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

Lord Willis of Knaresborough Excerpts

Monday 16th November 2020 Lords Chamber

[Lord Willis of Knaresborough (LD) [V]]

My Lords, I thank the noble Baroness, Lady Ludford, and the noble Lords, Lord Greaves and Lord Bourne, for their very useful and sensible comments at the beginning of this debate. I also thank the Minister for his, as ever, very courteous and thorough explanation of the SI. It would have been wonderful if this evening he had had a road to Damascus moment, realising that, whatever new arrangements are being put in place, and no matter how complicated and effective they are, they are likely to be inferior, more costly and more inconvenient than what already exists. However, I suspect that that moment has gone. I therefore wish to seek guidance and reassurance from him on a small number of points.

The first is on cross-border healthcare. This is perhaps at its best and most innovative on the island of Ireland, where co-operation on everything from research to critical care, staff training and development has helped transform services for all residents, north and south of the border. Indeed, seeing one of my relatives in a very remote village in Donegal being offered one of the most up-to-date cancer treatments at the Altnagelvin Hospital in Derry, rather than having to travel to Dublin, was a very personal example. Another was the opportunity to address an all-Ireland nursing conference alongside Health Ministers from both sides of the border, where the discussion was on how to improve nursing services for all residents. It made me realise that cross-border healthcare was more than a political ideal; it is the bedrock of a more civilised society.

I was delighted when the Minister, in his opening remarks, mentioned that an agreement had been made with the Republic on cross-border healthcare. But are we getting exactly the same arrangements as we have now? Will they be translated into a legal document? If not, can he identify what will change for residents both in the United Kingdom and on the other side of the Irish border?

Secondly, I recognise that from 1 January UK and EU nationals who are working or studying in either the EU or the UK will be able to continue to be in receipt of the current reciprocal healthcare arrangements—I am delighted that that has been clarified again. However, most UK nationals, particularly in areas such as IT, are working as fixed-term contractors and not as permanent employees—they are not permanently in the country of their work. Will the Minister clarify whether any fixed-term contractor who currently works between the UK and the EU but is currently fulfilling a contract in the UK before returning to one in the EU will qualify for continuation of reciprocal cross-border healthcare arrangements, or will they have to be working in the EU on 1 January, as mentioned earlier?

Will EU au pairs who currently reside with UK families—their number has gone down from 90,000 to around 20,000 since the Brexit agreement—continue to receive free healthcare, should they, as is very likely, return home over the Christmas period? I realise that they will get it if they continue to stay after 1 January but, if they go home for Christmas for two or three weeks, will they then be denied that healthcare when they return to their families in the UK after Christmas?

Thirdly, I am incredibly worried about the cross-border flow of students. The noble Lord, Lord Greaves, mentioned the Erasmus programme, but it is not just that programme that has brought huge benefits to the UK, as well as to the EU over a great many years. Clearly, existing students will continue to enjoy reciprocal arrangements, provided that they continue in their course this year, but will universities—I use as an example Hull, which offers its German language undergraduates a year’s experience in Germany—as institutions have to fund health insurance? Will they pass on that cost to their students or will they be able to purchase exactly the same arrangements in some cross-border arrangement?

Finally—the noble Lord, Lord Bourne, referred to this briefly—will the Minister now, or in a note placed in the Library, say how successful the NHS has been in recovering health-related fees from non-UK residents over the past five years and what the administration costs have been as a proportion of overall recovered costs? I ask this because I have not seen anywhere assessments relating to the recovery of costs from the huge rise in claims that will be made by hospitals and other healthcare institutions when EU visitors, students and workers not currently operating in the UK do so after 1 January 2021. I am sure your Lordships would agree that it would be perverse if we had a system that costed the NHS in the UK far more than at present, simply because of the administration and bureaucracy surrounding those recharging facilities. As ever, I look forward to the noble Lord’s—as usual—courteous reply.