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

Lord Rennard Excerpts

Thursday 21st March 2019 Lords Chamber

[Lord Rennard (LD)]

My Lords, I am pleased that the second of the statutory instruments in this group is not being moved now, because the issues involved in that one require more consideration than we might have given them today. The Government should think rather more carefully about some of these issues because it is clear that a considerable number of UK citizens living in other EU countries are incredibly concerned about them. They would be even more concerned if they had heard the remarks of the noble Baroness at the beginning of this discussion on these SIs. The idea that they may have to apply for extra insurance policies, social insurance schemes and so on as soon as a week on Saturday illustrates why it is so important that we do not crash out of the EU on Friday of next week. People are also acutely aware of how the Government at the moment appear to be treating rather differently issues such as the voting rights of UK citizens living overseas and the healthcare rights of UK citizens currently living in EU countries.

Tomorrow the Government will support a Private Member’s Bill in the House of Commons to give permanent voting rights in UK elections to all UK citizens living overseas. However, many of them were denied votes in the EU referendum and now find themselves potential victims of that decision in terms of fundamental changes to their existing healthcare rights. The winding down of reciprocal healthcare arrangements was not really examined in the referendum campaign as a potential consequence of that vote.

On Tuesday the Minister of State for Health, Mr Stephen Hammond, sought to allay some of their fears. But the Guardian today reports on the furious reaction of UK nationals who have retired to EU countries. The offer by the Government to cover healthcare costs for up to one year, if they have applied for or are undergoing treatment before exit day, is a terrible one. One of the people quoted in the Guardian article today says that if a person,

“has paid into the system all their lives and retired to an EU country in good faith, with all the reciprocal arrangements in place, they could be left high and dry if they, say, get cancer after 29 March”—

next Friday. Tuesday’s Written Statement by the Minister said that pensioners will be eligible to return to the UK and get treatment on the NHS under the contingency plans. But another of the people quoted in the article today asks:

“How can pensioners with cancer, cardiac problems or other major issues be expected to make or even afford repeated visits to the UK for regular vital treatment?”


The present system works well and is cost effective, because healthcare is cheaper in many EU countries than in the UK, so the existing system helps save the NHS money. We are losing a benefit and incurring more expense.

Campaign groups such as Bremain in Spain, British in Italy and Expat Citizen Rights in EU have all raised practical problems with the Government’s plans. They are right to criticise the way in which people who have paid national insurance contributions for many years, and may continue to pay taxes to HMRC, may now be deprived of their rights to reciprocal healthcare arrangements where they now live. They may in practice be unable to return to the UK for treatment they need.

Those of us living here who travel to Europe have come to regard the EHIC as a major advantage, and it has helped to keep travel insurance costs within Europe far lower than for the USA, for example. It is welcome that the cards may remain valid to the end of 2020, as opposed to next Friday, but only where a separate memorandum of understanding is in place with the relevant country. From what we heard a few moments ago, I understand that this is not the case with many countries so far. The basis of the statutory instruments relies heavily on the Government’s ability to agree transitional reciprocal healthcare arrangements with EU member states. Few agreements have already been reached, eight days before some people want us to leave the EU. It is hard to see how the new arrangements proposed can be subject to proper scrutiny—particularly without the relative costs of the new arrangements being assessed—together with what appear to be major drawbacks for UK citizens living in or visiting EU countries in future.

Current EU reciprocal healthcare arrangements allow UK citizens to have access to healthcare when they live, study, work, or travel in the EU, EEA and Switzerland, and vice versa. What they get in future may not be nearly as good, and the costs of the new arrangements are not known. The Government have admitted in these SIs that,

“there is a high level of uncertainty around the precise value of the costs and benefits”.

It is also clear that the Government are relying on powers to be given to the Secretary of State via the Healthcare (International Arrangements) Bill to make any provisions for after 31 December 2020, but we do not know who that Secretary of State will be then, or what it will be possible for them to agree. Does the Minister accept that we cannot give proper scrutiny to legislation when so much is unknown and uncosted? Can she say something about what the costings really are? Does she accept that it is regrettable that the timeframe for consideration of these measures means that there has not really been any proper public consultation about them, particularly with UK citizens living across different EU states?

Like the noble Baroness, Lady Thornton, I also want to know what arrangements the Government will make for advising travellers and expats as to their healthcare coverage status if we leave without a deal next Friday. We have seen little preparation for that so far. How will the date of 31 December 2020, outlined in the SIs as the day when all current arrangements with other member states cease, be revised if the Government succeed next week in securing an extension to the Article 50 process?

