My Lords, I thank my noble friend Lord Lansley for Amendments 27 and 41, the noble Baroness, Lady Thornton, for Amendment 33, my noble friend Lord Dundee and the noble Lord, Lord Foulkes, for Amendment 34 and the noble Lord, Lord Marks, for Amendments 35, 36 and 38. Each amendment speaks to concerns we have heard during the passage of the Bill to date about the breadth of the regulation-making powers and the scrutiny afforded to them.
I wish to open by saying that I listen very carefully to these concerns. I assure the noble Baroness, Lady Thornton, that I see this process as neither a game nor a tussle. The suite of measures on reciprocal healthcare we are introducing is intended entirely to reassure UK citizens living in Europe and elsewhere, and EU citizens living in the UK, that we will work hard to ensure continuity of care for them in this uncertain time and that we are looking forward and thinking about providing care in other places, as a Government should.
To assist our consideration of these issues, I thought it might be helpful to set out the intention of some of the delegated powers as drafted, as we have not yet had a chance to do so in much detail. As I indicated previously, Clause 2(1)(a) is intended to be used to set out the detail of complex payment arrangements under reciprocal healthcare deals because payments can be made in a variety of ways. For example, the UK pays France the actual cost of treatment provided, meaning that a claim for the cost of each person’s individual treatment is made to the UK, whereas in Spain, we pay an average cost per person of treatment provided. In Portugal, on the other hand, we offset payments. That is why that power has been drafted in that way.
Clause 2(1)(b) provides for regulations to be made in connection with the provision of healthcare abroad outside reciprocal arrangements, allowing us to put in place complex arrangements outside a bilateral agreement in an urgent situation. That is designed specifically for an EU exit situation that may be an emergency.
Clause 2(1)(c) is needed to give effect to comprehensive healthcare agreements entered into with another country or international organisation, such as the EU. This provides the power to implement agreements in domestic legislation. We believe that it would be unworkable to produce new primary legislation to implement each agreement on an individual basis; I am sure that the House would agree.
Clause 2(2) sets outs examples of the type of provision that might be included in regulations under Clause 2(1). As we have said before, it is an illustrative list of the kinds of provision that would already be included. I took note of the concern about conjunctives under this clause.
Clause 2(2)(a) highlights that complex healthcare agreements may include a mechanism for calculating payments and regulations but would need to specify how the cost of healthcare would be calculated between different countries.
Clause 2(2)(b) indicates that regulations may establish eligibility criteria that specify which people can access healthcare outside the UK. Establishing robust eligibility criteria is key to preventing the misuse and abuse of healthcare, as referred to already by my noble friend Lord Lansley in previous debates.
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Clause 2(2)(c) indicates that regulations made under this Bill may also be used to specify the types of healthcare covered in relation to healthcare arrangements abroad. For example, under the current EU reciprocal healthcare scheme, the EHIC scheme provides access
to needs arising whereas the S2 route provides access to pre-planned treatment. That would be how we would enter that into domestic legislation, a point that the noble Lord, Lord Foulkes, was concerned about.
Clause 2(2)(d) indicates that the regulations may provide for set-off arrangements. This is when the amounts that both countries charge for reciprocal healthcare are offset, with only the difference being paid by the country owing the most money. This is the kind of arrangement that we have at the moment with Portugal.
Clause 2(2)(e) indicates that regulations may provide for determining reimbursement levels, including caps. For example, the Government may negotiate future agreements that will bear the cost of certain treatments abroad, but only up to the cost of the treatment on the NHS, which is the arrangement that we have with some of our reciprocal healthcare partners at the moment.
Noble Lords have rightly drawn attention separately to issues of dispute resolution and rights of appeal which we have debated in a previous group. Clause 2(2)(g) indicates that this is something that the Government recognise as important. Regulations made under Clause 2(1) can be used to make domestic provision about appeals and dispute resolution processes pertinent to an agreement.
Clause 2(2)(h) indicates that regulations may be used to confer functions on the Secretary of State or any other person, as we already discussed in the first group. Finally, Clause 2(2)(i) indicates that regulations may be used for delegating functions. Reciprocal healthcare agreements are implemented in partnership with a number of NHS bodies and organisations as well as with non-NHS organisations such as the Department for Work and Pensions, which obviously covers pensions and social security. They need to be identified and be given a clear legal responsibility and operating mandate to do so.