Healthcare (International Arrangements) Bill
Public Bill Committee, 27 November 2018.
Graham Stringer (Labour, Blackley and Broughton)
Before we begin, I have a few housekeeping notes. I ask hon. Members to switch their phones and other electronic devices to silent mode, and remind them that tea and coffee are not allowed during sittings. Today, we will first consider the programme motion on the amendment paper, then a motion to allow the reporting of written evidence for publication, and then a motion to allow us to deliberate in private about our questions before the oral evidence sessions. In view of the time available, I hope that we can deal with those matters formally, without debate. The programme motion was discussed yesterday by the Programming Sub-Committee for the Bill.
Graham Stringer (Labour, Blackley and Broughton)
The deadline for amendments to be considered at the first line-by-line sitting of the Committee was Monday 26 November and therefore has passed. The deadline for amendments to be considered on the second day of line-by-line consideration of the Bill is the rise of the House on Thursday.
Graham Stringer (Labour, Blackley and Broughton)
Copies of written evidence that the Committee receives will be made available in the Committee Room.
Graham Stringer (Labour, Blackley and Broughton)
We will now go into private session to discuss the lines of questioning.
Examination of Witnesses
Graham Stringer (Labour, Blackley and Broughton)
Q We will now hear evidence from the Academy of Medical Royal Colleges and the British Medical Association.
I remind hon. Members that questions should be limited to matters within the scope of the Bill, and that we must stick to the timings in the programme motion that the Committee agreed for this session. We have until 10.25 am. I hope, because the Minister has to be on his feet on the Floor of the House immediately after this, to cut a couple of minutes off the session to enable him to carry out his duties.
Are there any relevant interests to declare? No. Will the witnesses introduce themselves?
Stephen Hammond (Conservative, Wimbledon)
Q Good morning, gentlemen. Thank you for coming to give evidence to us this morning. Mr Henderson, in your evidence to the House of Lords European Union Committee, you noted that you want to see the current arrangements preserved. Could you just say how you think the current regulations for reciprocal healthcare work and why they are so satisfactory?
Stephen Hammond (Conservative, Wimbledon)
Q In your evidence to the Lords Select Committee, you stated that pretty clearly as well. The Bill obviously aims to replicate and continue the current arrangements. I assume that, given your support for the regulatory system, you think that this is a sensible way for the Government to proceed.
Stephen Hammond (Conservative, Wimbledon)
Q This is my final question to you, Mr Henderson. In your evidence to the Lords Select Committee, you also made the point about costs and administrative burdens. As I understand it, if a new system were needed or if a no-deal scenario unfortunately arose—that is not the Government’s intention—the costs or administrative burden would be a change in coding, rather than any other major administrative burden. Is that your understanding as well, in terms of cost recovery?
Stephen Hammond (Conservative, Wimbledon)
Q Thank you.
Mr Jethwa, good morning. I noticed in your written brief that the BMA stated that the Government should undertake every effort to retain the current model of reciprocal healthcare. My first question is the same as that to Mr Henderson: can you state why you think the current system works so well?
Stephen Hammond (Conservative, Wimbledon)
Q Given that, and given that that is the intention of the Bill, do you think that the Government are taking the right approach to ensuring that they put those arrangements in place and that the legislation has the flexibility to cover both what we hope for, which is an achievable deal, and a no-deal situation?
Stephen Hammond (Conservative, Wimbledon)
Q In terms of the security arrangements, do you mean security of data?
Stephen Hammond (Conservative, Wimbledon)
Thank you.
Justin Madders (Labour, Ellesmere Port and Neston)
Mr Henderson, you said you consider that the system works well at the moment. I think it is pretty universally accepted that the cost recovery element does not work so well. Do you feel that more ought to be done in respect of that, and if so what would you like to see doneQ ?
Justin Madders (Labour, Ellesmere Port and Neston)
Q You say that you have basically the same system for 32 or 33 different countries. If we end up in a situation in which we have to make arrangements with each individual country—potentially significantly different arrangements depending on what is negotiated—what effect do you think that will have on your members, in terms of what they can deliver?
Justin Madders (Labour, Ellesmere Port and Neston)
Q May I ask Mr Jethwa some questions? Have you looked at all at the situation as it might affect the island of Ireland?
Justin Madders (Labour, Ellesmere Port and Neston)
Would you like to say what you are doing?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Do you have any idea what the contingency plans might be if an appropriate deal is not put in place?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Have you looked at what the possible impact might be of a no-deal scenario on increased demand on services if, for example, pensioners currently living abroad came back?
Julie Cooper (Labour, Burnley)
Good morning. Mr Henderson, you mentioned the protections around personal data in the Bill. Do you feel that the Bill gives enough protection? Are there enough controls in the BillQ ?
