Healthcare (International Arrangements) Bill

Earl of Dundee Excerpts

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[The Earl of Dundee (Con)]

My Lords, I join others in congratulating my noble friend the Minister on her very useful introduction of this debate and on an excellent maiden speech.

I welcome the Bill but I share concerns over a number of its defects. These include: inadequate parliamentary scrutiny; insufficient awareness of cost consequences; and, still left by it, the degree of uncertainty affecting United Kingdom citizens living abroad and foreign citizens living here. As my noble friend Lord O’Shaughnessy explained, it is sensible that the Secretary of State should be given wide powers. Since any particular Brexit outcome is as yet unknown, that is the best way to protect international healthcare arrangements in a Bill such as this. Thereafter, no doubt, the negative statutory instrument procedure might otherwise have been the right method for ongoing parliamentary supervision. For, as the Government already argue, by then, although not now, the focus of Parliament would be able to be on a specific post-Brexit healthcare agreement. Also, negative statutory instrument procedures are often the means of looking at regulations made under all Bills, including this one.

The alternative is to make use of the affirmative statutory instrument procedure. In this instance, does the Minister agree that we should do that instead? There are clear benefits. These are against a background of public anxiety over all post-Brexit plans and their detailed results, corresponding to a correct and increasing public desire for maximum transparency. The affirmative procedure responds to this demand. Its deployment instead of the negative procedure—against which the noble Lords, Lord Foulkes, Lord Marks of Henley-on-Thames and Lord Kakkar, among others, have warned—would therefore provide much greater reassurance that ongoing parliamentary scrutiny will be carried out in a proper and accurate manner.

As a number of your Lordships have cautioned, we might also harbour misgivings about excessive costs. So far, these may have been underestimated because meaningful budgeting has to depend upon the terms of a future withdrawal agreement—as yet a matter for speculation, not least on whether there will be one at all. In view of that, as my noble friend Lord Ribeiro emphasised, it is impossible just now to anticipate the financial burden on the NHS of British nationals who might return to the United Kingdom for treatment; equally unable to be calculated at present are the administrative costs of carrying out, as envisaged, all sorts of concordats with the European Union, with the EEA and with other countries across the world. Clearly, we hope for efficient reciprocal healthcare arrangements arising from a competent withdrawal agreement at the outset. However, although germane and even crucial to it, these still lie outside the Bill. Within its scope, conversely, is the opportunity for Parliament to monitor all expenditure and income to do with healthcare plans. Does the Minister therefore concur that reports with these details should be laid before Parliament annually?

On this issue in another place, the Government may have prevaricated slightly and hidden behind the skirts of obvious current circumstances. While they say that the Bill should not prescribe a particular timetable for reporting back until new healthcare plans have come to light, they also claim that a number of reporting processes can anyway be deployed instead. Yet is there not a simple and necessary corollary to this? If we really want to increase confidence and transparency, why not just make sure that Parliament is given relevant healthcare facts and figures at least once a year? Then, if the Government wish to report further through any other processes, they are free to do so.

Then there is the safeguarding of the reciprocal healthcare rights of United Kingdom citizens abroad and foreign citizens here. The aim is to avoid slippage and to maintain equivalence. This is the common theme of all post-Brexit challenges and obstacles, which many of us, including myself, while determined to meet and overcome them, are also regretful to have to confront at all, believing as we do that by far the best deal for the United Kingdom would be not to leave the European Union in the first place. Along with us, United Kingdom citizens living abroad will acknowledge the usefulness of the Bill. Nevertheless, at the same time, and as we do, they will recognise that for the proposed legislation to work efficiently, a robust and reciprocal deal for international arrangements has to be put together to begin with.

Meanwhile, the Bill should be improved in several respects, amended so that parliamentary affirmative procedures and annual reports can enhance supervision and transparency, and, as your Lordships have urged, with a stronger commitment of intentions to the people concerned, through a proper undertaking to those wishing to travel and who suffer long-term medical conditions. There must be a firm resolve not to short-change but to preserve reciprocal medical delivery as it is, and there must be greater clarity on the role of the European court to protect such standards as they are.