Healthcare (International Arrangements) Bill

Martyn Day Excerpts

Wednesday 14th November 2018 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Clearly, Brexit threatens the loss of reciprocal healthcare arrangements for millions in Scotland and across the UK. As a bottom line, the Scottish National party believes that all current reciprocal health agreements must remain intact, regardless of what form Brexit takes. The Bill is yet another rushed job on the part of the Government. In their panic, they have woken up to the fact that millions across the UK and thousands of expats abroad, particularly pensioners, could face having either no access to healthcare within the EU or paying exorbitant costs for treatment. It is another example whereby no contingency planning was done prior to the Brexit referendum.

With an estimated 900,000 to 1.2 million UK citizens living in the European economic area and 3.2 million EEA citizens residing in the UK, Brexit will potentially have severe ramifications for them and the NHS. Approximately 27 million active EHIC cards are in circulation as of September 2017. They are used to pay for around 250,000 medical treatments each year. Ensuring that all current reciprocal health agreements remain intact and in place must be the bottom line regardless of what form Brexit takes.

The consequences of a no-deal Brexit on healthcare are yet one more example of why this extreme Tory Brexit is not worth the cost. In evidence to the House of Lords EU Committee, a representative from the Association of British Insurers gave a rough estimate that in a no-deal scenario, travel insurance premiums for EU travel could increase by 10% to 20%. A no-deal scenario will end up restricting the travel arrangements of those with underlying health conditions and disabilities. In such a scenario, the British Medical Association said that the insurance issue will be

“a particular concern for those with disabilities or long-term conditions, as the cost of health and travel insurance for those with pre-existing conditions could be prohibitively high.”

The Bill’s impact assessment concludes that in a no-deal scenario:

“If UK citizens in the EU are treated as 3rd country nationals (i.e. they cease to have rights of movement and access to services in EU Member States, and are treated like citizens coming from non-EU countries) some may face additional financial costs or difficulties accessing healthcare services, with potential implications for their health and wellbeing.”

That is something none of us wants to see.

Reciprocal healthcare arrangements must not be viewed as affecting only those who live or travel abroad. The impact of a no-deal Brexit would have a devastating effect on our NHS services at home. The agreement in the joint report does not provide long-term assurances regarding the future of the EHIC. As things stand, health insurance will stop for millions of UK citizens post-Brexit.

While the UK Government have stated their commitment to securing ongoing access to the EHIC, the EU has been unwilling to agree to that due to the Government’s stance on freedom of movement post-Brexit. The UK would also be a significant outlier were it to retain access to reciprocal schemes while ending freedom of movement. The SNP position on single market and customs union membership would, of course, remove all such obstacles.

If these healthcare schemes were removed, it would inevitably lead to massive pressures on the NHS, as UK citizens return home to receive treatment. Those pressures are compounded by the impact of the health workforce reduction, which has seen England and Scotland lose 19% and 14% of EU doctors respectively and a 90% drop in EU nurses registering to work in the UK.

As we have heard, the UK contributes around £630 million annually towards UK citizens’ care and receives £50 million—I think the Minister mentioned £60 million—for care provided to EU nationals in the UK. The BMA and the Nuffield Trust has estimated that if the UK did not conclude a withdrawal agreement with the EU, and were all these pensioners to return to the UK, the NHS would need some 900 additional beds and 1,600 nurses to ensure sufficient capacity. All in all, providing this additional healthcare would amount to somewhere in the region of £1 billion.

Current EU nationals living in the UK could face losing access to health facilities. First, their residency was threatened and now their healthcare rights are in danger; we must give them peace of mind and security. Were the UK to lose access to existing reciprocal arrangements and no alternative be established, EEA citizens living in or visiting the UK would also face a significant change in their access to care. Depending on the deal secured between the UK and the EU on citizens’ rights, this could mean that EEA residents might face the same costs and terms of access to the NHS as other non-EEA visitors and migrants do currently.

The Scottish Government have never been opposed to common frameworks, but these must be agreed in discussion and with the consent of the devolved Administrations. I was grateful to hear the Minister’s commitment to working with the devolved nations in this regard. We all understand the desperate need for all these reciprocal healthcare agreements to continue and the Scottish Government will work with the UK Government to ensure that they do.

Through the Joint Ministerial Committee, we believe that a common framework system can be achieved that ensures these specific health agreements can be administered through common agreement between the UK Government and the Scottish Government. Many issues need to be resolved for this to happen effectively, particularly if we are forced to deal with a no-deal Brexit. For instance, in Scotland, unlike in England, certain categories of resident non-EU overseas patients are exempted from healthcare charges, including the self-employed, volunteers and students. In Wales and Northern Ireland, regulations provide similar exemptions, and in Northern Ireland they clarify that entitlements are applicable both to primary and secondary care.

As Professor Jean McHale told the Lords inquiry on this very issue, post-Brexit

“if there are no reciprocal agreements on healthcare made with other EU member states and treatment is sought other than in an emergency situation then certain EU citizens could be exempt from NHS charges for secondary care…if they are living in Scotland, Wales and Northern Ireland whereas this would not be the case in relation to those resident in England.”

In conclusion, I am not opposing the Bill, as it basically just gives powers to the Secretary of State to agree reciprocal deals, and I look forward to the Bill Committee where we can progress those further. However, I point out that today’s business is another example of otherwise unnecessary work related to Brexit coming before us. This prompts the question of just how much time and effort is being put into such work that could have been used for other things, had we not been going through the Brexit fiasco. I believe that we will not get a better reciprocal arrangement deal than we currently have.