Regulations and directions

Healthcare (International Arrangements) Bill – in the House of Commons at 7:15 pm on 21st January 2019.

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Votes in this debate

  • Division number 298
    A majority of MPs voted not to require the explicit approval of both houses of Parliament for reciprocal healthcare agreements with other countries.

Amendment proposed: 1, page 3, line 44, leave out subsections (5) and (6) and insert—

“(5) Any statutory instrument which contains regulations issued under this Act may not be made unless a draft of the instrument has been laid before Parliament and approved by a resolution of each House.” —(Justin Madders.)

This amendment would make all regulations issued under this Act subject to the affirmative procedure and require approval from Parliament before they become law.

Question put, That the amendment be made.

The House divided:

Ayes 261, Noes 298.

Division number 298 Healthcare (International Arrangements) Bill — Parliamentary Approval of Specific Arrangements

A majority of MPs voted not to require the explicit approval of both houses of Parliament for reciprocal healthcare agreements with other countries.

Aye: 260 MPs

No: 298 MPs

Ayes: A-Z by last name


Nos: A-Z by last name


Absent: 88 MPs

Absents: A-Z by last name

Question accordingly negatived.

Third Reading

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care) 7:43 pm, 21st January 2019

I beg to move, That the Bill be now read the Third time.

We have had a productive debate on the Bill, and I am grateful to all Members, including those who recently contributed, who have engaged so constructively with the passage of the Bill and demonstrated a shared commitment to protecting the healthcare-access options of UK nationals in the EU. The support shown to the Bill throughout its passage shows the value of reciprocal healthcare. I wish to put on record my appreciation for the consensual approach shown by all parties in the House, and particularly to note the contributions from the hon. Members for Burnley (Julie Cooper) and for Ellesmere Port and Neston (Justin Madders). Not only in Committee but on Report, they raised objections but were very helpful in respect of the passage of the Bill.

Although the Bill is short, it is nevertheless important. The powers it contains will ensure that we are prepared, whatever the outcomes of exiting the EU are, and also that we are able better to implement complex reciprocal healthcare agreements with members and non-member states. Powers under the Bill will enable the UK to fund and give effect to our future relationship with the EU on reciprocal healthcare. The Bill allows us to look to the future. The powers it contains will allow us to implement strengthened reciprocal healthcare arrangements, or new ones with countries outside the EU. It is necessary to provide the Government with the powers to ensure a smooth transition from our current relationship with the EU to the future one.

Let me take this opportunity to thank those Members who served on the Public Bill Committee, in particular my hon. Friend Sir Gary Streeter and Graham Stringer, who ably chaired the Committee. I reiterate my thanks to those who gave oral evidence to the Committee and to those who provided written evidence, including Mr Alastair Henderson, Mr Raj Jethwa, Ms Alisa Dolgova and Ms Fiona Loud. Their expertise and perspectives were vital in understanding the importance and impact of reciprocal healthcare arrangements to medical professionals, insurers and, most importantly, the patients. I also put on record my thanks to my officials, who have guided me through this process.

As a responsible Government, it is important that we plan not only for every eventuality currently before us but for the future. The Bill is intended to provide reassurance to UK nationals living in the EU or those planning to travel to the EU. Again, I thank Members for their support. I commend the Bill to the House.

Photo of Julie Cooper Julie Cooper Shadow Minister (Health and Social Care) (Community Health) 7:46 pm, 21st January 2019

First, as the Bill is given its Third Reading, may I thank all Members who have contributed?

We will not oppose the Bill at this stage, as we acknowledge the importance of safeguarding healthcare for the estimated 190,000 UK expats living in the EU and the 50 million nationals who travel abroad to EEA countries each year. That is not to say that the Bill is perfect—far from it. There are issues that for us remain unresolved, and we are anxious about the implications of the sweeping powers that the Bill will give the Secretary of State. We hope that Members in the other place will pick up on some of these concerns.

We are now only 67 days away from formally leaving the EU. On Second Reading—which, coincidentally, was 67 days ago—there was a clear assumption on the Government’s part that an agreement with the EU would be reached and that arrangements would carry on as now. I do not think it is an understatement to say that that is now looking rather less certain.

I said at the time that the Government’s own impact assessment seemed seriously to underestimate the consequences of a no-deal scenario. As my hon. Friend Justin Madders said earlier, the impact assessment set out how the costs of establishing future reciprocal healthcare arrangements on the same basis as now would be £630 million per year. It then went on to estimate that, in the event of a no-deal scenario, the costs would be expected to be similar or less, depending on the number of schemes that were established. It has never been made clear why the costs might be less, unless we stop reciprocating with other countries, and I do not believe anyone expects that.

