Healthcare (International Arrangements) Bill 2017-19

“Whether on holiday, working or retiring abroad, British people want to know they can access the same high quality healthcare that they enjoy in the NHS. This Bill will allow us to implement new healthcare arrangements with other countries – in the EU and elsewhere – so that UK citizens can travel with confidence.” Lord O’Shaughnessy UK Health Minister

While the UK is in the EU it means that  healthcare for UK citizens within the EU is currently enabled by EU Regulations. A series of Brexit Bills have been introduced to try and adjust the UK Government’s current legislation around withdrawal from the EU.

The Healthcare (International Arrangements) Bill 2017-19 was introduced to the House of Commons on 26th of October 2018 to:

“safeguard healthcare for 190,000 UK expats living in the EU, and the 50 million UK nationals who travel abroad to EEA countries every year, through agreements with the EU or its Member States.”

After December 2020, (if there is a transitional arrangement from 29th of March 2019 which would protect the current arrangement for a short period), the UK would no longer be part of the reciprocal health care arrangement. That means UK citizens on holiday, working, or who have retired to an EU country would no longer be covered. This also includes the sharing of data. There are currently 32 countries who participate in the arrangement – 28 EU states, three EEA/EFTA states – Norway, Iceland and Liechtenstein – and Switzerland

It might  be the case that after Brexit the UK would have to make separate arrangements with individual countries.

The Bill is to allow extra powers to be given to the UK Secretary of State for Health and Social Care to avert what will be a very costly situation for UK citizens both for their finances and their health.

The extras powers would be:

• fund, arrange and make payments in relation to healthcare outside the UK
• give effect to any healthcare arrangement between the UK and other countries,  territories or international organisations (such as the EU)
•  make provision in relation to data processing, which will be necessary to underpin these arrangements and agreements.

Pensioners

Approximately 180,000  UK citizens have retired to parts of the EU. More than 90% of them  and their dependents have chosen to reside in Ireland, Spain, France and Cyprus. They receive their  UK  state pension  and their health care costs are covered.

“for state pensioners and their dependants who have moved abroad, the state that pays their state pension is responsible for paying the costs of their healthcare – known as the S1 route” 

It has been estimated that if British pensioners lost their health care cover in EU states and had to return to the UK to access care, the extra annual costs to the NHS could  amount to as much as £1 billion – this is twice what the UK currently pays in the S1 scheme.

EHIC

EHIC is a European Health Insurance Card and covers necessary care during temporary stays.  There are 27 million active UK EHIC cards in circulation and these are used to pay for around 250,000 medical treatments each year.

Planned Medical Care

For planned medical treatment in the EU , costs are paid by the Member State that has referred them – via either the S2 scheme or the Patients’ Rights Directive. 1,300 UK residents per year travel overseas to receive planned treatment.

This table illustrates the number of UK citizens claiming for healthcare in EU countries.

It also covers EEA states and Switzerland. When the UK leaves the EU the arrangements will also be lost with the EEA states and Switzerland.

“UK nationals residing in another state may obtain treatment as a resident of the country in question. The range of medical services in EU countries may be more (or less)  restricted than under the NHS, and in some cases patients need to make a contribution towards the costs of their care (copayments), but they ensure access to healthcare at reduced cost (and in some cases for free).”

Arrangements are also made if you need to have a prescription fulfilled whilst in an EU country.

10,000 employees of UK firms/bodies working in the EU/EEA (including their dependents) including those who live in the UK but travel to work in the EU are also funded for their healthcare.

The Sharing of data

As a member of the EU, medical information and the processing of payments is all covered by the reciprocal arrangements. That will change when the UK leaves. Here’s an example:

“after EU Exit, a person who is paid a UK pension but resides in Spain is to have their healthcare funded by the UK, it may be necessary for the relevant Spanish healthcare provider to share information with the relevant government department in the UK (for which the Spanish healthcare authority would rely on its own domestic powers to process data) to determine that the person is, in fact, in receipt of a UK pension and to confirm that person’s identity.

