Healthcare (International Arrangements) Bill

Baroness Brinton Excerpts

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I join others in welcoming the noble Baroness, Lady Blackwood of North Oxford, and congratulating her on her maiden speech. It is always slightly bizarre for a maiden speech also to be a ministerial introduction to a Bill, but she did it extremely well and set out the case. Along with my colleagues on the Liberal Democrat Benches, I may disagree with some of the things that she said, but she set out the Government’s position eloquently.

In addition to thanking the Library for its very good briefing, I want to thank the BMA for its own. One point that it makes has not been covered so far in our debate today. It says:

“It is essential that any alternative cost-recovery system introduced post-Brexit should not place an undue burden on either the NHS or on doctors or allied health professionals working within the health service”.


In view of the rearrangement of the BBC charter, whereby the BBC is taking on responsibility for the public benefit of TV licences for the over-75s, I worry that a Government in future might take the attitude that it is perfectly acceptable to offset—so I completely support the BMA in saying that it must not affect costs.

Others have spoken eloquently about the number of UK residents who hold EHICs and have received reciprocal treatment. I speak as someone who lost their father-in-law 10 years ago in France. He had the most wonderful treatment over a three and a half-week period after a brain haemorrhage, but sadly died. At no stage of the treatment, moving from a front-line hospital to a big regional hospital of excellence, was there any problem with the card or the E111 form. The only slightly bizarre thing that happened was that, after he died and all treatment was concluded, my mother-in-law received a bill for the ambulance service. It was not that she had to pay it, because if one is covered by E111/EHIC form the cost is met by the state, but every family gets a copy of the ambulance bill because it reminds them how expensive it is—and, guess what, in France there is no abuse of the ambulance paramedic system whatever.

At paragraphs 75 and 76 of the EU Committee report, Brexit: Reciprocal Healthcare, published in March last year—about one year ago—the committee sets out its concerns about making sure that negotiations should start early. It stated:

“We applaud the spirit underlying this ambition”—


of wishing to maintain reciprocal healthcare arrangements—

“but it is difficult to square it with the Government’s stated aim of ending freedom of movement of people from the EU”,

which is of course symptomatic of the principle of reciprocal healthcare. It went on to state:

“More generally, reciprocal healthcare arrangements will only be achieved by agreement between the UK and the EU. The Government has not yet set out its objectives for the future UK-EU relationship. We … urge the Government to confirm how it will seek to protect reciprocal rights to healthcare of all UK and EU citizens post-Brexit, as part of any agreement on future relations”.


It is worth noting that, 52 days away from 29 March, we are still not clear about what the UK wants from the arrangements. We seem to be going back to the negotiating table. I suspect that that explains what the noble Lord, Lord O’Shaughnessy, said about the sparsity of information. It is almost as if Ministers are saying, “Trust the Government, because we don’t quite know yet where we are”.

Some of the points made later in the EU Committee’s very good report give a signpost to where we might be. Chapter 6, on reciprocal arrangements, private healthcare and insurance, talks about contingency planning for the S1 and S2 arrangements and the EHIC. I will not dwell on those, because colleagues have mentioned them, but I remain concerned about arrangements with insurers. The chapter’s final conclusions state:

“Time is now short for the Government to provide much-needed clarity to the insurance industry to help with planning, particularly for multi-trip travel insurance policies that will include the period beyond March 2019”.


It goes on to say:

“There will be consequences not just for the insurance industry, but for tourism and individual travellers. While the industry might derive some benefit should it be required to play an expanded role in providing cover, we recommend that any move for greater reliance on private medical insurance by UK citizens travelling within the EU post-Brexit be subjected to careful scrutiny, particularly in terms of the further regulatory oversight that might be needed to ensure that patients and consumers are treated fairly”.


