Healthcare (International Arrangements) Bill

Lord Foulkes of Cumnock Excerpts

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

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, before I revert to my usual mode of careful scrutiny, I offer a sincere triple congratulations to the Minister: first, on her elevation to this place—she did a great job in the other place and we welcome her here—secondly, on her appointment as Minister; and thirdly, as the noble Lord, Lord O’Shaughnessy, said, on a really excellent maiden speech. She comes to us with a great reputation and, I understand, undoubted ability. Given this Bill, she is going to need a lot of that.

This is an astonishing piece of legislation. With respect, relatively few have understood the wide and serious implications—and the consequences—of this Bill. I am astonished that the Scottish Government have not seen the implications, and that some of my colleagues down in the other place have not yet seen them. Thankfully, our Delegated Powers and Regulatory Reform Committee has understood it and produced a very good report. I am particularly grateful to the noble Lord, Lord Blencathra, and his colleagues for it. It particularly refers to Clause 2. I have read a few reports in my time, but this is really quite devastating. I will quote from it:

“We draw attention to clause 2 of the Bill. If the reason for the Bill’s introduction is to protect British citizens if a ‘no deal’ scenario affects current reciprocal healthcare agreements with other EU countries”,


which it does,

“clause 2 of the Bill goes considerably wider. It allows the Secretary of State to make regulations”,

first,

“in relation to the payment by the Secretary of State of the cost of all forms of healthcare … provided by anyone anywhere in the world”—

astonishing—secondly,

“for and in connection with the provision of any such healthcare, provided by anyone anywhere in the world”,

and thirdly,

“to give effect to international healthcare agreements”.

It goes on to say:

“Clause 2 has a breath-taking scope. Indeed, the scope of the regulations could hardly be wider … There is no limit to the amount of the payments … There is no limit to who can be funded world-wide … There is no limit to the types of healthcare being funded … The regulations can confer … powers and duties … on anyone anywhere … The regulations can delegate functions to anyone anywhere … the regulations can amend or repeal any Act of Parliament ever passed”—


astonishing powers—and that:

“The Government say that clause 2 ‘enables the Secretary of State to address essential matters relating to healthcare abroad’. But the powers in the Bill go much wider than essential matters”.


It continues:

“All regulations made under clause 2 are subject only to the negative procedure”.


My noble friend Lord Adonis knows that that is a very—

[Lord Adonis (Lab)]

Dangerous.

[Lord Foulkes of Cumnock]

—dangerous procedure, but also that there is very scant scrutiny in that procedure. The report states that the regulations are subject to the negative procedure,

“save where they amend primary legislation. If, without such amendment, the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure”.

It is really quite astonishing. That is a great report. I could not have done better myself.

[Lord Adonis]

Why Arizona?

[Lord Foulkes of Cumnock]

Anywhere. That is just a random choice. It could be Texas or Alaska—it would be a bit more expensive in Alaska.

That is a really wide provision. Before we finally pass this Bill, Clause 2 needs drastic amendments. I say to my noble friends on the Labour Front Bench, to my friends—and they are my friends—on the Liberal Democrat Front Bench, to members of the committee and to Cross-Bench and Conservative Members that I hope that we will see those amendments in Committee. I hope that we will properly scrutinise this Bill because it has not yet been done.

The inevitable consequence of the Bill is to replace a system that works well and gives peace of mind to many thousands of British citizens with completely unnecessary worry and uncertainty. Whatever the Minister says, it will be about damage limitation. Of course, the worst of all options is no deal, which would immediately remove the guarantees which British citizens living in the European Union and European Union citizens in the UK currently take for granted. That the no-deal option is still on the table is an indictment of the Government and their failure to face up to the consequences of their attempts to appease the hard right of the Tory party. All we are offered by the Bill is uncertainty and “Trust the Minister; everything’ll be okay”. The Bill allows her or him to do just about anything, but instructs them to do absolutely nothing. That is a recipe for uncertainty.

