Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019

Baroness Thornton Excerpts

Thursday 21st March 2019 Lords Chamber

In conclusion, I want to make it clear that these instruments make miscellaneous amendments to EU references in retained EU law, such as removing references to EU concepts. Moreover, the Bill and these instruments are necessary legislative vehicles to ensure that the UK Government are ready to deal with reciprocal and cross-border healthcare in any EU exit scenario. These instruments provide us with an effective mechanism to ensure that there is no interruption to people’s healthcare in a no-deal situation. I know that I have spoken for a long time but I felt that it was important to set out this issue clearly for the House. I beg to move.

[Baroness Thornton (Lab)]

I thank the Minister for introducing the regulations and for clarifying the position on the National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations—I have just taken about four pages out of my speech. I am sure that we will meet at the Dispatch Box to discuss them at some point next week.

The transitional elements allow for all ongoing treatment to continue for a maximum period of a year following exit and for pre-authorised treatments. Similarly, dedicated regulations deal with the special situation in Northern Ireland, where such arrangements are more frequent due to the land border with the Republic of Ireland.

I know that the Department of Health and Social Care regards these regulations as providing temporary provision until what is now no longer called the Healthcare (International Arrangements) Bill takes effect by allowing for the current system—including the European Health Insurance Card and S1—to continue until December 2020 with individual countries, but only if a memorandum of understanding is in place. I must say, taking at random an article that appeared yesterday, it seems that British nationals in Europe regard the healthcare plans for pensioners as uncaring. They feel that they are being thrown under and a bus and abandoned. They do not regard the one-year undertaking as at all adequate. The Minister and her colleagues will need to deal with the fact that this measure does not reassure many of our fellow citizens who are living and accessing healthcare abroad.

I will repeat what I have said on every occasion during debates on the many SIs we have had to deal with that prepare us for the “crashing out” scenario. It is quite dreadful. I found these regulations particularly depressing, because they affect many older people in many parts of Europe, and there is enormous anxiety. My questions for the Minister are not about the mechanisms being proposed here to deal with healthcare, but about how they are being communicated to UK citizens all over Europe for whom we are responsible.

I suspect that these regulations are needed now more than ever—perhaps even more than when they were first laid. It is a shame that they are needed at all. The Government are lurching in a disorganised fashion towards goodness knows what kind of exit from the European Union. “When?” also now seems to be an open question. These regulations, along with dozens of others, are necessary for a no-deal exit. They provide for a wind-down of UK reciprocal healthcare arrangements with the EU and European Economic Area in the case of a no-deal Brexit. I feel very sad when I say these words, because it feels like we are throwing away something precious—sharing what we have with our European friends and nations.

I think that the Minister can anticipate considerable anxiety about these regulations, which the Prime Minister’s actions and words yesterday have done nothing to alleviate. Entering a blame game when you are the Government and have the power to resolve the situation seems the height of irresponsibility, and I am not surprised that some Conservative MPs have expressed their dismay and shame.

Let us turn to the statutory instruments concerning Northern Ireland. I am very grateful to the British Medical Association for its briefing and for the attention it has drawn throughout our discussions to the benefits of cross border co-operation on health services. I will put on the record some of those benefits, as I have done in the past. I seek reassurance from the Minister that these benefits will remain safe in a “crashing out” scenario.

Health services in Northern Ireland and the Republic of Ireland work separately, but often they do not have sufficient demand to provide cost-effective and highly specialised medical services, so cross-border co-operation on health services with the Republic of Ireland over the past two decades has allowed a high quality of such services to be delivered on an all-island basis. Patients in Northern Ireland no longer have to travel to England to receive care. Between 2003 and 2015, more than €40 million euros was invested in cross-border health and social care initiatives via co-operation and working together, creating a partnership between health and social care services in Northern Ireland and in the Republic.

Additional project applications amounting to €53 million were submitted in relation to acute hospitals, prevention, early intervention, tackling health inequalities and other services. Examples of this include the paediatric cardiology service based at Our Lady’s Children’s Hospital in Dublin, which enables children from throughout the island of Ireland to receive treatment without having to travel to England. The radiotherapy unit at Altnagelvin Area Hospital provides access to radiotherapy treatment for more than 500,000 cancer patients living in both Northern Ireland and the Republic of Ireland. The creation of this unit has had the greatest impact on patients in the north-west and Donegal, removing the need for lengthy journeys to Galway, Dublin and Belfast for treatment.

