Brexit: Reciprocal Healthcare (European Union Committee Report)

Lord Jay of Ewelme Excerpts

Tuesday 3rd July 2018 Lords Chamber

Moved by

[Lord Jay of Ewelme]

That this House takes note of the Report from the European Union Committee Brexit: reciprocal healthcare (13th Report, HL Paper 107).

[Lord Jay of Ewelme (CB)]

My Lords, I have the honour to chair the EU Home Affairs Sub-Committee, which produced this report, and I thank the members and staff of the sub-committee and our excellent specialist adviser, Tamara Hervey, for their support and advice. Perhaps I should say at this point that I have little doubt that if Gareth Southgate had known that, by losing to Belgium, England’s next match in the World Cup would coincide with this debate, he would not have rested Harry Kane and the result of the Belgium match would have been different—but we are where we are.

I think that we would all agree that reciprocal healthcare is one of the great benefits of our European Union membership. We almost take it for granted that, when travelling, we can access emergency care free of charge, or that we can retire to another EU country and rely on continuing to receive care on similar terms to that offered by the NHS. But, as in so many other areas, Brexit means that we now have to go back to the drawing board.

This inquiry was launched last autumn, when the overriding concern of our witnesses was over the status of UK and EU nationals who had already exercised their right to free movement—the 3 million or so EU nationals resident in the UK, and the more than 1 million UK citizens, many of them elderly, vulnerable or in poor health, who live in the EU 27. We heard compelling evidence of the fears felt by these people, most of whom, let us not forget, had no vote in the referendum.

Happily, the agreement set out in December’s joint report, and embodied in the draft withdrawal agreement published by the Commission on 28 February, has allayed many of those fears. Perhaps that reassurance could have been offered earlier, but it would be churlish not to pay tribute to those who reached what was, in respect of citizens’ rights, a largely satisfactory outcome.

Since the December joint report, the tone of the Government’s statements about citizens’ rights has been increasingly positive. This is exemplified by the Government’s response to our report, published on 13 June, which begins with confirmation that safeguarding citizens’ rights is a “top priority” for the Government. It also says:

“It is vital that NHS treatment is always available to those who need it”,


including EU citizens. Taken alongside the Home Office’s recent announcement about the process for acquiring settled status, this is good news. I take this opportunity to thank the department for supplying such a considered response, and thank the Minister, the noble Lord, Lord O’Shaughnessy, for the support he personally gave us throughout our inquiry.

So much for the good news. The more difficult issues relate to the long-term UK-EU relationship. Here the government response is thinner—perhaps not surprisingly, given that a White Paper on the future relationship is expected next week. However, it restates the Government’s wish to retain in any future agreement the key benefits of reciprocal healthcare. These are described as: first,

“the rights of UK state pensioners who retire to the EU (and vice versa) … to benefit from a reciprocal healthcare scheme”;

secondly,

“the rights of UK residents to continue to receive needs-arising treatment in the EU under the EHIC scheme (and vice versa)”;

and, thirdly,

“the rights of UK residents to be able to receive planned treatment in an EU Member State when this is pre-authorised by the UK (and vice versa)”.

That list begs a few questions, which I hope the Minister will be able to address at the end of the debate.

The over-arching point is that contained in paragraph 75 of our report. Reciprocal healthcare rights in the EU do not exist in isolation; they exist to remove barriers to the free movement of people. So it is difficult to square the department’s laudable ambition to maintain such rights with the Government’s overriding objective of bringing free movement to an end. The government response, at page 9, states:

“Freedom of movement is ending but there will continue to be migration and mobility between the UK and the EU after the UK leaves”.


That is the crux of the issue and, while I acknowledge the Government’s point that there are agreements covering access to emergency healthcare with other countries, such as Australia and New Zealand, those agreements are simply not comparable in scope or depth to the comprehensive arrangements in place in the EU and the EEA.

I fully support the Government’s underlying goal, but I can almost hear the accusations of cherry picking that will be made when the Government propose continuing UK participation in this specific component of the free movement framework. How will the Government address such concerns? It is also notable that, in the passage I have quoted, the Government do not refer to the S1 and S2 schemes as such. They refer only to UK state pensioners, who are the primary beneficiaries of the S1 scheme, but the scheme is more widely drawn than that, covering, for instance, posted workers. Later in the response, however, the Government state that they will,

“seek UK participation in the EHIC, S1 and S2 schemes as a non-EU Member State”.

Can the Minister confirm that the Government will seek to replicate the full scope of the S1 scheme in any future agreement?

