Brexit: reciprocal healthcare Contents

Chapter 1: Introduction

Overview: reciprocal healthcare and Brexit

1.The free movement of persons, one of the four freedoms of the EU internal market, provides for a right of movement and residence for workers, the right to enter and reside for family members, and the right to work in, and be treated on an equal footing with nationals of, other Member States.

2.One of the primary aims of the EU’s reciprocal healthcare arrangements is to support free movement by eliminating the financial or bureaucratic barriers that individuals would otherwise face in accessing healthcare. In the words of the preamble to the Patients’ Rights Directive of 2011, reciprocal healthcare arrangements seek “to improve the functioning of the internal market and the free movement of goods, persons and services”.

3.The Government has repeatedly emphasised that one of the fundamental objectives of Brexit is to bring an end to free movement of persons: this is, indeed, a ‘red line’ in negotiations between the UK and EU. If this red line is adhered to in full, it follows that one of the fundamental rationales for reciprocal healthcare arrangements, as they have evolved during the UK’s EU membership, will disappear upon Brexit. Yet much of the evidence heard in the course of this inquiry stressed the importance of continuing as far as possible with existing reciprocal healthcare arrangements post-Brexit, which, for the campaign group Brexpats in Spain, would be the “ideal outcome”.1 Raj Jethwa, Director of Policy at the British Medical Association (BMA), told us that that “the best situation is one in which you are able to replicate or mirror as closely as possible the current reciprocal arrangements”.2 Lord O’Shaughnessy, Parliamentary Under Secretary of State at the Department of Health and Social Care, said that the Government’s ambition was to “continue the rights that the current arrangements provide”.3

4.Underlying this apparent paradox is a distinction between, on the one hand, UK and EU citizens who have already exercised free movement rights (on the understanding that they will benefit from reciprocal healthcare arrangements), and, on the other, those who might wish, at some point after the date of Brexit, to travel or reside in each other’s countries. In practical and human terms, the interests of these two groups coincide in many areas; but in terms of the negotiations on Brexit, they are entirely separate. The rights of citizens who have already exercised free movement rights have been treated as a ‘phase 1’ issue, which will be addressed in the Article 50 Withdrawal Agreement. The rights that UK and EU citizens may or may not enjoy post-Brexit are a ‘phase 2’ issue, which will only be discussed as part of the negotiations on the future relationship between the UK and EU—negotiations that cannot begin formally until the UK becomes a ‘third country’ on 29 March 2019 by officially leaving the EU.

5.The negotiations on the future relationship have yet to begin, but in December 2017 the UK and the EU reached the outlines of a phase 1 agreement. This is reflected in a ‘Joint Report’4, setting out the terms of what will ultimately become the final Article 50 Withdrawal Agreement. Most of our evidence, however, was taken before December 2017, and was heavily coloured by what was then the most pressing issue—namely, the protection of the rights of the over four million UK and EU citizens who currently live in each other’s countries. We have sought in this report to do justice to the deeply felt concerns expressed to us in late 2017—not least because those concerns, while they may have been allayed by the December agreement, will not be finally put to rest until they are ratified in the final Withdrawal Agreement.5

6.We sought further evidence after the Joint Report was agreed, including from key stakeholders and Lord O’Shaughnessy. This informed our analysis of the second issue: the extent to which the UK and EU could agree long-term reciprocal healthcare arrangements post-Brexit. That evidence remains, however, lacking in detail, reflecting the fact that the hugely complex negotiations on future relations have yet to begin, and that within those negotiations healthcare will be just one of many strands. We nevertheless make some recommendations about what the Government should be aiming for, and identify some of the issues affecting individuals and the NHS that may arise if no long-term agreement is reached on reciprocal healthcare. Lastly, we look at the possible future of reciprocal healthcare in Northern Ireland and the devolved administrations.

7.The report is part of a coordinated series of Brexit-themed inquiries launched by the European Union Committee and its six sub-committees following the referendum on 23 June 2016, which have sought to shed light on the main issues likely to arise in negotiations on the UK’s exit from, and future partnership with, the European Union. It draws on a series of evidence sessions that the Sub-Committee held between 13 September 2017, when the inquiry was launched, and 7 March 2018.

8.We make this report to the House for debate.


1 Written evidence from Kidney Care UK (BRH0016), Royal College of Physicians of Edinburgh (BRH0013), British Medical Association (BRH0012) and Brexpats in Spain (BRH0011)

4 European Commission and HM Government, Joint Report on progress during phase 1 of negotiations under Article 50 TEU on the UK’s orderly withdrawal from the EU, (8 December 2017): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/665869/Joint_report_on_progress_during_phase_1_of_negotiations_under_Article_50_TEU_on_the_United_Kingdom_s_orderly_withdrawal_from_the_European_Union.pdf [accessed 20 March 2018]

5 On 28 February 2018, the Commission published a draft Withdrawal Agreement that represents in legal form its interpretation of December’s Joint Report. European Commission, Draft Withdrawal Agreement on the withdrawal of the United Kingdom of Great Britain and Northern Ireland from the European Union and the European Atomic Energy Community, (28 February 2018): https://ec.europa.eu/commission/sites/beta-political/files/draft_withdrawal_agreement.pdf.[accessed 20 March 2018]. This was transmitted to the United Kingdom on 15 March 2018. European Commission and HM Government, Draft Agreement on the withdrawal of the United Kingdom of Great Britain and Northern Ireland from the European Union and the European Atomic Energy Community (15 March 2018): https://ec.europa.eu/commission/sites/beta-political/files/negotiation-agreements-atom-energy-15mar_en.pdf [accessed 20 March 2018] An updated version of this agreement was published on 19 March 2018, with the agreed text colour-coded. European Commission and HM Government, Draft Agreement on the withdrawal of the United Kingdom of Great Britain and Northern Ireland from the European Union and the European Atomic Energy Community (19 March 2018): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/691366/20180319_DRAFT_WITHDRAWAL_AGREEMENT.pdf [accessed 20 March 2018]. The Government’s current proposal is to “enshrine” the Withdrawal Agreement in UK law through a ‘Withdrawal Agreement and Implementation Bill’. Department for Exiting the European Union, ‘New Bill to implement Withdrawal Agreement’, 13 November 2017: https://www.gov.uk/government/news/new-bill-to-implement-withdrawal-agreement. [accessed 20 March 2018]




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