- Report
- 3:10 pm
- Clause 1: Power to make healthcare payments
- Amendment 1
- 1: Clause 1, page 1, line 3, leave out “outside the United Kingdom” and insert “in a European Economic Area country or Switzerland”
- My Lords, I rise to move Amendment 1 and speak to consequential Amendments 2, 12, 13, 14, 45, 46 and 47. The House will realise that these are the same amendments that we discussed in Committee. I am grateful for the support for them that I have received from across the House: from the noble and learned Lord, Lord Judge, the noble Earl, Lord Dundee —who, we learned yesterday, cannot be with us today—and the noble Baroness, Lady Jolly. I like to think that the reason for their support, and that of other noble Lords in Committee, is the amendments’ simplicity in revising the scope of the Bill to deal with the healthcare arrangements for the EU/EEA and not the whole world.Like other noble Lords, I am very grateful to the Minister for the time and effort she and her team have put into discussing the Bill with noble Lords. We can see from today’s amendments that the Government have listened to concerns expressed during the Bill’s stages. That is to be welcomed. I am afraid, however, that on this issue—the scope of the Bill—we find ourselves some distance apart.We need to remember that the DPRR Committee noted the Bill’s breathtaking scope and commented that the scope of the regulations could hardly be wider. The committee said that it was one thing to introduce skeletal legislation needed in the event of no EU withdrawal agreement, but that this Bill was as much to do with implementing future reciprocal healthcare arrangements with non-EU countries—indeed, that it went much further than merely giving effect to healthcare agreements and covered the provision of any healthcare by anyone anywhere in the world. It concluded that the powers of the Bill were inappropriately wide and had not been adequately justified by the department.This view was expanded in many ways by the Constitution Committee, which said that while the exceptional circumstances of the UK’s departure from the European Union might justify legislation containing broader powers than would otherwise be constitutionally acceptable, this did not extend to giving effect to new policy unrelated to Brexit. It concluded that the Bill should be limited to future reciprocal healthcare arrangements with countries that participate in the existing European health insurance card scheme. We agree. These are the tests that need to be brought to bear on the Bill, as was so eloquently expressed by the noble and learned Lord, Lord Judge, in Committee.
- 3:15 pm
- We completely accept the need for a Bill to deal with these important issues, and we wish to support the Government in getting the appropriate Bill and powers to achieve the right protections and the transfer of access to healthcare. Furthermore, as this is an enabling Bill, the impact assessment cannot and does not indicate the potential costs of administering all sorts of new arrangements with the European Union, the EEA and the rest of the world. We suggest the administration of international healthcare agreements, but this is a herculean task, and we do not think this Bill is the appropriate way to do it.
- In addition, surely we need to focus on the finances of the EU reciprocal healthcare arrangements. Many trusts struggle to recoup the money owed under current EU arrangements, and some costs are never recovered. The UK is getting back less than £50 million a year for the cost of treating European patients, while paying out £675 million for the care of Britons in Europe. It seems to me that the priority is to get on top of recouping EEA healthcare costs before we start thinking of making non-EEA agreements.
- The policy issue is very serious. The scope of the Bill introduces new policy into the Brexit considerations. Last year, during the passage of the European Union (Withdrawal) Bill, the Government gave an undertaking not to introduce new policy. We do not believe the Minister has argued a compelling case for the urgency of global scope, and the global scale of the Bill flies in the face of that undertaking. The policy agenda that leads to a Bill with global scope, as this one does, does not, to my knowledge, even have the cover of having been in a Conservative manifesto. There has been no consultation and we have seen no compelling evidence of the urgency, need and demand, unlike that for European healthcare arrangements.
- As I have said to the Minister, a global healthcare arrangements Bill may be a legitimate aspiration. Therefore, it should be included in the upcoming Queen’s Speech. It would then have the necessary wide consultation with the many stakeholders involved that such a proposal deserves; there could be pre-legislative scrutiny; and it could be brought forward as a fully fledged Bill. That is what the global healthcare issue deserves. Trying to shoehorn an important issue such as this into a Bill that needs urgently to address EU matters, and to do so by giving the Secretary of State huge powers, is not the way to proceed. It leads to bad legislation and outcomes, as the noble Lord, Lord Wilson, told us in Committee.
- I am aware that the UK currently has reciprocal agreements with several non-EEA countries, including New Zealand and Australia. The Minister has explained that these agreements are less complex, and that post exit the Government,
- “may want to strengthen these to ensure that we are delivering important opportunities for UK nationals abroad”.
- In her letter to all Peers dated 8 March, she states:
- “This is key to delivering greater security and certainty for UK nationals post-exit, and the powers of the Bill enable us to do that”.
- I agree with that aim, but this is absolutely the wrong way to go about achieving it. The Minister’s colleague in the other place put it more bluntly. He said it was the Government’s ambition to implement such agreements where it would be,
- “cost-effective and support wider health and foreign policy objectives after the EU exit”.—[Official Report, Commons, Public Bill Committee, 29/11/18; col. 22.]
- We suggest that this aspiration for global healthcare arrangements needs to be left until post Brexit. Nothing in the statements by the Minister justifies the sweeping powers and the blank cheque from the taxpayer which this Bill as drafted contains. I beg to move.
- Lord Judge (CB)My Lords, I thank the Minister for her efforts to improve the Bill and her courtesy in accommodating my concerns, meeting me and discussing various amendments. I am particularly grateful to her—I emphasise this—for her amendment, which we will consider later, that delivers us from the tyrannous shackles of King Henry VIII. Perhaps this might be the start of a new understanding that the ghost of that monstrous ogre should no longer walk about the corridors of power in this country. Chance would be a fine thing but I commend a little touch of Blackwood to the House.However, although the Bill has been significantly improved, it is still not good enough. We are faced with nine major regulatory powers, which are put before us as examples of regulations that the Bill might have in mind, or extend to. It works on the basis that we must—as we must—recognise the need of our citizens living in the EU to have their healthcare properly attended to. That puts great pressure on all of us. If it were not for that pressure, I would not accept that the scope of the Bill should be allowed to extend as far as the EU and Switzerland but I understand why it must be so. We are brought, in effect, to face up to the creation of unacceptable powers, and we have no choice, so far as the EU and Switzerland are concerned.However, we have a choice in relation to international places other than those in the EU. There are many countries to which these powers could be extended, payments made and so on. Last time I said I was being modest. My real worry is about the creation of legislation for such places as Guadeloupe and the Galapagos; and these powers would extend to Venezuela, where the present Government may not be in power indefinitely. We therefore need to think carefully. Introducing out of the blue nine regulations, which are only examples of the powers that would be given to Ministers, goes too far. It is not the way in which we should legislate.My objection to the Bill, and the reason why I support the amendment, is simple. We must not legislate in this way. We need time to think, reflect and ponder on what limitations and constraints should be put on the power of Ministers. We are therefore being asked to go too far under the pressure of events surrounding Brexit.