Healthcare (International Arrangements) Bill

Baroness Jolly Excerpts

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

[Baroness Jolly (LD)]

My Lords, I join other noble Lords in welcoming the noble Baroness, Lady Blackwood of North Oxford, to the Dispatch Box and in congratulating her on her very fine maiden speech. I hope she learns to love her brief. On these Benches we look forward to working with her, improving legislation and asking fairly regular questions.

One of the privileges of membership of the European Union is that, no matter where we are in the EU, our health needs are safeguarded when we need medical attention. Under EU agreements, the UK has participated in a variety of reciprocal healthcare arrangements with other countries, with the result that all citizens and visitors are protected. This Bill aims to allow the Government to implement new relationships with our EU neighbours, but it goes far further. It aims to give the Secretary of State powers to fund healthcare outside the UK and to give effect to healthcare arrangements between the UK and other countries. It gives data powers to the Secretary of State that exceed what one might think he or she should need.

We know how crucial it is that people’s health is protected after 29 March. In 2016, 91,000 British citizens used their EHICs while abroad in Spain. In Germany, 22,000 British citizens accessed medical help when they urgently needed it. Each year, thousands of older British people who have retired to the EU rely on reciprocal healthcare to access services as they age. Kidney Care UK has called for greater certainty for people living or travelling abroad with long-term health conditions and for those of us who have booked holidays for after Brexit. The BMA warns that care needs may not be met if many people are forced to return from abroad where their health needs are no longer covered. The BMA and the Nuffield Trust have estimated that in that scenario, an additional 900 beds might be needed. Of course, social care might also be affected.

A Bill of this kind is necessary if we are to leave the European Union. I do not believe that the extraordinary scope of the overall Bill has been adequately justified by the department, and I have several areas of concern. First, I am concerned by the extent of the powers called for. This issue has been raised several times today, but it is important to reiterate it. In November, the House’s Delegated Powers and Regulatory Reform Committee described the scope of Clause 2 as “breath-taking”. The committee noted that the clause covers everything from what kinds of healthcare can be funded to whom functions can be delegated to. That would appear to be everyone, everywhere. The Bill does not limit its scope just to Europe. It calls for worldwide powers to make healthcare agreements with any country, anywhere. Why is this necessary? Surely the focus of the Bill should be purely on building new agreements with the EU and EFTA countries.

Clause 4 makes any healthcare provider and anyone the Secretary of State decides an authorised person. Does this mean that confidential health records can be shared with private healthcare providers and anyone else the Secretary of State gives authority to, in the UK or abroad? I appreciate that data is important, but I wonder whether the Government are getting distracted from the key issue at hand.

In direct contradiction to the Government’s promises regarding the Bill, only last week a no-deal technical notice was published by the Department of Health and Social Care which recommended that British nationals living abroad should buy health insurance.

I am seriously concerned by the lack of comprehensive affirmative procedure in the Bill. Under this version of the Bill, regulations which do not contain provisions that make modifications to primary legislation are subject to the negative resolution procedure. Simply put, the Bill does not make provision for adequate parliamentary oversight, is too wide, and is unfocused in what it covers. As the DPRR Committee noted in paragraph 11 of its report, there is nothing that would prevent the theoretical funding of incongruous or excessive health procedures with the blessing of the Secretary of State. It is regrettable that these issues have been raised countless times since November, yet the Government have not fully explained why they request so much power and so much scope. Will the Minister, in her summing up, therefore justify in plain terms the reasons for the Bill being formulated in such a way?

I will spend some of my time considering the issue of devolution. I was glad to catch up with the noble Baroness at a recent meeting before she became Minister, when we were able to share ways of working—probably the nicest way to put it—which could be useful. I was pleased to hear that the Bill team has been working closely with Scotland, Wales and Northern Ireland, as the Bill will affect their NHS systems too. Scotland and Wales have already voiced their support for the Bill, but I will draw attention to some reservations. The Senedd noted that,

“given the significant impact on devolved areas it is crucial that Welsh interests are appropriately considered in the development of reciprocal health arrangements and that mechanisms are in place to ensure that the Welsh Government contributes to the making of decisions that affect Wales”.

