Wednesday, 9 October 2019
Health and Childcare Support (Miscellaneous Provisions) Bill 2019: Second Stage
I thank the Acting Chairman and Seanad Éireann for facilitating what I hope will be the passage of this important legislation this afternoon. Of course, our Brexit preparedness work as a Government and as an Oireachtas continues. This is an important piece of legislation in terms of the Republic of Ireland ensuring that we provide supports to citizens in Northern Ireland. There is cross-party support, in this House and the other House, to make sure that we do that and that we fulfil not only our obligations under, but the spirit of, the Good Friday Agreement. Particularly from my perspective as Minister for Health, it is so appropriate that we have endeavoured to put in place a scheme which effectively means if somebody from Northern Ireland gets sick while on holiday in the European Union or, indeed, while in the European Union, we here in Ireland will ensure their costs are covered.
I welcome the opportunity to introduce the Bill. This Bill is being introduced on my own behalf, as Minister for Health, and on behalf of my colleague, the Minister for Children and Youth Affairs, as it contains two sets of legislative provisions. The health-related aspect concerns the provision of similar benefits to those available under European health insurance cards, EHIC, to eligible residents of Northern Ireland in the case of a no-deal Brexit. The Bill also includes amendments to the Childcare Support Act 2018, to provide for British citizens to have access to the forthcoming national childcare scheme on the same basis as Irish citizens.
Before discussing the provisions of the Bill in more detail, I will put this legislation in context. The legislation has been identified by Government as a clear priority in the context of ongoing contingency planning for a no-deal Brexit. I acknowledge and appreciate the co-operation of colleagues in this House, and indeed the other House, who facilitated the Bill for debate as a matter of priority, taking account of the short timeframe between publication of the Bill on Monday last and its introduction in the Seanad today. I also thank my officials and officials in the Department of Children and Youth Affairs and the Department of Foreign Affairs and Trade for what has been intense and sustained work and effort to ensure that we could have this legislation at this point. This tight timeframe has unfortunately been necessary due to the pressing urgency for the legislation to be enacted before the end of this month, given that the Government continues to plan for a no-deal Brexit.
Brexit has undoubtedly raised a number of issues regarding the provision of, and access to, health services that need to be addressed. In recognition of this, in April the Oireachtas enacted legislation which, if commenced, will allow for the continuation of reciprocal healthcare arrangements between the State and the UK. This was necessary to provide a statutory means to facilitate the continuation of a range of existing reciprocal healthcare arrangements between Ireland and the UK, after the UK leaves the EU.
In the context of planning for a possible no-deal Brexit, ensuring that the citizenship and identity provisions of the Good Friday Agreement are respected and upheld in all relevant policy areas is an important issue, and one that the Government remains very engaged on. The Government will continue to work with the UK to reinforce the message that the rights and entitlements of all those living in Northern Ireland are of fundamental importance and must be protected to the greatest extent possible. The Government is proactively working to ensure that people in Northern Ireland can continue to enjoy access to EU rights, opportunities and benefits, including the benefits of EHIC, in the future.
The way EHIC works is that the state that issues the card, in this case Ireland, meets the cost of any services accessed by the holder in another EU or EEA jurisdiction. The practical effect is that EU citizens can visit another member state and avail of necessary public healthcare during a temporary visit there. Therefore, the objective of this legislation is to ensure that if the UK leaves the EU without a withdrawal agreement, eligible residents in Northern Ireland will not be out of pocket if health expenses are incurred while on a temporary stay in another EU or EEA member state or Switzerland.
This Bill has been brought forward, therefore, to ensure continued provision of the equivalent benefits of EHIC to eligible residents of Northern Ireland, as part of our ongoing planning for a possible no-deal Brexit. It is important to note that in the event of an orderly Brexit, the transition period will ensure no effective change in terms of access to EU programmes, including EHIC, thus highlighting the benefit of a Brexit with a deal rather than a no-deal Brexit scenario.
Under the Good Friday Agreement, all the people of Northern Ireland are recognised as having the birthright to identify themselves and be accepted as Irish or British, or both, as they so choose, and accordingly the right to hold both Irish and British citizenship.In view of the various adverse effects of a no-deal Brexit outcome for EU citizens in Northern Ireland, among which is the loss of access to the benefits of EHIC when travelling to another member state, and recalling the relationship between the EU and the Good Friday Agreement, the Government is putting in place this measure in an effort to mitigate this loss to EU citizens, which includes Irish citizens as well as British citizens. The scheme will be based, as far as possible, on the rules that apply under EHIC. For example, the applicant must not travel for the purpose of receiving planned healthcare, and any co-payments which apply to residents of the country being visited will not be reimbursable.
