Brexit: Reciprocal Healthcare (European Union Committee Report)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)
My Lords, I begin by saying that I will try to be concise, as all Lords have been, but I want also to cover the many interesting and important points that have been made. I congratulate the committee and the noble Lord, Lord Jay of Ewelme, for his chairmanship and for clearly putting together a very good-quality piece of work, and congratulate all noble Lords who contributed through that committee and, indeed, in this debate.
We have discussed tonight how reciprocal healthcare arrangements help people to live, work and travel across Europe in the knowledge that healthcare access is not a barrier. They are especially important for elderly people and those with long-term conditions. They enable people to access treatments or give birth abroad, promoting choice and healthcare collaboration. They have other economic benefits as well, such as tourism and helping the NHS to manage demand.
That is why we believe as a Government that a reciprocal healthcare agreement between the UK and EU is in the best interests of all. It is worth stating that good progress has been made in negotiations so far, and that is one reason why we are confident that we will secure good reciprocal healthcare arrangements as part of our future relationship discussions. Many noble Lords have asked why we have not done more, or been able to promise more, so far. It has to be said that the rate-limiting step has been the Commission’s mandate in what we were allowed to discuss and, indeed, in its insistence that nothing is agreed until it is all agreed. That was not our position, but the mandate the Commission gave to the Article 50 negotiating team. We have achieved as much as we possibly could within that mandate.
It is important to note—and many noble Lords have done so—that there is history in this area. The UK has a long-standing tradition of reciprocal healthcare agreements. My noble friend Lord Ribeiro pointed out that, for the last century, UK and Irish citizens have been able to access healthcare in one another’s countries. Noble Lords have talked about the many powerful ways in which that co-operation brings benefits to the peoples of both countries.
Since the 1950s, the UK and its European neighbours have had reciprocal healthcare and social security agreements too. I will deal quickly with the point my noble friend Lord Kirkhope made about whether, during negotiations, we are always as good as we could be at securing the moneys that are owed to us; I think it is fair to say that historically, we have not been. It is something we are starting to do better. One example is that we are now able to flag immigration and entitlement status on electronic health records, so that doctors do not constantly have to ask for that kind of information; it can be logged and secured through these agreements.
The UK also has agreements with the rest of the world, including Greenland, the Faroes, the Balkans, Australia, New Zealand and many of our overseas territories; there are precedents, current and historical, for the kind of deal we are aiming to strike.
The Select Committee report rightly recognises the importance of reciprocal healthcare. It has been pointed out in the debate that the NHS currently provides healthcare to over 3 million EU nationals living in the UK and that there are about 1 million UK nationals who live, work and use healthcare in the EU.
The noble Lord, Lord Ricketts, rightly pointed out that about 190,000 UK state pensioners have chosen to retire in Europe, notably Ireland, France, Spain and Cyprus. I am not sure that Ireland is where you would go on holiday if you were after sunshine in the winter but you would certainly choose the other three. It is worth mentioning that this is not just about the number of people who carry EHIC cards; 250,000 medical incidents affecting UK tourists are resolved via an EHIC, and a further 1,500 UK residents travel for planned treatment via the S2 scheme. That is what is at stake.
Several noble Lords referred to the achievements to date. The first of those was the joint report agreed in December 2017, which covered the entitlements of those exercising their reciprocal healthcare rights on exit day. I shall go into more detail on that shortly.
Following the agreement in December, there was further agreement in March 2018 on the implementation period. That means that the rights secured through the negotiations so far will, once the implementation period is agreed, continue until 31 December 2020, providing more reassurance. It includes healthcare for pensioners and workers, as well as the EHIC and S2 schemes, and nothing will change over that period.
Before turning to the impact on British citizens of the withdrawal agreement and implementation period, it is worth talking about the status of EU citizens living in the UK. That was raised by the noble Baroness, Lady Janke, my noble friends Lord Balfe and Lord Kirkhope, the noble Baroness, Lady Thornton, and others. The Prime Minister has been very clear that EU citizens who have made their lives in the UK should be able to continue with their lives here. We have that agreement and, indeed, we now have a route for that. As noble Lords have commented, we have opened the settled status route, which provides a specific legal mechanism by which people can secure their status to live in this country.
I reassure noble Lords that the department was one of the first to act on this new route. We have written to all NHS trusts to make sure that the many staff whom they employ and whose work we value so much are able to access that route as quickly as possible so that we can secure their future in the NHS and social care system. We want to allay their anxiety and I hope that that goes some way to doing so. It is worth pointing out, as always, that there are more EU staff working in the NHS today than there were two years ago, and of course we hope that they will stay.
What does the withdrawal agreement mean for UK nationals in the EU? The noble Lord, Lord Ricketts, and the noble Baroness, Lady Thornton, talked about the state pensioners living in the EU. We have agreed that the S1 scheme will continue for that group so that they continue to be able to access reciprocal healthcare in the same way as they do now. To answer the question from the noble Baroness, Lady Thornton, we will of course look at data on whether there are returners, although we have not seen any evidence of them yet. It is also worth pointing out that this group of S1 beneficiaries will also be able to use an EHIC to obtain healthcare if they visit other member states—the so-called onward rights.
More broadly, UK nationals living and working in the EU at the end of 2020 will be able to access healthcare on terms similar to those in place now under the implementation agreement, in line with the rights that we have agreed for EU nationals living in the UK.
