Tobacco Harm Reduction

Lord Foulkes of Cumnock Excerpts

Tuesday 2nd April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I emphasise that smoking is now at the lowest levels recorded, and we should be proud of the fact that the UK is seen as a world leader in tobacco control. However, we are by no measure complacent, because there are variations between different groups and across the country. That is why the NHS Long Term Plan contains a commitment to do more to target smokers in NHS care, why NHS health checks offer an opportunity to smokers to quit, why PHE backs the very successful Stoptober campaign, why we are introducing smoke-free prisons, why we are introducing interventions for those within the mental healthcare system, and why we are introducing a new smoke-free pregnancy pathway. All those things will ensure that we continue to reduce the incidence of smoking in the UK.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, will the Minister look at the experience of Scotland 20 years ago? A factory was opened that produced these small tobacco pouches, but it was closed down within a year—I was one of the people responsible—because of the incidence of mouth cancer. We saw that, in the United States and elsewhere, mouth cancer was caused by sucking those pouches. It really is a crazy suggestion from the noble Viscount.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his point. I shall certainly look at the experience of Scotland. There will be an evidence-based review, which will look at the risks as well as at the proposals.

Healthcare (International Arrangements) Bill

Lord Foulkes of Cumnock Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Lord Marks of Henley-on-Thames (LD)]

My Lords, I have in my name Amendment 4, which has a great deal in common with the other amendments in the group. It is intended to achieve two objects, the second of which is to restrict the operation of the Bill to the EU, the EEA and Switzerland—as do other amendments of the group—by ensuring that the object of any regulations under the Bill would be limited to replicating existing arrangements. The first sentence of my amendment would delete subsections (2) to (4) and thereby drastically narrow the regulation-making power to replicating the reciprocal healthcare arrangements we have now. That part of my amendment fits more sensibly with the amendments in the second group, and I shall address it then. I will be brief in speaking about this group because I agree with every word that the noble Baroness, Lady Thornton, and the noble and learned Lord, Lord Judge, said.

This House has shown conclusively that it supports ensuring that we can continue to provide EHIC cards to the 27 million British citizens who enjoy them and guarantee continuing healthcare to British pensioners living elsewhere in the EU along with the other arrangements for reciprocal healthcare that we enjoy as members of the European Union. Those arrangements are in place. They work extremely well in providing guaranteed healthcare across the countries that they cover. They enjoy very wide public support and are clear. Millions of our countrymen and countrywomen would be very unhappy to lose them as a result of Brexit, but there is absolutely no urgency for introducing legislation now for healthcare deals around the world.

Throughout the debates on this Bill, the Government have not come up with a single reason why we should not now pass this legislation limited to agreeing the continuation of our existing reciprocal healthcare arrangements while deferring legislation for new healthcare agreements with third countries to another time, and then considering the Secretary of State’s powers in the context of those arrangements in another Bill. Before we legislate for new international healthcare agreements, we should be able to consider in detail the criteria for making them, what should be their objects and limitations, what they should contain, who should be in charge of monitoring them and how we might seek to improve them. We should also have clear arrangements in place for their parliamentary scrutiny better than exists under the existing CRaG rules for consideration of treaties by the House of Commons.

It may be, as the noble Baroness, Lady Thornton, said, that international healthcare agreements could be beneficial to Britain and British citizens, but they could also be detrimental, with unacceptable increases in pressure on the NHS and with the potential for healthcare agreements being offered without proper scrutiny in exchange for trade deals on terms that many would find offensive. All we are asking on this side of the House and, as we have heard, from some of the Cross-Benchers, is to give this Bill a fair wind and pass it quickly only to enable the reciprocal arrangements that we have to be continued but giving Parliament a chance to consider carefully the far wider and more difficult issues involved in agreeing new healthcare agreements across the world. This Bill does not do that.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, I support my noble friend Lady Thornton who has done a splendid job in dealing with this Bill, in analysing it and bringing forward amendments for consideration by the House. According to the Delegated Powers Committee, this Bill has “a breath-taking scope”. I have not heard that said about any other Bill coming before the House. All the other Bills and statutory instruments that we have considered deal with providing exactly the same arrangements that we have at present in the event of no deal. They have been precautionary for that. This is the only one, as I understand it, and this is the only department that is trying to include something completely new, very wide and extensive, as the noble Lord, Lord Marks, and my noble friend Lady Thornton said.

If the Government want to do that, as my noble friend said, they can wait until the Queen’s Speech. We know that the Government Chief Whip does not know when that will be, but there has to be one eventually and that is the right time for us to consider it. We can then look at the proposals in detail and, as the noble Lord, Lord Marks, said, examine them then. These additional powers are opposed by the trade unions, the BMA and a whole range of people. Indeed, I have not found anyone except Conservative Members and Ministers in favour of this wide extension, this “breath-taking scope”, of the Bill. I hope that the House today will support my noble friend’s amendment and reject the proposal put forward by Her Majesty’s Government.

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[Baroness Chisholm of Owlpen (Con)]

My Lords, I cannot agree with these amendments. As we pointed out during the progression of the Bill, we live in a global world, with more people travelling internationally for all kinds of reasons. There is obviously a huge demand for healthcare systems between countries, giving the traveller peace of mind that the foreign country they are in can respond to healthcare needs.

As was also mentioned, we already have simple reciprocal agreements with non-EU countries. The domestic implications are limited, and our current powers to charge domestic overseas visitors, and the regulations under such powers, provide for domestic implementation. Importantly—

[Lord Foulkes of Cumnock]

May I interrupt the noble Baroness?

GP Partnership Review

Lord Foulkes of Cumnock Excerpts

Thursday 21st February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I absolutely have had a large number of conversations with general practitioners who have struggled. In my previous role as a Member of Parliament, I visited a large number of general practices in my constituency. I am also the daughter of a doctor and I have a rare disease, so I spend a lot of time in the NHS as a patient and, perhaps, as a mystery shopper—so I assure the noble Lord that I have extensive experience of the NHS. I would not claim, however, to understand what it is like to be a general practitioner, so I would always hope to learn by continued experience of listening to their experiences and challenges.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, why does the Minister think that the reality that we see every day in the outside world differs completely from what she says at the Dispatch Box?

[Baroness Blackwood of North Oxford]

I do not think that that is the case. I think we are making good progress. It is a challenging picture for general practitioners; that is exactly why, since the New Year, we have introduced the long-term plan to increase funding for the NHS, and in particular for general practice. We have introduced this review with support from the department, new GP practice with support from the BMA and the new GP IT Futures plan so that we can bring in the most innovative technology for GPs so that they can bring the best and most innovative care to patients.

Healthcare (International Arrangements) Bill

Lord Foulkes of Cumnock Excerpts

Committee: 2nd sitting (Hansard): House of Lords
Thursday 21st February 2019 Lords Chamber

[Lord Lansley (Con)]

My Lords, I shall speak to Amendments 37 and 39 in this group, which are in my name. The noble Lord, Lord Marks, has helpfully introduced them in the point he made towards the latter part of his remarks about the distinction made in the EU withdrawal Act between retained direct principal EU law and retained direct minor EU law.

As the noble Lord said, that principal EU legislation should be subject to the affirmative procedure was recommended for the Trade Bill. That was accepted by the Government but has not been incorporated into this legislation. My Amendments 37 and 39 would do precisely what the Constitution Committee recommended on Monday. Happily, I tabled my amendments last week, rather than waiting until after Monday, as that would have been rather late. The amendments would allow the Government to indicate their support for this process. I hope that they are drafted correctly and that they would do the job, but, even if they do not, we will have the opportunity for that to be remedied on Report. I hope that my noble friend on the Front Bench will say that it is the Government’s intention to make this change.

Participating in the Committee stages of both the Trade Bill and this Healthcare (International Arrangements) Bill gives one an opportunity on occasion to make a positive comparison between the two. However, it is getting confusing. The Trade Bill is intended to roll over existing agreements and specifically does nothing else. Members—not least on the other side—are spending much of their time trying to persuade the Government that it should include reference to how things should be agreed in the future. The Bill before us creates a power not only to roll over existing agreements but to make new ones. On Tuesday, much time was spent on Members of the House arguing that this was inappropriate and should be left to future legislation. As they say: you cannot have it both ways. But it seems that in this instance, at least on this specific point, we can ask Ministers to change the Bill for this purpose.

I commend to the Front Bench Amendments 37 and 39, which would incorporate an affirmative requirement for amendments to retain direct principal EU law.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, I strongly support the amendment of the noble Lord, Lord Marks, and everything he said. I fear that, given the welter of things happening in politics at the moment, this kind of Bill is getting through without proper scrutiny and that many people, in both Houses, do not realise the importance and far-reaching implications of what we are considering. We are therefore very grateful to people like the noble Lord, Lord Marks, for drawing attention to this issue. I am astonished that this has apparently got through unchallenged in the other place. Many of my colleagues—with the notable exceptions of my noble friend Lady Thornton and her colleagues on the Front Bench—have not realised what an urgent matter this is.

