Brexit: Reciprocal Healthcare (European Union Committee Report)

Lord Ribeiro Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Lord Ribeiro (Con)]

My Lords, I thank my noble friend Lord Jay—I use that term advisedly, as he chaired our committee with great skill—for securing and introducing this debate.

It is clear that the major issue still to be resolved in the Brexit negotiations is the border arrangements between Northern Ireland and Ireland. From a medical perspective, that border does not exist and healthcare has been freely exchanged for some time. Indeed, it predates the UK and Ireland joining the EU.

In my role as secretary of the Association of Surgeons of Great Britain and Ireland in the early 1990s, I met a young trainee surgeon in Dublin who was blazing a trail for the adoption of laparoscopic surgery for gall-bladder disease and hernia repairs. He subsequently transferred to the Central Middlesex Hospital as a consultant general surgeon and, soon after, was invited to become professor of surgery at St Mary’s Hospital in London. That surgeon was the noble Lord, Lord Darzi, from whom we will hear more on Thursday when he presents the debate on the NHS at 70.

Free movement of people allowed many surgical trainees to gain experience of laparoscopic surgery in Ireland. This was to the benefit of the UK, which was a little slower to adopt the technique of laparoscopic cholecystectomy. Free movement is a two-edged sword and, as our report demonstrates, children in Belfast have benefited from having their cardiac surgery performed in Dublin after the service ceased in Belfast in 2015. They are now in the all-Ireland children’s heart surgery centre.

Here I must declare an interest. When I was chairman of the Independent Reconfiguration Panel, we reviewed the report of the Joint Committee of Primary Care Trusts on children’s heart surgery in England. The report was called Safe and Sustainable and was published in 2012. It proposed a mandatory standard of four full-time surgeons and 400 paediatric surgical procedures per centre, driving a need for reconfiguring services. We concluded that centres providing surgery and interventional cardiology must have,

“at least four full-time consultant … surgeons”,

to provide,

“comprehensive … round the clock care, training and research”.

Although the Joint Committee of PCTs found the unit at the Royal in Belfast safe, it was not sustainable. The decision to centralise on one site in Dublin justifies its recommendations at the time.

In our report on reciprocal healthcare, we noted that there were probably as many people using directly agreed services through bilateral arrangements as there were using the EHIC, S1, S2 or patient rights’ directive. Services across the border serve both communities and reach enough patients to achieve economies of scale, and make it possible to recruit consultants to work in rural areas and communities which, on their own, would not justify a consultant appointment. I can testify to this, having visited Northern Ireland as president of the Royal College of Surgeons and seen the services provided at that time.

We also noted that joint services included oral and maxillo-facial services and a radiotherapy centre at the Altnagelvin Hospital, which opened in 2016 and was co-funded and co-planned by both jurisdictions. This form of co-operation would be threatened by a lack of agreement in the run-up to Brexit. One of our witnesses, Ms Bernie McCrory, described how co-operation in the ENT services had led to improved access to healthcare on both sides of the border. As is quoted in our report, she said:

“Children were waiting for maybe four years for their first appointment if they had hearing difficulties, with all of the problems that that would have thrown up education-wise and so on. There was a very robust ENT service in the southern trust in Northern Ireland where we had four ENT surgeons working on a rota. The EU money allowed us to employ two more ENT surgeons. The surgeons rotated into the south of Ireland, into Monaghan, where they did out-patient and day-case work. Then the patients travelled to Northern Ireland, to Craigavon and Daisy Hill Hospitals in the southern trust, to receive more complex surgeries that were not possible in a small rural hospital … [In 2016] 155 patients travelled from the south of Ireland to Northern Ireland for complex surgery, but the consultants who travelled down to the Republic saw over 2,000 patients in both out-patient and day-case procedures”.


We also heard evidence of how patients’ lives have been saved because of free and open access to emergency services across the border. They made the case for not returning to the bad old days of the Troubles when ambulances would park on one side of the border while the patient was transferred across to another ambulance on the other side. The Belfast agreement took years to broker and cross-border healthcare was described as one of the success stories of the Good Friday agreement. Surely nothing should be done to jeopardise this agreement. I know that my noble friend the Minister and the Government share this view.

The December joint report acknowledges the importance of these cross-border arrangements on health and notes that,

“the UK and Ireland may continue to make arrangements between themselves relating to the movement of persons between their territories (Common Travel Area)”—

the CTA predates our EU membership. We urge the Government to avoid such a hard border for patients and the health professionals who treat them. The continued access under the CTA to emergency, routine and planned care must continue if we are not to destabilise healthcare in the border areas. It is therefore not surprising that our report asks for healthcare to be treated as a priority in the negotiations on the island of Ireland, and the future relations between the EU and the UK.

In parallel to this report, we also took evidence on the impact of leaving the Euratom treaty and how this would affect the movement of radioisotopes, which we rely on for diagnosis and therapeutic treatments. There are some 700,000 nuclear medicinal procedures per year in the case of technetium-99m, which is used in 80% of all diagnostic procedures. We flagged up the importance of developing a new generation of alpha and beta-emitting isotopes for cancer treatment to mitigate any possible interruptions to treatments through delays at the ports, mindful that some radioisotopes have a short shelf life. I would like to ask my noble friend the Minister what the UK is doing to accelerate cyclotron production, in addition to the proposed new plant by Alliance Medical, which the Minister referred to in his letter dated 1 March to the noble Lord, Lord Jay.

Another form of treatment is proton beam cancer treatment. This begins at the Christie hospital in Manchester this August and is a first in the UK, with the University College Hospital in London following in 2020. Hopefully, this will prevent patients such as Ashya King being transferred from Southampton to Prague for treatment—if your Lordships recall, that caused quite a hullabaloo in this country. Can my noble friend say when we can expect more of these to mitigate the impact of leaving the EU and in the event that the S2 arrangements fail to be honoured? After all, nothing is agreed until everything is agreed, but it is difficult to see how we can secure reciprocal healthcare while we continue to oppose freedom of movement of people from the EU, as my noble friend pointed out.