Turning to the EHIC and the S2 scheme, during the withdrawal agreement and implementation period discussions so far, we have not agreed long-term continuation of the EHIC and S2 schemes for the reason that I gave. However, we have agreed that a transitional arrangement will ensure that people visiting the UK or the EU on holiday or for study will be able to continue to use their EHIC while in that state of travel. People receiving planned treatment via the S2 route will be able to complete their course of treatment abroad, however long the treatment lasts, so that there will be no disruption to their care. We will also continue to press for the right of people covered by the withdrawal agreement to move to other member states—a right that we have been able to secure for pensioners under the S1 scheme.
Inevitably, the debate has focused on what the future relationship will look like. The Government have been clear about what we are seeking to achieve: the right of UK state pensioners who retire to the EU to access healthcare in those states; full ongoing UK participation in the EHIC scheme; and the right of UK residents to receive planned treatment in the EU, when the NHS authorises it.
The noble Lord, Lord Jay, asked: why S1 rights? I think that he has in mind, for example, frontier and posted workers. It will inevitably depend on wider agreements about mobility and security rights. There is a co-dependency between those citizens’ rights and the more extensive application of the S1 right to healthcare. However, the other elements of the reciprocal healthcare rights do not have the same co-dependency with the wider citizen rights.
The noble Baroness, Lady Janke, my noble friend Lord Balfe, the noble Baroness, Lady Thornton, and the noble Lord, Lord Ricketts, also asked about the no-deal arrangement. Indeed, if noble Lords did not mention it, it is certainly on everyone’s mind. The committee obviously heard about and described the anxiety that there would be if people could not easily access healthcare abroad, and it suggested solutions that we could adopt, such as bilateral agreements. I reassure noble Lords that it is our intention to secure a deal, given the commitment to protect the interests of citizens from both sides in the negotiations. I should also reassure noble Lords that the department is doing everything it can and everything necessary to avoid any kind of cliff edge. There is a programme of work that aligns with the ideas already posed by the committee in the unlikely event of a no deal.
We are of course planning for all scenarios. I think that British citizens would find it bizarre if we did not prepare for all eventualities, not just on reciprocal healthcare but on other health issues and across the piece. I am afraid that noble Lords will have to forgive me: this is not the time for me to go into further details about what those no-deal preparations look like, although of course at some point in the future we will have more to say. I shall resist the entreaty from the noble Baroness, Lady Thornton, to give her probabilities—I am terrible at betting, so she would not want to trust me anyway.
Ireland has obviously been a heavy feature of the debate and the report. My noble friend Lord Ribeiro spent much time highlighting the benefits of that relationship, and the noble Baronesses, Lady Pinnock and Lady Janke, talked about it as well. As somebody who has an Irish connection, it is something that features heavily in my, as well as the Government’s, thinking. I reassure noble Lords that the UK and Ireland have agreed that we will protect healthcare access and co-operation for our populations whatever the outcome of the EU exit. That would take place under the common travel area and other agreements that we have made together.
The discussions are progressing well. I recently met my counterpart, the Irish Health Minister, Simon Harris. We are both satisfied by the progress in this area. I reassure noble Lords—particularly the noble Baroness, Lady Pinnock, who was very interested in this matter—that it is a priority for us and that we are making good progress.
My noble friend Lord Balfe asked about the devolved Administrations. We are of course engaging with them all the time and making sure that they are involved in the decision-making. As we go forward, we will be seeking a deal that works for all parts of the UK, and it therefore needs to work for and be agreed by the devolved Administrations too.
The noble Baroness, Lady Janke, made some important points about insurance, as did the noble Baroness, Lady Pinnock. We are continuing to engage with the Association of British Insurers. Clearly, the exact outcome and its implications for travel insurance will depend on the future relationship, we agree. But for the reasons that I have said, I will not go into the detail now of preparations for no-deal scenarios. I can tell the noble Baronesses that we have that open relationship and are having discussions, and we understand exactly what is at stake here.
Finally, my noble friend Lord Ribeiro raised the issue of radioisotopes. It is a topic that we have discussed several times. He will know that we are investigating not only domestic production but making sure that there are customs arrangements and other arrangements such as trading arrangements to make sure that the supply of radioisotopes is not impacted in any way by the circumstances under which we leave the European Union. I am reassured from the work that has gone on in this House through our debates on the withdrawal agreement and the Nuclear Safeguards Bill that we have a proper understanding of how we achieve that. Noble Lords made a fantastic contribution to that work. Of course, as the noble Lord will know, regarding the proton beam, there is a centre open at the Christie and another one to follow, so we will be able to provide more of that therapy at home for UK citizens.
I thank the committee again for its fantastic work, the noble Lord, Lord Jay, for his expert chairmanship and all speakers. I think we are all agreed on what we want to achieve from these negotiations and why we want to achieve it. It is inevitably a complex task. The input of the committee is highly welcome and has been very productive and influential on our thinking as a department. I want to make sure that that is reflected as much as possible in the work we do and the proposals we make, whether in a White Paper or other routes. I hope that we will continue that dialogue so that we can make sure that concerns are raised and properly dealt with and we end up with an outcome that protects citizens’ and patients’ rights after we leave the European Union.