Policy paper

Health and Care Bill: reciprocal healthcare arrangements

Updated 10 March 2022

This was published under the 2019 to 2022 Johnson Conservative government

This fact sheet explains how the government plans to implement comprehensive reciprocal healthcare agreements with countries around the world.

Background

Reciprocal healthcare agreements strengthen international healthcare co-operation. They support UK residents to access necessary and emergency healthcare when they travel abroad, including the treatment of long term conditions such as kidney dialysis. They can also facilitate cooperation on planned treatment and other areas of healthcare policy. These agreements support tourism and short-term business travel and can particularly benefit those with long-term health conditions.

Under the current legislation, the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 (HEEASAA), the UK is limited to implementing comprehensive arrangements with countries in the European Economic Area (EEA) and Switzerland.

While the UK has multiple reciprocal healthcare agreements with countries outside the EEA and Switzerland, such as Australia and New Zealand, they are relatively outdated, offer varying levels of coverage, and without financial reimbursement or data sharing mechanisms, these agreements are limited in scope and reach.

The proposed legislation will expand the geographical scope of HEEASAA. The amendments will give the UK government the opportunity to strengthen existing agreements and agree new reciprocal healthcare arrangements with more countries, subject to negotiations, where this is for the benefit of the people of the UK.

The negotiation of international agreements is a reserved matter for the UK government but some of the policy areas relating to the implementation of reciprocal healthcare agreements are devolved, for example overseas visitor charging and planned treatment (see Guidance on devolution - GOV.UK (www.gov.uk) for further information).

What the Bill will do

The reciprocal healthcare arrangements clause amends HEEASAA to enable the government to implement comprehensive reciprocal healthcare agreements with countries outside the EEA and Switzerland.

The amendments extend the geographical scope of the Bill and are enabling provisions that will allow the Secretary of State to be able to make regulations to implement healthcare agreements with countries outside the EEA and Switzerland, subject to negotiations.

The provisions do not relate to trade deals. The reciprocal healthcare provisions in this Bill will improve access to healthcare for British residents abroad and healthcare cooperation with other countries.

The amended regulation making power will:

• enable the Secretary of State to pay for healthcare provided in another country where there is a reciprocal healthcare agreement in place where the payment is a) in scope of the agreement or b) outside the scope of the agreement but justified by exceptional circumstances
• enable the Secretary of State and the devolved authorities to confer or delegate functions to public authorities, such as Local Health Boards , so that they can administer reciprocal healthcare on behalf of the Department of Health and Social Care (DHSC). The regulations could, for example, confer the function of administering payments pursuant to an international healthcare agreement on a public authority

We are committed to working closely with the Scottish Government, Welsh Government and Northern Ireland Executive to collectively deliver an approach that works for the whole UK. The proposed legislation provides the devolved authorities with concurrent powers to implement reciprocal healthcare agreements in devolved areas.

As a consequence of the amendments the existing data sharing provisions in HEEASAA will extend to countries beyond the EEA and Switzerland, which will provide a legal basis for facilitating data processing to support the making of payments and the giving effect to healthcare agreements in those countries. As required by HEEASAA, this data sharing will be fully in line with UK data protection legislation.

Further, the proposed measures in this Bill revoke the unilateral payment powers in relation to the EEA and are not seeking to introduce such power for countries outside the EEA and Switzerland. This power was previously included in legislation to allow the UK government to protect UK nationals in a no deal outcome. It is no longer required and our approach in removing seeks to address the concerns expressed previously in the House of Lords regarding the breadth of this power. However, the Bill will enable the government to make discretionary independent arrangements to pay for healthcare, if we consider it to be necessary in exceptional circumstances.

How these provisions help the government to support UK residents

The amendments are enabling provisions that allow the government to implement comprehensive reciprocal healthcare agreements with countries around the world. These agreements could make healthcare more accessible for UK residents when they travel abroad for tourism or short-term business purposes.

Reciprocal healthcare arrangements also support individuals with long-term conditions, disabilities and the older population who may pay higher travel insurance premia or face difficulties in getting comprehensive insurance cover. Higher costs can make traveling prohibitively expensive. In this way, reciprocal healthcare agreements have the potential to improve equality of opportunity to travel for work or leisure.

Further reciprocal healthcare arrangements will also facilitate more efficient cost recovery processes for the NHS by enabling state-to-state reimbursement of healthcare costs rather than recovering costs from individuals. The exchange of data between countries for the purposes of reimbursement will allow for constant monitoring and evaluation of the cost-effectiveness of these agreements over time.

Reciprocal healthcare arrangements can also support the UK government’s broader global health agenda including on health security and research. The pandemic’s global impact demonstrates the increasing importance of closer international collaboration. These agreements will strengthen collaboration on healthcare with our international partners, supporting improved health outcomes for all.

Further information

Department of Health and Social Care Integration and innovation: working together to improve health and social care for all.