125.Healthcare is a devolved matter in Scotland, Wales and Northern Ireland, and the recovery of costs from non-EEA nationals is also devolved. But, as discussed earlier in the report, the Department of Health and Social Care is responsible for overseeing reciprocal healthcare arrangements with the EU, liaising with devolved administrations and NHS England “where appropriate”.
126.Lord O’Shaughnessy told us that the Department was “engaging with the devolved administrations” on Brexit, and that “they support the continuation of reciprocal healthcare”. He said that the existing centralised system for managing reciprocal healthcare in the UK “works well”, and that the Government was “moving ahead” on the basis of retaining the current operating structure, which remained “appropriate for the future”. In further written evidence, the Minister gave little indication of the extent to which the Department of Health and Social Care had engaged with the devolved administrations following the publication of the Joint Report, noting only that Department officials were having “regular engagement” with the administrations.
127.Fiona Loud told us that Kidney Care UK had written to each of the devolved administrations, but had received a reply only from the Scottish Government, and was not aware that any of the devolved jurisdictions was looking to do “something separately” on reciprocal healthcare. The RCPCH saw a need to put in place a process for all devolved administrations to play a role in agreeing future reciprocal healthcare arrangements with the EU.
128.Professor McHale also highlighted the degree of divergence across the devolved jurisdictions. In Scotland, unlike in England, certain categories of resident non-EU overseas patients are exempted from healthcare charges, including the self-employed, volunteers, and students. In Wales and Northern Ireland regulations provide similar exemptions, and in Northern Ireland they clarify that entitlements are applicable to both primary and secondary care.
129.Professor McHale therefore concluded that, post-Brexit,
“if there are no reciprocal agreements on healthcare made with other EU member states and treatment is sought other than in an emergency situation, then certain EU citizens could be exempt from NHS charges for secondary care … if they are living in Scotland, Wales and Northern Ireland, whereas this would not be the case in relation to those resident in England.”
130.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.
171 Written evidence from the Department of Health and Social Care ()
173 Supplementary written evidence from Lord O’Shaughnessy ()
175 Written evidence from the Royal College of Paediatrics and Child Health ()
176 Supplementary written evidence from Professor Jean McHale ()