Healthcare (International Arrangements) Bill — House of Lords, 2019-02-05
Topic: Health
Bernard Francisco Ribeiro (Conservative, Centre-right): My Lords, it is indeed a pleasure to take part in this debate, and in particular to follow the noble Lords who have spoken and to welcome our new Minister to the Front Bench in her new position. I declare an interest as a member of the EU Home Affairs Sub-Committee and commend to the House its report, Brexit: Reciprocal Healthcare, published in March 2018 Like many of your Lordships, although I use travel insurance when I am in Europe, I am always grateful to have in addition my EHIC. Some years ago, while I was on holiday with my family in France, one of my children broke a toe while going down a slide. Faced with having to pay for her surgery and then claim back the cost, I produced my form E111 with a flourish—noble Lords may remember those days. I managed to convince the hospital authorities in my pidgin French, although that was more challenging. The E111 form worked a treat and surgery was performed at no cost to me. The current EHIC is equally reassuring, but mine runs out in May 2019, so I seek reassurance from my noble friend the Minister that I will be able to renew it during the implementation period of the withdrawal Act—if it is finally implemented What happens in the event of a no-deal Brexit, the drums for which are continuing to beat in some quarters? Our report confirmed that some 27 million cards, as has been mentioned, exist in the UK, from which only 250,000 claims—less than 1%—have been made so far each year. In relation to UK citizens living in Europe, approximately 190,000 UK state pensioners, as we have heard, rely on the S1 scheme. This provides ongoing access to healthcare, the costs borne by the member state with the social security system to which the individual has contributed the longest. The scheme supports the elderly and ensures that reciprocal healthcare is a portable benefit. On page 10, paragraph 16 of our report says: "A disproportionate number of UK citizens benefit from the S1 scheme. There are only around 1.2 million UK citizens living in other EU countries compared with around three million EU citizens living in the UK. But some 190,000 of those UK citizens are pensioners, who are more likely to benefit from the S1 scheme, compared to only 5,800 EU/EEA citizens who have registered for the S1 scheme in the UK" That is quite a disproportionate number In all this, we remain net beneficiaries. I hope that noble Lords will forgive me for focusing on the no-deal scenario, but the implications are dire for this group of UK citizens and the 27 million EHIC holders whom I mentioned, many of whom, as we know, voted to leave the EU. If the EHIC is not maintained—which is a distinct possibility with no deal—short–term visitors to the EU would need travel insurance. In giving evidence to the committee, Mark Dayan of the Nuffield Trust told us that the highest cost of travel insurance was the medical cost. Without the EHIC, the cost of travel insurance is bound to rise There is also concern about the onward movement of UK citizens living or working in the EU in relation to free-movement rights or rights to reciprocal healthcare, which are not covered by the joint agreement or the withdrawal agreement. It has been suggested that bilateral and multilateral arrangements, as currently occur with countries outside the EU such as Australia or New Zealand, could be applied to the EU. But these arrangements largely cover emergency healthcare and not the arrangements we currently enjoy through the S2 scheme in relation to planned treatments. For example, as I mentioned in my speech on 3 July 2018, the proton beam cancer treatment available in Prague and other European cities is not currently available here, although we hope it will very soon come on stream. So what reassurances can the Minister give that future relations and arrangements will protect the current S1 and S2 arrangements, which form part of the four routes to reciprocal healthcare? Reciprocal healthcare is assured until December 2020, as we have heard—if we have an agreement. In the event of no deal, which is fast approaching, what assurances can the Minister give that the deadline of December 2020 can still be maintained to allow "alternative arrangements" to be negotiated between individual EU countries and the UK? It is important that we provide reassurance to UK citizens, many of whom are in their twilight years and have chosen to reside in EU member states, that their health needs are protected. This should happen, deal or no deal. If we end up with no deal, analysis by the Nuffield Trust shows that British pensioners will lose healthcare cover in EU states and have to return to the UK to access care. The cost of that care in the NHS is estimated at about £1 billion—pounds, not euros, although it is about the same—which is twice as much as the UK currently spends on the care of people abroad under the S1 scheme, as spelled out earlier by the noble Lord, Lord Foulkes, when he referred to this. The resource implication of such expatriate return to the UK is the equivalent of two new NHS hospitals the size of St Mary’s Hospital, Paddington. We noted in our report a large amount of evidence expressing concern at the additional costs to the UK and the NHS of returning expats. What contingency plans do the Government have in the event of such an outcome occurring?