failing to invent a test which measures what they are really interested in.

This one, however, matters more than many for two big reasons. The first is VW is one of the world’s two largest motor manufacturers, accounting for more than 10 m vehicles out of a total world production of 90 million last year. VW exhausts have quite an impact on the world. The second is the output from car exhausts is of more concern to green groups than  practically any other source of carbon dioxide and pollutants, as green lobbyists are especially critical of personal transport whilst being less angry about home systems for heating ,cooking and washing that also use energy and produce pollutants.

The origins of this current controversy lie in the growing success of the global warming movement in the 1990s. They made regulators and lawmakers concentrate on carbon dioxide rather than pollutants. The diesel industry came up with good ways of cutting carbon dioxide output from vehicle engines, and in the process offered the motorist something he or she wanted – greater fuel efficiency. When I switched from petrol to diesel I gained more than a third in fuel economy from the switch. It was known at the time that older or dirtier diesels produced more pollutants including particulates, NOx and SOx. The Regulators set ever tougher standards to cut down these adverse side effects of going for the more fuel efficient diesel. The industry responded with much cleaner diesel engines.

Today the EU, governments and regulators have some explaining to do.  Did they do enough when they adopted aggressive carbon dioxide targets to police pollutants from engines? Did they set the right tests to make sure the vehicles performed as they needed? Can they now assure us they have in place the right tests, so when we buy a modern diesel we know for sure that it does achieve the high standards we expect in reducing or eliminating pollutants out of the back? And have they also set the right tests and made the right demands of petrol engines?

During this debate it might also be a good idea to look at domestic heating boilers and systems, and to remember just how much pollution still comes out of our power stations. Its total pollution which matters most. Regulators need to get a grip, and to see the volumes in proportion to the totals.