Summary of conclusions and recommendations
Reciprocal healthcare and citizens’ rights
1.The S1 scheme has provided comprehensive healthcare coverage to many thousands of UK pensioners lawfully resident in other EU Member States, and has been especially useful for people living with diabetes and other long-term conditions. We welcome plans to include these people in the Withdrawal Agreement as the best means of securing clear legal entitlement to this scheme. We note that the legislation dealing with the implementation of this agreement in the UK will be presented to parliament in the coming months as part of the Withdrawal Agreement and Implementation Bill. (Paragraph 34)
2.To allay any outstanding fears about the status of children and dependents, the Government should now provide details to EU27 citizens lawfully resident in the UK about its plans and timetable for legally protecting their rights, stressing in particular that they will continue to enjoy the same rights to access healthcare that they and their dependents currently enjoy under EU law. (Paragraph 35)
3.We would be concerned if EU/EEA citizens were already being denied access to the treatment to which they are entitled, as witnesses suggested to us. We therefore underline the imperative of securing enforceability of rights in the Withdrawal Agreement. In addition, we call on the Government to restate as clearly as possible to the NHS and its staff the current healthcare entitlements of EU/EEA citizens, and to communicate the entitlements contained in any future UK-EU agreement on reciprocal healthcare as soon as it is possible to do so. (Paragraph 36)
The Joint Report
4.The Joint Report agreed in December 2017 covers the entitlements of those within the personal scope of the Withdrawal Agreement benefiting from reciprocal healthcare arrangements at the time of Brexit. Though we acknowledge that its provisions are yet to be set down in law, and note that “nothing is agreed until everything is agreed”, we welcome the progress that the Joint Report has made in providing some reassurance to the millions of UK and EU citizens who currently reside in other Member States. (Paragraph 50)
5.We would not wish to see this progress reversed in the future. This Committee has already called upon the Government to make a unilateral guarantee to protect the rights of the lawfully resident three million EU citizens who have, on the basis of EU free movement rights, made their lives in the UK. We therefore support proposals to ‘ring-fence’ in law the agreement on citizens’ rights embodied in the Joint Report, to provide clarity both to patients and to providers of reciprocal healthcare in the UK and EU. (Paragraph 51)
6.We note that the Joint Report does not cover the right of UK citizens resident in the EU to move between EU Member States. Nor does it cover the position of EU27 citizens resident in the UK covered by the Withdrawal Agreement who subsequently leave the UK and then return. These are significant omissions, and we urge the Government to ensure that the final text of the Withdrawal Agreement includes 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. If this proves impossible, we ask the Government, when replying to this report, to set out a detailed and clear position addressing this issue. (Paragraph 52)
7.It is essential that, as well as having a continuing right to access long-term healthcare, EU citizens lawfully resident in the UK should be provided with a practical means by which to exercise that right. We call on the Government to use domestic legislation to clarify the means by which all EU citizens lawfully resident in the UK at the time of Brexit will be able to continue to access essential healthcare. We note the suggestion that anti-discrimination legislation might assist in confirming the rights of EU citizens to continue to access healthcare post-Brexit, and look forward to further detail in the final text of the domestic legislation that implements this aspect of the Withdrawal Agreement. (Paragraph 53)
The future relationship and reciprocal healthcare
8.The Joint Report covers only the free movement healthcare rights of UK and EU citizens who are resident in another Member State before Brexit. It says nothing of whether and how the reciprocal healthcare entitlements of other UK and EU citizens will be protected post-Brexit. In the absence of an agreement on future relations that covers this topic, the rights currently enjoyed by 27 million UK citizens, thanks to the EHIC, will cease after Brexit. Other rights, provided for by the S2 scheme and Patients’ Rights Directive, will likewise come to an end. (Paragraph 73)
9.Our evidence suggests that it is not in the UK’s interest for reciprocal healthcare arrangements to cease. Because of higher insurance costs—and in the case of dialysis patients, people living with rare diseases, and disabled people, the difficulty of obtaining travel insurance at all—without EHIC or an equivalent arrangement it will become much more expensive for UK citizens with chronic conditions to travel to the EU post-Brexit, for holidays, recuperation or treatment. (Paragraph 74)