I arrived late on Tuesday and was unable to participate in the debate on the first amendment. I missed the wonderful speech by the noble and learned Lord, Lord Judge. He raised the issue again at Question Time today and was answered by the noble Lord, Lord Young of Cookham, who is with us. Astonishingly, as the noble and learned Lord, Lord Judge, said on Tuesday and said again today:

“The harsh reality is summarised in the fact that it is exactly 40 years since the other place rejected a statutory instrument—40 years”.—[Official Report, 19/2/19; col. 2172.]


For the last 40 years, we have been dealing with legislation without the ability to amend it. Whether the procedure is affirmative or negative—I will come to that later—does not matter: we have not had the opportunity to amend it. What happens? The statutory instrument is drawn up by civil servants and put forward to Parliament by the Government. What is Parliament asked to do? You have to agree it or not—and if you do not agree it, you get threats. You get people saying, “This is a killer amendment” or, “This is a killer resolution”. That happened yesterday, I think, on a couple of statutory instruments, and the amendments were not moved in the end.

So we have a take it or leave it situation with statutory instruments, unlike with primary legislation. When the subject was raised, the noble Lord, Lord Young of Cookham, said that it was a much wider issue—it had been raised in the wider context. A trickle of SIs has become a flood. More and more issues that ought to be dealt with by primary legislation are being dealt with by secondary legislation. The more that happens, the bigger the transfer of power from the legislature to the Executive. That is exactly what the Government are doing. I ask them to think carefully. This Conservative Government will not be in power for ever. I hope some people agree with me on that—somebody say, “Hear, hear”.

[A noble Lord]

Hear, hear!

[Lord Foulkes of Cumnock]

Thank you. I wonder what the noble Baronesses, Lady Blackwood and Lady Manzoor, and the noble Lord, Lord Young, think of the possibility of my good friend Jeremy Corbyn bringing in legislation through statutory instrument after statutory instrument without any ability for scrutiny by a Conservative Opposition. That has to be thought about. This is a parliamentary democracy and people have to think about that and about what they are storing up for themselves. That is exactly what is happening.

I go back to the excellent speech by the noble and learned Lord, Lord Judge. He said:

“A late Victorian, or maybe Edwardian, professor of history described Henry VIII as ‘the mighty lord who broke the bonds of Rome’, but even Henry VIII was compelled to do it through express, primary legislation enacted in the Reformation Parliament. On one view, it may be a misdescription to call this a Henry VIII clause. Bearing in mind that it applies to both UK and EU primary legislation, perhaps in this context it is a Henry XVI clause”.—[Official Report, 19/2/19; col. 2171.]


That was a wonderful description.

Earlier, at Question Time, the noble and learned Lord said that we might issue a stamp commemorating 40 years since the last statutory instrument was overturned by the other place. We all thought that was very amusing and it was a lovely description, but it is a very serious matter. I understand the take it or leave it approach to appropriate secondary legislation, but when the issues considered ought to be dealt with through primary legislation, we get into very dangerous territory indeed. I hope the Minister, in the context of this Bill, and the Government, in the wider context of other Bills, will realise the constitutional implications of what they are proposing and that their short-term political expediency will have some long-term consequences that they might live to regret.

[Lord Butler of Brockwell (CB)]

My Lords, I agree with the noble Lord that our parliamentary processes for dealing with statutory instruments are unsatisfactory—in particular, that we cannot amend them. But is not the remedy in Parliament’s hands? If we were a little bolder and rejected some statutory instruments, it would not be difficult for the Government to reintroduce them in an amended form. The amendment could be very slight. It seems that statutory instruments are necessary, particularly when we are dealing with all those that result from our leaving the European Union. Therefore, we need to look very carefully at the parliamentary process for dealing with them. It seems, as the noble Lord, Lord Young of Cookham, said at Question Time, that this is in Parliament’s hands. We could be bolder and achieve the objective of amending statutory instruments by rejecting some of them.

--- Later in debate ---

My experience of the amending of statutory instruments, which is rather long, is that if the thing has to be amended, it is much better to send it back and let it be reconsidered. That is the real purpose of the way the system was developed: that you do not allow an instrument to pass which is defective; rather, you should throw it out and let the Government amend it.

[Lord Foulkes of Cumnock]

I was going to intervene in the speech of the noble Lord, Lord Butler, but this applies equally here. I have to be careful not to give away too many secrets and internal arrangements, so this is a purely theoretical example. Certainly that can be done, but if a Chief Whip tells you that voting against this is a fatal Motion and urges you not to do it, when that kind of situation builds up it is very difficult. It may well happen. It may already have happened, without giving too much away.

[Lord Mackay of Clashfern]

If a defect was pointed out in a statutory instrument, I would consider that a matter for stopping it going forward. Most of the arguments I have heard in recent times do not point to any mistake in an instrument. They are more theoretical. I do not wish to examine them in detail—I have done that once—but it is important. That is what was proposed when these instruments were originally laid. It is much easier to amend an instrument by taking it back and starting again than with an Act of Parliament. That is the appropriate procedure for correcting a defective instrument, and it happens, not necessarily formally, but quite often instruments are withdrawn when a mistake is pointed out; they get round to writing it again and hopefully the second time it is improved.

--- Later in debate ---

I shall certainly—as the noble and learned Lord, Lord Hope, has said—be considering all the issues that have been raised in this debate, and taking them away. I hope that the context that I have given of the strictly limited intended use of the Henry VIII powers and the reasoning that we have used for EU retained law has been helpful; and that our commitment to engage with noble Lords further on this critical matter will mean that the noble Lord is able to withdraw his amendment.

[Lord Foulkes of Cumnock]

The Minister has been very helpful and said that she will consider the points raised. Am I raising my hopes too high by expecting that the Government may come forward with some amendments on Report?

[Baroness Blackwood of North Oxford]

The noble Lord is right to expect that I will take these questions away and consider them.

--- Later in debate ---

[Lord Lansley]

I am grateful for the opportunity to move Amendment 27, which is linked with Amendment 41. Noble Lords will recall that at Second Reading and again on Tuesday there was considerable debate about the distinction between agreements which are effectively rolled over—existing agreements the purpose of which is to replicate the EU reciprocal healthcare agreement presently in place—and other agreements made under this legislation. In the previous group of amendments, we discussed the Henry VIII power and in what circumstances it should be applied. This is different. From my point of view, this group is about which agreements should be subject to what procedure by way of parliamentary scrutiny where implementing legislation is required in relation to them.

After our debate at Second Reading, it struck me that a clear distinction should be made with what I call “continuity healthcare agreements”, which, as one will see if one looks at Amendment 41, are defined as agreements the purpose of which is to replicate the terms of agreements made presently under the EU social security regulations as there specified. Those are continuity healthcare agreements; they are being rolled over. They are not novel and do not bring new issues to bear. I think that their purpose is entirely agreed: we want to make it swift and certain that existing rights under EU reciprocal healthcare are reproduced in future and implemented rapidly. So it seemed perfectly reasonable for those agreements to be subject to the negative procedure. Therefore, if we could define continuity healthcare agreements in Amendment 41, it would enable those that are not continuity healthcare agreements to be subject to the affirmative procedure. That is what Amendment 27 would do; it would require the additional time and scrutiny to be devoted to where there was a new healthcare agreement—or, as it happened, a substantial amendment to an existing healthcare agreement.

I am not sure that the drafting will necessarily meet with my noble friend’s approval, but my purpose at this stage is to establish the principle that there are two kinds of healthcare agreement. We spent a lot of time on Tuesday arguing whether any extension of the powers beyond existing agreements was desirable and I do not want to re-enter that debate today. However, if we proceed down this path with this Bill, substantially amending existing reciprocal healthcare agreements or adding new ones, we should make a distinction between rollover agreements—that is, continuity healthcare agreements—and those which have substantial changes in them. So I commend Amendment 27 to my noble friend and beg to move.

[Lord Foulkes of Cumnock]

My Lords, I will make a couple of apologies. The first is to my noble friend Lady Thornton. She is absolutely right about our colleagues in the House of Commons anticipating this problem and the wide powers in this Bill. I accept her correction. Indeed, it was my noble friend who alerted me to the powers in the Bill and got me involved—she may be regretting it now, but I am grateful to her. I apologise also to the Minister for not being able to get to the meeting that she arranged with the noble Earl, Lord Dundee, and the noble Lord, Lord Marks. I was invited, but we had a very long Labour group meeting yesterday. I will not go into any of it in any detail whatever, because I am bound to total secrecy—but you can imagine what fun it was.

I want to deal with the distinction between negative and affirmative instruments. In my previous speech I expressed concern that statutory instruments are being used more and more, and inappropriately. Here, at least affirmative resolutions are better than negative instruments. As things stand, the Secretary of State has very extensive powers through this Bill. As the Delegated Powers and Regulatory Reform Committee said, they are of “breath-taking scope”. If all future legislation relating to the Bill were to be laid through a negative procedure, parliamentary accountability and scrutiny would be further—and substantially—undermined. Introducing the made affirmative, as per the amendment, would be in line with the majority of other legislation. Crucially, the Government could not legislate in the knowledge that they would not face parliamentary scrutiny. The Government argue that the absence of scrutiny will relate mostly to administrative actions. However, given the breadth of the Secretary of State’s powers, the negative procedure could easily be misused.

