Healthcare (International Arrangements) Bill

Julie Cooper Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Monday 21st January 2019 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

First, as the Bill is given its Third Reading, may I thank all Members who have contributed?

We will not oppose the Bill at this stage, as we acknowledge the importance of safeguarding healthcare for the estimated 190,000 UK expats living in the EU and the 50 million nationals who travel abroad to EEA countries each year. That is not to say that the Bill is perfect—far from it. There are issues that for us remain unresolved, and we are anxious about the implications of the sweeping powers that the Bill will give the Secretary of State. We hope that Members in the other place will pick up on some of these concerns.

We are now only 67 days away from formally leaving the EU. On Second Reading—which, coincidentally, was 67 days ago—there was a clear assumption on the Government’s part that an agreement with the EU would be reached and that arrangements would carry on as now. I do not think it is an understatement to say that that is now looking rather less certain.

I said at the time that the Government’s own impact assessment seemed seriously to underestimate the consequences of a no-deal scenario. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) said earlier, the impact assessment set out how the costs of establishing future reciprocal healthcare arrangements on the same basis as now would be £630 million per year. It then went on to estimate that, in the event of a no-deal scenario, the costs would be expected to be similar or less, depending on the number of schemes that were established. It has never been made clear why the costs might be less, unless we stop reciprocating with other countries, and I do not believe anyone expects that.

The British Medical Association and the Royal College of Paediatrics and Child Health have expressed concern that, should no EU-wide reciprocal agreement be achievable, the significant costs of establishing bilateral reciprocal arrangements with the EU and EEA countries would in future fall on the NHS. Perhaps in the scenario we now face, we will be able to replicate exactly what is in place now, but that is not certain, and the implications are potentially significant. I therefore ask the Minister whether he would mind keeping us updated on the progress in bilateral discussions.

UK state pensioners living abroad account for 75% of the total amount that we spend on reciprocal healthcare, and they will be anxious to know that they will be able to enjoy the same access as they do now. If not, those with chronic conditions or complex healthcare needs may need insurance that is prohibitively expensive—if it can be found at all. The potential implications of that cannot be underestimated. For those travelling abroad, the BMA and others have said that, without a reciprocal healthcare agreement, patients with disabilities would also be among the most affected. Again, for those groups, as much information on progress as possible would be appreciated.

Associated with that is a lack of clarity over how dispute resolution will work in the event of bilateral agreements being necessary. We know from what the Minister has told us that, if we manage to reach full agreement with the EU27, there will still be a limited role for the European Court of Justice, but we do not know what the dispute resolution procedure will be if we do not. Can he confirm whether it is still the Government’s position that the ECJ will have no jurisdiction in the event of bilateral agreements being necessary? I am not sure what incentive there will for other countries to agree to a brand new dispute resolution architecture, and I doubt very much that they would want to pay for one. It seems to me that, sooner or later, the Government will have to come clean with their own Back Benchers that, in this area at least, the ECJ will still have a role to play, even in the event of a no-deal scenario.

Even under the current arrangements, cost recovery is something that we do not appear to have handled satisfactorily and the fault for that lies with the Government alone. In 2012-13, the NHS charged only around 65% of what it could have done to visitors from outside the EEA and Switzerland, and only 16% to visitors from within that area. Although I accept that things have improved since then, they are still far from perfect. Indeed, as my hon. Friend the Member for Ellesmere Port and Neston mentioned, the Public Accounts Committee said that it was chaotic.

The Law Society of Scotland was clear on the importance of this issue when it gave evidence to the Lords Committee. It said that

“as the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.”

So the Government need to raise their game in terms of cost recovery. If there is an additional administrative burden on the NHS in setting up new systems of cost recovery because of agreements reached, will the Minister give a commitment that NHS providers will be adequately compensated?

Perhaps the issue of reciprocal healthcare matters most on the island of Ireland where the border area has a dispersed population of around 2 million people, with an integrated healthcare system that has to survive whatever the future arrangements end up being. They cannot be failed by this Bill, which is why we believe that there needs to be maximum parliamentary oversight.

This Bill is necessary, but it does seem that the Government have used the opportunity to give themselves powers far beyond those that are necessary to achieve the objective set out under this legislation. They are using every trick in the book to avoid proper scrutiny of their actions. That is part of a disturbing trend that we are seeing across much of the Brexit legislation. It is a trend that does the Government no credit and it is a trend that I believe Members from across the House will come to regret.