I suspect this debate will be slightly less contentious than the earlier statements, and probably a lot quicker.
The Bill basically gives powers to the Secretary of State to agree reciprocal deals. However, I believe that we will not get a better reciprocal arrangements than those we currently have. We recognise the need for all these arrangements to continue, and the Scottish Government will do all they can to work with the UK Government to ensure that they do, and of course we note the legislative consent motion that has been granted. Through the Joint Ministerial Committee we believe a common framework system can be achieved that ensures these specific health arrangements can be administered through common agreement between the UK and Scottish Governments. Clearly, Brexit threatens the loss of reciprocal healthcare arrangements for millions in Scotland and across the UK. The Bill’s impact assessment makes this conclusion in relation to a no-deal scenario:
“If UK citizens in the EU are treated as 3rd country nationals (i.e. they cease to have rights of movement and access to services in EU Member States, and are treated like citizens coming from non-EU countries) some may face additional financial costs or difficulties accessing healthcare services, with potential implications for their health and wellbeing.”
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In evidence to the House of Lords European Union Committee, a representative from the Association of British Insurers gave the rough estimate that in a no-deal scenario travel insurance premiums for EU travel could increase by between 10% and 20%. In Committee, we heard from Alisa Dolgova from the ABI, who informed us:
“Firms are currently pricing in the assumption that there will be a withdrawal agreement in place with a transitional period that will allow more time for the Government to enter into a reciprocal healthcare arrangement.”
There will therefore be a significant price to pay if there is no deal. There is real concern that the cost of health and travel insurance could become prohibitively high for many with underlying health conditions, and thus restrict travel arrangements. This concern was well illustrated in Committee by Fiona Loud, the policy director of Kidney Care UK, who advised us about people who undergo ongoing dialysis treatments while travelling abroad. She said:
“We have people who are taking the option to travel now because they have no idea what will happen after 29 March. For them, the ability to travel with confidence—I think there is something in the Bill about people being able to travel with confidence—is something they can do now, and they are not confident yet that they will be able to do that after 29 March.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 13.]
She went on to advise that dialysis could cost about €1,000 a week.
Of course it is not just a no-deal scenario that we should be concerned about. The Prime Minister’s deal would have hugely damaging implications for our NHS and care services, depriving us of EEA doctors and nurses. The care sector is particularly reliant on EU citizens. The UK Migration Advisory Committee concluded that EEA migrants contribute more to health and social care in financial resources and through work than they consume in services. A November 2018 British Medical Association survey of 1,527 EEA-trained doctors across the UK found that 78% were unconvinced by promises that their rights would be protected in the event of a no-deal Brexit, 37% were unaware of the Westminster Government’s settled status scheme and 35% were considering moving abroad. Last year alone, we witnessed the loss of almost 2,500 experienced EEA nurses and midwives across the UK. In exit surveys, many EEA registrants gave continuing uncertainty about their future lives and careers as a significant factor in deciding to leave the register and the UK.
All these concerns would be compounded, should the reciprocal schemes cease and UK citizens return home to receive treatment. The British Medical Association and the Nuffield Trust have estimated that if all those people—mostly pensioners—were to return to the UK, the NHS would need some 900 additional beds and 1,600 nurses to ensure sufficient capacity. All in all, providing this additional healthcare would cost around £1 billion. It would be fair to say that I have a number of concerns. Current progress appears to prioritise pensioners and, welcome though that is, it does not give enough
consideration to children and adults with long-term illnesses. The effect of having no reciprocal agreement in place on sick and/or disabled children of UK citizens living abroad implies that parents and carers will have to either pay for treatment or return to the UK. Those with long-term conditions will be disproportionately adversely affected, in terms of their ability to travel, by the cost of health and travel insurance. Under existing reciprocal arrangements, the average cost of care received by UK citizens in other EEA nations is frequently cheaper than the equivalent care would be if provided by the NHS, meaning that the UK spends less on care funded through existing reciprocal arrangements than it would if that care had to be provided domestically. In conclusion, we will not get better reciprocal arrangements than we already have. Ensuring that all current reciprocal health agreements remain intact and in place must be the bottom line, regardless of what form Brexit takes.