In her concluding remarks at Second Reading, the Minister, the noble Baroness, Lady Blackwood, said that she had heard,

“noble Lords’ preference for wider use of the ‘made affirmative’ procedure, which I will reflect on more as we head towards Committee”.—[Official Report, 5/2/19; col. 1487.]

We are in Committee now, so will she tell us the result of that reflection—or will we have to wait further to find out about it? The BMA echoed this stance and insisted that,

“any new powers granted to the Secretary of State are proportionate, subject to thorough scrutiny, and that all regulations are subject to the affirmative procedure in Parliament”.

I hope that we will get that assurance.

I return finally to that wonderful speech by the noble and learned Lord, Lord Judge, on Tuesday— I have quoted from it twice or three times already. He said:

“I will try not to bang on any longer”.


I will try not to bang on too long as well.

“If we had time and exit day was further away, I should propose that this Bill should be sent packing back to the Government to redraft it and produce a Bill that is constitutionally acceptable”.


“Hear, hear”, I say to that.

“That option is not open. The healthcare of our citizens in Europe, and EU citizens here, must continue and survive”.—[Official Report, 19/2/19; col. 2172.]


That is what we face. It is a gun pointed at our head: “If you do not agree to this, we are going to go out of the European Union with a bang and our people will suffer”. That gun is being put to our head. It is a pity that it is, otherwise I would support the noble and learned Lord, Lord Judge, in getting rid of Clause 5 altogether. In the meantime, all we can do is try to improve it a bit, and I hope that the Minister will give us an assurance that the statutory instruments will be of the affirmative nature rather than the negative one.

[The Earl of Dundee (Con)]

My Lords, I shall speak to Amendment 34. Reflecting concerns about the wide scope of regulations, it seeks for them to be subject to affirmative rather than negative procedures. That, in turn, would enable Parliament to exercise more scrutiny.

However, this aim should perhaps be viewed in three different contexts. The first context is reciprocal healthcare arrangements between the United Kingdom and the European Union. The second is arrangements between the United Kingdom and countries outside the European Union. The third is other possible ways and means, apart from affirmative or negative procedures, for redressing what so far may appear to be an imbalance, with too many powers given to the Secretary of State and too little influence assigned to Parliament.

On reciprocal healthcare plans between the United Kingdom and the European Union, the Minister will be right to caution that we should retain negative procedures. After a healthcare agreement is in place, those would be better able to avoid uncertainty and time delays in order to protect the interests of all direct participants within the new scheme.

Yet reciprocal healthcare arrangements between the United Kingdom and the European Union are a different matter. Does the Minister concur that in that regard there is a strong case for replacing the use of parliamentary negative procedures with affirmative ones, and that to do so would provide a more acceptable balance between the influence of Parliament, which becomes greater, and not putting people at risk within the new scheme?

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[Lord O'Shaughnessy]

The different Governments have clearly taken different approaches. The noble Lord will know that it does not automatically follow, even if you know where you all want to get to, that you can agree it overnight. I am sure that my noble friend the Minister will be able to update us.

[Lord Foulkes of Cumnock]

My Lords, I want to endorse everything that my noble and learned friend Lord Wallace of Tankerness has said. He has the great distinction of having been for some time Deputy First Minister of Scotland and, for a short period, acting First Minister. Very few people can claim that distinction. Again, I agree with every word he said. I describe him as my noble and learned friend in every sense of the term—I hope that is not misunderstood. I also agree with everything said by the noble Baroness, Lady Humphreys.

What I find difficult to understand is why this Bill has received the legislative consent of the Scottish Parliament—which is usually more reluctant to give consent—and not that of the Welsh Parliament. I can only assume that it is because the noble Lord, Lord O’Shaughnessy, kissed the Blarney Stone before he went to Edinburgh again, and was able to persuade them. I am interested to know why and will try to find out from my contacts in Scotland before Report.

I suspect that a lot of the points made about the omissions in this Bill have arisen because this legislation, like much of the legislation we are considering at present, is being rushed because of Brexit, without proper consideration being given. I do not blame the officials, who have so much work to do. I went to a briefing they held right at the start of this process and I know that they work very hard. However, I would rather see them doing more constructive work than some of what they are being required to do on Brexit.

I agree with the noble Lord, Lord Hain—and I find this not only in health but in a lot of other areas—that some officials, particularly at the higher level in Whitehall, still have not come to terms with devolution; they do not quite understand what it means, or that the health service in Scotland is run completely by the Scottish Parliament. It is difficult for those officials who have been involved since before devolution to understand that fully. I hope that we will do more to get the message across as we move forward. I hope that the next Government, of whatever shade—a non-Conservative Government; I will put it that way—take more care of the devolved settlements.

The noble Lord, Lord O’Shaughnessy, said that he has had discussions with the Cabinet Secretary for Health and Sport in Scotland, Jeane Freeman. The Minister has taken over very recently and will not yet have had time to do this, but can she assure us that she will have an opportunity to meet with Jeane Freeman to discuss this issue between now and Report? I hope she will be able to report back to us in more detail on the attitudes of the Scottish Parliament and let us know whether it is satisfied on some of the points that have been raised by the noble Baroness, Lady Humphreys, and my noble and learned friend Lord Wallace of Tankerness.

[Baroness Wheeler (Lab)]

My Lords, I am moving Amendment 42 in the name of my noble friend Lady Thornton and the noble and learned Lord, Lord Wallace. The noble and learned Lord has already spoken to the amendment and covered many of the points that we need to raise. The amendment focuses on ensuring that the commitment to involve, consult and have regard to the views of the devolved Administrations, before regulations on new health agreements are drawn up, is in the Bill and set out as a clear duty on the Secretary of State. The amendment ensures that:

“Before making any regulations under this Act, the Secretary of State must consult the Scottish Government, the Welsh Government and … if there is no Executive on the day on which this Act is passed the relevant Northern Ireland Department”.


The Minister told the House at Second Reading that the Government have been working with the devolved Administrations and fully understand the need for legislation on reciprocal healthcare agreements to fully respect the devolution settlements. The amendment would reassure the Committee on this matter—that reassurance has to be given, as speakers have illustrated. We also support the principle of the safeguard set out in Amendment 30A, moved by the noble Baroness, Lady Humphreys, and Amendment 30B.

As we have heard, given the significant impact on devolved authorities, it is crucial that their interests are appropriately considered in the development of reciprocal health arrangements and that mechanisms are in place to ensure that each Administration contributes to the making of decisions that affect Scotland, Wales and Northern Ireland. I look forward to the Minister’s update in respect of the Scottish Government. The noble and learned Lord, Lord Wallace, provided us with some of the detail of the ongoing discussions, despite the Scottish Government having carried the legislative consent memorandum. I look forward to the Minister’s updated response to the issues the noble and learned Lord raised.

As we heard from the noble Baroness, Lady Humphreys, and my noble friend Lord Hain, the Welsh Government have so far declined to recommend that the Welsh Assembly give its legislative consent to the Bill. The Welsh Minister for Health and Social Services expressed particular concern about Clause 2 because it does not require consultation with or consent from Ministers in devolved Administrations. However, the Minister of State’s offer to amend the Bill to place a statutory duty on the UK Government to consult the devolved Administrations where regulations under Clause 2 would be within their legislative competence is welcome. This would be underpinned by an accompanying memorandum of understanding, stating that all parties will seek to proceed on the basis of consensus. Draft agreements would be discussed with the devolved Administrations before they are shared with third countries and Ministers would be consulted on the content and drafting of regulations made under Clause 2 where they relate to devolved matters. Could the Minister confirm this?

This approach would be a welcome step that would help to create a positive framework in which the future of reciprocal healthcare arrangements can be discussed on a collaborative and constructive basis. Consulting before making regulations would also smooth the process for making regulations, given that any statutory instrument which amends Welsh, Scottish or Northern Irish primary legislation would of course be subject to a statutory instrument consent memorandum in each legislature, which would decide whether to recommend that consent be given in the circumstances.

As noble Lords underlined, the importance of reciprocal health arrangements to the people of Northern Ireland—and of Ireland—has been raised by noble Lords at Second Reading and in our separate amendment dealt with earlier. A statutory commitment to consult and seek the views of either the Northern Ireland Executive or the relevant NI department on regulations enacting new healthcare agreements would provide reassurances about the continued funding arrangements.

Finally, I hope the Minister will be able to respond to the recommendation from the Constitution Committee’s report, which underlined the need for the Government to set out how they intend to manage those overlapping competences relating to the Bill. As the committee points out, while the making of international agreements is a reserved matter for the UK Government, healthcare is a devolved matter and the potential for overlapping competences increases as all powers are repatriated from the EU, as does the scope for disagreement about such issues. This will need to be managed.

Our amendment places the Minister’s commitments to consultation and involvement with the devolved Administrations in the Bill—no more, no less.

Healthcare (International Arrangements) Bill

Lord Foulkes of Cumnock Excerpts

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Thornton]

I congratulate the Minister on her summing up and answers. As these things go, it was absolutely perfect. I did not agree with a lot of it, but I commend her skills.

I thank all noble Lords who have taken part in this debate. I know it has taken almost two hours, and I knew this would be a very important debate because it is about the scope of the Bill. The noble Lord, Lord Patel, was right to put down clause stand part, because it focuses the mind—of the Government, certainly—when you are facing a clause stand part. We all knew that this was probing the scope of the Bill, which was exactly right.