[Baroness Manzoor]

My Lords, I thank the noble Baroness, Lady Thornton, and the noble Lord, Lord Rennard, for their valuable contributions to this debate. The effect of these two sets of regulations is to make miscellaneous amendments to EU references in retained EU law relating to reciprocal and cross-border healthcare. I understand the wider points that both noble Lords have made, but am not in a position to comment on those wider points in relation to exit. I am in a position to comment on these SIs. I reassure the House and both noble Lords who have spoken that we are doing everything we possibly can to ensure that we have arrangements in place for reciprocal healthcare with the EU. These regulations ensure continuity of reciprocal healthcare arrangements, where appropriate, for UK citizens living, working or travelling abroad, while removing these arrangements in the longer term, as the noble Lord, Lord Rennard, said.

I turn to specific points raised by noble Lords. The noble Baroness, Lady Thornton, referred to the common travel area. I reassure her that the UK and Ireland are both committed to continuing the reciprocal healthcare arrangements on a bilateral basis after the UK’s withdrawal from the EU. We recognise our unique relationship with Ireland and the importance of the common travel area, and in healthcare, as in other relevant policy areas, we have been working closely with Ireland to ensure that the rights associated with the common travel area continue to be protected, and we have made good progress. Discussions to continue reciprocal healthcare arrangements are under way between the UK and Ireland and, once concluded, these instruments will provide a mechanism to implement the agreement and thereby ensure that there is no interruption to healthcare arrangements between the UK and Ireland for a transition period.

The noble Baroness, Lady Thornton, asked about the impact the legislation arrangements that are in place will have on an all-Ireland basis. The north-south arrangements to provide healthcare services on the island of Ireland are not impacted by the UK’s withdrawal from the EU or by these SIs. These arrangements operate under MoUs, as she correctly identified, and service level agreements between Irish and Northern Irish health authorities will continue to operate after exit day. The UK Government have made a commitment to ensure that these arrangements continue and that new arrangements can be made. The noble Baroness is aware that healthcare is devolved to Northern Ireland, and this statutory instrument has been brought forward in the absence of a Northern Ireland Executive.

I share the concerns raised by the noble Baroness in relation to paediatric heart surgery and cancer. I reassure her that the north-south arrangements to provide services such as paediatric heart surgery are not impacted by the UK’s withdrawal from the EU and the UK Government have made a commitment to ensure that those arrangements continue and that no new arrangements in relation to those areas are put in place.

The noble Baroness, Lady Thornton, asked what guides are available. The website GOV.UK contains “Living in country guides”, which contain country-specific information on the steps that people can take in relation to healthcare, and is regularly updated. However, I take on board the comments the noble Baroness has made and I will feed them back to the department to ensure that any further information is put in these guides.

The noble Baroness, Lady Thornton, and the noble Lord, Lord Rennard, asked about bilateral agreements if there is no deal. I acknowledge that the timescales are challenging. The Secretary of State for Health has written to all Health Ministers in the EU to offer an agreement on a reciprocal basis with other member states that individuals continue to be covered for healthcare under the same terms as now if they retire in, work in or visit the other country. We are currently engaging with member states to see whether these arrangements can be put in place should we exit the EU without a deal. While it would not be appropriate to share details of the negotiations with member states at this stage, I reiterate that our clear focus is to protect healthcare access for people in the EU.

The noble Lord, Lord Rennard, raised the issue of how we inform individuals of their rights in a no-deal scenario. I refer him to the answer I have just given in relation to the website and the guidelines. If they need to be updated with new information, the department will certainly do that.

One of the final issues raised by the noble Lord, Lord Rennard, on which I can comment relates to the costs of spend-on arrangements with the EU. The longer-term costs of reciprocal healthcare arrangements are subject to negotiations between the UK and the EU, as the noble Lord will be aware. Expenditure under the current EU reciprocal healthcare arrangements was approximately £630 million in 2016-17, and we expect future expenditure on EU reciprocal healthcare arrangements to reflect current costs. Our intention is that Parliament will have clear and easy-to-access details of public spending on healthcare arrangements implemented under the Healthcare (International Arrangements) Bill. We have made a government amendment reflecting the suggestion by the noble Baroness, Lady Thornton, and others to provide Parliament with a regular report on payments made using the powers under the Bill. We anticipate that this report will be a baseline. We intend to go further than reporting on payments, but we cannot provide a statutory obligation to do so at the moment.

I think those are the key questions that I can answer.