I shall speak to all the amendments in this group. I am very grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for their support. All the amendments in this group address Clause 151. The purpose of this clause is to enable the Secretary of State to implement reciprocal healthcare agreements with countries other than the EEA states and Switzerland, where we already have such agreements. These agreements were provided for by the Healthcare (European Economic
Area and Switzerland Arrangements) Act 2019. This Act was the subject of intense debate as it passed through this House. Noble Lords approved the inclusion in the Act of explicit constraints on the powers of the Secretary of State to make such agreements. This ensured that wider and different purposes, such as privatisation, could not be included. I make it clear at this point that we strongly support the intention to extend the geographical range of reciprocal healthcare agreements.
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Clause 151 works to do this by amending and then renaming the 2019 Act. However, the structure of an amended 2019 Act would differ significantly from what it is now. These differences are chiefly in removing the list of explicit constraints on the way in which the Secretary of State can use the regulatory powers and in changing the definition of a “healthcare agreement”. This can be read as suggesting a wider agenda than just providing reciprocal healthcare. In particular, removing the list of constraints and the redefinition of “healthcare agreement” seems to allow far wider scope to alter our existing healthcare provisions, perhaps including elements of privatisation. This all looks a lot like a potential privatisation Trojan horse, or at least a privatisation Trojan pony.
All the amendments in this group, taken together, restore the detailed constraints imposed on the Secretary of State by the 2019 Act. There are eight of these constraints; the main three are:
“Regulations … may only do one or more of the following things … specify or describe levels of payment and how they are to be calculated … specify or describe persons in respect of whom payments and provision may be made”,
and
“specify or describe the types of healthcare in respect of which payments and provisions may be made”.
These are very tight and prescriptive constraints, whose meaning is entirely and immediately clear. They make it absolutely plain that the powers granted to the Secretary of State by the Act can be used only in the narrowly defined context of reciprocal healthcare agreements and for nothing else. It is puzzling and worrying that the Government seek to remove these explicit constraints. It would be good to hear from the Minister the reason for their removal, and perhaps even better to hear an assurance that the Secretary of State’s discretion has not been materially widened.
The second major area for concern is over the proposed revised definition of a “healthcare agreement”. The existing definition, in Section 3 of the 2019 Act, is
“an agreement made between the government of the United Kingdom and an EEA state or Switzerland or an international organisation, concerning either or both of the following … healthcare provided in an EEA state or Switzerland, payments in respect of which may be made by the government of the United Kingdom”
or, the reverse,
“healthcare provided in the United Kingdom, payments in respect of which may be made by an EEA state or Switzerland”.
All that is perfectly clear, and defines precisely the meaning of a “healthcare agreement”.
The Government propose in Clause 151 to drop this simple and narrow definition and intend to replace it with new Section 2B(5). The new definition would read
“an agreement or other commitment between the United Kingdom and either a country or territory outside the United Kingdom or an international organisation, concerning healthcare provided anywhere in the world”.
There is no mention of payments in this definition. Why is it more widely drawn? What other elements could be put into a healthcare agreement, and what are these other commitments that suddenly appear? Those are the major changes that the amendments address.
There is one further change proposed by Amendment 184ZC; it makes all the statutory instruments generated by Clause 151 subject to the affirmative procedure. As the Bill stands, all these statutory instruments would be subject to the negative procedure, which of course provides no real opportunity for parliamentary scrutiny at all.
I close by offering my sincere thanks to the Minister and his officials for their very close engagement on all the issues that I have mentioned. I am very grateful for their generosity in providing time for our many discussions, and I look forward to the Minister’s response. I beg to move.