I say to the noble and learned Lord, Lord Judge—just keep banging on. I agree with other noble Lords that this is very important. All of us will be reading the noble and learned Lord’s remarks very carefully, because they have given us a lot of material for how we are going to take these discussions forward. The noble and learned Lord may have used the term “carte blanche Bill”. My honourable friend Justin Madders in the other place called it the Martini Bill: good “any time, any place, anywhere”. I wanted to join in with finding different ways of describing the Bill and the experience of the noble Baroness.

The noble Lord, Lord Ribeiro, was right to draw attention to the issue of no deal and to talk about the problems of the scope of this Bill. I welcome the remarks of the noble Lord, Lord Lisvane, because he has such huge knowledge of the powers that are being talked about in this Bill. With the noble Lords, Lord Cormack and Lord Wilson, he expressed enormous frustration—from enormous knowledge, power and experience—with what we are dealing with here and how unacceptable it is. I am afraid that the Minister and the noble Lords, Lord O’Shaughnessy and Lord Lansley, have not dealt with that frustration. I take one grain of hope from the fact that the noble Baroness said she was open to discussion, and that was very wise of her. We will need to have more discussions.

I am looking forward to the future amendments in the name of noble Lord, Lord Marks, but this was a very useful amendment to put into this group. The noble Baroness, Lady Brinton, is quite right to talk about changes to NHS procurement. As we know—and I declare an interest as the chair of the procurement committee for a clinical commissioning group—European rules do rule, and that is important.

[Lord Foulkes of Cumnock (Lab Co-op)]

I apologise to my noble friend that I was not here earlier, due to travel difficulties—

[Noble Lords]

Oh!

[Lord Foulkes of Cumnock]

It is in order to ask a question during Committee.

[Baroness Thornton]

As much as I admire and love my noble friend, he should probably not intervene at this moment, but he has lots of opportunities to do so in the next few hours and I know he will take them.

The letter that the Minister sent, and the representations of the Government to the DPRRC, really did not take these concerns seriously. My noble friend Lady Andrews was right when she said that while these long letters are full of interesting things, they do not address the powers. The powers are not just for Brexit and the following years—they are for ever. That is the point.

While of course I will withdraw the amendment, because that is what we do in Committee, I assure the Minister that unless something changes in the next few weeks regarding discussions with her, I suspect we will be returning to this at the next stage of the Bill. I beg leave to withdraw.

--- Later in debate ---

[Lord Foulkes of Cumnock]

The noble Lord has quite rightly referred to the existing countries—Australia, Bosnia-Herzegovina, North Macedonia, Montenegro, New Zealand and Serbia, as well as our independent territories—with which we have reciprocal agreements. They are being dealt with at the moment without the need for this Bill, so is my noble friend Lady Thornton not right to be suspicious, irrespective of the Minister’s assurances? We know that 24 Tory MPs and Peers have links to 15 private healthcare companies which have £1.5 billion worth of NHS contracts. We are right to be suspicious about what they are up to; indeed, there is one of them sitting opposite.

[Lord Marks of Henley-on-Thames]

My Lords, I am grateful for that intervention: I did not know the facts about the involvement of certain members of our political establishment in healthcare arrangements. I agree that we are right to be suspicious and I shall come to that later in my contribution, but for now I will go on to the second fundamental fault with the Bill, which is that the proposed powers would enable the Secretary of State not only to make healthcare arrangements with countries across the world but to make such arrangements on whatever terms he or she chooses. That is a dangerous concept.

Many noble Lords, including me, quoted the Delegated Powers Committee’s powerful first report on the Bill at Second Reading. We have now had its second report, published on 14 February. It is in similarly strong terms, speaking, for example, of,

“unprecedented powers for Ministers to make law by statutory instrument”.

The powers are described as far too wide and,

“drafted in far wider terms than are necessary to give effect to the Department’s limited aims”.

I agree with the noble Baroness, Lady Andrews, that the Government ought to be listening more carefully to that committee and to the Constitution Committee. I agree that it is frankly outrageous that, on receipt of the first report of a committee that, when I was a member of it, generally expected its reports to be accepted by the Government, instead of that report being accepted, the Government came back with a response that stuck by every word in the Bill, made no real amendments to it, and provoked the second, outraged report of the committee. That, in my experience, is unprecedented. The committee chose, on this occasion, to deal with the Bill before the Commons had finished dealing it, rather than between Second Reading and Committee in the House of Lords, and the Government, frankly, took no notice.

The Constitution Committee said:

“We agree with the Delegated Powers and Regulatory Reform Committee that the powers in clause 2 are ‘inappropriately wide and have not been adequately justified’”.


I went through the powers in outline at Second Reading. The committees have been through the powers in detail, but the Bill puts absolutely no limit on the Government’s power to enter such deals. The Secretary of State would be empowered to authorise payments and claim reimbursement at any level he or she chooses and for any kinds of healthcare arrangements. Parliament would have no effective scrutiny or control. I urge the Committee to remember the Delegated Powers Committee’s central point, which it repeated in its second report, that,

“we assess powers by how they are capable of being used, not by how governments say that they propose to use them”.

The Government now profess entirely innocuous motivations for taking the powers contained in the Bill to make international healthcare arrangements outside the European context. Indeed, the noble Lords, Lord O’Shaughnessy and Lord Lansley, almost suggested that this was an exciting prospect. In closing the Second Reading debate, the Minister spoke of,

“a natural opportunity to consider how we can best support Britons in an increasingly global world … Global reciprocal healthcare agreements have the potential to protect public health by supporting international visitors to access emergency and needs-arising treatment when they need it”.—[Official Report, 5/2/19; col. 1488.]

She may be right. She repeats all those points in her long and detailed letter—a well-drafted, well-written and impressive letter that she sent to all of us yesterday or the day before. However, I am afraid that what she envisages as the use of the powers misses the point, as her answer to the noble Lord, Lord Brooke, on the possibility of a healthcare arrangement with the United States, illustrated. It is the powers that count, not what Ministers of the day might envisage for their use. The powers are not limited to such benign purposes.

I am not generally a cynic, but if we leave without a deal, then the day after Brexit one can foresee this Government, battered by the failure to reach an agreement, being desperately keen to make all kinds of trade deals with third countries across the world, in an effort to protect a vision of our future as “global Britain”, and no doubt to give the Department for International Trade a purpose to fulfil at the same time. There is a serious risk, in such a climate, of the Government offering third countries health deals in return for trade deals. The terms of such health deals could be seriously detrimental to the United Kingdom. Access to the NHS could be sold cheaply, and across wide and populous markets. UK taxpayers could be committed to unreasonable payments to foreign countries for offering treatment to UK citizens, and all as sweeteners to secure free trade deals. This is why I share the suspicions of the noble Lord, Lord Foulkes, and all this in an attempt to rescue an economy in difficulties—

--- Later in debate ---

[Lord Marks of Henley-on-Thames]

That does not, as I understand it, prevent the Government offering other countries access to the NHS on terms that are sweet for them.

[Lord Foulkes of Cumnock]

Clause 3(b) concerns,

“healthcare provided in the United Kingdom, payments in respect of which may be made by a country or territory outside the United Kingdom”.

So it is reciprocal and the noble Lord, Lord Lansley, who is one of the people involved with private healthcare, is trying to mislead the House by intervening.

[Lord Lansley]

I object to what the noble Lord has said: I am not involved in private healthcare in any sense. Not now nor at any time in the past have I acted in any way as a representative of the private healthcare sector. I think the noble Lord should simply withdraw that.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I listened to the first part of the debate today, and I add my welcome to the Minister to her new post. I regret that I was unable to be here at Second Reading because of a commitment that I could not cancel, and I declare that I am a member of the European advisory group to the Wales Assembly Government. I added my name to the amendment because the Bill goes far beyond its purported remit by providing the ability for the Government to create new policy relating to healthcare agreements with countries outside the European Union, the EEA and Switzerland.

We all understand that there is need for speedy passage of the Bill because of the approaching deadline, but the question arises: why not restrict it to the problem that it has to solve? Given that the purpose of the Bill is to ensure that reciprocal healthcare arrangements are in place once we have left the EU, it is appropriate that the Secretary of State’s powers are limited to do just that and nothing more. As I understand it, that is what the amendment is intended to, and does so for three reasons, because it aims to achieve three things.

First, it aims to ensure that UK patients in the EU and vice versa can continue to access healthcare easily, including those with long-term conditions. Secondly, our NHS is protected from a dramatic increase in demand for services that a failure to reach an agreement could generate. We anticipate that 190,000—some figures say 180,000—UK pensioners in Europe are currently reliant on reciprocal healthcare. They may otherwise have to return to the UK for treatment if healthcare agreements are not replicated. Thirdly, the General Medical Council has already pointed out that the medical profession could be deemed to be at breaking point. Those working in healthcare need to be able to focus on providing care rather than on cost-recovery and complex administration.

I have questions for the Minister on that. In the event that we do not have an agreement and cannot get reciprocity, as we would like, how will the identity for eligibility be confirmed? How many people will need to be employed to make the relevant checks? Do the Government plan to issue current NHS cards that must be presented to prove eligibility, and would such NHS eligibility be incorporated in visas to work, study or be resident here?