Julie Cooper (Labour, Burnley)
Q Thank you. Mr Jethwa, would you like to comment on the same issue?
Maggie Throup (Conservative, Erewash)
Mr Jethwa, when you look at the current regulations, do you think the powers in the proposed legislation are proportionateQ ?
Matt Western (Labour, Warwick and Leamington)
Mr Henderson, I think you described the existing arrangements as pretty well universal. Could you explain a little more what the gaps areQ ?
Justin Madders (Labour, Ellesmere Port and Neston)
Q I have one more question to both of you—I am not sure if either of you will know the answer. Some of the reciprocal arrangements we have at the moment are based on the actual cost expended and some are based on an average—Estonia, Denmark, Finland, Hungary, Malta and Norway. I am not clear why that is the case. Is there some sort of historical issue? If either of you can shed any light on that, that would be extremely helpful. One of you is shaking your head.
Stephen Hammond (Conservative, Wimbledon)
Q Can I come back on the data point that you both commented on? Clause 4 deals directly with that and provides the usual protections in terms of data. I heard Mr Henderson’s point, and it is important that there needs to be a flow of data, although that needs to be secure. Are you happy that the protections in the Bill at the moment are the normal and adequate protections?
Graham Stringer (Labour, Blackley and Broughton)
Does the Committee have any more questions? No. I thank the witnesses for helping the Committee with its deliberations, and call the next witness.
Examination of Witness
Graham Stringer (Labour, Blackley and Broughton)
Q The next evidence is from the Association of British Insurers. Good morning. Would you please introduce yourself?
Stephen Hammond (Conservative, Wimbledon)
Q Good morning, and thank you for coming to give evidence this morning. Could you set out the advantages of the EHIC scheme as the ABI sees them?
Stephen Hammond (Conservative, Wimbledon)
Q Specifically on travel insurance, if reciprocal arrangements were not in place, what would be the implications in terms of cost, and are there any other potential implications that we should understand?
Stephen Hammond (Conservative, Wimbledon)
Q Have you made any estimate of what the increase in premiums would be if reciprocal arrangements were not in place?
Stephen Hammond (Conservative, Wimbledon)
Q Do you have some indication of what the typical current premiums are for people with complex and acute conditions who travel to Europe, and what the premium increase would be if reciprocal arrangements were not in place?
Stephen Hammond (Conservative, Wimbledon)
Q I want to ask you broadly the same set of questions, but specifically with regard to health insurance and what the implications would be if reciprocal arrangements were not in place for UK citizens travelling to the EU.
Stephen Hammond (Conservative, Wimbledon)
Q If reciprocal arrangements were not in place, you would have to have extra healthcare insurance to cover eventualities abroad and in the EU.
Stephen Hammond (Conservative, Wimbledon)
Q Have you given any thought as to what the cost implications would be if you had to put those arrangements in place?
Stephen Hammond (Conservative, Wimbledon)
Yes, for health specifically.
Stephen Hammond (Conservative, Wimbledon)
Q Given what we have just said and some of the implications for not having reciprocal arrangements in place, can I assume that in principle the ABI thinks that the Government are acting in the correct way to put in place reciprocal arrangements, or arrangements to make reciprocal arrangements?
Stephen Hammond (Conservative, Wimbledon)
So, the sooner the Bill gets Royal Assent, the happier you will be.
Justin Madders (Labour, Ellesmere Port and Neston)
Q On the cost point, I think some evidence was given to the House of Lords Committee that in a no deal you expected premiums to increase by between 5% and 10%. Does that sound like a familiar figure?
Justin Madders (Labour, Ellesmere Port and Neston)
Q In that context, what advice are you giving to people about insurance requirements post 29 March 2019?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Has there been an increase in premiums because of that added uncertainty, do you know?
Justin Madders (Labour, Ellesmere Port and Neston)
Q In the event that there are not arrangements in place, have your members done any work on the number of people who might not be able to travel, because they effectively become uninsurable or the premiums are so high that they are prohibitive?
Justin Madders (Labour, Ellesmere Port and Neston)
Q I appreciate that. There will almost always be a product; it is the size of the premium that can dictate whether that product is really available. Have you looked at the potential size of premiums in those situations? Are there particular pre-existing conditions that people might have that will have a negative impact on the size of the premium?
Justin Madders (Labour, Ellesmere Port and Neston)
Q My final question is about the overlap between EHIC costs and insurance costs. I had a recent example in my constituency of a constituent who came back from Spain with a medical bill for £15,000. It was not for repatriation costs; it was purely for medical treatment. Obviously, the question is, why is that not covered by the normal arrangements? How often does that situation arise, and can you give me some insight as to why that might be happening?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Okay. I think my constituent’s situation was an emergency and I do not think that any consideration was given to the type of hospital. I think that what you are saying is that reciprocal arrangements do not necessarily give you the same or equivalent coverage in other countries, because it depends on the system that operates there.