In November last year, my noble friend Lord Bruce of Bennachie asked the noble Lord, Lord Bates, about the arrangements and advice that would be provided to UK residents planning to book a holiday in an EU member state commencing after the end of March 2019. The noble Lord, Lord Bates, said, in summary, that he did not have details, but went on to say:

“The Government continue to strongly encourage all British nationals travelling abroad, including within the EU, to take out comprehensive travel insurance that covers their personal circumstances and meets their needs. In the unlikely event of no deal, travel insurance policies will remain valid”.—[Official Report, 1/11/18; col. 1424.]


Last week, my honourable friend Tom Brake, who is the Liberal Democrat Brexit spokesman in another place, reported that we had done some mystery shopping for travel insurance in the preceding week, in January 2019. Of the seven travel insurers spoken to, only two firms said that insurance would be paid out as normal in the event of a no-deal Brexit. Three said that they did not know what would happen if a no-deal Brexit came into force. Most worryingly, two of the companies said that holidaymakers would not be covered in this event because they had not yet got any policy on it. That is why I am really worried by the lack of detail in the Bill, which is symptomatic of the lack of detail and discussions going on with the industry itself.

I will briefly touch on Northern Ireland. The noble Lord, Lord Foulkes, has spoken about the importance of arrangements elsewhere in the union. The arrangements that pertain in Northern Ireland at the moment are absolutely not the same as elsewhere in the European Union. Joint health services allow patients to get medicine at any pharmacy, north or south of the border, irrespective of the location of the GP responsible for the prescription. Ambulances on both sides of the border are currently free to travel across it to attend emergencies. People across the island of Ireland are allowed to receive radiotherapy at a new £50 million centre for cancer patients from both sides of the border in Derry. It is important that that specialist provision is available, yet there is no pathway for managing these difficult cross-border issues in Ireland. Will these current arrangements remain in place after 29 March, in the event of a no-deal Brexit? Even in the event of a deal, will it continue if there is no final agreement? Are specific discussions going on between the Republic, Northern Ireland and the UK Government to ensure that there are no cliff edges for residents of Northern Ireland or the Republic? This is not just holidaymakers, or a handful of workers abroad. This is a full, two-way process.

Finally, I move on to the Henry VIII powers. I am grateful to my noble friends Lord Marks and Lady Barker and to the noble Lord, Lord Foulkes, for expressing their concerns in detail. I will not repeat them, but I agree with them about the enormous scope of the Bill and of the underlying arrangements it sets in place. The noble Lord, Lord O’Shaughnessy, responded to the DPRRC saying that there were “too few constraints” on power by saying that there needed to be flexibility because of future trade deals. He will know of my concerns in this area, because I raised questions with him about the protection of the NHS when he was the Minister. One of the lesser-known pillars currently protecting our NHS is the EU directive on public health procurement. It governs the way in which public bodies purchase goods, services and works and seeks to guarantee equal access and fair competition for public contracts in EU markets.

I was concerned by the noble Lord’s mention of future trade deals. We know that the United States of America wanted, through TTIP, to use trade deals to get a foot in the door of larger contracts within the UK. In the past I have said to colleagues on the Labour Benches that we have the protection of the EU directive. I now worry that that will disappear in a puff of smoke if we have a no-deal Brexit on 29 March. I am grateful to the noble Lord, Lord Livingston of Parkhead, who answered my question on this issue in November 2014 by saying:

“Commissioner de Gucht”—


from the EU—

“has been very clear: ‘Public services are always exempted ... The argument is abused in your country’”—

the UK—

“‘for political reasons’”.—[Official Report, 18/11/14; col.274.]

Can we count on the Prime Minister’s statement that all EU law will be enacted fully in the UK and that if changes are to happen they will follow later? Can I take it from that that this EU directive will be enacted and in force on 29 March to protect the NHS from unscrupulous trade deals that we were promised would not happen?

I am particularly concerned. When I asked these questions in the past, Barack Obama was President of the United States. Under President Trump I remain even more concerned about the protection of the NHS. The Minister may say that this should not be affected, because this is about arrangements, but I worry that the scope which sits behind it might actually allow it to happen—so I look forward to hearing from the Minister.