Clause 2 authorises the Secretary of State to make regulations,

“in relation to the exercise of the power conferred by section 1 … for and in connection with the provision of healthcare outside the United Kingdom … to give effect to a healthcare agreement”.

I fully accept the Minister’s sincere confirmation that this is not a trade Bill, but I have a question about that. We have had firm confirmation here but, in the other place, something contrary was said and recorded. Which has precedent? Does what was said in the other place take precedence over any assurances given here? I accept that they are given after the event but, as far as I am aware, we have not received anything in writing or had placed before us anything from the Minister to say that that was not the case.

Another issue, raised in previous debates by the noble Baroness, Lady Jolly, concerns the risk of the Bill being used as a political tool to promote a global healthcare strategy by enabling the Secretary of State to make arrangements with countries across the world, without restrictions on the terms under which that would happen. As a clinician working in the NHS, my concern relates simply to overburdened NHS services. At the same time, I understand that the Welsh Government have not yet provided a consent Order in Council on the Bill. Has there been consultation? How do the Welsh Government anticipate the Welsh NHS coping in the event of no deal and the failure of reciprocal arrangements?

[Lord Foulkes of Cumnock]

My Lords, I apologise to the noble Lord, Lord Lansley, and accept his assurance, which was given in good faith. I support the amendment very much. In his intervention, the noble Lord, Lord O’Shaughnessy, said that anyone in their right mind would not do the kind of deal indicated by the noble Lord, Lord Marks. Anyone in their right mind would not be moving us towards a no-deal Brexit, which I am afraid the Government are doing, so sometimes we do not believe them. We expect all our politicians, particularly the current ones, to be in their right mind.

I am not a Corbynista, as my noble friend Lord Liddle knows very well, but I am still in the Labour Party because it is my party. I had the awful experience of 16 years in the other place with the Conservatives in office, so I have become increasingly wary of what they get up to. I watch them very carefully indeed. I listen to their assurances and see them broken. I listen to what they say about the health service and see it undermined, slowly but surely. It would have been further undermined if we on these Benches and those on the Labour Benches in the other place had not done as much as possible to protect it, which is why I am suspicious of what is proposed.

Our current reciprocal arrangements work very well; my son works in New Zealand where, as in Australia, they work very well. They have been dealt with through current legislation so why do we need additional legislation? The Minister has not explained that properly. If we can have such arrangements now—not just with New Zealand, Australia, Bosnia-Herzegovina and Serbia, whose arrangements were achieved under the current legal framework—why do we need something new? I am sure the Minister understands why we are suspicious of this being tacked on to a Bill originally planned to deal solely with the problems that would arise in the health service and our reciprocal arrangements with the European Union in the event of a no-deal Brexit.

This matter raises all sorts of issues with priorities. Which countries would come first? Would it be the EU 27, collectively or individually? Which other countries would be on the list of priorities? Would this be a priority for the hard-worked officials in the health department? The Minister did not answer that question properly in her intervention. Of course, as she knows, she can intervene in the debate in Committee just like the rest of us—as long as we are here at the beginning of the debate on a particular amendment, as I was reminded earlier and accept.

In her intervention, the Minister said that any deals would of course be scrutinised by Parliament. Yes, but we will come to debate later scrutiny and the negative procedure versus the “made affirmative” procedure, neither of which can amend instruments. That is the problem with the scrutiny here: it is not proper scrutiny. We are taking that up in another context to deal with it. We see it happening at the moment with statutory instrument after statutory instrument being pushed through without proper scrutiny as we rush towards the cliff edge of Brexit. That is why we are very suspicious.

Like the noble Baroness, Lady Finlay, I welcomed the Minister at Second Reading; the debate was very good and the Minister replied well to it. I hope that she will excuse me but I spent 26 years in the other place and have seen the differences between a Conservative Government undermining the National Health Service and a Labour Government expanding it, developing it and putting more resources into it. I hope that she understands why we get a bit suspicious sometimes.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I offer my thanks to the noble Lord, Lord Marks, the noble Baroness, Lady Thornton, and my noble friend Lord Dundee for tabling Amendments 4 and 10, and for the opportunity to speak to our intentions for reciprocal healthcare arrangements. I also thank all noble Lords who have participated in the debate on this group.

My first point, in response to the noble Lord, Lord Marks, is that, far from going global with this Bill, we are already global when it comes to reciprocal healthcare. The UK has had reciprocal healthcare agreements with individual countries in Europe and the rest of the world since the 1950s and has taken part in EU arrangements since the 1970s. We want reciprocal healthcare arrangements with the EU after we leave, and that is the purpose behind a suite of measures that we are taking. But when it comes to non-EU arrangements, which perhaps the noble Lord, Lord Foulkes, missed in my summing up on the previous group, one of the reasons we are seeking the powers in this Bill is that currently we do not exchange money or data in non-EU reciprocal healthcare arrangements. We do not have those powers in our domestic legislation. That is why we are seeking them, so that we can strengthen those non-EU reciprocal healthcare arrangements.

The Government’s intention is to continue current reciprocal healthcare arrangements with countries as they are now in any exit scenario—deal or no deal—until 2020. The in-principle agreement that we have reached with the EU is that during the implementation period ending in 2020, all reciprocal healthcare entitlements will continue and there will be no changes to healthcare for pensioners, workers, students, tourists and other visitors, the EHIC scheme or planned treatment.

[Lord Foulkes of Cumnock]

The noble Baroness said that no money was exchanged in the case of New Zealand and Australia. So how do these reciprocal healthcare arrangements work? As I understand it, we have the same healthcare when we go to New Zealand as a New Zealander, and vice versa. Should that not be done? Why does it need the exchange of money?

[Baroness Blackwood of North Oxford]

It is done through waiver agreements.

Longer-term rights would also be guaranteed for those covered by the citizens’ rights deal, including people living in other countries at the end of the implementation period.

[Lord Foulkes of Cumnock]

The noble Baroness said that this was done through waiver agreements. If they work through waiver agreements, why can waiver agreements not work with other countries as well? They work in Serbia and Bosnia and Herzegovina, along with a number of other countries, as well as Australia and New Zealand, under current legislation. The Minister still has not explained why these extra powers are needed.

[Baroness Blackwood of North Oxford]

We have relatively simple agreements with these countries that do not allow for the level of complexity which we have within the EU reciprocal healthcare agreements, which allow for tourists, posted workers and UK pensioners who live in EU countries. We do not have that scale of agreements with non-EU countries. Perhaps we might like to explore that, as it has many benefits for people who go to those countries. However, that is yet to be explored and is part of the reason why we would be seeking those powers.

Perhaps I may continue to speak to the amendments in this group. The Government want to secure a wider reciprocal healthcare agreement with the EU following exit that supports a broader range of people such as those not covered by citizens’ rights when they move between the UK and the EU for leisure, work or study. We would then use the Bill to enable the UK to implement any future relationship with the EU on reciprocal healthcare from 2021. In a no-deal scenario we are attempting to prepare for any outcome.

I would like to speak to the points raised by the noble Baroness, Lady Finlay. She asked how people would be identified and for the details of implementation and communication with individuals regarding potential changes in circumstances. These issues will be addressed in quite a lot of detail in the eighth or ninth group, so if she will forgive me, I will not address them now. Regarding the points she raised around trade, I would hope that the assurances that I have offered from the Dispatch Box today and in writing in my letter at the beginning of this week will offer the assurance that she is seeking that the position I have laid out is the position of the Government and it is not going to change.

Finally, regarding her question about the devolved Administrations and our consultations with them, we are very pleased to have received a legislative consent Motion from the Scottish Government and agreement from Northern Ireland, and we are in advanced discussions with the Welsh Government. I hope to be able to report back on that point in more detail on Report and I will be happy to continue discussions with her on it.

I will go into a little more detail on our offer to the EU, EEA and Switzerland. It is to maintain reciprocal healthcare agreements so that nobody faces sudden changes to how they access healthcare. Maintaining the current arrangements as they are now is possible only with agreement from other member states. I can reassure noble Lords that we have commenced formal discussions on this issue. The two SIs we have introduced under Section 8 of the EU withdrawal Act, and which I wrote to your Lordships about, afford the UK a mechanism for ensuring that there is no interruption to healthcare arrangements after exit day in those member states which agree to maintain the current arrangements after exit day. Through these instruments, the UK can maintain current EU reciprocal healthcare arrangements for countries where we have agreed reciprocity for the transitional period lasting up to 2020. These arrangements would not apply to a member state which did not agree to maintain the current reciprocal healthcare arrangements. Importantly, the SIs also provide protection for individuals regardless of reciprocity, both here and overseas, who are in a transitional situation. This would provide additional protection for people who are, for example, in the middle of treatment.

