Bill on no-deal OAP health moves on but worries remain

A bill giving the UK government powers to sign and fund bilateral healthcare deals to help cope with impacts of a no-deal Brexit was passed in the House of Lords yesterday – but with warnings given about the generalised nature of the wording and the dangers of relying on such deals.

6 February 2019
By Oliver Rowland

It comes after the UK put out wording on its site advising Britons living in the EU to consider the possible need to buy private insurance in the case of no-deal, which Baroness Thornton (Lab) said had caused panic and alarm among UK citizens who are dependent on the S1 scheme for life-sustaining treatment and medication.

The bill, already debated by MPs, will now go to a committee of both houses of Parliament for final tweaks. It is most urgently needed so the government could make agreements with countries like France to replace the EU’s S1 form scheme under which British pensioners in the EU have their healthcare funded by the UK. Arrangements for them after a no-deal Brexit in countries including France remain uncertain

However debate on the bill also included references to other matters such as replacing the Ehic scheme for travellers. What is more the bill’s wording is very general, relating to possible healthcare agreements worldwide in the broadest terms, such as in connection with future trade treaties – a fact on which several peers expressed concerns. Baroness Thornton said she suspected a minister or “very bright civil servant” had seen the bill as “an opportunity to start a discussion about healthcare deals in many other countries”, but “where I come from we call that being too smart by half”.

Government Health Minister Baroness Blackwood conceded that there was still “much work to be done on the bill” in the next stage, whose date has yet to be set.

Lib Dem life peer Lord Marks, a former barrister, also told the house that “it is very dangerous… to tell the public that all will be well in the event of no-deal. Even if this bill and the regulations go through as quickly as they can, there will be a very serious hiatus”.

Baroness Blackwood said this was “an important point”, adding that the government “have been very clear in outlining some of the risks associated with no-deal and exactly why they are seeking a deal”.

During the debate it was stated that the UK has ‘light-touch’ healthcare agreements with other countries including Australia and New Zealand, but nothing as wide-ranging as the protection under the S1 and Ehic which are used respectively by 180-190,000 British pensioners in EU countries and 27 million Britons who hold Ehic cards (used by holiday visitors, second home-owners and pensioners living in the EU when they visit other EU countries). The S1 is also currently used by British pensioners living in the EU to gain access to NHS care on a visit back to the UK (apart from in emergencies or for GP visits, which are free to all in the UK).

The UK also funds healthcare for 10,000 posted workers in the EU/EEA/Switzerland and 1,350 UK residents who travel each year for planned treatment in the EU.

The costs of reciprocal care to the UK are £630m/year while the UK recovers £66million from EU countries, an amount which is increasing as the NHS “becomes better at identifying EU visitors” but which is unlikely to change “dramatically” because far more UK pensioners go to live in the EU than the other way around.

Baroness Blackwood said it is “clearly in the interests of the British public” that “similar” reciprocal arrangements should continue after Brexit.

She said: “In the event of no-deal… the bill would enable the UK to act swiftly to protect existing healthcare cover for British nationals in the EU, EEA and Switzerland, whether deals are made with the EU or with individual member states. This is clearly undesirable but it is the job of a responsible government to prepare for all scenarios.”

Conservative former health minister Lord O’Shaughnessy said he had met most of his European counterparts and “without exception, those countries want to continue the reciprocal healthcare agreements once we leave the EU”.

Labour peer Lord Foulkes warned however that putting in place new bilateral deals with the EU states would be “lengthy and costly” and no-deal would be “a real disaster for healthcare”.

He said it would “replace a system that works well and gives peace of mind to many thousands of British citizens with completely unnecessary worry and uncertainty – whatever the minister says, it will be about damage limitation”. He said there is a real risk that many British pensioners would have to return to the UK “in fear of facing astronomical health bills elsewhere”, and the NHS would have to “take the strain”.

Crossbencher Lord Kakkar said: “The anxiety that attends any uncertainty about access to healthcare, particularly for those with chronic, long-standing conditions, through arrangements that have been well tried and tested, is clearly unacceptable and something with which no UK government would ever wish to be associated with.”

Conservative former health minister Lord Lansley noted that “generous” provisions given under the EU reciprocal scheme are part of EU free movement – which the UK had voted to stop – and without it the UK could in theory stop paying for people who move to countries like Spain because they are no longer ‘ordinarily resident’ in the UK. However he said UK pensioners in the EU would be “extremely anxious and distressed by the removal of something they have been accustomed to” and “we do not want to create that distress”.

He knew of no current plans to sign similar deals around the world.

Lord Ribeiro (Con) said the Nuffield Trust estimates total healthcare costs to the UK if many pensioners return would be double that of paying for their care in the EU, notably due to the need for new hospital places, potentially equivalent to building two large new hospitals.

As for loss of Ehics – which the UK government is currently warning are only valid until March 29 – Lord Foulkes said that if not replaced this would mean extra travel insurance costs, impacting especially on those who “have struggled just to get enough money to go abroad” and less so the well-off.

Baroness Barker (LD) said with no Ehic, insurance for travellers will not only be costly but difficult to obtain for those with pre-existing conditions.

A Lib-Dem ‘mystery shopping’ exercise found only two of seven travel insurers asked said claims would be “paid out as normal in the event of a no-deal’. It was also clarified in the debate that while ‘travel insurance’ costs are estimated by the Association of British Insurers to rise 5-20% in a no-deal, at the same time ‘travel insurance’ as currently used by British visitors to the EU is not in fact ‘healthcare insurance’ [as it assumes essential healthcare to be covered by the Ehic scheme].

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