Healthcare (International Arrangements) Bill

Baroness Barker Excerpts

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[Baroness Barker (LD)]

My Lords, I, too, congratulate the noble Baroness, Lady Blackwood of North Oxford, on the clarity with which she introduced this legislation. On the basis of her speech, I look forward to many spirited debates with her in your Lordships’ House. I have a fair degree of sympathy with her as she has to bring forward this Bill under the constraints of her maiden speech. I thought she did that extremely well.

Before we get lost in a Bill which is bereft of detail, it is important to reflect on the purpose of the law, which is to enable citizens to understand and exercise their rights and to enable them to fulfil their obligations as citizens. It is not to provide a blank cheque or a blanket set of excuses to the Executive. This Bill is deficient in that respect. I do not believe that any citizen of this country reading the Bill would understand their rights and responsibilities under it as of April. The noble Lord, Lord Foulkes, who went first, reported the thunder of the Delegated Powers and Regulatory Reform Committee. Some noble Lords have heard me use the description of that committee given by Mark D’Arcy, which is that they are a group of people among whom the raising of an eyebrow can be considered severe criticism. A report such as its report on the Bill is the equivalent of throwing a chair through a window because it is pretty strong:

“Clause 2 has a breath-taking scope. Indeed, the scope of the regulations could hardly be wider … There is no limit to the amount of the payments … There is no limit to who can be funded world-wide … There is no limit to the types of healthcare being funded … The regulations can confer functions (that is, powers and duties, including discretions) on anyone anywhere”.


I and many Members of your Lordships’ House have many a time sat through debates in this House about the detail of primary legislation that enables citizens of this country to go abroad for healthcare and the circumstances in which that would be approved by the National Health Service. There is nothing in this Bill about that. I wonder whether the Government are not setting themselves up for a slew of court cases at some point in the future in which people who have been unable to receive treatment in this country see that it is possible to have such treatment in another part of the world, as the noble Lord, Lord Kakkar, said, and try to do so. In particular, I am thinking of things such as fertility treatment. I do not imagine that that is the intention behind the Bill, but it is certainly possible.

We seem to be moving from a situation in which over time we have worked with our European partners, who have broadly comparable health systems and systems of publicly funded health provision which exercise similar clinical standards, and are seeking to extrapolate from that agreements with countries across the world where that does not apply and where the public provision may be extremely limited or expensive, as in the case of the United States. I think we are in some difficulty. The noble Lord, Lord Lansley, was correct when he put it to the House that the Government are putting in place temporary, almost emergency, continuity arrangements for public healthcare but have given us this Bill, which is so bereft of detail that it can be much more widely interpreted. That is a problem, not just for individuals but for business.

I shall tell your Lordships about a young man I talked to about 18 months ago on this very subject. He was desperately worried about his future. He is a young man who would expect to go abroad during his career and to be a high earner and highly successful. The problem is that he is HIV positive, which means that it would simply not be possible for him to pursue his career in many places. He would be unable to do so in the Commonwealth because he would have to divulge his status and either he would not be admitted or he would not be allowed to live in a country legally. He cannot go to the Middle East, and he cannot go to America due to the healthcare costs. Therefore, he can see his world and his job prospects shrinking. Coming forward at such a late date with a Bill that is so lacking in detail makes life difficult for people like him.

I noticed during the discussions in another place that questions were put to the insurance industry, which was very honest. It is as much in the dark as anybody else. It was very forthright in saying that there are only two conditions that it can deal with under the changes in our arrangements with Europe: either having the EHIC or not having the EHIC. Frankly, if we do not have it, the cost of travel insurance will go up. Not only that but it will not be as easy for people with pre-existing conditions or disabilities to get insurance to travel for business or pleasure as it is for the rest of us.

I want to concentrate on one area which I do not think has been mentioned so far—the reciprocal provision between the United Kingdom and the Republic of Ireland. From what has been said, I understand that citizens of the Republic of Ireland and the United Kingdom benefit from the common travel area arrangements. We also have arrangements that are currently underpinned by the Belfast/Good Friday agreement. I understand that it is not the Government’s intention to cease the common travel arrangement. It is very beneficial to people on both sides of the border: people can access specialist treatment in the Republic of Ireland; equally, citizens of the Republic can travel for treatment in the north.

Ministerial Statements are extremely important, so, when the noble Baroness responds, I would like her to explain whether under the terms of this legislation the arrangements between the United Kingdom and the Republic of Ireland will be those in place as of 29 March and, if not, whether they are to be updated. For example, if treatments that are not currently available were to become available in the future in either the United Kingdom or the Republic of Ireland, would citizens of either country be able to take advantage of them? That is a very important point.

I think that we are in some difficulty with this Bill, and there is a particular danger for women. They might well get pregnant within whatever the timescale is, depending on what arrangements are agreed, and they might need treatment under maternity and gynaecology services. I would like to think that at the very least we might be able to give them some reassurance that they will, if only on an emergency basis, be able to seek treatment. I have absolutely no doubt that medical people the world over will abide by the oath of their profession; they will not seek to deny treatment to anyone in urgent need. However, that is not the point; the point is that we need to try to secure arrangements around which individuals and businesses can build their lives and construct their future prosperity.

I agree with my noble friend that this is not taking back control; it is a constitutional land grab. As a matter of principle, we should not let legislation as deficient as this pass through without an intense amount of scrutiny, and I hope that the Government are willing to come back with the degree of detail that should have been in the original Bill.