Turning to Amendment 10, I can assure the noble Baroness, Lady Thornton, and my noble friend Lord Dundee that we want a relationship with EU member states that includes reciprocal healthcare. The fact that we have introduced this Bill is evidence of that. However, I have concerns about the amendment. First, there is good reason for the convention that one does not put negotiating terms on the face of primary legislation, because that does not allow for dynamic international relations—and we are in quite a dynamic situation at the moment. Secondly, it is important that reciprocal healthcare arrangements are consistent with wider mobility arrangements between the UK and the EU, such as the rights of different groups of people to move and work. These are areas that will also be under negotiation and may have implications for reciprocal healthcare. It is necessary that we have the flexibility to make changes in response to that.

--- Later in debate ---

[The Earl of Dundee]

My Lords, I will speak to Amendment 9 in this group, which, as the noble Baroness, Lady Wheeler, has indicated, differs from Amendment 6 in only one respect: through its reference to the European court. It is intended as a probing amendment.

It may have been implied that post Brexit we will not have recourse to the ECJ for arbitration or any other purpose. However, so far, that has not been clarified. Is my noble friend able to comment?

Could it be that we might come to use the ECJ for dispute resolution all the same, even if such were to be confined to reciprocal healthcare only? If not, how confident are we that, compared with the ECJ, an alternative system of arbitration will not be much more expensive—as the noble Baroness, Lady Wheeler, warns—and perhaps much less efficient? Who will the judges be? Where will adjudication take place? Will it be an open process?

If, as the Government have indicated in another place, the ECJ must keep a limited role in any case—this being for an accurate interpretation of EU law—might it then follow that it should therefore be retained more widely?

That would be the case not least if, as a result and compared with alternatives, this were to emerge as a cheaper and more convincing way for achieving competent arbitration in reciprocal healthcare disputes in the United Kingdom and the EU.

[Lord Foulkes of Cumnock]

My Lords, there is very little I can add to what my friend the noble Earl, Lord Dundee, said. If there is not a role for the ECJ, what system will there be? If there are disputes, how will they be resolved? I would like to hear what the Minister suggests.

[Baroness Blackwood of North Oxford]

My Lords, I thank the noble Baroness, Lady Wheeler, for moving Amendment 6 in the names of the noble Baroness, Lady Thornton, and the noble Lord, Lord Marks. I thank also my noble friend Lord Dundee and the noble Lord, Lord Foulkes, for tabling and speaking to Amendment 9. These allow me the opportunity to dwell for a moment on the importance of dispute resolution in the context of the Bill.

I am sympathetic to the spirit of these amendments and agree that it is of great importance that the Government establish robust dispute resolution in future healthcare agreements. We have every intention of being transparent and accountable as this develops. There are a number of ways in which dispute resolution might be approached in future reciprocal healthcare arrangements, but the majority would not require or benefit from regulations under the Bill. Dispute-resolution mechanisms that apply between two international parties should be set out in the agreement itself rather than in domestic regulations, since such regulations cannot bind another country’s Government. These regulations would be used to make any necessary domestic provisions for the agreed dispute-resolution mechanism.

I would, however, like to give further reassurance on the Government’s intention for future dispute-resolution mechanisms. There are different options for dispute-resolution mechanisms and it will be important to discuss these as part of future negotiations with other countries or the EU in respect of a future relationship.

To give some further context, as has been debated, the primary mechanism for resolving disputes on the withdrawal agreement is through consultation at the joint committee with the aim of reaching a mutually agreeable resolution. If parties are unable to resolve a dispute in the joint committee, either party can request the establishment of an independent arbitration panel to resolve the dispute. Prior to this, the parties can also agree to refer the dispute to independent arbitration. Future agreements for reciprocal healthcare may therefore seek to set out similar dispute mechanisms, but this is all subject to negotiation on an international rather than domestic level. This would be the case in a no-deal scenario as well as in a scenario post 2020.

In particular, noble Lords raised the point about clarity over the role of the ECJ in any future agreement with the EU. This is one point on which I believe the Government have been consistently clear, and I am happy to lay out our position. As we leave the EU, the direct jurisdiction of the European court will come to an end. However, as outlined in the political declaration, we have agreed that where a dispute raises a question of interpretation of EU law, the arbitration panel can refer this question to the CJEU for interpretation.

I reassure the Committee that, in resisting this amendment, the Government are in no way indicating that we do not place importance on dispute resolution; nor do we intend to conceal from noble Lords the approach that we may pursue. Instead, we resist this amendment as it would not be feasible or necessary to provide this level of detail regarding all possible dispute-resolution mechanisms in the regulations used to give effect to future negotiations and agreements. The correct place for this detail is in the international agreement itself, as I am sure your Lordships will agree.

The CRaG procedure will provide opportunity for scrutiny of those international agreements, which are legally binding and require ratification. We have been and will continue to be transparent about the agreements we reach. I am sure Noble Lords will agree that we abide by the rule of international law and take those commitments seriously. This means that we would be committed to upholding our end of any international agreement, including dispute resolution, and we would hold our partners accountable for doing the same.

I hope I have addressed the crux of the concerns raised and that the noble Baroness will withdraw the amendment.

--- Later in debate ---

Those are the purposes of my amendments. They are grouped with Amendments 17 to 19, which I will say nothing about other than it seems, on the face of it, that the Government want to achieve those objectives. I am rather hopeful that the Minister will be able to give that assurance. It would therefore not normally be necessary to put into the Bill those things which the Government intend to achieve in any case, and which do not require statutory backing. However, I am rather hopeful that she will see some merit in at least thinking about Amendments 7 and 8, and whether the Government should be clear about how far they should go—and where they should not go—on payments or persons for whom payments are made. I beg to move.

[Lord Foulkes of Cumnock]

My Lords, it is encouraging that on this occasion the noble Lord, Lord Lansley, and I are on the same page. We agree in relation to this. I declare my interest as chair of Age Scotland, which is concerned with the interests of older people in Scotland. Amendments 18 and 19 deal with travellers with long-term medical conditions, and pensioners. These are particularly vulnerable categories in the case of the noble Lord’s amendments. We are suggesting that the current provision in respect of healthcare for UK citizens with long-term medical conditions travelling to the EU, and for EU citizens with such conditions travelling to the United Kingdom, should remain the same. This would create an essential legal commitment for those travelling to the European Union, who would otherwise have to face astronomical insurance charges that could price them out of travelling altogether.

There may be one or two Members of this House over the age of 75. If they have tried to get travel insurance to a non-European country, I think they will have found that very difficult. The banks often give insurance as part of having your account with them up to the age of 75, but after that Age UK or Saga—I again declare my interests—may be the only two companies or organisations which can provide insurance for such older people, particularly those with long-term medical conditions, so we are in a difficult area.

The cost of overseas medical treatment varies according to the country and the type of treatment needed but the costs for those with long-term illnesses are inevitably much higher. If we do not put arrangements in place, often families will go away without some of their older relatives being able to go. The costs add up extremely quickly; as we know from countries where we do not currently have healthcare agreements, they can be thousands of pounds. As we heard in previous debates, we do not currently enjoy reciprocal health arrangements with most of the world. This means that, at the moment, the EU and EEA countries present the only realistic travel option for many people with health conditions. It is a tragedy for them that they may not have that option after 29 March.

Take those who have kidney dialysis, for example. There are 29,000 who get kidney dialysis, usually on about three days a week. At present when they travel to the EU, they need to book slots in units near where they stay. The EHIC allows them to do that, but in the event of no deal, UK citizens would be required to pay for those slots. That could cost anything between €250 and €350 for each session—something like €1,000 a week, which will be impossible for most people. The Law Society of Scotland has reported that more than a quarter of disabled adults already feel that they are being charged more for travel insurance, or simply denied it, because of their condition. That is at the moment but it would be as nothing compared with the post-Brexit scenario. The Association of British Insurers has written to all of us, I think. It is supportive of this amendment, stating that it,

“would encourage detailed agreement with the EU to be sought in order to provide certainty for travellers with long-term medical conditions”.

If the ABI supports it, I would hope that the Government will, too.

I turn to healthcare provision for pensioners. There are currently 180,000 UK state pensioners and their dependants living abroad, as mentioned earlier by the noble Lord, Lord Lansley. They are mostly in Ireland, Spain, France and Cyprus. Under the S1 scheme, the UK provides healthcare for all those British people abroad. The S1 covers not only pensioners but some others with exportable benefits, such as frontier workers and posted workers, for an initial period. It is estimated that UK state pensioners and their dependants made up about 75% of the total cost of £468 million in 2016-17.

The UK Government have said on their website that the S1 will be invalid with effect from 30 March. But the website offers no sensible advice—I hope that the Minister will—or alternatives to UK pensioners resident in the European Union, who are totally dependent now on the S1 for their medical care. British in Europe, which is the coalition of UK citizens in Europe, said:

“The maintenance of this scheme from March 30th in the event of No Deal is absolutely vital for those it covers. It is quite literally their only life-line. It is their NHS. They moved to the EU confident that they would be entitled to healthcare for life, based on this scheme”.


In fact, when I was in France last weekend, some people talked to me about it and they were deeply worried about their future. This is understandably causing alarm among all these citizens.

After Second Reading, I received an email from a British citizen living in Germany who had written to the Department of Health and Social Care. I hope that the Minister may have seen and even replied to his letter. He said:

“Any decision by the German authorities giving us a token right to stay after a No Deal Brexit would be pointless if we did not have the financial means to do so”.


