Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they are proposing to reduce the overall number of cigarettes smoked in England.
Answered by Lord O'Shaughnessy
The Government continues to provide leadership and guidance on the most effective interventions, ensuring that the new legislation is implemented well and that organisations with national responsibilities are joined up and effective in achieving these ambitions. We will aim to provide access to training for all health professionals on how to help patients quit, promote links to stop smoking services across the health and care system and strive to achieve a smokefree National Health Service.
We will support local councils to identify local solutions, particularly where prevalence remains high so they can help people to quit. The Government will maintain high duty rates for tobacco products to make tobacco less affordable and will ensure that sanctions in current legislation are effective and fit for purpose. Our end goal is a smoke-free generation.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how much they claimed in EEA medical costs from the Republic of Ireland under (1) Article 93, (2) Article 94, and (3) Article 95, during activity period 2016–17.
Answered by Lord O'Shaughnessy
The Department, on behalf of the United Kingdom Government, reimburses other European Economic Area (EEA) countries and Switzerland for the cost of providing treatment to people we are responsible for under European Union law, based on pension and benefit eligibility and irrespective of nationality. In the same way, other EEA countries and Switzerland reimburse the Department, on behalf of the UK Government, for the cost of the NHS providing treatment to people they are responsible for under EU law, irrespective of nationality and including UK nationals insured in another EEA country or Switzerland.
Requested figures for 2016-17, the latest available, are provided in the following table, rounded to the nearest pound. Member states can submit claims up to 18 months in arrears so claims for any 12 month period do not necessarily reflect treatment provided in that period.
Country | Article 22.1c | Article 93 | Article 94 | Article 95 | Total |
Ireland | £6,445,232 | £7,166,070 | £0 | £4,865,850 | £18,477,152 |
Source: Resource Accounting and Budgeting exercise. Totals are based on estimates of the costs of EEA healthcare claims made annually for the purposes of provisions made in the Department of Health accounts in accordance with HM Treasury resource accounting rules.
Notes: Article 93 claims are combined claims for healthcare costs relating to temporary visitors (via European Health Insurance Cards), workers temporarily posted abroad by their employer, referrals for treatment in other EEA countries, or equivalent claims calculated on a formula basis under bilateral arrangements. Due to the nature of the claims system between member states, it is not currently possible to disaggregate the data consistently for all member states by either type of claim or type of treatment.
Article 94 claims are healthcare costs relating to dependents of workers not resident in same member state as the worker.
Article 95 claims are for healthcare costs relating to pensioners and dependents of pensioners.
Article 22.1c refers to patient referral claims.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the role of manufacturers of medical products in restrictions of supply to pharmacists, and of the relationship of such restrictions to the pricing of those products.
Answered by Lord O'Shaughnessy
No such assessment has been made. However, the majority of products supplied through restricted wholesale models are branded medicines, for which prices are controlled by the Pharmaceutical Price Regulation Scheme. The Department, Medicines and Healthcare products Regulatory Agency, and pharmaceutical supply chain stakeholders agreed best practice guidelines for dealing with supply and distribution of medicines. These set out that where restricted wholesale models are in place, manufacturers should put contingency arrangements in place so that pharmacies can obtain the product directly from the manufacturer if they cannot get it from their wholesaler.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of arrangements for the payment of healthcare costs for EU pensioners living in the UK and UK pensioners living in the EU after the UK leaves the EU.
Answered by Lord O'Shaughnessy
The Department, on behalf of the United Kingdom Government, reimburses other European Economic Area (EEA) countries and Switzerland for the cost of providing treatment to people we are responsible for under European Union law, based on pension and benefit eligibility, and irrespective of nationality. In the same way, other EEA countries and Switzerland reimburse the Department, on behalf of the UK Government, for the cost of the National Health Service providing treatment to people they are responsible for under EU law, irrespective of nationality and including UK nationals insured in another EEA country or Switzerland.
Member state claims against the UK are in local currency, so totals are significantly affected by the exchange rate at the time of payment and can mean a difference of millions of pounds. Member states can submit claims up to 18 months in arrears, so claims for any 12 month period do not necessarily reflect treatment provided in that period.
Due to the size of the data, figures for the amount paid by the UK to each EU member state for healthcare in 2016/17 are provided in the attached table. These figures are the latest available and rounded to the nearest pound.
After the UK leaves the EU, and in a reciprocal deal, the UK will continue to export and uprate the UK state pension and to provide associated healthcare cover on behalf of the UK within the EU.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how much was paid (1) by the UK to each EU member state for healthcare provided to (a) UK citizens, and (b) UK pensioners resident in of those states in the last year; and (2) by each EU member state to the UK for healthcare provided to (a) their citizens, and (b) pensioners resident in the UK.
Answered by Lord O'Shaughnessy
The Department, on behalf of the United Kingdom Government, reimburses other European Economic Area (EEA) countries and Switzerland for the cost of providing treatment to people we are responsible for under European Union law, based on pension and benefit eligibility, and irrespective of nationality. In the same way, other EEA countries and Switzerland reimburse the Department, on behalf of the UK Government, for the cost of the National Health Service providing treatment to people they are responsible for under EU law, irrespective of nationality and including UK nationals insured in another EEA country or Switzerland.
