Reciprocal and Cross-Border Healthcare (Amendment etc.) (EU Exit) Regulations 2020

Lord Bethell Excerpts

Monday 16th November 2020 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 30 September be approved.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, this instrument amends regulations from 2019 to remove provisions that have now been superseded by the protections for people contained within the withdrawal agreement. It makes some technical fixes to reflect this and ensures that the statute book is fit for purpose. It also provides protections for people benefiting from the cross-border healthcare directive, as the directive was not carried forward in the withdrawal agreement.

Before I turn to the details, I will start with an overview of current reciprocal healthcare and our steps to prepare for the end of the transition period. Reciprocal healthcare arrangements with the EU have continued during the transition period. This means that people will see no changes in their access to healthcare for the rest of the year. From 1 January 2021 healthcare arrangements will also continue for those within the scope of the withdrawal agreement. I hope that this provides much welcome reassurance. State pensioners and workers who have moved from the UK to the EU or vice versa, and are residing there before 31 December 2020, will have lifelong reciprocal healthcare rights for as long as they remain in scope of the agreement. That includes the use of the European Health Insurance Card, the EHIC.

The agreement also protects those who are in the EU on a short stay at the end of the transition period. For example, someone who travels to an EU country before the end of the year can continue to use their EHIC there until they return to the UK. UK students on a stay in the EU, beginning a course of study before 31 December 2020, can also use their EHIC in that country for immediate and necessary healthcare for the duration of their course. Finally, people receiving planned treatment can commence or complete their treatment if authorisation was requested by 31 December 2020. All this provides much-needed certainty for UK nationals already living in the EU and vice versa.

As noble Lords are aware, future reciprocal healthcare arrangements are subject to ongoing negotiation with the EU. We understand the value of access to healthcare when travelling on holiday or for work, and I know that this is particularly important for those with pre-existing or long-term conditions. This is why the UK has been clear that it wishes to establish necessary healthcare arrangements such as the EHIC for tourists, short-term business visitors and service providers. I am sure that noble Lords will be aware that these discussions are continuing. I reassure them that, should these discussions not conclude with a healthcare agreement, we will continue to look at this issue carefully.

Should we not achieve an EU-wide deal, we would seek to agree reciprocal arrangements with EU and EEA countries bilaterally. But we cannot start these discussions until the negotiations with the EU have concluded. The one exception to this is of course Ireland. I am very pleased to report good progress on agreeing a healthcare arrangement with Ireland, under the common travel area. These arrangements will mean that residents of the UK and Ireland can continue to access necessary healthcare when visiting the other country, and it will cement co-operation between UK and Irish healthcare providers.

The instrument that we are debating today is a technical instrument to update legislation made in 2019. This now needs updating to reflect the terms on which we are leaving the EU. We need to ensure that our legislation is ready for the end of the transition period. We also need to ensure protections for those accessing cross-border healthcare on an ongoing basis at the end of the year, as this is not covered in the withdrawal agreement.

In April 2019 the Government made three statutory instruments to correct deficiencies in retained EU law relating to reciprocal healthcare. This was part of the UK’s preparations for leaving the EU without a deal. Those instruments made provision to revoke that body of retained EU law, protected people in the middle of a course of treatment and provided a mechanism for the UK to maintain bilateral reciprocal healthcare arrangements on a transitional basis until 31 December.

Some of this has now been superseded by the transition period and the withdrawal agreement protections. If we do not agree this instrument, the retained law will be incoherent and unworkable. There will also be uncertainty over protections for patients in the middle of a course of treatment.

As such, the first change our SI makes is a series of consequential and technical amendments to four EU exit instruments to make them workable and coherent. These instruments are: the Social Security Coordination (Reciprocal Healthcare) (Amendment etc.) (EU Exit) Regulations 2019; the National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019; the Healthcare (European Economic Area and Switzerland Arrangements) (EU Exit) Regulations 2019; and the Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019. The second change is that this SI updates EU references in NHS legislation that will no longer be appropriate at the end of the year. Thirdly, as I mentioned, it will clearly set out transitional protections for people accessing healthcare under the cross-border healthcare directive.

The directive gives patients the right to receive healthcare in another EEA country and receive reimbursement from their home country. It is separate from broader reciprocal healthcare under EU regulations and was not included in the withdrawal agreement. This means that the directive will no longer apply from 31 December 2020, and it is therefore important that patients who are in the course of being treated are appropriately protected. This instrument will specifically allow the Government to fund patients in the middle of treatment, or who have already applied for authorisation, at the end of this year.

Turning to the impact on industry, as this instrument proposes no significant changes to the current regulatory regime, there would be no significant impacts on industry or the public sector. As this instrument makes technical amendments and does not introduce new policy, we have not conducted an impact assessment.

The instrument also makes provision in relation to Northern Ireland and Wales. The devolved Administrations have been consulted. There has been excellent engagement between the department and the devolved Administrations and I am confident that we have clear arrangements in place.

I am pleased to say that we have worked openly and collaboratively with NHS England and NHS Improvement, as well as the NHS Business Services Authority. They are our key delivery partners and have continued delivering their day-to-day operations, such as issuing EHICs to people, while making changes to successfully implement the withdrawal agreement.

In summary, the overarching aim of the instrument is to ensure that UK legislation is functional and reflects the withdrawal agreement. It also ensures that there will be appropriate protections for people accessing treatment under the cross-border healthcare directive at the end of the year. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I express admiration and gratitude for the stamina of the noble Baroness, Lady Thornton, for sitting through this debate several times. I have also sat through it several times. I fear that some of my answers will be the same as those the noble Baroness and others will remember.