I heard a pensioner in France say that she would be in difficulties in this way as well. This Brit in Germany went on to say that,

“most pensioners will have paid national insurance contributions and taxes into the UK system all their working lives. I continue to pay all my taxes into the UK. For what? Even if I could afford an extra €400-500 premium monthly for public health insurance … I should not have to”.

Of course he should not have to. He continued:

“If I am unlucky enough to require hospital or medical treatment after 29th March, the UK Department will be receiving the relevant invoices or will have to provide details of how they will be reimbursing me for my national insurance contributions”.


He has paid for it and is getting nothing in return. He said:

“Otherwise, it would just amount to the UK Government pocketing our contributions”,


and he is right on that. He also said:

“UK expat pensioners are innocent people caught in the middle of this debacle. We can’t just go out next month and top up our income if we are a bit low in funds. Please don’t play political games with people’s lives and livelihoods. If we must leave the EU”—


incidentally, as everyone knows here, I do not think that we should—

“then at the very least, please ensure Citizens’ Rights are properly protected”.

In cases where UK residents are not eligible for permanent residency, there will in some countries be potential for a voluntary opt-in to public health insurance schemes but that will vary from state to state and generally involve additional costs. In Spain, for example, there is a public health insurance policy if you have lived in that country for more than five years. However, it costs €1,900 for those 65 and over and €700 for those under 65. These are costs which British citizens in Europe do not currently incur. For them, it will be another Brexit tax. These innocent citizens will be caught out in this way because of Brexit. The Government must offer them some hope; otherwise it will be a really sorry situation.

[The Earl of Dundee]

My Lords, in this group, I support Amendments 18 and 19, which were addressed by the noble Lord, Lord Foulkes of Cumnock. As with a number of earlier amendments, here there are two specifications, each of which serves a clear and useful purpose: giving assurance without applying any onerous impositions.

In their forthcoming negotiations, the Government will clearly seek to protect current arrangements, in this case including those affecting travellers with long-term medical conditions as well as those for pensioners.

Be that as it may, incorporating these categories in the Bill would give much-needed comfort to direct participants as it would to others desirous of protecting them. If that is a positive effect, there is really no downside. That is avoided through Amendment 18, which states:

“It shall be the objective of Her Majesty’s Government”.


Post Brexit, those words will encourage the Government to replicate what already obtains without forcing that eventuality against insurmountable difficulties if any such should happen to intervene.

Healthcare (International Arrangements) Bill

Lord Foulkes of Cumnock Excerpts

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

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, before I revert to my usual mode of careful scrutiny, I offer a sincere triple congratulations to the Minister: first, on her elevation to this place—she did a great job in the other place and we welcome her here—secondly, on her appointment as Minister; and thirdly, as the noble Lord, Lord O’Shaughnessy, said, on a really excellent maiden speech. She comes to us with a great reputation and, I understand, undoubted ability. Given this Bill, she is going to need a lot of that.

This is an astonishing piece of legislation. With respect, relatively few have understood the wide and serious implications—and the consequences—of this Bill. I am astonished that the Scottish Government have not seen the implications, and that some of my colleagues down in the other place have not yet seen them. Thankfully, our Delegated Powers and Regulatory Reform Committee has understood it and produced a very good report. I am particularly grateful to the noble Lord, Lord Blencathra, and his colleagues for it. It particularly refers to Clause 2. I have read a few reports in my time, but this is really quite devastating. I will quote from it:

“We draw attention to clause 2 of the Bill. If the reason for the Bill’s introduction is to protect British citizens if a ‘no deal’ scenario affects current reciprocal healthcare agreements with other EU countries”,


which it does,

“clause 2 of the Bill goes considerably wider. It allows the Secretary of State to make regulations”,

first,

“in relation to the payment by the Secretary of State of the cost of all forms of healthcare … provided by anyone anywhere in the world”—

astonishing—secondly,

“for and in connection with the provision of any such healthcare, provided by anyone anywhere in the world”,

and thirdly,

“to give effect to international healthcare agreements”.

It goes on to say:

“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 … powers and duties … on anyone anywhere … The regulations can delegate functions to anyone anywhere … the regulations can amend or repeal any Act of Parliament ever passed”—


astonishing powers—and that:

“The Government say that clause 2 ‘enables the Secretary of State to address essential matters relating to healthcare abroad’. But the powers in the Bill go much wider than essential matters”.


It continues:

“All regulations made under clause 2 are subject only to the negative procedure”.


My noble friend Lord Adonis knows that that is a very—

[Lord Adonis (Lab)]

Dangerous.

[Lord Foulkes of Cumnock]

—dangerous procedure, but also that there is very scant scrutiny in that procedure. The report states that the regulations are subject to the negative procedure,

“save where they amend primary legislation. If, without such amendment, the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure”.

It is really quite astonishing. That is a great report. I could not have done better myself.

[Lord Adonis]

Why Arizona?

[Lord Foulkes of Cumnock]

Anywhere. That is just a random choice. It could be Texas or Alaska—it would be a bit more expensive in Alaska.

That is a really wide provision. Before we finally pass this Bill, Clause 2 needs drastic amendments. I say to my noble friends on the Labour Front Bench, to my friends—and they are my friends—on the Liberal Democrat Front Bench, to members of the committee and to Cross-Bench and Conservative Members that I hope that we will see those amendments in Committee. I hope that we will properly scrutinise this Bill because it has not yet been done.

The inevitable consequence of the Bill is to replace a system that works well and gives peace of mind to many thousands of British citizens with completely unnecessary worry and uncertainty. Whatever the Minister says, it will be about damage limitation. Of course, the worst of all options is no deal, which would immediately remove the guarantees which British citizens living in the European Union and European Union citizens in the UK currently take for granted. That the no-deal option is still on the table is an indictment of the Government and their failure to face up to the consequences of their attempts to appease the hard right of the Tory party. All we are offered by the Bill is uncertainty and “Trust the Minister; everything’ll be okay”. The Bill allows her or him to do just about anything, but instructs them to do absolutely nothing. That is a recipe for uncertainty.

Let us first take the S1 scheme, which is central to this debate. This allows individuals from one EEA member state to receive healthcare in another, with the cost of that care met by the state in which the patient would ordinarily reside. Some 190,000 UK pensioners living in the European Union or the EEA are currently registered for this scheme. What happens to their rights if we leave without a deal? Many would have to return to the United Kingdom in fear of facing astronomical health bills elsewhere. That would affect not only those currently benefiting from the S1 scheme but the NHS, which would have to take the strain of the increase in number of elderly returning citizens. A report by the Nuffield Trust estimated that if expats returned in large numbers, we would require 900 extra beds and over 1,000 more nurses. Where would they come from? It certainly would not be from European Union countries, since the Government are already busy telling them that they are not really welcome in the United Kingdom.

That brings me to the EHIC. I hope that everyone has it. I have mine. Every time I go abroad, I take it with me. We rely on it to make travel abroad a possibility. At present, 27 million active United Kingdom EHICs are in circulation. They are used to pay for around 250,000 medical treatments each year. Incidentally, I tried to find out how to apply for or to renew an EHIC. I put “European health insurance card” into the Google search. I pressed it and what did I get? “This page cannot be displayed”. We cannot find out. Can the Minister tell us why the Government are not allowing people access to the EHIC? Is it in anticipation of a decision relating to it? Is it in anticipation of a deal or no deal?

[Lord Adonis]

“Alternative arrangements”?

[Lord Foulkes of Cumnock]

If we lose this right, the only ones celebrating will be the insurance industry. When I tweeted something about the EHIC no longer going to be available, lots of people tweeted back saying, “Ah, but we can get travel insurance”. That is all right if you are reasonably wealthy, but for ordinary people who have struggled just to get enough money to go abroad, it is an extra cost.

These arrangements are the cornerstones of the freedom of movement principle which the European Union rightly sees as its own but which the UK Government, sadly, are hell-bent on opting out of. There are those who point to the deal that the EU has with Switzerland at present. It is true that, under the Bill in the event of no deal, we would be able to implement new bilateral agreements with European Union states, Norway, Iceland and Switzerland. This would be lengthy and costly, ultimately leaving the European Union without reciprocal arrangements for an unknown period. I raised this with the Minister and her counterpart in the Commons when they kindly held a briefing on it. They would be scrabbling around the European Union—indeed around the world—negotiating bilateral agreements. If the Health Secretary is as successful in doing deals as the Trade Secretary, there are going to be an awful lot of sick Britons scattered around the world for years to come.

We need to approve the Bill—of course we do; the Minister said it; the noble Lord, Lord O’Shaughnessy, said it—but with some appropriate and significant amendments to Clause 2. Without it, the Secretary of State will not even be allowed to do the deals which will protect British citizens abroad. However, there should be no doubt at all that the very good arrangement which we have at present is being replaced by, at the very least, an inferior one. It remains to be seen if the operative word really is “inferior” or if, as I fear, “disastrous” is a better way to describe what we are facing if we go for no deal. I hope everyone in this House will do everything they can to ensure that that does not happen. For the health of British expatriates and of those of us who travel overseas, it is vital that we do so.

