Brexit Poses Risks to Reciprocal Healthcare Programmes
One of the great unsung achievements of the European Union has been its creation of highly efficient but yet simple ways of guaranteeing us free or subsidised access to national health services in other EEA countries and Switzerland as we move around.
These take two main forms. The first and much the largest is the European Health Insurance Card (EHIC), which assures national health service treatment to visitors while they are spending short periods in any other member countries. The second, known as S1, has ensured that nationals of one country who are resident in another member country can benefit from access to the medical services provided by its national health services on the same terms and conditions as its own citizens. Most S1 participants are recipients of UK old age pensions, living in other EU countries. The future of S1, however, is uncertain following the UK invocation of Article 50 and will vary between host countries.
Over 27 million British people have EPICs and quite a lot of them must have been through experiences like those of our friends’ daughter, Olivia. who recently visited Malta with her parents and partner. On a trip to the smaller island of Gozo, in her haste get into the sea, she slipped amongst the rocks and banged her head on one – nothing too serious, but an ambulance arrived and took her to Gozo General Hospital. The medical treatment she received was prompt and of a high standard. She was cleaned up and given a stitch on the back of her head, and then a CT scan was organised to ensure there was no further damage. In fact, this showed that she had no problem with her head injury, but the consultant explained that the scan had highlighted blocked sinuses. She had been complaining of slight headaches for a number of months, but she put them down to eye-strain: although she had mentioned them to her doctor, no action had been taken. So it took a trip to Malta and a nasty fall to diagnose the problem!
With an EPIC, getting immediate free and competent medical attention over a thousand miles from home could not have been simpler.
I and my wife are British citizens who have lived and worked in Italy for decades. We have enjoyed equally positive experiences in using our Italian-issued EPICs when we have briefly visited our native Scotland. We are also recognised as S1 beneficiaries in Italy because we have paid voluntary contributions into UK National Insurance throughout our working lives and now receive old age pensions from Britain.
When we were visiting her brother over Christmas a couple of years ago, my wife was diagnosed with suspected pneumonia by the local GP and ended up in Ayr hospital for a week of top class treatment, funded, with no fuss at all, through EHIC.
Three years before that, at home in Italy, Roberta skidded on some wet floor tiles, fell heavily and broke a hip. The ambulance came quickly and whisked her off to Grosseto hospital. The next morning, she was given a hip replacement and was brought home by an ambulance after a week. A few days later, our GP came our house to remove the stitches. The district nurse (his wife!) came too and arranged for 10 free physiotherapy sessions at home. The social security manager in the local council also offered us the option of help in the home for several weeks – which we declined as we felt that we could cope. Thanks to the S1 programme, this was also free of cost and of bureaucracy!
Many people who use these programmes have no idea that they have been created by the European Union but are implemented by each member country through its social security and health service providing institutions. As in the case of so many other EU programmes, there is no question of a need for “taking back control” because the shape of the programme in each country is already defined and managed at national level. The European Commission has, however, invested heavily in creating operating systems that make it easy for responsible national institutions to communicate with each other electronically and to manage funding in a coordinated and transparent manner.
It is extremely worrying, therefore, that the continued access of UK nationals to both these excellent reciprocal healthcare programmes is at risk after Britain leaves the European Union on 29th March 2019. The risks stem from the fact the programmes are based conceptually on the idea of ensuring and facilitating freedom of movement of nationals between all EEA member countries: if the UK government continues, as part of its negotiating strategy, to claim a right to restrict the freedom of movement of EU citizens into the country, it inevitably not only excludes itself from a future frictionless trade deal with the EU but may also find itself without full access to the full benefits of the reciprocal health programmes.
These concerns have recently led the House of Lords Inquiry on “Brexit – Reciprocal Healthcare” to observe that “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.”
At the time of the EU referendum the “Leave” campaign never told us that we would be putting EHIC – and our wellbeing – into jeopardy if we voted their way. It is now the moment for voters to make an objective reassessment of all that we stand to lose if the government continues to pursue its “hard” Brexit approach with no care for what it means for all of us. As it now looks, we seem bound to lose some of the economic benefits of being part of the single market and customs union, and the ease of travelling around Europe, including free access to health care, that we have become so used to could become a thing of the past.