Healthcare (International Arrangements) Bill — House of Commons, 2018-11-14
Topic: Health
Julie Elizabeth Cooper (Labour, Centre-left): I am grateful for this opportunity to close the debate on behalf of Labour. It is clear that Members on both sides of the House understand the importance of the Bill. The UK currently enjoys reciprocal agreements for the provision of healthcare with all the nations of the European Union. Under existing arrangements, the healthcare of 190,000 UK state pensioners living abroad—principally in Ireland, Spain, France and Cyprus—and their dependent relatives is protected. In addition, UK residents who visit the EU or the European economic area on holiday or to study may use the European health insurance card to access healthcare for emergency treatment and healthcare needs that arise during their stay. Anyone who is ordinarily resident in the UK qualifies for an EHIC and 250,000 claims for medical treatment are made each year under this scheme. By the same token, EU nationals visiting the UK can use their EHIC to receive free care from the NHS for any emergency healthcare needs and for healthcare needs that arise during their stay. I am grateful to the hon. Member for Chelmsford (Vicky Ford) for reminding the House that the card does not cover repatriation and other associated expenses, but visitors to the EU can currently be reassured that their immediate emergency costs will be met. That is something that we would seek to protect By means of the S1 form and the EHIC, current arrangements also provide for the healthcare of employees of UK companies and organisations working in the EU and the EEA, as well as for that of frontier workers living there, and vice versa. Importantly, the agreement also provides funding for UK residents to travel overseas to receive planned treatment in other countries—for example, for procedures unavailable in the UK within a medically justifiable timescale, or to return home to give birth Providing for pensioners, visitors, students and workers to live, work, study and travel in EU member states with complete peace of mind with regard to the provision of healthcare is a priority for Labour. We therefore support this Bill in principle, although we are quite shocked that we have had to wait so long for it, given that there are only 135 days left until the UK exits the EU. It is essential that we seek to safeguard, through agreement with EU member states, the healthcare of the 190,000 expats and the 50 million who travel abroad every year. I do not for one moment think that anyone here would want to contemplate the consequences if an agreement were not possible when the UK exits the European Union. We therefore welcome the Government’s intention, as outlined in the White Paper on the future relationship with the EU, to continue a reciprocal healthcare arrangement by means of an agreement with the EU, the EEA and Switzerland We are concerned, though, about the scope of the Bill. It includes no detail of specific reciprocal arrangements, although at this stage we understand why it is not possible, in the absence of any certainty, to outline such details. We will not seek to block the Bill, because we want to ensure the seamless continuation of reciprocal healthcare arrangements, but we are not prepared to give the Government carte blanche to secure any agreement at any price. We are not prepared to hand them a blank cheque We are concerned that the Bill includes no requirement for the Secretary of State to report back to Parliament. Nor does it incorporate any facility for parliamentary scrutiny, even in the event that a member state decides not to reciprocate. The British Medical Association shares our concerns on this point. It rightly maintains that the discretionary powers granted to the Secretary of State in the Bill should be proportionate and subject to thorough scrutiny, and that all regulations should be subject to the affirmative procedure in Parliament. We also have concerns about the protection of patient data, and we wish to ensure that appropriate safeguards are in place in the Bill. We will look to address those concerns in Committee The Health Secretary is on record as saying with confidence that this is one part of the Brexit deal that is resolved. I welcome his confidence and that of the hon. Member for Walsall North (Eddie Hughes) on this—I wish I had their confidence. However, the Secretary of State does offer the proviso that that is "so long as we land a good deal." That is surely the crux of the issue, given the current uncertainty about whether we will get a deal at all I hope the Minister is able to give some reassurances on this issue, because the failure to facilitate a reciprocal arrangement for healthcare would be catastrophic for UK citizens seeking healthcare routinely within the nations of the EU. The thought of 190,000 expats losing their right to free healthcare is unthinkable. As the Minister rightly said, UK citizens have paid their taxes all their lives, and they need and deserve the certainty of the right to free healthcare and of knowing that it is protected. That is something the hon. Member for North Thanet (Sir Roger Gale) was keen to support, and we agree with him. It is unthinkable that expats living in the EU should be reduced to the status of third country nationals in a queue for healthcare. Similarly, the 50 million visitors to the EU each year will need certainty, as the hon. Member for East Renfrewshire (Paul Masterton) pointed out—I am sure the whole House is interested to hear more about his stag trip. Without a reciprocal agreement in place, costs for citizens overseas may well be prohibitive, and there are obvious implications for health insurance premiums We are also concerned about the impact on our NHS in the UK if expats need to return here for treatment. Our system is already having to cope with unprecedented demand, and the thought of adding to that is something we are concerned about. I reiterate the concerns of my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) that the issue is not covered in the impact assessment. We also know that no assessment has been made of the impact on disabled citizens and those with pre-existing medical conditions Importantly, neither is there any mention, as the hon. Member for Totnes (Dr Wollaston) said, of how any future disputes will be adjudicated. The Prime Minister has ruled out the future involvement of the European Court of Justice, so we are concerned about this issue going forward. Perhaps the Minister can advise us today which body he envisages being used to adjudicate in any such event. We also hope that the Bill can be used to outline processes for the efficient collection of moneys owed to the UK under any future arrangements for reciprocal healthcare We look forward to addressing these concerns in Committee. We want to see this Bill go further and be used as an opportunity to strengthen reciprocal arrangements further and to provide for enhanced arrangements with other nations worldwide, in line with the UK’s ambition to extend its range of trading partners.