--- Later in debate ---

[Lord Lansley (Con)]

My Lords, I join colleagues across the House in welcoming my noble friend to this House and to her new position. I had the privilege to serve in the other place with her. I know how highly regarded she was for her work there and in her constituency. As a former Member for South Cambridgeshire, I think it is very like north Oxford as a place. I had the pleasure of campaigning with my noble friend in Abingdon and had something to do, in a very small way, with getting her elected in the first place. The Commons’ loss is our gain. We are delighted to have her with us. I know that the Department of Health and Social Care is delighted to have its former Minister back.

I very much share the view of my noble friend Lord O’Shaughnessy, who was instrumental in the Bill’s composition, that it is very important and necessary. It is important that we do not alarm people about the circumstances of their healthcare. We should make it clear, if we can, that we are all setting out to try to ensure that there is continuity in the existing arrangements for reciprocal healthcare across the European Economic Area. We might not be in a position to guarantee that because the withdrawal agreement might not be implemented. If it is, that will be all well and good, but if not, we have to put something in its place. As a consequence, there may be some urgency associated with securing bilateral agreements to deliver that continuity. That is at the heart of what needs to be in the Bill: an ability for the existing healthcare arrangements to be replicated through bilateral agreements in short order, not necessarily waiting on the approval of the two Houses of Parliament in a logjam.

I know that noble Lords will immediately say, “Hang on a minute, we have to be able to approve this thing”. I bring to the discussion of this Bill the benefit of having just been involved in Committee on the Trade Bill. Because there was a lack of powers, on the Trade Bill we were asked to provide the necessary powers to secure continuity and the rollover of existing agreements. In legal terms, this is not the same. We are not rolling over agreements—we may be implementing agreements —but the substantive purpose is the same: to enable healthcare provision across Europe to be provided for UK residents in the future in the same way as in the past. As we go through the legislation we need to make a distinction between what is a continuity provision and what is a new provision for new agreements. Where the Trade Bill was concerned, we did not need to do that; it was not about new agreements.

The noble Lord, Lord Marks, must be careful with the point he made about Clause 5 and regulations that,

“may amend, repeal or revoke primary legislation”.

Yes, it can be,

“(a) for the purpose of conferring functions on the Secretary of State or on any other person”,

but he added an “or” before paragraph (b). He said,

“or to give effect to a healthcare agreement”,

but it is not this; it is,

“to give effect to a healthcare agreement”.

As my noble friend Lord O’Shaughnessy said, this is all in order to implement international treaties.

[Lord Foulkes of Cumnock]

The noble Lord is absolutely right to distinguish between continuity legislation and totally new provisions in legislation. Does he not agree that it is bad enough to push to get a number of Bills and other legislation through quickly by the end of next month when it is continuity legislation—but that if it is totally new legislation, there is absolutely no justification at all?

[Lord Lansley]

We spent four days in Committee on the Trade Bill. I do not know how much time is planned for this Bill but it is perfectly possible for us to consider this legislation and to put in place the necessary powers for future agreements, as long as it is done with the necessary scrutiny and approval provisions. I will come on to make one or two points about that, and I am sure we will go on to debate that robustly—as my noble friend on the Front Bench said—in the days ahead.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I thank my noble friend Lord Lansley for that intervention. One of the reasons why I raise that process is because I am aware that there are ongoing discussions in other parts of the House. We will reflect on that as we progress the Bill.

My noble friend Lord O’Shaughnessy spoke of positive engagement with his EU counterparts on bilateral arrangements in the event of no deal. A number of noble Lords raised what would happen should the withdrawal agreement not go forward. My noble friends Lord Ribeiro and Lord Lansley both raised the question of no deal. My noble friend Lord Lansley is right that we should be careful and seek to reassure those who currently rely on reciprocal healthcare that they will be able to rely on these arrangements going forward. Great interest has been expressed by our counterparts in the European Union, where we are seeking bilateral arrangements with relevant member states in the event that we reach 29 March without a deal with the EU.

[Lord Foulkes of Cumnock]

The Minister has been really helpful in her reply and has dealt extremely well with the points raised. She has come to a crucial one now. I think that everyone understands that if there is a deal along the lines that have been agreed, reciprocal arrangements will continue. That is one of the positive things about it. However, if there is no deal the Minister and the Government need to be honest with us and the public about it. It will not be easy to negotiate bilateral deals with 27 different countries if we come out with no deal. If the Minister and the Government are honest about that, it will make people understand that it is vital, if we are to leave the European Union, that there must be some kind of deal, because no deal would be a real disaster for healthcare.

[Baroness Blackwood of North Oxford]

The noble Lord, Lord Foulkes, raises a very important point, and he is absolutely right that the Government do not seek to have no deal. The best way to avoid no deal is to have a deal. Under the withdrawal agreement there is protection of reciprocal healthcare arrangements for EU citizens in the UK and for UK citizens abroad, and that is what the Government seek to deliver. We have set out a number of steps to ensure that individuals who currently receive reciprocal healthcare can be protected as much as possible under a no-deal scenario. One of them is to put in place the powers in this Bill so that we can go very quickly to seeking bilateral arrangements. That is why I hope we will receive the support of the noble Lord as we go forward with this legislation.

Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Lord Foulkes of Cumnock Excerpts

Wednesday 19th December 2018 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

With the leave of the House—perhaps more in hope than expectation—I would like to move the three Motions standing in my name on the Order Paper en bloc.

[Lord Foulkes of Cumnock (Lab Co-op)]

Object.

[The Lord Speaker (Lord Fowler)]

Then we will take the first Motion on the blood safety regulations.

--- Later in debate ---

[Lord Foulkes of Cumnock]

My Lords, this is yet another one. I will take up the suggestion of the noble Lord, Lord Trefgarne, and look forward to attendance at Grand Committee in future, where I will do as I did on the aviation statutory instrument yesterday and seek to have it negatived so that we can have a proper debate on the Floor of the House. The Government are sneaking through Grand Committee very important matters which affect this country and there is no proper debate on many of them, which is unfortunate. As my noble friend on the Front Bench said, if the House of Commons had had an opportunity to vote, we could have eliminated the possibility of no deal and freed up civil servants to get on with productive work, which is what they should be doing and what they would like to do.

[Lord O'Shaughnessy]

Perhaps the noble Lord should consider attending some of these debates. We had a very good debate, attended by Front-Benchers of the Liberal Democrats and the Labour Party as well as Cross-Benchers, about these incredibly important regulations which are designed to provide continuity to people who rely on such things as blood and organs and the ability to exchange information for surrogacy purposes—which we want to encourage. While I respect the noble Lord’s right to do what he is doing, it is not a good use of time. It would have been better spent if he had engaged in our debate last week.

Vaping

Lord Foulkes of Cumnock Excerpts

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

The right reverend Prelate is right. However, as I say, we do not see evidence of what is going on in the States happening in this country. The reason for that is that we have many more restrictions, and the US is now playing catch-up by introducing them.

[Lord Foulkes of Cumnock (Lab)]

My Lords, is the Minister aware that one of the consequences of the welcome ban on smoking in public places is that when you go out of a hospital or an airport you face a curtain of smoke and a carpet of fag ends? Will the noble Lord, as Health Minister, with his colleagues, do something about ensuring that that does not take place and that there are secluded places for people to smoke where the rest of us do not have to go?

[Lord O'Shaughnessy]

I agree with the noble Lord from personal experience. Organisations are encouraged to make sure that there are outside places for people to smoke which are in discreet areas and do not interrupt others.

Personal Social Care: Funding

Lord Foulkes of Cumnock Excerpts

Tuesday 16th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I am not sure that a trial is required; what is needed is a systematic change in the way we do things for everybody. I am interested to hear what the noble Baroness says about the under-65s. One thing I can tell the House is that the Green Paper we will publish this year will deal with adults of not only retirement age but working age. Those were two separate streams that were working in parallel, but they will be contained within the same Green Paper.

[Lord Foulkes of Cumnock (Lab)]

With respect, the Minister has not answered the question he was just asked. Free personal care has been implemented to a large extent in Scotland. How is it possible to do it there but not here?

[Lord O'Shaughnessy]

It is the Scottish Government’s decision to do that. Of course, they receive higher public funding per citizen than we do in England, and we make different decisions, just as we have on higher education funding and so on. As I said to the noble Baroness, the details of the proposal will be set out in the Green Paper during the year, and I am afraid that the noble Lord will have to wait.

Health: Medical Respite for Children

Lord Foulkes of Cumnock Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right. Local authorities and CCGs have a number of responsibilities. We are applying pressure and making clear to all bodies that they have those responsibilities. We have of course provided funding through local authorities and CCGs for that to happen, and we expect it to.

[Lord Foulkes of Cumnock (Lab)]

My Lords, further to the question from my noble friend Lady Royall, I have great respect for the Minister but how can we believe what he says about enough money being available when health authority after health authority throughout the country says that not enough money is available and some of them are forecasting deficits? Who is right, the Minister or those who are running our health service?

[Lord O'Shaughnessy]

I do not deny for a minute that the health sector is under pressure—I have never once pretended that that is not the case. There is growing demand in all areas, whether that is children, adults or older people. We have provided more funding year on year during a difficult time of fiscal retrenchment, and indeed the Budget provided more money. Of course there is more to do, but I think that what I have said shows our commitment to funding the NHS as much as we can.