National Health Service (Cross-Border Healthcare and Miscellaneous Amendments etc.) (EU Exit) Regulations 2019

Baroness Jolly Excerpts

Wednesday 27th March 2019 Lords Chamber

Finally, we need to ask what the implications are for this SI of the reduced scope of what was the Healthcare (International Arrangements) Bill. Given that that is on the statute book and has been prayed in aid several times in the Government’s answers to questions asked by the statutory instruments committee, is this SI fully compliant now, or does it need to be looked at again? I beg to move.

[Baroness Jolly (LD)]

My Lords, I think there is agreement across the House that provision of healthcare for British nationals travelling, living and working abroad must be a priority for the Government. I apologise to noble Lords for having missed the first outing of this SI, before it was rumbled, and I thank my noble friend Lord Rennard for stepping into the breach on that occasion. This SI aims to preserve current arrangements for reciprocal healthcare with the EU until 31 December 2020—we will come to the dates later. Success appears to rely on the Government’s ability to agree this approach with individual EU member states. However, Minister Stephen Hammond seemed to suggest last week that several of these agreements have yet to be finalised. This represents an unacceptable level of uncertainty. As was noted by the Minister last week, at least 180,000 British nationals living abroad currently access their healthcare through EU systems. Many more visitors use the EHIC scheme when they are in need.

My first question is whether, since last week’s debate, any further progress has been made with EU member states regarding continuing current healthcare arrangements under a no-deal scenario? I know we are less clear than we were last week— although I am not sure how clear we were last week—about the end game of all this, but how is it being communicated to people? Which are the priority states and who determines the negotiation order? Is it alphabetical, by popularity with holidaymakers, or by the number of British residents living in those states?

This SI also makes reference to what was previously known as the Healthcare (International Arrangements) Bill. Through the diligence and hard work of noble Lords, some present today, necessary amendments—which I too am delighted the Government have accepted—have made this Bill more acceptable.

More generally, it worries me that we have seen plenty of substandard legislation brought to this House recently; the Government appear almost totally unprepared for a no-deal scenario. We are here today because this SI failed the scrutiny of the Joint Committee on Statutory Instruments. The committee drew the attention of both Houses to problems with this SI, on the grounds that it requires elucidation in two respects and fails to comply with proper legislative practice in one. I thank the Minister for her comments just now reacting to these concerns, but will emphasise a few points and ask her a few questions.

Given that there has already been some uncertainty about the extent of powers afforded to the Secretary of State under what was originally known as the Healthcare (International Arrangements) Bill, it is worrying to see similar uncertainty in this SI regarding Regulation 16.

The committee highlighted that greater clarity was needed under Regulation 18 to comply with proper legislative practice. In the SI as it stands, there remain areas of ambiguity over how this regulation interacts with other areas of legislation. For those trying to determine their health rights in the future, this ambiguity is potentially damaging and certainly confusing.

I thank the noble Baroness, Lady Thornton, for highlighting last week the difficulties of finding information about post-Brexit healthcare abroad on the Government’s web pages. In light of this, in addition to further clarity in the legislative text, will the Government confirm that they will additionally produce explanatory material that will be user-friendly? That final word is important; the material must be for the average families who holiday once or twice a year and use their EHICs for that, because clearly that will no longer be possible and they need to understand what the options are and what the alternatives should be. I note that the Minister said that the Government would do something like this; this would fulfil exactly what she suggested.

Does the Minister agree that the use of a narrative impact assessment, and hence the decision not fully to quantify or monetise the relative costs and benefits of the options under consideration, has made it harder for Parliament to offer this legislation proper scrutiny? Also, the impact assessment used for this SI, and the others considered last week, referred repeatedly and explicitly to the,

“Cost Recovery Regulations (EU Exit) SI”.


Can the Minister confirm which of the SIs this in fact referred to? It appears to be a mistake.

Can the Government explain why they believed that a public consultation was not necessary for these SIs? My noble friend Lord Rennard noted last week that the reaction to them from expat groups abroad has been one of unhappiness and confusion, particularly regarding the 12-month guarantee for treatments agreed or begun before or on exit day. I am particularly concerned about those elderly people who will not be fit to travel back to the UK for treatment should they require it after we have left. I take it from the Minister’s remarks just now that this matter has now been clarified and resolved.

Given the uncertainty of the Brexit timetable, how do the Government intend quickly and effectively to alert travellers and expats to their healthcare coverage status in the event that we exit without a deal? In particular, how will they keep citizens updated on which countries have agreed to continue current reciprocal healthcare arrangements until 31 December next year? Dates are confusing to us all; will the date of 31 December 2020, outlined in this SI as the day on which transitional continuation of current arrangements with other member states will cease, be revised given that we will no longer exit on 29 March?

[Lord Lansley (Con)]

My Lords, I did not have an opportunity to contribute to this statutory instrument earlier last week on the related SIs, for which I apologise, but I certainly contributed to the discussion on the then Healthcare (International Arrangements) Bill. This instrument relates directly to that. I am quite pleased to follow the noble Baroness, Lady Jolly, who asked some good questions. I shall not repeat what she said but I just say that, good questions though they are, none of this adds up to a criticism of the statutory instrument and its drafting, as such. Rather, these are matters of elucidation and practice in bringing the instrument in, so an amendment expressing regret would be slightly excessive under the circumstances.