Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Thornton Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I join other noble Lords in congratulating the EU committee on its report Brexit: Reciprocal Healthcare. I suspect it was no accident that the committee turned its attention to this matter early on in its considerations about the effects of Brexit. I congratulate the Government on turning around their response in three months. This is better than the last healthcare response, which took a year, so we should be pleased and congratulate the Minister. I thank the BMA and the Nuffield Trust for providing the most up-to-date information.

I proposed and supported amendments on these matters during the passage of the Brexit Bill most recently considered, so I looked at the record to see how it compared with the answers that the Government have given. I spotted some advances but, I am afraid, not many.

In preparing for this debate, I learned from IPSOS Mori that Brexit has now joined the NHS as the top two issues the public are most concerned with—for 46% and 44% of people respectively. Today we have a confluence; it seems that as time goes on, millions may be justified in their anxiety about both Brexit and health. We heard, as several noble Lords have mentioned —including the noble Lord, Lord Balfe, and the noble Baroness, Lady Janke—that the head of NHS England is preparing plans for the supply of medicines in the event that the UK crashes out of the EU without a deal. I suppose the first question, as reflected in this report, is what happens after the implementation period? What planning is being done for a no-deal scenario for reciprocal healthcare? Indeed, the noble Lord, Lord Ricketts, mentioned the human cost of that.

Two years for implementation is not so long. Just think how the last two years have flown since the Brexit vote, with so little progress. It is, of course, important, as other noble Lords have mentioned, that the negotiations so far have enabled the Government to achieve their aims for reciprocal healthcare in the first and implementation phases of negotiations. These include access to the European health insurance card for those visiting the EU on exit day and continued access to the S1 scheme for existing retirees living abroad. But does the Minister agree that the next phase of negotiations needs to secure ongoing access to EHIC and reciprocal healthcare arrangements, either through retention, or comparable replacement of existing reciprocal healthcare arrangements with the EU after Brexit?

Some 27 million people hold a UK-issued European health insurance card and 190,000 UK pensioners living elsewhere in the EU are registered to the S1 scheme. The Nuffield Trust has calculated that, if the 190,000 UK state pensioners signed up to the S1 scheme and, living within the EU, needed to return the UK to receive care, it would incur additional costs to health services of between £500 million and £1 billion per year.

This simultaneous increase in cost and demand would place even greater strain on the UK health and social care sector. There is some anecdotal evidence that indeed people are returning from France, Spain and elsewhere since the Brexit vote and the ensuing lack of assurance and clarity. Are the Government monitoring the numbers who are coming home already?

As reflected in this report, ending reciprocal arrangements may also require the application of existing cost recovery methods for non-EEA patients to EU and EEA patients in the UK, or the development of a new, alternative system. This could increase the complexity of the cost recovery process, so well described by the noble Lord, Lord Balfe, as well as the administrative burden on clinical staff. Does the Minister agree with the BMA’s long-standing position that doctors and clinical staff should be able to devote their attention to treating patients and not to recovering the cost of care?

If the UK loses access to these arrangements, or fails to agree comparable alternatives, it could severely impact on the healthcare arrangements of UK and EU nationals and place additional strain on our already stretched NHS. Healthcare affects all of us who travel, work and live in Europe and, just as we might legitimately expect post-Brexit that we can take for granted the supply of the most up-to-date, clinically approved medicine and remedies, we expect to continue to travel and work all over Europe and for our healthcare to be assured, without having to take out insurance. On a scale of 1 to 10, with 10 being the most likely, what is the Minister’s best estimate of this being the case post the implementation period?

The ease with which people can continue to do what they are used to doing is what will colour how people will judge whether Brexit is succeeding and whether it has been worth while. In many ways, the most important recommendations in this admirable report, most of which I agree with, are those which concern clarity and transparency. Recommendations 5 and 6 concern free movement, and recommendation 11 asks if reciprocal healthcare will be included in the objectives set out by the Government, which we hope will emerge in a White Paper, with white smoke, some time next week.

This paragraph also concerns our children and grandchildren and their ability to work across Europe, which will be curtailed, as was so well explained by the noble Lord, Lord Jay. He said we have a long way to go and he is absolutely correct. The problem is, we have a long way to go but we do not have a great deal of time. I thank noble Lords for their usual high-quality contributions and I look forward to the Minister’s reply.