The United Kingdom’s decision to leave the European Union could have a particularly significant impact on the UK’s access to EU reciprocal healthcare arrangements, which support the free movement of persons by eliminating the financial or bureaucratic barriers that individuals would otherwise face in accessing treatment. Reciprocal healthcare oils the wheels of the day-to-day lives of millions of citizens, both UK nationals resident in the EU and those from the rest of the EU who are resident here.
By their very nature, the arrangements bring greatest benefit to some of the most vulnerable members of our society. Over the course of our inquiry, we heard convincing evidence about the vital role that reciprocal healthcare plays in improving the lives of people with disabilities, the elderly, and children. For people living with long-term health conditions (including those needing frequent dialysis, or who suffer from rare diseases), reciprocal arrangements mean that they can avoid the high insurance costs that would otherwise make travel prohibitively expensive. And, by providing treatment outside the country to UK citizens with complex needs, reciprocal healthcare has eased some of the burden that the NHS currently faces.
The Government’s ambition post-Brexit is to continue the access to reciprocal healthcare provided by the current arrangements. December’s ‘Joint Report’ by the UK and EU Brexit negotiators, recording progress made so far, went some way to guaranteeing reciprocal healthcare entitlements. In broad terms, those UK citizens accessing healthcare in the EU, and EU citizens doing the same in the UK at the time of Brexit, will have their rights protected to continued access to healthcare. This means that visitors to the UK or the EU receiving emergency treatment will be able to finish their treatment. On the other hand, those who are legally resident would have their access protected for life.
The Joint Report will find legal expression in a Withdrawal Agreement, to be given effect in domestic law by means of a Withdrawal Agreement and Implementation Bill later this year. While we look forward to the protection that the Withdrawal Agreement will give to existing rights, we note that until it is made legally binding, there will still be a question mark over access to reciprocal healthcare for the people covered by the agreement. We therefore support proposals to ‘ring-fence’ in law the agreement on citizens’ rights embodied in the Joint Report, in order to provide clarity both to patients and to providers of reciprocal healthcare in the UK and EU.
The Joint Report contains two significant omissions, however. It does not cover the right of UK citizens resident in the EU at the time of Brexit to move between EU Member States. Nor does it cover the position of EU27 citizens resident in the UK on Exit Day who subsequently leave the UK and then return. We therefore call on the Government to seek to add to the Withdrawal Agreement provision for onward free movement rights, including the right to healthcare provision for UK citizens on the same terms as are enjoyed by EU citizens, and vice versa.
Nor does the Joint Report say anything about whether and how the reciprocal healthcare entitlements of those people who fall outside its scope will be protected post-Brexit. These people’s rights are due to be discussed in the next phase of the Brexit talks, which will address the future EU-UK relationship. But in the absence of an agreement on future relations, the rights to reciprocal healthcare currently enjoyed by 27 million UK citizens, thanks to the European Health Insurance Card, will cease after Brexit. Other rights, provided for by the S2 scheme and Patients’ Rights Directive, which cover planned treatment in other EU Member States, will also come to an end.
We therefore remain unconvinced that reciprocal healthcare for people falling outside the scope of the Joint Report can continue in its current form. Without more detail from the Government about how exactly it intends to maintain reciprocal healthcare arrangements or provide a suitable replacement, this report argues that we should not take the future of UK-EU reciprocal healthcare for granted. Because reciprocal healthcare benefits derive from freedom of movement, we agree with our witnesses that it is difficult to square the Government’s ambitions for reciprocal healthcare with its stated aim of ending freedom of movement of people from the EU.
We also heard from witnesses about the significant successes that cross-border collaboration in healthcare has brought to Northern Ireland and the Republic of Ireland. Ambulances are currently able to travel freely across the border, medical professionals from one country can work in the other, and patients can easily cross the border to access healthcare. In our view, a hard border on the island of Ireland would be highly detrimental to healthcare for patients on both sides of the border, including children and other vulnerable patients.
Lastly, we call on the Government to ensure the active participation of the devolved administrations in setting the UK’s position on future arrangements for reciprocal healthcare, so that the implications of any potential changes fully reflect perspectives and powers across the United Kingdom. The importance of reciprocal healthcare in enabling citizens from across the UK to travel easily to the rest of Europe, and for European citizens to travel to all regions of the UK, demands a coherent approach.