National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019

Debate between Baroness Manzoor and Lord Lansley

Wednesday 27th March 2019 Lords Chamber

[Baroness Manzoor]

My Lords, may I be so bold as to entirely agree with the noble Lord, Lord Foulkes? The House always plays a very important part in scrutiny and deliberation, and I am always in awe of the skill, expertise and experience right across the House that enables us to scrutinise legislation in the way it should be done. I am delighted that, as a result of that scrutiny, we have been able to take the healthcare Bill forward in the way that the House envisaged and that is has now received Royal Assent.

I take this opportunity to thank all noble Lords who took part in that debate; I did of course do so at Third Reading, and now it is an Act. There are too many people to mention, some of whom are not in their place, but I put on record my thanks and appreciation. I also take this opportunity to thank all noble Lords who have taken part in this debate today—the noble Baronesses, Lady Thornton and Lady Jolly, my noble friend Lord Lansley and the noble Lord, Lord Foulkes—for their valuable contributions.

I want to reassure the noble Baroness, Lady Thornton, and entirely agree with my noble friend Lord Lansley that the effect of the regulations is to ensure continuity of cross-border healthcare arrangements, where appropriate, for UK citizens, while removing them in the longer term if we exit the EU. This instrument, together with the Healthcare (European Economic Area and Switzerland Arrangements) Act, will give us the best possible chance to ensure that there is no loss of cross-border healthcare arrangements for UK citizens in the EU and EEA. This is critical, and I welcome the support from across the House, because noble Lords recognise its importance.

I am pleased also that the explanations I have offered today about the scrutiny committee’s report have been accepted. I reassure the noble Baroness, Lady Thornton, and others that this legislation complies with proper legislative practice and does not lead to lack of clarity concerning specific rights.

A number of questions were raised by noble Lords. I must admit to the noble Baronesses, Lady Thornton and Lady Jolly, that I had to think and think again when I read the notes on making exit day clear. I reassure them that in the guidance that we will issue on the instrument, we will provide clear, practical information for patients so that they can understand their rights. That is fundamental, because, if we do not do that, there is no point in moving forward. It is important to safeguard those rights, but it is just as important that patients understand their rights.

Meanwhile, I restate the fact that we provided the clarity sought by the committee and it accepted it. The instrument was not reported for defective drafting. I want to reassure the noble Baronesses, Lady Jolly and Lady Thornton, and my noble friend Lord Lansley on the issue of improving communications on this issue; they are very important, as I said. We issued advice via GOV.UK and NHS.UK to UK nationals living in the UK, UK residents travelling to the EU and EU nationals living in the UK so that they can easily see what we advocate.

I assure noble Lords that the Government listened to the concerns raised by the noble Baronesses, Lady Thornton and Lady Jolly; indeed, we had this discussion last week. Information on each country can be found in the living in country guides on GOV.UK and by researching healthcare abroad on NHS.UK. That advice sets out how local healthcare systems work in each country, people’s options in accessing healthcare under local laws in the member states they live in and what people can do to prepare if we do not have bilateral agreements in place. As I said, we are totally committed to ensuring that important information on healthcare is easily accessible. We will continue to provide up-to-date information to individuals as soon as it becomes available.

The noble Baroness, Lady Thornton, asked why reimbursement cannot continue. There is no process for reimbursing individuals living abroad and it would not be feasible to establish one for the hundreds of thousands of UK expats based throughout 30 member states. However, it is true that in limited cases, and following EU regulations, DHSC or the NHS reimburses healthcare charges for UK residents visiting the EU or EEA. That happens when individuals are charged for healthcare that should have been covered by a reciprocal agreement or such an agreement should have paid for equivalent private healthcare. There are a few thousand such cases each year; payments are generally of low value and made in arrears, usually several months after the person paid up front. The application process normally involves the presentation of invoices and validation with the member state that healthcare was provided. This scheme is manageable because the vast majority of healthcare use is dealt with through the EHIC scheme or travel insurance. However, it would not be feasible to continue it and scale up the current process for the hundreds of thousands of UK nationals who fall ill when visiting the EU.

[Lord Lansley]

To jump back, my noble friend’s point that the Government already provide information suggests, as I hope would be the case, that if needs be, the Government can publish the list referred to in regulation 16(4). Do the Government propose to publish such a list in the next few days?

