Healthcare (International Arrangements) (EU Exit) Regulations 2023

Lord Naseby Excerpts

Wednesday 5th July 2023 Grand Committee

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend on bringing forward what I view as very welcome regulations for us this afternoon. I have to declare an interest, as I currently have an EHIC, which I assume will expire at the end of this year, and visit a very small number of the countries on this list. Given that the list on page 5 in the Schedule seems very full, I take this opportunity for my noble friend to put my mind at rest, because originally—it was a year ago, 2022—it was pointed out that the GHIC, which my noble friend explained will replace the EHIC in the regulations, originally did not cover countries such as Norway, Iceland or Liechtenstein, but they appear on the list. Is that because the original primary legislation did not cover them, or were we just waiting for the regulations before us this afternoon? Can he confirm that the EHIC covers those three countries and that the GHIC will also cover them?

From a practical point of view, I have never yet had to make a claim. I once, rather unfortunately, contracted salmonella poisoning as a Conservative candidate at a hotel which will remain nameless in north London, which rather sorrowfully served chicken drumsticks but did not have the foresight to defrost them. Unwittingly, I was so hungry I ate the chicken drumsticks, and within 36 hours I was in a very sorry way, but not as bad as some of my older colleagues at the time, who had to be hospitalised because of salmonella poisoning. I was then fortunate enough to be injected, not in my arm but in another part of my anatomy by a French doctor and had to have a course of whatever tablets they were.

Are we under these arrangements required to pay similar costs to those in that scenario up front, keep receipts and claim them back when we are back in the UK? Is that how it works? I think most of us are covered, and I know the department and the Foreign Office encourage all of us who travel outside the UK to have the fullest possible medical insurance that we can. Is it reciprocal? Does, say, a Norwegian, a Dane, a Liechtensteiner or someone from whatever third country pay here and is then reimbursed by their medical authorities—just to be absolutely clear on the reciprocity of the situation?

I give the regulations before us this afternoon a very warm welcome.

[Lord Naseby (Con)]

As I understood it, the Schedule on page 5 covers overseas territories and dependent territories. I note that the Cayman Islands is not listed. I have not had time to check whether anywhere else is off the list, but I wondered whether my noble friend could find out and let me know. I ought to declare an interest: one member of my family is working in the Cayman Islands, and there may be others. I recently attended a conference of all the overseas territories and dependent territories, and there seemed to be rather more than appear here, but that may be me and my memory bank. I leave that question with my noble friend.

[Lord Allan of Hallam (LD)]

My Lords, I also welcome this statutory instrument, which seems to be a helpful tidying-up exercise overall. Of course, it is humane and to our credit that we seek the maximum number of reciprocal arrangements so that people in the UK travelling to other countries can get healthcare when they need it and people coming here can benefit from our health service. That is important as a humane response.

First, on the comments from the noble Baroness, Lady McIntosh, I have a GHIC card; I think I was one of the first out of the traps in 2021. My understanding—the Minister will confirm this later—is that the “G” is rather more aspirational than material; that the GHIC is really an EHIC because it does not count in any other places, such as Australia or New Zealand; and that it is really a version of the EHIC rebranded with a rather fetching union jack. I am interested to hear from the Minister whether I have understood that correctly. Of course, it seems to be the Government’s aspiration that, one day, the “G” in your GHIC will be meaningful but as I say, as I understand it today, it is an “E” rather than a “G”.

We are pleased that there was consultation with Ministers in Northern Ireland, Wales and Scotland. Again, a regular theme of the stuff that we debate in this House is that there have been a number of other instances where that has not happened, such as with the minimum service levels Bill. It is good to see that, here, Ministers have given their approval.

I want to ask a few questions. The first is a material one on the scope of UK-insured persons; that is some of the language used in the instrument. My understanding is that there is a difference. For example, as long as they are a UK-registered resident, somebody who is resident and a taxpayer in the United Kingdom—whatever passport they hold—can get a GHIC card and use it in the European Union but they would not be able to do so in Switzerland because it has a narrower category of people who qualify; people there would, I think, need a UK passport to take advantage of the relationship.

That opens up a wider question: what is the Government’s policy? Is it that anyone who is a UK resident and taxpayer here should benefit from the reciprocal arrangements, or are the Government content to leave it such that we limit the scope in some countries? I followed the links to look at the information provided to people on GOV.UK. Oh my God; I am not sure whether I regret going there because it is incredibly complex. If noble Lords look at it, they will see that some countries want a driving licence, some want a passport—some want a UK passport while others want any passport—some want proof of residence and some want the magic card. There is a huge plethora of proofs of identity and qualification. Again, people’s expectations would be that, if they live in the UK and pay their taxes here, they should be able to benefit from the reciprocal arrangement. However, that is not what we see at the moment.

Regulation 6 says that the NHS Business Services Authority has a duty to

“maintain a service making available to the public information”.

Something useful could be done on the BSA working with GOV.UK to give people a much easier way to say, “I am going to country X: do I qualify? If I do, what documents do I need? At the moment, there is a long list that is incredibly confusing”. This is just a thought for the Minister as to whether Regulation 6 would include asking the Business Services Authority to improve the quality of the information offered at present.

My second substantive point concerns Regulation 7, which says that the

“BSA must assist the Secretary of State with the Secretary of State’s exercise of functions”.

Another critical piece of information here is understanding what is happening through this arrangement. What are the costs in and out? How many people from another country are using the NHS? How many people from the United Kingdom are using services in another country? Can the Minister clarify whether, as well as information about the workings of the reciprocal arrangement being provided to the Secretary of State, he anticipates such information being provided to the public and to us as parliamentarians? I do not mean to penny-pinch—as I say, the starting point should be that it is humane to offer treatment at both ends—but it is a matter of information.

The Minister referred to how additional countries might be added to the list. We would all welcome that but, again, when that happens, there will have to be a business case that must make predictions about how much usage of the scheme there will be. I welcome the fact that the Minister says that the addition of another country will come back to us for approval, but I hope that he can also commit to us being given the information we need on existing arrangements and predicted future arrangements to help us make those determinations.

Clarifications on those substantive points about eligibility and the provision of information and data on how the arrangements are working would be really helpful but, substantively, we welcome the instrument.