If the Bill passes, will the Government commit to consulting the devolved nations when new reciprocal healthcare relationships are negotiated?

Northern Ireland, as has already been stated, faces a particularly tricky set of issues with regards to healthcare post Brexit. For example, children regularly travel from Northern Ireland for cardiac surgery in Dublin, and there is a radiology unit in Derry that is a cross-border initiative available equally to patients on either side of the border. It is co-staffed and co-funded, and ambulance routes cross the border many times a day. While we are on Northern Ireland, could the Minister consider this scenario of a citizen of the Republic of Ireland living in France and returning to live in London? How do they stand with regard to the Bill? I am pleased that the Minister has confirmed that close work is going on between Westminster and relevant officials in Northern Ireland and the Republic to ensure that no individual reliant on cross-border services faces disruption in the case of a no-deal situation.

I am also concerned by the provisions for data sharing in the Bill. The noble Lord, Lord Kakkar, referred to that issue in his speech, and we will come to it in quite a lot of detail in Committee. Clause 4 provides a legal basis for “authorised people” to process personal data for reciprocal healthcare after the UK leaves the EU. This could be as part of an agreement with the EU, an agreement with a non-EU country, or in connection with no-deal plans. Clause 4 clarifies that this data sharing must be in accordance with data protection legislation. But how do we guarantee our data safety once it is exchanged with bilateral partners? Health data, by its detailed nature, proves particularly sensitive in this regard even when it is made anonymous.

In the NHS, the Caldicott principles were developed in 1997 to consider how patient information is handled across the system. Principle 4 states that access to personal confidential data should be on a strict need-to-know basis. Clause 4 does not adequately safeguard this need-to-know principle. The purpose of this clause appears to be so that we can know how many citizens of other countries are using the NHS, and vice versa. The noble Lord, Lord Thurlow, made the point earlier that it is important that we should know that, but it is not contained in this part of the legislation. In practice, we all know that this is very tricky data to collect. NHS England and the devolved NHSs all use different data management systems. This NHS England data will be in the purview of the Minister; I wish her the best of luck with it, because it needs a strong hand.

A core value of our NHS is that it is free at the point of need. We know already that our hospitals and surgeries are not set up to process treatment charges, let alone to feed this information back into a complex system to be adequately anonymised and passed to the relevant country. We heard about dummy bills; I lived in the Middle East for some years in the 1990s, and in the country where I was living healthcare was free. You went to see the doctor and were given a prescription, you had a conversation and might be referred on, and you were given a dummy bill so that you understood what the value of your care was. That was quite an eye-opener. I am sure that it would be quite difficult to implement here—they were starting with an almost brand-new health service—but it brought you up short and made you think. Have the Government fully considered the practicalities of implementing some aspects of Clause 4?

I fail to understand why the Bill is of global scope when it is brought in in order to mitigate the damaging effects of Brexit. The Bill should refer to future reciprocal health arrangements with EU and EFTA members only. I am also worried by the extent to which data protection and devolution issues have been considered. These are key areas where the Government can achieve their objectives to guarantee reciprocal healthcare without reaching for such powers. It seems that the Bill embraces a somewhat laissez-faire approach to our future international healthcare arrangements. By asking for far-reaching powers, the Government neglect thinking critically about what they will truly need to negotiate future agreements.

I am sure that we will explore these issues in more depth in Committee, when I hope that the Minister will listen to and act upon the concerns that are expressed by this House. Parliament should not, and I am sure will not, lightly hand such sweeping powers to the Executive to do as they please. Parliament has the right to say no. If the Government do not listen to this House and do not act to limit the powers in the Bill, we will have no choice but to vote against its passing at Third Reading.