[Baroness Manzoor]

Such guidance, or any list, is subject to our exit should there be no deal. Therefore, it depends on what happens in Parliament over the next week or two, so I cannot give my noble friend a definitive answer.

[Lord Lansley]

I suppose I am asking whether the Government would be ready to publish such a list on 12 April, were it necessary to do so.

[Baroness Manzoor]

As I understand it, it is not the Government’s intention to publish a list. The approach would be holistic, as I said in my opening remarks.

[Lord Lansley]

I am sorry; I hope my noble friend will forgive me. Regulation 16(4) states:

“The Secretary of State must maintain a list”.


From that list flows the structure of access to healthcare arrangements between the United Kingdom and other member states where continuity healthcare arrangements subsist. If you do not have a list, you do not know where it applies.

[Baroness Manzoor]

I am happy to write to my noble friend on that matter, but of course it would depend on the reciprocal arrangements with those different countries. We are still in discussions with some of them.

I have inspiration: we will publish the list of countries. Any bilateral arrangements or agreements will come from negotiations and, as I said, we are part of negotiations.

Healthcare (International Arrangements) Bill

Debate between Baroness Manzoor and Lord Lansley

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Lord Lansley]

I am making a simpler point: it is no good asking for information that is not collected. There is a good reason why it is not collected. Although, this might happen in future, at the moment I do not think anybody is proposing to switch the Australian and New Zealand agreements to ones where there is reciprocal reimbursement. In this case, I do not think the information is being collected.

[Baroness Manzoor]

My Lords, I am grateful to the noble Baroness, Lady Thornton, for her amendment and to the noble Baroness, Lady Brinton, and my noble friend Lord Lansley for their contributions. I am not sure I want to go down this route. However, if the noble Baroness, Lady Brinton, wants me to write to her to clarify the point she raised, I will certainly do so. From what I have seen, my noble friend Lord Lansley is correct in saying that we have a reciprocal agreement with the countries he mentioned, where money does not exchange hands.

I can reassure the noble Baronesses, Lady Thornton and Lady Brinton, that—as I indicate—the Government have listened to the need for greater transparency in the administration and implementation of reciprocal healthcare arrangements. I welcome the support around the House for our intentions. We understand the importance of presenting this information in a clear and accessible document, which is why we propose to go beyond the current reporting requirements. Our initial commitment to the DPRRC is contained in the amendment that the Government have tabled on this matter.

As I said, the government amendment directly addresses concerns raised by noble Lords. I hope it reassures noble Lords and demonstrates that we have listened to the clear request for increased scrutiny of the use of public money.

The amendment of the noble Baroness, Lady Thornton, would ensure that specific requirements are reported on. The detailed content of the financial report should—and could only—be determined, once reciprocal healthcare agreements have been made and technical and operational details are known. We do not know what these agreements may be in future. If we accepted the amendment, we would be placing a statutory duty on future Administrations to collect and report on data we have not yet agreed to exchange with other countries. This is not appropriate.

Our amendment is a more feasible way of reporting on future healthcare arrangements that does not pre-empt their nature or how they may be implemented, but still allows for transparency and accountability, which the noble Baroness, Lady Thornton, and other noble Lords seek. It is a baseline, and we intend to go further than just reporting on payments, but we cannot provide a statutory obligation to do so.

The Department for Health and Social Care is currently working to ensure that UK nationals can continue to access healthcare in the EU in the same way they do now, either through an agreement at EU level or through agreements with relevant member states. In either case, we will have to agree how eligibility is evidenced, how—and how frequently—that information is exchanged and the reimbursement mechanisms that will govern those new agreements. Such agreements will have to take into account the operational possibilities and limitations of each contracting party to ensure the smooth operation of reciprocal healthcare arrangements. This should include how NHS trusts in the UK can evidence eligibility for the treatment of non-UK citizens in the most efficient and least burdensome manner.

Once those administrative details are known, the Government will be able to speak confidently to the specific measures that can be reported on for each country. There is an annual reporting mechanism in the government amendment to provide such detail. I acknowledge that the amendment of the noble Baroness, Lady Thornton, is well meaning and agree with its spirit, but the level of detail proposed in it could constrain or create unnecessary burden when administering future healthcare arrangements that have not yet been negotiated.