Let us first take the S1 scheme, which is central to this debate. This allows individuals from one EEA member state to receive healthcare in another, with the cost of that care met by the state in which the patient would ordinarily reside. Some 190,000 UK pensioners living in the European Union or the EEA are currently registered for this scheme. What happens to their rights if we leave without a deal? Many would have to return to the United Kingdom in fear of facing astronomical health bills elsewhere. That would affect not only those currently benefiting from the S1 scheme but the NHS, which would have to take the strain of the increase in number of elderly returning citizens. A report by the Nuffield Trust estimated that if expats returned in large numbers, we would require 900 extra beds and over 1,000 more nurses. Where would they come from? It certainly would not be from European Union countries, since the Government are already busy telling them that they are not really welcome in the United Kingdom.

That brings me to the EHIC. I hope that everyone has it. I have mine. Every time I go abroad, I take it with me. We rely on it to make travel abroad a possibility. At present, 27 million active United Kingdom EHICs are in circulation. They are used to pay for around 250,000 medical treatments each year. Incidentally, I tried to find out how to apply for or to renew an EHIC. I put “European health insurance card” into the Google search. I pressed it and what did I get? “This page cannot be displayed”. We cannot find out. Can the Minister tell us why the Government are not allowing people access to the EHIC? Is it in anticipation of a decision relating to it? Is it in anticipation of a deal or no deal?

[Lord Adonis]

“Alternative arrangements”?

[Lord Foulkes of Cumnock]

If we lose this right, the only ones celebrating will be the insurance industry. When I tweeted something about the EHIC no longer going to be available, lots of people tweeted back saying, “Ah, but we can get travel insurance”. That is all right if you are reasonably wealthy, but for ordinary people who have struggled just to get enough money to go abroad, it is an extra cost.

These arrangements are the cornerstones of the freedom of movement principle which the European Union rightly sees as its own but which the UK Government, sadly, are hell-bent on opting out of. There are those who point to the deal that the EU has with Switzerland at present. It is true that, under the Bill in the event of no deal, we would be able to implement new bilateral agreements with European Union states, Norway, Iceland and Switzerland. This would be lengthy and costly, ultimately leaving the European Union without reciprocal arrangements for an unknown period. I raised this with the Minister and her counterpart in the Commons when they kindly held a briefing on it. They would be scrabbling around the European Union—indeed around the world—negotiating bilateral agreements. If the Health Secretary is as successful in doing deals as the Trade Secretary, there are going to be an awful lot of sick Britons scattered around the world for years to come.

We need to approve the Bill—of course we do; the Minister said it; the noble Lord, Lord O’Shaughnessy, said it—but with some appropriate and significant amendments to Clause 2. Without it, the Secretary of State will not even be allowed to do the deals which will protect British citizens abroad. However, there should be no doubt at all that the very good arrangement which we have at present is being replaced by, at the very least, an inferior one. It remains to be seen if the operative word really is “inferior” or if, as I fear, “disastrous” is a better way to describe what we are facing if we go for no deal. I hope everyone in this House will do everything they can to ensure that that does not happen. For the health of British expatriates and of those of us who travel overseas, it is vital that we do so.

--- Later in debate ---

[Lord Lansley (Con)]

My Lords, I join colleagues across the House in welcoming my noble friend to this House and to her new position. I had the privilege to serve in the other place with her. I know how highly regarded she was for her work there and in her constituency. As a former Member for South Cambridgeshire, I think it is very like north Oxford as a place. I had the pleasure of campaigning with my noble friend in Abingdon and had something to do, in a very small way, with getting her elected in the first place. The Commons’ loss is our gain. We are delighted to have her with us. I know that the Department of Health and Social Care is delighted to have its former Minister back.

I very much share the view of my noble friend Lord O’Shaughnessy, who was instrumental in the Bill’s composition, that it is very important and necessary. It is important that we do not alarm people about the circumstances of their healthcare. We should make it clear, if we can, that we are all setting out to try to ensure that there is continuity in the existing arrangements for reciprocal healthcare across the European Economic Area. We might not be in a position to guarantee that because the withdrawal agreement might not be implemented. If it is, that will be all well and good, but if not, we have to put something in its place. As a consequence, there may be some urgency associated with securing bilateral agreements to deliver that continuity. That is at the heart of what needs to be in the Bill: an ability for the existing healthcare arrangements to be replicated through bilateral agreements in short order, not necessarily waiting on the approval of the two Houses of Parliament in a logjam.

