No Deal Healthcare – the BiE response

British In Europe response to the Department of Health and Social Care announcement on No Deal Healthcare in the EU

UK Government proposals published just 10 days before Brexit could see thousands of British pensioners, the disabled and other vulnerable Brits on the continent being denied long term healthcare in the event of a no deal Brexit.

In January British in Europe wrote to the Prime Minister calling on her, in the event of No Deal, to continue unilaterally to pay for this healthcare until bilateral arrangements with either the EU or individual states could be agreed.

In its response of 19th March, the Department for Health and Social Care said that the UK will fund S1 healthcare for UK nationals and others for whom the UK is responsible “who have applied for, or are undergoing, treatments in the EU prior to and on exit day, for up to one year”.   This will help those who are undergoing, or “have applied for”, treatment for serious conditions such as cancer or kidney failure. The Government has also invited EU states to continue all the present reciprocal healthcare arrangements until the end of 2020 but this will not happen unless they agree.

S1 is the reciprocal EU scheme under which the country to which people have paid their taxes and pension contributions while working remains financially liable for their healthcare when they retire to another EU state.  It is, in effect, their NHS.

Jane Golding, Co-Chair of British in Europe said:

‘Clearly this is a small step towards doing the right thing.  But the British government is abdicating responsibility for tens of thousands of other pensioners and leaving a lot of questions unanswered.  In effect, the British government is telling some seriously sick, elderly people that they are on their own at this vulnerable point in their life’.

Key concerns that the statement does not address

What happens to those that discover they have a serious condition shortly after Brexit? On the basis of this announcement, will get no help at all from the UK.  They too moved to the EU relying on the fact that they could face old age without having to worry about medical bills.  They too will struggle to get health insurance at all or if they can get it the premiums will be loaded because of their age.

  • What happens when the year is up?
  • Will the UK pay for drugs, often very expensive, that are needed on a long-term basis?
  • What happens in those countries where the possession of an S1 certificate, which will no longer be valid, is essential for enrolment in the health service?
  • The scheme is ill defined, meaning it may be challenging for hard-pressed administrators in surgeries and hospitals over 27 different countries.  Does this mean they may either refuse treatment or insist that the patient pays?
  • And there are no guarantees at all about the  wider question of maintenance of the current S1 system for those who have not applied for or are undergoing treatment for serious conditions.

Will British pensioners be forced to return to the UK?

The ministerial statement clearly recognises the inadequacy of the scheme, and that it may well force British citizens to leave the homes they have made for themselves and their families, as it goes on to say “Should UK nationals face changes in how they can access healthcare, they may use NHS services if they return to live in the UK.

Jeremy Morgan, Deputy Chair of British in Europe said:

‘This is no more than a restatement of the obvious right of any UK citizen to NHS treatment if they live in the UK.  And it is all the crazier because the evidence is that it costs the UK about half as much to pay EU countries to treat its S1 holders as it would cost if they all had to be treated in the UK under the NHS.’

Continuing the status quo

The ministerial statement says the Government has invited EU states to continue all the present reciprocal healthcare arrangements until the end of 2020.  This is a welcome initiative but it is to be hoped that this is not the full extent of their ambition.  Previously it was understood that they aimed to continue the current reciprocal arrangements for those covered by them indefinitely, and not just for 21 months.

The EU line is not to engage in bilateral discussions on issues like healthcare so it is unlikely they will respond to this UK initiative.

Jane Golding said:

‘We remain disappointed that the EU27 are not prepared to even discuss the continuation of the existing reciprocal arrangements as part of contingency measures for no deal.  Financial instruments and landing rights of course, but not the medical treatment on which people’s lives depend. This lamentable situation gives the lie to both sides’ claims that the rights of those most directly affected by the referendum in which most of them had no vote is their “first priority”.  Both sides could have done much, much more if they really wanted to.’


22 March 2019