Healthcare (International Arrangements) Bill — House of Lords, 2019-02-05
Topic: Health
James O’Shaughnessy (Conservative, Centre-right): I congratulate my noble friend on a truly outstanding maiden speech and say how delighted I am to see her in her place. Her speech has shown a glimpse of the many qualities that she will bring to this House: her intelligence, her humour and her commitment to public service. She did not mention that she is also a superb singer and flautist; perhaps today is not the day, but I hope she will give noble Lords the opportunity to hear and appreciate her musical skills at some point. I have dropped her in it now—not for the first time Not only did my noble friend give me the great honour of supporting her introduction yesterday but we had the opportunity to work together as Ministers for six months. During that time, she gave me one of the best pieces of advice I have ever had: watch your mailbag. It is an early warning signal when things are going wrong and problems need to be seen to. Because I was watching carefully under her very sage advice, I noticed more and more letters about problems with transvaginal mesh and sodium valproate. In many ways, they led to the review that my noble friend Lady Cumberlege is carrying out on medicine and medical device safety. That is the kind of impact that my noble friend has already had in her life as a Minister and she will go on to have an even more profound impact. She will know as well as I do that it is a huge privilege to hold the job that she does and I hope she enjoys it as much as I did. I would also like to join her in congratulating my noble friend Lady Manzoor on holding the fort so ably in the last month The Bill before us is an incredibly important piece of legislation, for two reasons. First, it will give the Government the powers they need to continue our mutually beneficial reciprocal health agreements with EU member states. The advantages of these are already enjoyed by many of our citizens: 250,000 British tourists make medical claims every year under the EHIC card, 180,000 British pensioners live in the EU and hundreds of people take planned treatments paid for by the NHS but delivered abroad Secondly, as my noble friend said, as we become an independent trading nation once again, we want to be able to enter into similar arrangements with our trading partners. Lighter versions of our reciprocal healthcare arrangements already exist with Australia, New Zealand and some of the EU accession states. However, as we strike new trade and other agreements, it is absolutely right that the British Government make the most of the opportunities these present for our citizens to travel, work and retire abroad It is also a necessary Bill because the powers on which we base our current ability to strike reciprocal healthcare agreements derive from EU law, specifically EU Regulations 883 and 987. These will become inoperable once we leave the European Union, however that should happen. At the risk of disappointing the noble Lord, Lord Foulkes, who will speak directly after me, this legislation does not fit into his category of the no-deal planning which he believes to be a waste of time and money. It is quite the opposite: we need these powers for any deal that we strike with the EU, whether the one agreed by the PM, the one that is official Labour Party policy or any other that might emerge For these reasons I strongly support the Bill, which will not come as a surprise since I was the Minister responsible for it until the end of December. However, I also believe it is one that all noble Lords should support because of the benefits it will bring to British citizens. Critically, this point is recognised by the Scottish Government, not the greatest friend of either this Government or Brexit but who have exceptionally agreed to a legislative consent Motion for the Bill Nevertheless, as this debate will show, and as debates on the Bill in the other place and the report of the DPRRC have brought out, there are some significant questions about the legislation that must be dealt with. The first, which was the subject of Labour Front-Bench amendments in the Commons, is to do with creating specific reporting requirements on any spending involved in new reciprocal deals. I can understand the desire for such information but there is already a robust annual reporting process, which is used today and which covers reciprocal health and other departmental spending, that allows for scrutiny by both Houses of Parliament as well as by the Public Accounts Committee and the NAO. It is of course also covered in the DHSC’s annual report. If the current procedures are good enough while we are still members of the EU, and if our intention is by and large to recreate the same kind of relationships, then I see no good reason to change this approach. The second question is the criticism, made forcibly in the DPRRC report, that there are too few constraints on the powers that the Bill gives to the Secretary of State. I always take the opinion of the committee very seriously but in considering its view, it is essential to consider not only the intent of the Bill but its reach. On intent, as I have said, the overall aim is to agree reciprocal deals that are similar to those we currently enjoy with the EU and to strike new, more sophisticated deals with our trading partners. However, with our new-found freedoms it is likely that we will want to consider additional, yet to be anticipated approaches The Bill clearly ought to be flexible enough to accommodate this, because it is simply impossible to determine in advance what might be desirable as we agree new trade deals and other international agreements. On its own, I accept that this might be a cause of concern, until one realises that the reach of the Bill is in fact limited because the powers it confers on the Secretary of State can be used only within the scope of an international treaty, which will always be subjected to detailed scrutiny and approval in Parliament. In that sense, the Bill is essentially concerned with giving the Secretary of State implementation powers under the broader aegis of an international treaty, each of which will require parliamentary approval. I believe that this ought to give noble Lords reassurance that the powers in the Bill cannot be misused Thirdly, there is the issue of regulation-making powers and affirmative procedures, as already mentioned by my noble friend. It is somewhat ironic to find those who vehemently oppose the UK’s departure from the EU promoting this cause, given that our membership gives the UK Parliament no say whatever in whether EU law should be implemented, but let us not dwell on that inconsistency. The approach outlined in the Bill, using the affirmative procedure only for changes to primary legislation, is entirely reasonable and consistent with other legislation. Nevertheless, my noble friend the Minister will no doubt want to reflect on the findings of the committee and the views of the converts to the cause of taking back control as we move forward Finally, there is the issue of data security. The exchange of data is essential to any sophisticated reciprocal healthcare agreement, which is why it features so prominently in the Bill. But as my noble friend the Minister will know—she understands the data issue deeply—it is of great concern to the public, so I hope she will be able to reassure the House that we would enter into such data-sharing arrangements only if the highest standards of security can be met I will end by talking about what is at stake here. It is not just our citizens who support the continuation of reciprocal healthcare arrangements with our European neighbours; so do the citizens and Governments of those countries. During my time as a Minister, I went to several EU health ministerial meetings and met most of my European counterparts. As your Lordships might imagine, that involved some interesting and occasionally challenging conversations. But without exception, those countries want to continue the reciprocal healthcare agreements once we leave the EU. Indeed, while my job in those meetings was to present the case for a deep and special relationship with the EU on health and other issues post Brexit—sometimes receiving polite nods and the line "the Commission leads on negotiations"—on reciprocal healthcare, several Ministers initiated discussions with me about how we could continue our partnership in future. This is partially about financial self-interest—the UK is a net contributor to EU member states through the current arrangements—but it also reflects a profound and historical commitment, in some cases dating back pre-war, to partnership and co-operation What this Bill represents is not only the chance to do the right thing for British citizens and patients, but also to extend the hand of friendship to our European neighbours and our partners around the world as we leave the European Union. That is a laudable cause, which I hope will draw support from noble Lords across the House today.