More than meets the eye

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Glenys Thornton digs deeper into the purpose of the Healthcare (International Arrangements) Bill, ahead of today’s Lords Second Reading

The Healthcare (International Arrangements) Bill is regarded by the government as the most straightforward and simple piece of health-related Brexit legislation. Healthcare for people working, living and traveling across Europe and those coming to the UK is clearly an urgent matter. That much is blindingly obvious. Yet here we are, just over seven weeks away from leaving the EU (whether by accident or design), and this issue is still not resolved. 

Millions of people are affected, including many who intend to travel in Europe this summer. Thousands of our fellow UK citizens living in Spain and elsewhere in the EU will be watching the progress of this bill with some anxiety. Ministers have said they want both UK and EU citizens to continue to use the European Health Insurance Card (EHIC) scheme after Brexit but that this will need to be agreed going forward.

The future relationship will be negotiated during the transition period, rather than as part of the actual withdrawal agreement. If therefore, we end up with a no deal outcome, the rights to reciprocal healthcare currently enjoyed by many millions of UK citizens will cease. Asked recently how I should personally respond to such a scenario, a Commons Minister advised taking out health insurance if we crash out. Otherwise, I might end up forking out hundreds or thousands of pounds for urgent treatment.

The Bill, which has its Lords Second Reading today, is small but broad in intent and goes wider than the issue of reciprocal health care. Indeed, it seems to open the door to healthcare negotiation across the rest of the world, including as part of trade and foreign affairs discussions. That begs three related questions. Which countries does the government have in mind? For what purpose? And why is the Bill addressing world issues rather than limiting itself to the EU?

The wider international dimension scope is important because as the Bill confers unlimited powers on the Health Secretary. It is rare to read the words “Clause 2 has breath-taking scope. Indeed, the scope of the regulations could hardly be wider” in a report from the Lords Delegated Powers and Regulatory Reform Committee. They then list nine areas of concern, including “The regulations can delegate functions to anyone anywhere”.

So far, the government has failed to convince anybody – Peers or MPs – concerned that such powers are necessary. But either way the regulations will create an interesting challenge, to be explored during our scrutiny of the Bill. And while Ministers will be able to sign the related orders up front, the Lords and Commons will have the 40 days that follow to debate and possibly reject them. 

There are, of course, other matters of concern in this Bill, including a loosely worded clause about the necessary use of patient data. That begs questions about data protection for NHS patients who access health care in the EU which is then provided by the private sector. (A matter we are also raising with the National Data Guardian for Health and Social Care.) Plus there are very serious issues of the arrangements between Northern Ireland and the Republic; and the fact that an explanation of both costings and accountability are missing.

Yesterday, saw the introduction of the new health minister, Nicola Blackwood into the Lords, and it is something of an understatement to say that she will be cutting her ministerial teeth on this Bill.

Baroness Glenys Thornton is Shadow Health Minister in the House of Lords. She tweets @GlenysThornton

Published 5th February 2019

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