Brexit: Reciprocal Healthcare (European Union Committee Report)

Lord Balfe Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Lord Balfe (Con)]

My Lords, I begin by thanking the chairman and the members of the committee, of which I am not one, so I hope my intrusion will be forgiven.

On Thursday your Lordships will debate the 70th birthday of the NHS—it is just slightly younger than I am. Evidently it is one of the great post-war success stories but 45 of its 70 years have been spent inside the European Union. Over those 70 years, we have seen a continuing internationalisation of medicine and Europe working together more and more. I spent some 25 years in the European Parliament and represented the great teaching hospitals of Guy’s and St Thomas’ and had dealings with them from time to time. There was never a straightforward medical role for the European Union, but it was certainly involved in medical priorities.

The NHS is probably the best-loved child of the Attlee Government and probably a beneficial outcome of the Second World War. Throughout the Second World War, the first thing that people realised was that you had to have an efficient health service. You could not have people bombed out of their houses without adequate medical care. The predecessors of the NHS—people like Ernest Brown, the wartime Health Minister—did a lot to set down the parameters within which the health service has existed.

As we know, it is quite different from continental health systems. Having had a residence in Brussels for the better part of 40 years, I have had dealings with both the Belgian and French systems, which are pretty good and comprehensive. We see a lot of figures and tables, and I noticed one this morning in which we are just behind France in what we spend. However, they seldom take account of the insurance costs and the cost of running the insurance schemes. Every time you go to the doctor in Belgium, you do not pay much but you generate a lot of paper. You fill in a form; you part with €40; the doctor fills in a form to claim back the money; then you fill in a form to claim back about €35 of the €40 using yet another form which the doctor has given you. I am sure that the Minister will be aware of the cost of running an insurance-based scheme. It is certainly a factor which we need to keep in mind when we look at European schemes and how we can benefit from them. One direct benefit from the European Union that I was involved in was its funding of videos which were made by doctors at Guy’s Hospital in London who were doing certain operations, mainly on joints. These were then used to teach doctors in Portugal. It was remote learning of a kind which would now be done more easily with Skype, but even in the 1980s we had reciprocal healthcare and that has been quite a success story.

The NHS itself is a success story and one of the reasons for this is that the middle class supported it. It is a universal service and middle-class intervention has been quite crucial. This all leads me to the point that there is a lot of concern about Brexit and a desire that it should not impede the rights of citizens. If it does, there will, to put it crudely, be a lot of trouble. Europe is far too small not to have reciprocal healthcare arrangements. They are an absolute necessity. On page 6 of the government response to the report it states:

“The UK Government and the Commission have stated that providing certainty for citizens was a priority and we believe it would be unlikely for any deal on citizens’ rights agreed early on to be reopened”.


However, recommendation 4 states quite clearly that,

“nothing is agreed until everything is agreed”,

as we keep learning. In other words, it may be unlikely to be reopened, but it will be if there is no agreement. Leaving the EU without an agreement, as is the wish of some of the more extreme supporters of Brexit, would mean no healthcare cover for UK citizens abroad or for EU citizens here, presumably. I am quite sure that there would be a scramble to get some emergency measures in place, but that is not the best way of making public policy.

The noble Baroness, Lady Janke, referred to the interview with Simon Stevens on Sunday, repeated in the Times, which said:

“NHS prepares for no-deal drug and doctor shortage”.


The article outlined the problems potentially facing the NHS, including a worst-case scenario of hospitals running out of medicines in just two weeks, and the fact that it is now planning. Apparently 37 million packs of medicine arrive in the UK from the EU every month, with 45 million going back the other way. There is a very big common market in drugs. When Simon Stevens, CEO of NHS England, says that “extensive work” for a no-deal scenario is being done in collaboration with the pharmaceutical industry, I need to ask the Minister when he will be in a position to tell us about the nature of this extensive work. Although it is not his direct responsibility, has he been in contact with the devolved Administrations and are they also doing “extensive work”?

Paragraph 11 of the report’s conclusions asks the Government,

“to confirm how it will seek to protect reciprocal rights to healthcare of all UK and EU citizens post Brexit”.

In their response, the Government state that they want,

“a wider agreement with the EU on reciprocal healthcare into the future”.

Of course we do, but how are we going to get this alongside ending free movement? This is all part of a package. What is the status of current negotiations in pursuit of this wider agreement? Are they currently ongoing, and which department is in the lead—DExEU or Health and Social Care? Again, are the devolved Administrations involved, and how are they being co-ordinated?

Finally, it is clear from the briefings that I and other noble Lords have received that there is still much work to be done with regard to the position of reciprocal healthcare if the Government carry out their intention to end free movement. We need to prioritise access to reciprocal healthcare and we need a realistic assessment as to whether ending free movement is necessary or desirable. Simon Stevens has drawn attention to the fact that 10% of NHS doctors and 7% of nurses are nationals of other EU member states. This supply is apparently drying up because they do not have the confidence to come and work here. A solution is clearly needed, as is devising a retention strategy for the staff who are here.

I will make a prediction to the Minister. Being a bit of a cynic, I have said all along that Britain will end up in a Norway situation. We will be within the single market; we will have free movement, maybe with a minor concession at the edges; we will pay a very large bill; we will need extra staff in our embassy in Brussels to keep an eye on things. We will be represented at none of the meetings but will be subject to all of the decisions. That is the direction in which we are going. I finish with an absolutely true story. A year ago, I was in a ministry in Norway, talking to the Minister. He said: “You are going to find it is really difficult. We find it difficult in Norway, but at least we have got a direct line to Sweden and we are roughly the same size as them. Sweden and Norway have a long tradition of working together”. He went on to say: “The only other English-speaking country you have to fall back on is Ireland. Your relations are not quite as close with them, and there are a lot of problems that you are going to have to solve”. When we are outside the tent, so to speak, we are going to have far more difficulties in getting influence than Norway. I hope that I am wrong, but I fear I am right.