Member state claims against the UK are in local currency, so totals are significantly affected by the exchange rate at the time of payment and can mean a difference of millions of pounds. Member states can submit claims up to 18 months in arrears, so claims for any 12 month period do not necessarily reflect treatment provided in that period.
Due to the size of the data, figures for the amount paid by the UK to each EU member state for healthcare in 2016/17 are provided in the attached table. These figures are the latest available and rounded to the nearest pound.
After the UK leaves the EU, and in a reciprocal deal, the UK will continue to export and uprate the UK state pension and to provide associated healthcare cover on behalf of the UK within the EU.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
Her Majesty's Government what measures they are taking to reduce the level of smoking in both indoor and outdoor public places.
Answered by Lord O'Shaughnessy
Legislation introduced in 2007 made it illegal to smoke in all public enclosed or substantially enclosed areas and workplaces. There are no current plans to introduce further smoke free legislation to outdoor places.
Local authorities can however, consider adopting more extensive no smoking policies locally. Local authorities are best placed to do this working with its local population to develop flexible plans that suit the local area.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government (1) what are the current arrangements for quantifying the amount paid by the UK to the Republic of Ireland and by the Republic of Ireland to the UK for the healthcare costs of resident pensioners; (2) what were the amounts paid by the UK and the Republic of Ireland in the last three years; (3) how many UK and Irish pensioners are involved; and (4) when the system will next be reviewed.
Answered by Lord O'Shaughnessy
The basis on which pensioner figures are calculated was included in a letter of 11 July 2011 to Ireland’s Department of Health and Children. The relevant section of that letter is included below:
“Reimbursement arrangements for 2010-2013
For 2010-2013, we agreed that we would not pursue the use of another triennial survey, which otherwise would have been due. As an alternative arrangements, we have agreed that between 2010 and 2013, UK liability to Ireland (currently 40%) will fall, year on year, by 1.13%. This figure was agreed after both parties noted an average downward trend in UK liability for dual pensioners since the start of the bilateral agreement in 1971. As a result, UK liability will be 35.48% by 2013. Applying the same principle, Irish liability will stand at 4.44%. We agreed that such a deal would provide a logical and pragmatic approach; remove the need to enter negotiations about Department for Work and Pensions resource for a triennial survey (along with your equivalent), and see an end to protracted negotiations regarding pensioner numbers and categories of UK liability for those years.”
This 1.13% reduction in United Kingdom liability was extended through to 2016, resulting in a current UK liability of 32.09% of UK pensioners living in Ireland.
Following negotiations with Ireland, UK liability for 2016 was based on an estimated baseline number of 109,000 UK state pensioners and Ireland’s liability is based on being responsible for 3.15% of an estimated baseline number of 40,000 Irish state pensioners living in the UK.
Discussions on new arrangements to determine respective pensioner numbers for 2017 will begin this year.
The UK’s estimated income and expenditure for healthcare activity in the past three years as it relates to UK and Irish pensioners is in the table below:
| 2013/14 | 2014/15 | 2015/16 |
Expenditure | £223,761,423 | £200,591,178 | £168,069,004 |
Income | £6,707,569 | £4,422,239 | £4,423,115.93 |
Source: Resource Accounting and Budgeting exercise. Totals are based on estimates of the costs of European Economic Area healthcare claims made annually for the purposes of provisions made in the Department of Health accounts in accordance with Treasury resource accounting rules.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what are the current arrangements for quantifying and registering EU/EEA pensioners living in the UK and those close to pensionable age, for the purposes of reclaiming their healthcare costs from their home countries; what were the total costs and payments last year to those countries, and what are their plans to reform the UK counting system.
Answered by Lord O'Shaughnessy
Under the relevant European Union regulations, European Economic Area (EEA) countries and Switzerland are obliged to pay for the healthcare costs of those in receipt of state pension or other certain exportable benefits in their countries (based on pension and benefit eligibility, not nationality), but who live elsewhere in the EEA or Switzerland, including the United Kingdom.
EEA state pensioners moving to the UK, unless insured by the Republic of Ireland, need to apply for an S1 form in their own country. Once issued, the form is registered by being sent to the Overseas Healthcare Team at the Department for Work and Pensions to be processed.
EU rules set out the framework for determining which EEA country is ‘responsible’ for an individual under EU law. This is commonly referred to as ‘insurability’. The UK has a residency-based healthcare system which means that “insurability” is generally determined by residency (being “ordinarily resident”). Ordinarily resident means, broadly speaking, living in the UK on a lawful basis and properly settled for the time being, which would include EEA and Swiss residents below their respective state pensionable age but not in receipt of state pensions.
We do not make payments to EEA member states for their state pensioners living in the UK but we claim from those member states for those in receipt of EEA member state pension. The table below provides information about how much was paid to the UK for individuals in receipt of state pension from another EEA country or Switzerland.