10.The Department of Health and Social Care wishes to continue to maintain reciprocal healthcare arrangements, including the EHIC, post-Brexit. We applaud the spirit underlying this ambition, but it is difficult to square it with the Government’s stated aim of ending freedom of movement of people from the EU. (Paragraph 75)
11.More generally, reciprocal healthcare arrangements will only be achieved by agreement between the UK and the EU. The Government has not yet set out its objectives for the future UK-EU relationship. We therefore urge the Government to confirm how it will seek to protect reciprocal rights to healthcare of all UK and EU citizens post-Brexit, as part of any agreement on future relations. (Paragraph 76)
The implications of Brexit for the NHS and insurers
12.We received a large amount of evidence expressing concern both that the loss of existing reciprocal healthcare rights would impose significant additional future costs upon the NHS, and that the introduction of new reciprocal healthcare arrangements might impose a significant administrative burden. (Paragraph 86)
13.We urge the Government, as part of its contingency planning, to clarify further whether it will seek UK participation in the EHIC, S1 and S2 schemes as a non-EU Member State; set up a separate scheme with the EU27; or explore the possibility of reaching bilateral arrangements with individual Member States. (Paragraph 87)
14.Whichever is the case, we call on the Government to ensure that NHS procedures and practices are sufficiently robust to secure reimbursement for the healthcare of EU27 citizens provided by the NHS post-Brexit. Should the Government look to establish an independent scheme for reciprocal healthcare, we propose that it set out publicly its financial modelling of that scheme, including how the extra administrative costs will be met. (Paragraph 88)
15.In the event that no future reciprocal healthcare agreements were agreed with EU countries, we would ask the Government to explain how NHS and social care capacity planning will secure sufficient capacity to care for future generations of retired people. In so doing, we suggest that the Government engage closely with the NHS and with those groups that will potentially be affected. (Paragraph 89)
16.Time is now short for the Government to provide much-needed clarity to the insurance industry to help with planning, particularly for multi-trip travel insurance policies that will include the period beyond March 2019. The European Commission has proposed a transition period that will expire on 31 December 2020, during which existing reciprocal healthcare arrangements will be maintained. This period will be essential for the insurance industry as it plans for the future arrangements that the UK agrees with the EU. (Paragraph 97)
17.There will be consequences not just for the insurance industry, but for tourism and individual travellers. While the industry might derive some benefit should it be required to play an expanded role in providing cover, we recommend that any move to greater reliance on private medical insurance by UK citizens travelling within the EU post Brexit be subjected to careful scrutiny, particularly in terms of the further regulatory oversight that might be needed to ensure that patients and consumers are protected fairly. (Paragraph 98)
Reciprocal healthcare provision in Northern Ireland and Ireland
18.We note the success of cross-border collaboration on healthcare between Northern Ireland and the Republic of Ireland, particularly in radiotherapy and Ear, Nose and Throat services. We also note that ambulances are currently able to travel freely across the border, that medical professionals from one country can work in the other, and that patients can easily cross the border to access healthcare. (Paragraph 121)
19.We welcome the assurances contained in the Joint Report about the importance of maintaining freedom of movement under the Common Travel Area and cooperation under the 1998 Belfast/Good Friday Agreement. Regardless of the other arguements against a hard border, any such barrier would be highly detrimental to healthcare for patients on both sides of the border, including children and other vulnerable patients. (Paragraph 122)
20.We urge the Government to avoid such a hard border for patients and the health professionals who treat them, and to secure continued access under the Common Travel Area to emergency, routine and planned treatment. (Paragraph 123)
21.Given the key role that bilateral and EU-level cooperation has played in improving access to healthcare in the border areas, we call on both sides of the negotiations to treat healthcare as a priority in the final settlement of issues relating to the island of Ireland. (Paragraph 124)
Reciprocal healthcare provision and devolution
22.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. (Paragraph 130)