“The government department in the UK would need to share personal data with that Spanish health authority to confirm the person’s identity and their receipt of a UK pension, so that the reciprocal healthcare arrangement in this scenario can operate correctly.”

Deal or No Deal financial costs of the new ‘arrangements as estimated by the UK Government

• Deal: £630million per year , if the UK continues to participate in the current EU arrangements.
• No Deal: £630million per year if the UK has a bilateral arrangement with every EU/EEA Member State and Switzerland

” it is not possible at this stage to provide a full estimate of the expenditure which may be incurred”.

Other Health Care Arrangements

The UK does currently have reciprocal health care arrangements with specific states: Anguilla, Australia, Bosnia and Herzegovina, British Virgin Islands, Falkland Islands, Gibraltar, Isle of Man, Jersey, Kosovo, Macedonia, Montenegro, Montserrat, New Zealand, Serbia, St Helena, Turks and Caicos Islands.

” Many of the current reciprocal agreements are modernised versions of long-standing historical agreements that were arranged in the course of the 20th century. These do not, however, cover state-to-state cost reimbursement and are considerably more limited in scope as compared to the EU reciprocal healthcare arrangements”.

The UK Government will seek to strengthen these agreements after Brexit.

What about Non-UK citizens living in the UK?

The current situation before Brexit means:

“EU citizens currently in the UK are eligible for NHS-funded healthcare in the same way as a UK national who is resident in the UK, if they can show they are ‘ordinarily resident’ in the UK. In addition, those who present valid documentation (for example, a tourist or student who presents an EHIC) receive treatment on the NHS, the cost of which is reimbursed to the UK by the member state which provides the individual’s insurance.”

Refugees and asylum seekers are entitled to free healthcare in the UK.

Temporary migrants have to pay a health surcharge when applying for a Visa to stay in the UK for more than 6 months. This then covers them for access to free healthcare.

After Brexit – depending on the agreement reached between the UK Government and the EU the arrangements for EU citizens may change.

Being part of the EU’s reciprocal health care arrangements have been of benefit to  UK citizens whether they are on holiday, working or have retired. The situation is particularly worrying for Northern Ireland and Ireland where people are used to travelling for healthcare.

The UK will have the status of a Third Country with a no deal scenario. The British Medical Council (BMA) state:

“Should there be a failure to agree a withdrawal agreement by March 2019, access to reciprocal healthcare arrangements for UK citizens and residents within the EU, and EU citizens and residents within the UK, would end. This would lead to significant disruption to those individuals’ healthcare arrangements, an increase in costs of insurance, and uncertainty regarding accessing healthcare abroad. Moreover, the NHS would face a drastic increase in demand for services, which could dramatically increase its costs and place greater pressure on doctors and clinical staff.

“The impact of the loss of reciprocal care on patients would be significant, especially given the number of beneficiaries that are pensioners living abroad. Evidence given to the House of Commons Health Select Committee has suggested that many of them will be unable to fund private healthcare and so will be forced to return to the UK.

“UK citizens travelling within the EEA, and EEA citizens visiting the UK, will also need to purchase their own travel or health insurance should access to reciprocal arrangements be lost. This is a particular concern for those with disabilities or long-term conditions, as the cost of health and travel insurance for those with pre-existing conditions could be prohibitively high.”

The view from the Scottish Government

The Scottish Government wishes the reciprocal arrangements with the EU to continue.

“whatever form Brexit takes, the UK should continue to cooperate closely with the EU on issues that will affect people’s prosperity, well-being and quality of life. For example we want to ensure that Scots travelling to EU countries continue to have access to reciprocal healthcare…”

EU leaders are to meet on 17th and 18th of November to discuss what will happen if there is  no deal scenario and the UK crashes out of the EU on the 29th of March 2019

Also to note: EU Plans with No Deal Brexit

Reporter: Fiona Grahame