I am grateful for this debate. It is a quite reasonable and touching reminder of a key fundamental that travel is massively valued, particularly by those who travel for work, for study and to see relatives, but also by the population generally. Travel is of huge personal and financial value and protecting your health when you travel is incredibly important. People have a close association with that and are naturally deeply concerned about it. I agree with those noble Lords who emphasised the importance of these arrangements and in no way do I undervalue the importance of the EHIC programme and its successor to the British public.

In the withdrawal agreement we have a robust framework for some reciprocal rights that include significant long-term and traditional protections for EU and UK nationals. This piece of legislation is very much in that spirit. It is there so that UK legislation remains functional by reflecting the withdrawal agreement and the transition period and ensures that there are appropriate protections in place for those accessing healthcare under the cross-border healthcare directive. As veterans of this area will know—I apologise if this creates a sense of déjà vu—I remind noble Lords that the changes in this instrument do not concern the future relationship with Europe. The UK has made it very clear, and we continue to work on the fact, that we want to agree clear arrangements for providing healthcare cover for tourists, short-term business visitors, service providers and for all manner of British people who are travelling to the EU and vice versa.

However, any agreed arrangements will be entirely subject to the outcome of those negotiations. There is nothing I can do at this Dispatch Box to answer the great many perfectly valid but completely unanswerable questions that have been put about what those future arrangements might look like. However, I can update the House: the UK has had constructive discussions with Switzerland and the EEA/EFTA states of Norway, Iceland and Liechtenstein on our future relationship, including social security co-ordination and reciprocal healthcare. Those are promising and reflect well on our conversations with the EU. The progress of those discussions is, however, linked to the outcome of the EU negotiations on social security co-ordination, so I cannot offer concrete guarantees in that department.

To answer a point made by the noble Baroness, Lady Thornton, some people will be eligible for a UK EHIC under the terms of the withdrawal agreement. A new EHIC has been developed for those who are eligible, including people living, working and studying in the EU before the end of the transition period. We made that very clear very early on. Anyone with an S1 form or studying in a member state can apply for the new EHIC on the NHS website. For those not covered by the withdrawal agreement, the EHIC may not be valid from 1 January 2021, as the noble Baroness rightly pointed out. The Government are open to working with the EU to establish necessary healthcare arrangements that provide healthcare cover for tourists, short-term business visitors and service providers, but those conversations have not been finalised.

Future healthcare cover for tourists is subject to the future relationship. I understand that it is extremely frustrating not to be able to find exactly what that will look like. I acknowledge that one group which is particularly concerned will be those with pre-existing conditions; they will find it the most challenging to find the right travel insurance if there is no arrangement with the EU on necessary healthcare. This is something we are looking at closely. On a practical note, we know that getting insurance can be more difficult for those with long-term conditions. To support people, the Money Advice Service has recently launched an insurance directory for people with a serious medical condition, which brings together specialist firms with the aim of making it easier to find travel insurance that provides the right health cover. I understand that that service is proving of value.

In response to my noble friend Lord Bourne, communication has been incredibly important and we have gone about it in an energetic way. We have sought to prepare citizens for the change at the end of the transition period with advice tailored for different audiences, helping them to understand their choices and to act in their own best interests. Information is available and has been updated regularly on the NHS pages and GOV.UK to ensure that people are clear about their reciprocal healthcare rights. The Foreign, Commonwealth and Development Office has been leading a campaign, supported by DHSC reciprocal healthcare advisers, to UK-insured people living in the member states, and my understanding is that those communications have been effective.

The noble Lord, Lord Greaves, asked about readiness to implement the withdrawal agreement. I reassure him that the DHSC has made good progress, working openly and collaboratively with other social security departments and its operational delivery partners in NHS England, NHS Improvement and the NHS Business Services Authority, to ensure that reciprocal healthcare arrangements will be successfully implemented for those covered by the agreement. I also confirm that UK S1 holders in the EU and UK students studying abroad can now apply for their new EHIC under the withdrawal agreement.

The noble Baroness, Lady Jolly, asked about Ireland, and it is good news that we seem to have made progress on our arrangements for Ireland. The UK and Irish Governments have been discussing future arrangements for healthcare co-operation within the common travel area. Great progress has been made in these talks. These arrangements will ensure that residents of the UK and Ireland will continue to be able to access necessary healthcare when visiting the other country and benefit from co-operation between UK and Irish healthcare providers, regardless of the outcome of the negotiations with the EU. The example the noble Baroness gave of ambulances travelling across the border was very powerful.

These arrangements build on previous commitments that UK and Irish citizens who are living in the other country will continue to be able to access healthcare on the same terms as local citizens. The Healthcare (European Economic Area and Switzerland) Arrangements (EU Exit) Regulations 2019, which we debated previously, provide the mechanisms to implement these arrangements, so there should be no interruption in healthcare arrangements between the UK and Ireland.

The noble Lord, Lord Willis, asked about money reclaimed from other countries. That amount has grown substantially over the last five years. I cannot give the precise number that the noble Lord asked for, but the amount recovered from overseas healthcare visitors has risen to £760 million in 2019-20. That is a substantial amount, but we are continuing to work to make sure that all that money is reclaimed effectively.

These essential measures are being put in place to protect those who seek to travel abroad. For that reason, I beg to move.

Motion agreed.