It is in the interest of neither the Government nor Parliament to force unnecessary administrative burdens on the NHS, which the amendment could inadvertently cause. The level of detail required in the amendment may create new reporting requirements on front-line NHS services.

As always, should the noble Baroness wish, the Minister or others from the department would be very happy to meet her to talk further about the issues, once we have a clear understanding of future negotiations and how they progress. I hope I have reiterated the Government’s commitment to accountable financial reporting, and that the noble Baroness and other noble Lords feel reassured on our commitment to ensuring that sufficient and appropriate checks and balances are in place on reciprocal health agreements. I hope she will agree that her amendment, which places a statutory duty on future Administrations to collect and report on data we have not yet agreed to exchange with other countries, is inappropriate. I hope I have reassured her and other noble Lords and she feels able to withdraw her amendment.

Health: Public Health Grant

Debate between Baroness Manzoor and Lord Lansley

Monday 4th February 2019 Lords Chamber

[Baroness Manzoor]

My Lords, as I said, we will be making a robust case for the value of prevention in the spending review. The reduction to the grant to which the noble Baroness refers is not a new cut. It was agreed in the 2015 spending review in a difficult financial environment. Local authorities have been aware of these cuts for over a year and have been able to plan accordingly. But there is much more to public health than the grant itself—for example, our national childhood obesity strategy and NHS England’s world-leading diabetes prevention programme. As the noble Baroness knows, the NHS long-term plan has an emphasis on prevention.

[Lord Lansley (Con)]

My Lords, I was the Secretary of State who introduced the public health grant to local government. Is my noble friend the Minister aware that this was done because many of the wider social determinants of health can be better influenced through the action of local authorities than by the NHS alone? That was the reason why the public health grant was included within the ring fence in 2010 to 2014, which guaranteed a real-terms increase in the public health grant to local authorities; this was reversed in 2014. Will my noble friend the Minister consider restoring the value and growth of the public health grant in the context of an agreement with local authorities to act on those wider social determinants of health?

[Baroness Manzoor]

I agree with my noble friend, and that is why we are making a robust case to the Treasury in relation to the spending review. Health improvement is about far more than the services funded through the grant, as my noble friend says. The transfer of local health responsibility to local government provided the opportunity to join up public health with decisions on other local services such as housing and economic regeneration. We see local authorities commissioning different kinds of public health services which better fit local circumstances and priorities and deliver improved value. We therefore recognise the importance of the grant.

Welfare Reform and Work Bill

Debate between Baroness Manzoor and Lord Lansley

Wednesday 9th December 2015 Lords Chamber

[Lord Lansley]

The noble Baroness is drawing me into a debate that I was not intending to enter into. My point was not about whether having a structure in which those who are currently on ESA WRAG and then go into employment and come off it should lose the benefit after 2017. My point is that within the terms of the review, contrary to the argument that is being presented that there is no incentive effect of the level of benefits relative to work, people are arguing that that is not true and that there is a disincentive effect in going into work if the level of benefits is higher.

I shall conclude on that point. It seems to me that we need to be operating on each of these areas. As a Government and a country, we are doing well in providing opportunities for employment. If we do the right thing in terms of support, we can give people with disabilities greater access to those employment opportunities that are increasingly available and, most importantly, give people access to the support. The review gives very good material for the Government to continue the process of thinking towards what that structure of support should be to be of the greatest possible benefit for people with disabilities.

[Baroness Manzoor]

Surely with his health background the noble Lord is not saying that people who have been deemed to be sick and ill should be given jobs and should be made to go into employment. That is not what he is saying, is it?

[Lord Lansley]

No, it is not—and I do not think that we should construe an incentive structure as being coercion. It is precisely what it describes. We are talking about the level of relative benefits and if people fall properly into this category—I have not got into the question of whether the work capability assessment is accurately placing people in the WRAG ESA rather than the support group—they should be in a position to work. It is not about coercion. Sixty-one per cent want to work, but not enough of them are getting work. We should have incentive and support structures that help them to get that work and we should make sure that the incentives do not get in the way but support this. It is nothing to do with coercion.