The British Medical Association and the Royal College of Paediatrics and Child Health have expressed concern that, should no EU-wide reciprocal agreement be achievable, the significant costs of establishing bilateral reciprocal arrangements with the EU and EEA countries would in future fall on the NHS. Perhaps in the scenario we now face, we will be able to replicate exactly what is in place now, but that is not certain, and the implications are potentially significant. I therefore ask the Minister whether he would mind keeping us updated on the progress in bilateral discussions.

UK state pensioners living abroad account for 75% of the total amount that we spend on reciprocal healthcare, and they will be anxious to know that they will be able to enjoy the same access as they do now. If not, those with chronic conditions or complex healthcare needs may need insurance that is prohibitively expensive—if it can be found at all. The potential implications of that cannot be underestimated. For those travelling abroad, the BMA and others have said that, without a reciprocal healthcare agreement, patients with disabilities would also be among the most affected. Again, for those groups, as much information on progress as possible would be appreciated.

Associated with that is a lack of clarity over how dispute resolution will work in the event of bilateral agreements being necessary. We know from what the Minister has told us that, if we manage to reach full agreement with the EU27, there will still be a limited role for the European Court of Justice, but we do not know what the dispute resolution procedure will be if we do not. Can he confirm whether it is still the Government’s position that the ECJ will have no jurisdiction in the event of bilateral agreements being necessary? I am not sure what incentive there will for other countries to agree to a brand new dispute resolution architecture, and I doubt very much that they would want to pay for one. It seems to me that, sooner or later, the Government will have to come clean with their own Back Benchers that, in this area at least, the ECJ will still have a role to play, even in the event of a no-deal scenario.

Even under the current arrangements, cost recovery is something that we do not appear to have handled satisfactorily and the fault for that lies with the Government alone. In 2012-13, the NHS charged only around 65% of what it could have done to visitors from outside the EEA and Switzerland, and only 16% to visitors from within that area. Although I accept that things have improved since then, they are still far from perfect. Indeed, as my hon. Friend the Member for Ellesmere Port and Neston mentioned, the Public Accounts Committee said that it was chaotic.

The Law Society of Scotland was clear on the importance of this issue when it gave evidence to the Lords Committee. It said that

“as the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.”

So the Government need to raise their game in terms of cost recovery. If there is an additional administrative burden on the NHS in setting up new systems of cost recovery because of agreements reached, will the Minister give a commitment that NHS providers will be adequately compensated?

Perhaps the issue of reciprocal healthcare matters most on the island of Ireland where the border area has a dispersed population of around 2 million people, with an integrated healthcare system that has to survive whatever the future arrangements end up being. They cannot be failed by this Bill, which is why we believe that there needs to be maximum parliamentary oversight.

This Bill is necessary, but it does seem that the Government have used the opportunity to give themselves powers far beyond those that are necessary to achieve the objective set out under this legislation. They are using every trick in the book to avoid proper scrutiny of their actions. That is part of a disturbing trend that we are seeing across much of the Brexit legislation. It is a trend that does the Government no credit and it is a trend that I believe Members from across the House will come to regret.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons), Chair, Health and Social Care Committee, Chair, Liaison Committee (Commons) 7:53 pm, 21st January 2019

I do not intend to detain the House for long. I support this Bill, but only regret that it is necessary. I wish to tell the House about an email that I received from a friend recently. He told me about his 92-year-old father who was visiting France and had a fall. He phoned my friend, who dialled 999 in this country, and an hour later his father was in hospital—all of that at no cost to his father because he carried a European health insurance card. The close ties that we have involving our reciprocal healthcare are not just financial. They are also about those close links and data transfer. I profoundly regret that this is the kind of thing that people will not realise they have lost until it is gone. That is the great tragedy here. The point is that it is not people like us, who are relatively fit and healthy, who will necessarily lose out by having to spend an extra 10% to 20% on our health insurance costs; it is our constituents who are elderly, who have to have regular kidney dialysis or who have other complex medical conditions, who will simply find themselves uninsurable or having to face prohibitively expensive insurance costs, and who, if they run into difficulties while they are abroad, will find themselves really adrift.

I hope that the Minister will make it absolutely clear to our constituents that, 67 days from now—the chances are looking more likely that we could crash out with no deal—very, very many of our constituents will find themselves in a really dire situation should they fall into difficulties abroad. They need to be given clear and specific advice about their holiday plans. For those of our fellow citizens who have retired to the European Union and who find themselves in difficulties, I regret that this is a situation for which we will all have to take responsibility in years to come. I hope that the Government will rule out no deal because the consequences will be profound.

Question put and agreed to.

Bill accordingly read the Third time and passed.