Alberto Costa (Conservative, South Leicestershire)
You said that private insurance policies cover the areas above the benefits of the EHIC. But is it not the case that those of us who take out private travel insurance policies precisely for the healthcare benefits may not make use of EHIC? And is it the case that, because of that, the premium costs for private travel insurance are less, given that those of us who take out private insurance might not use EHIC and might rely on the private healthcare side instead?Q
Alberto Costa (Conservative, South Leicestershire)
Q What I am trying to ask is whether it might be the case that, without this Bill and without reciprocal arrangements, the cost of travel health insurance is likely to go up? Those of us who take out these policies are not necessarily reliant on EHIC, because we would refer to the private claim, whereas others who perhaps do not have healthcare benefits under a travel insurance policy would be entirely reliant on EHIC. What I am trying to tease out is whether, without this Bill, the healthcare side of travel insurance—the premiums—would potentially go up?
Matt Western (Labour, Warwick and Leamington)
Q Out of interest, can I ask you a really simple question? What happens currently, but also perhaps in future, when someone is abroad and has an injury, an accident or whatever for which some form of implant is required, and that implant subsequently fails when the person returns to the UK and it is not supported by the NHS? Where does the cost burden fall and how does that impact on insurance, and how may that work in future if we do not have regulatory alignment?
Matt Western (Labour, Warwick and Leamington)
Yes. If that implant failed, whatever it might be, and the cost to revise that implant were then borne by the NHS, who picks up the cost, and how does that work? How does it work currently, and how might it work in the future based on this?
Graham Stringer (Labour, Blackley and Broughton)
Are there any more questions from members of the Committee? If not, I thank you very much for helping the Committee with its deliberations on this Bill, and I call the next witness.
Graham Stringer (Labour, Blackley and Broughton)
Q We will now hear oral evidence from Kidney Care UK. Could you introduce yourself, please?
Stephen Hammond (Conservative, Wimbledon)
Q Good morning and thank you for coming. I am particularly keen to hear evidence from you about how the current reciprocal arrangements work for patients with high needs and complex arrangements. It would be very helpful to hear how you think the current arrangements work.
Stephen Hammond (Conservative, Wimbledon)
Q You will have heard the evidence we have just taken from ABI. I was particularly keen to understand the variations in insurance and exclusions that might currently exist where there are high needs and complex conditions. Could you set out for the Committee the experience of Kidney Care UK?
Stephen Hammond (Conservative, Wimbledon)
Q The intention of the Bill is to provide that confidence, so may I ask whether you support that intention in principle?
Stephen Hammond (Conservative, Wimbledon)
Q I know that you and my colleague, the noble Lord O’Shaughnessy, have had a discussion. Could you tell this Committee what the contingency issues you refer to are?
Stephen Hammond (Conservative, Wimbledon)
Q Finally, without putting reciprocal arrangements in place, as this Bill intends to give the Government the powers to do, presumably it would make it more or less impossible for your sufferers to travel.
Justin Madders (Labour, Ellesmere Port and Neston)
Q It is alarming to hear about some of your members seeing the expiry date on their EHIC card and assuming that carries—
Justin Madders (Labour, Ellesmere Port and Neston)
Q It is perfectly understandable: why would they not assume that? Are you aware of any publicly available guidance to warn people that that date may not be absolutely set in stone?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Obviously, we hope that we do not need to get into that situation. Do your members plan things quite far in advance because of the need to get the right treatment?
Julie Cooper (Labour, Burnley)
Q Good morning and thank you for coming along to help us. I want to ask about a couple of things. The aim of the Bill is to provide the confidence that we have talked about, to mirror as far as possible the reciprocal arrangements that we already enjoy. However, it does give the Secretary of State the authority to enter into any number of differential agreements with individual EU states. Do you have concerns about that? If we were in this situation—I hope we are not—the Bill empowers the Secretary of State to do that. What would be your view be on the arrangement with Spain being one thing and that with Italy another, and so on?
Julie Cooper (Labour, Burnley)
Q Thank you, that is very helpful. Could I just ask you one more question about costs? You rightly made the point that, if somebody is attending for dialysis three days a week, they are likely to have lower income than average. If it is not possible to continue something similar to the EHIC card, are you concerned that transferring extra costs to insurance premiums is going to make travel virtually impossible?
Graham Stringer (Labour, Blackley and Broughton)
Are there any more questions from the Committee? If not, I thank you very much for helping us with our deliberations today. That concludes our oral evidence-gathering for the Bill. The Committee will meet again on Thursday 29 November at 11.30 am in Room 12, when we will commence line-by-line consideration of the Bill.