There is also the unfinished business of onward free movement rights. As things stand, UK citizens also resident in an EU 27 country will, under the terms of the withdrawal agreement, have their reciprocal healthcare rights protected, but they will lose those rights if they move to another EU state. That may not be an issue for UK pensioners who have retired to Spain, but it is a serious issue for UK citizens of working age who are pursuing careers and raising families in the EU.

The government response identifies this as an important issue, and underlines that the UK “pushed strongly” for it to be included in the withdrawal agreement. I should add that the European Parliament has also lobbied strongly for onward free movement rights for UK citizens to be guaranteed. The logic of the Government’s position, I think, is that it would be addressed in the context of proposed UK participation in the S1, S2 and EHIC schemes. Is that correct, or do the Government envisage a separate agreement specifically relating to UK citizens already resident in the EU—a sort of “citizens’ rights plus” agreement?

We have a long way to go and time is short. The agreement last December was a key milestone, and I hope the Minister can confirm that there will be no back-tracking on citizens’ rights. But, since March, when the last iteration of the draft withdrawal agreement was published, progress seems to have ground to a halt. We all hope that next week’s White Paper will get us back on track but, if it is to do that, it needs to be realistic, detailed and specific. No doubt, that is what the meeting on Friday at Chequers will be discussing. Simply restating the Government’s desire to maintain the status quo on reciprocal healthcare, without acknowledging the legal and political challenges—and suggesting ways to overcome them—will not be enough.

I do not expect the Minister to divulge the details of the White Paper this evening, but I hope he will at least persuade us that the Government are approaching their task in the right spirit. I beg to move.

--- Later in debate ---

[Lord Jay of Ewelme]

My Lords, I am extremely grateful to the Minister for his characteristically thoughtful and considered reply and to all those who have taken part in this evening’s debate. I do not wish to detain your Lordships further this evening but I would like to say that the issues we have been discussing are not just abstruse. They may be abstruse and they may be complex and technical, but they affect the lives and livelihoods of enormous numbers of British citizens and citizens of other EU countries, including Ireland. Therefore, they need to be at the very top of the agenda of the Government in the very complex negotiations that lie ahead. I beg to move.

Motion agreed.

NHS: Global Health

Lord Jay of Ewelme Excerpts

Monday 20th December 2010 Lords Chamber

[Lord Jay of Ewelme]

My Lords, like other noble Lords, I congratulate the noble Lord, Lord Crisp, on initiating this debate. I declare an interest as chair of the international medical aid charity Merlin, which operates in the poorest countries after conflict and natural disasters. It is from that perspective that I want to speak this evening.

There is a long and fine tradition of trained British doctors and medical staff working in poor countries, bringing expertise, training medical staff on the ground and saving lives. To take one example, more than 70 NHS staff with different skills have worked with Merlin surgical teams in the aftermath of the earthquake in Haiti. This should not be seen just as altruism, important though that is. As the noble Lord, Lord McColl said, it should be encouraged as part of medical training in this country. Like so much in today’s world, medicine is global. This country will benefit directly if the doctors and other medical staff working here bring with them first-hand experience of conditions and diseases elsewhere in the world.

To give one other example, health staff who worked with Merlin on HIV and TB control programmes in Russia and Kenya have gone on to work in an NHS trust that covers Lambeth, Southwark and Lewisham, which have some of the highest rates of those diseases in the United Kingdom. That is to our advantage, as well as the advantage of those they are helping in other countries. So I do strongly support the proposal of the noble Lord, Lord Crisp, that medical training and practice in the UK should encourage and certainly not disadvantage those many British medical staff who wish to spend part of their training or part of their professional life working in poor countries. It seems to me heartening that so many medical staff training and working here should want to spend time working in developing countries and it is very much in our interest that we should encourage them in that laudable aim. There are, of course, problems but it really is in our interest to overcome those and to encourage, for example, deans of medical schools to use their existing discretion to encourage staff to serve in developing countries.

I was reading this afternoon the document Liberating the NHS. It states:

“We want everyone who works in the NHS to reach their full potential and achieve better health outcomes for their patients”.

Indeed we do, but it seems to me that working in developing countries and the experience our staff get there is an essential part of achieving that objective. We are right to be proud of the quality of our medical staff in this country and we are right to be proud, too, of those who wish to spend time helping others in poorer countries. Those two things should go together and not in any way be in conflict. It is very much in our interest that that should be so and, like others, I look forward to the Minister’s comments on that particular point.