Austria | £166,179.94 |
|
Belgium | £436,334.57 |
|
Bulgaria | £321,271.15 |
|
Cyprus | £0.00 |
|
Czech Republic | £32,419.18 |
|
Denmark (Waiver)1 | N/A |
|
Estonia Waiver 2 | £0.00 |
|
Finland 3 | £0.00 |
|
France | £434,456.14 |
|
Germany | £1,115,260.40 |
|
Greece | £32,711.24 |
|
Hungary (Waiver) 3 | £0.00 |
|
Iceland | £0.00 |
|
Ireland | £4,423,115.93 |
|
Italy | £80,217.23 |
|
Latvia | £930.95 |
|
Liechtenstein | £0.00 |
|
Lithuania | £512,024.85 |
|
Luxembourg | £39,428.73 |
|
Malta (Waiver)3 | N/A |
|
Netherlands | £2,604,068.06 |
|
Norway (Waiver)2 | £0.00 |
|
Poland | £2,173,380.73 |
|
Portugal | £172,785.11 |
|
Romania | £1,086.11 |
|
Slovakia | £3,723.82 |
|
Slovenia | £2,190.49 |
|
Spain | £165,462.33 |
|
Sweden | £456,332.82 |
|
Switzerland | £101,592.23 |
|
Total | £13,274,972.02 |
|
Source: Resource Accounting and Budgeting exercise. Totals are based on estimates of the costs of EEA healthcare claims made annually for the purposes of provisions made in the Department of Health accounts in accordance with Treasury resource accounting rules.
Notes: Waiver is an agreed intentional relinquishment of healthcare costs between Member States.
1 Denmark – Full waiver
2 Estonia and Norway – Waiver, excepting former Article 22.1c (patient referral) & Article 55.1c (industrial injury) claims
3 Finland, Hungary and Malta – Waiver, excepting former Article 22.1c (patient referral) claims
Since its inception in 2013, the Department of Health’s Visitor and Migrant NHS Cost Recovery Programme has been working to design and implement key improvements to ensure that those people who should pay for National Health Service care in England are identified and charged. The Department has also been working closely with the NHS to improve rates of recovery where these healthcare costs are the responsibility of other member states of the EEA via the European Health Insurance Card, S1 and S2 mechanisms.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 13 June (HL566), what the calculation systems are for payments by the UK to France, Ireland and Spain for the cost of providing treatment to people for whom the United Kingdom is responsible under European Union law.
Answered by Lord Prior of Brampton
Other European Economic Area (EEA) countries and Switzerland reimburse the United Kingdom for the cost of the National Health Service providing treatment to people they are responsible for under European Union law, including UK nationals insured in another EEA country or Switzerland. In the same way, the Department, on behalf of the UK Government, reimburses other EEA countries and Switzerland for the cost of providing healthcare treatment to people we are responsible for under EU law, irrespective of nationality.
As insurability under EU law is not determined on the basis of nationality, it is not possible to provide information on the number of citizens from each country covered by these rules.
Payment arrangements from the UK to France, Spain and Ireland are as follows:
France:
- All categories of insured persons: Actual costs (meaning the UK is billed for actual healthcare usage)
Spain:
- Temporary Visitors: Actual costs
- All other categories: Average costs (a lump sum is billed, irrespective of the amount of healthcare received)
Ireland:
- Temporary Visitors (not including planned treatment claims or workers): Formula agreement
- Planned Treatment claims: Actual costs
- Workers: Waiver agreement between the two countries
- All other categories: Average costs
The decision on whether to bill on the basis of average costs is for individual EEA countries to make.
Asked by: Lord Laird (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 13 June (HL566), for how many UK citizens currently residing in France, Ireland and Spain they are responsible, and for how many citizens from those countries currently residing in the UK are France, Ireland and Spain responsible respectively.
Answered by Lord Prior of Brampton
Other European Economic Area (EEA) countries and Switzerland reimburse the United Kingdom for the cost of the National Health Service providing treatment to people they are responsible for under European Union law, including UK nationals insured in another EEA country or Switzerland. In the same way, the Department, on behalf of the UK Government, reimburses other EEA countries and Switzerland for the cost of providing healthcare treatment to people we are responsible for under EU law, irrespective of nationality.
As insurability under EU law is not determined on the basis of nationality, it is not possible to provide information on the number of citizens from each country covered by these rules.
Payment arrangements from the UK to France, Spain and Ireland are as follows:
France:
- All categories of insured persons: Actual costs (meaning the UK is billed for actual healthcare usage)
Spain:
- Temporary Visitors: Actual costs
- All other categories: Average costs (a lump sum is billed, irrespective of the amount of healthcare received)
Ireland:
- Temporary Visitors (not including planned treatment claims or workers): Formula agreement
- Planned Treatment claims: Actual costs
- Workers: Waiver agreement between the two countries
- All other categories: Average costs
The decision on whether to bill on the basis of average costs is for individual EEA countries to make.