I know that noble Lords will immediately say, “Hang on a minute, we have to be able to approve this thing”. I bring to the discussion of this Bill the benefit of having just been involved in Committee on the Trade Bill. Because there was a lack of powers, on the Trade Bill we were asked to provide the necessary powers to secure continuity and the rollover of existing agreements. In legal terms, this is not the same. We are not rolling over agreements—we may be implementing agreements —but the substantive purpose is the same: to enable healthcare provision across Europe to be provided for UK residents in the future in the same way as in the past. As we go through the legislation we need to make a distinction between what is a continuity provision and what is a new provision for new agreements. Where the Trade Bill was concerned, we did not need to do that; it was not about new agreements.

The noble Lord, Lord Marks, must be careful with the point he made about Clause 5 and regulations that,

“may amend, repeal or revoke primary legislation”.

Yes, it can be,

“(a) for the purpose of conferring functions on the Secretary of State or on any other person”,

but he added an “or” before paragraph (b). He said,

“or to give effect to a healthcare agreement”,

but it is not this; it is,

“to give effect to a healthcare agreement”.

As my noble friend Lord O’Shaughnessy said, this is all in order to implement international treaties.

[Lord Foulkes of Cumnock]

The noble Lord is absolutely right to distinguish between continuity legislation and totally new provisions in legislation. Does he not agree that it is bad enough to push to get a number of Bills and other legislation through quickly by the end of next month when it is continuity legislation—but that if it is totally new legislation, there is absolutely no justification at all?

[Lord Lansley]

We spent four days in Committee on the Trade Bill. I do not know how much time is planned for this Bill but it is perfectly possible for us to consider this legislation and to put in place the necessary powers for future agreements, as long as it is done with the necessary scrutiny and approval provisions. I will come on to make one or two points about that, and I am sure we will go on to debate that robustly—as my noble friend on the Front Bench said—in the days ahead.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I thank my noble friend Lord Lansley for that intervention. One of the reasons why I raise that process is because I am aware that there are ongoing discussions in other parts of the House. We will reflect on that as we progress the Bill.

My noble friend Lord O’Shaughnessy spoke of positive engagement with his EU counterparts on bilateral arrangements in the event of no deal. A number of noble Lords raised what would happen should the withdrawal agreement not go forward. My noble friends Lord Ribeiro and Lord Lansley both raised the question of no deal. My noble friend Lord Lansley is right that we should be careful and seek to reassure those who currently rely on reciprocal healthcare that they will be able to rely on these arrangements going forward. Great interest has been expressed by our counterparts in the European Union, where we are seeking bilateral arrangements with relevant member states in the event that we reach 29 March without a deal with the EU.

[Lord Foulkes of Cumnock]

The Minister has been really helpful in her reply and has dealt extremely well with the points raised. She has come to a crucial one now. I think that everyone understands that if there is a deal along the lines that have been agreed, reciprocal arrangements will continue. That is one of the positive things about it. However, if there is no deal the Minister and the Government need to be honest with us and the public about it. It will not be easy to negotiate bilateral deals with 27 different countries if we come out with no deal. If the Minister and the Government are honest about that, it will make people understand that it is vital, if we are to leave the European Union, that there must be some kind of deal, because no deal would be a real disaster for healthcare.

[Baroness Blackwood of North Oxford]

The noble Lord, Lord Foulkes, raises a very important point, and he is absolutely right that the Government do not seek to have no deal. The best way to avoid no deal is to have a deal. Under the withdrawal agreement there is protection of reciprocal healthcare arrangements for EU citizens in the UK and for UK citizens abroad, and that is what the Government seek to deliver. We have set out a number of steps to ensure that individuals who currently receive reciprocal healthcare can be protected as much as possible under a no-deal scenario. One of them is to put in place the powers in this Bill so that we can go very quickly to seeking bilateral arrangements. That is why I hope we will receive the support of the noble Lord as we go forward with this legislation.