The cross-border cardiology service at Altnagelvin Area Hospital has enabled patients from County Donegal with diagnosed heart attacks to receive lifesaving treatments. Other services include shared dermatology clinics over four sites along the border; out-of-hours GP services at Castleblayney, County Monaghan and Inishowen in County Donegal; ENT services at Monaghan Hospital and Northern Ireland’s Daisy Hill and Craigavon hospitals. Cross-border collaboration has enabled ENT waiting lists in the Health Service Executive Dublin North East area to be significantly reduced by facilitating ENT consultants from Northern Ireland’s Southern Trust to practise in Monaghan.

Cross-border service arrangements have been established and are providing high-quality, safe care for patients in a range of areas, including primary care, cancer services and paediatric cardiac services. These vital health services should not be destabilised during or after the Brexit process. It is also vital that patient access to these key health services is not jeopardised. How is the Minister able to reassure the House, and indeed thousands of patients in the Republic and in Northern Ireland, that our cross-border arrangements will indeed be unaffected and safe?

I turn now to what was the third instrument, the Social Security Coordination (Reciprocal Healthcare) (Amendment etc) (EU Exit) Regulations 2019. Current EU reciprocal healthcare arrangements enable people for whose state healthcare costs the UK has responsibility, known as “UK-insured”, to have access to healthcare where they live, study, work or travel in the European Union, the EEA and Switzerland—and vice versa for people whose state healthcare costs those states have responsibility for. The EU reciprocal healthcare arrangements give people more life options, and support tourism, businesses and healthcare co-operation, as the noble Baroness explained in introducing the regulations.

What we are talking about here is the European health insurance card. Some 27 million of our fellow citizens hold the EHIC and, as the noble Baroness said, some 190,000 UK pensioners living elsewhere in the EU are registered with the S1 scheme. I decided to go on to the NHSE website to see what, one week away from Brexit, we are being told we need to do. I have to say that it was not encouraging, because the website is still encouraging people to apply for the EHIC even though it may not be valid in one week’s time, and it is very difficult to see what other advice is available.

I tried to follow the route through various parts of the website, but I could not find advice on what kind of cover I would need if I were travelling somewhere in Europe in two or three weeks’ time, post Brexit, particularly if we had crashed out without a deal. I could not find the advice mentioned by the noble Baroness about taking out insurance, and I could not find advice that might be available if I had a long-term condition. That seems to be completely inadequate and it will not do at this stage, when we are so close to what might be an exit without a deal.

My questions to the Minister are very straightforward. How do people know what to do? How will they find out? When will the NHS website be updated? What is going to happen to those people I quoted at the beginning of my remarks, who already feel abandoned, if in just over a week’s time we leave the European Union without a deal and they find that they cannot access clear, unbureaucratic advice on how to keep themselves and their families safe?

--- Later in debate ---

[Baroness Thornton]

I hope the Minister does not mind, but while she was speaking I went to GOV.UK to have a look. She is quite right that there is a lot of information there, but if I want to know about healthcare in France or wherever, I will go to the NHS website. That is the first place I would think of going. If I want to know about my passport or that sort of thing, I would go to GOV.UK or the Home Office. There is a really serious communication issue here that the Government must take seriously very quickly.

[Baroness Manzoor]

My Lords, I take the issue very seriously because communication is key, particularly in the healthcare industry where there are very vulnerable people. It is right that we make information available in an easy, clear format. I am grateful to the noble Baroness for checking that out. She makes a valid point. I will feed her comments back to the department and, if we are able to do so, we will put the information on the generic website because I suspect that I, or anyone else, would go to the NHS pages as well. It seems the most logical thing to do. She has seen the webpage, I have not, but I will take her comments back. I hope the noble Baroness is reassured—she is nodding.

These two instruments and the Healthcare (International Arrangements) Bill will give us the best possible chance of ensuring that there is no loss of reciprocal healthcare arrangements for UK citizens in the EU, the EEA and Switzerland.

Motion agreed.