Presentation of an EHIC by an EU citizen travelling to another member state, issued under governing EU legislation, generally results in accessing healthcare at a significantly reduced or no-cost basis, which is, of course, of benefit to patients. Given the limited timeframe to the end of October, and the absolute imperative to have a scheme in place for 1 November, the immediate priority is to devise and implement an approach which ensures that in the event of a no-deal scenario occurring, eligible residents of Northern Ireland can have access to arrangements that allow for them to be reimbursed for the cost of healthcare which may become necessary while on a temporary stay in an EU or EEA member state.
The scheme to be implemented is one where a patient will pay upfront for treatment received at the point of delivery. They will then claim reimbursement directly from the HSE following their return home. My Department has requested the HSE to design and build the ICT and administrative systems necessary to implement this scheme. I am pleased to say that this work is well under way. It is envisaged that the operational aspects underpinning the scheme will include an online application portal, with the aim of providing a user-friendly, single-step reimbursement application process for eligible residents in Northern Ireland. In order to ensure compliance with the rules of the scheme and guard against fraud, it will also be necessary to provide a robust system of verification of applications, including validating the applicant's eligibility status, for example, proof of residence in Northern Ireland, and validation of reimbursement claims, for example, by the provision of appropriate receipts when applying for reimbursement.
Part 3 of the Bill is designed to amend the Childcare Support Act 2018 in order to make provision for British citizens to access the national childcare scheme on the same basis as Irish citizens. The latter is a national scheme of financial support for parents towards the cost of quality childcare. Once introduced, it will replace the existing targeted childcare schemes with a single streamlined and user-friendly scheme, providing both universal and targeted childcare subsidies. An issue could arise for British citizens living in Northern Ireland who wish to access the scheme in the State, and register their children with childcare providers here, and also for British citizens moving to here to live. In the event of an orderly withdrawal of the UK from the EU, British citizens will be treated as nationals of EU member states for the period of the transition. However, in the event of a no-deal outcome or in the longer term, the policy approach reflected in this Bill, consistent with the principles and intent of the common travel area, is to make provision for British citizens to access the national childcare scheme in the State on the same basis as Irish citizens.
The amendments in Part 3 put beyond doubt that British citizens will be eligible to apply for the national childcare scheme in the event of a no-deal Brexit. As such, it offers assurance to British citizens living in Northern Ireland who wish to access the scheme and avail of childcare services in the State, as well as British citizens moving to Ireland to live.
I will now briefly outline the main provisions of the Bill. Part 1, section 1, provides the Short Title of the Bill and provides for the commencement of the various parts of the Bill. Section 2 is a standard provision concerning the paying of expenses in respect of the administration of the Bill. Section 3 sets out the definitions required under Part 2 of the Bill.
Section 4 makes provision for the implementation of a scheme for the reimbursement of expenses incurred by eligible persons resident in Northern Ireland in respect of necessary medical treatment. Section 5 provides that the Minister may, with the consent of the Minister for Finance and the Minister for Public Expenditure and Reform, make regulations to provide for the administrative arrangements to give full effect to the provisions of Part 2. It also outlines the principles and policies the Minister shall have regard to when drafting the regulations.
Section 6 provides that the HSE, for the purposes of Part 2 of the Bill, may enter into arrangements with competent institutions in other member states. Such arrangements may cover matters such as the processing of reimbursements, the calculation of the value of medical expenses to be reimbursed, the exchange of information between the two bodies and the facilitation of other administrative and technical co-operation in respect of the reimbursement of medical expenses.
Section 7 provides that the HSE may have regard to the decisions of the Administrative Commission for the Coordination of Social Security Systems in respect of the operation and administration of the EHIC as operated under EU Regulations 883/2004 and 987/2009. Section 8 requires the HSE to carry out a review of the operation of the Act not later than two years after its commencement and that the Minister must lay that review before the Oireachtas not later than one month after the report is received.
Part 3, section 9, provides for the definition of "principal Act" for the purposes of Part 3. Section 10 provides for an amendment to section 7 of the Childcare Support Act 2018 to make explicit reference to the eligibility of a British citizen to apply for financial support under the Act. Section 11 is a consequential amendment to section 15 of the Childcare Support Act to provide that payment will not be made where the person does not satisfy the eligibility criteria in section 7 of the 2018 Act, as amended now by section 10 of this Bill.
Statutory regulations will also be required in respect of Part 2 in order to define, as necessary, the administrative arrangements for the direct reimbursement scheme. Officials from my Department will progress the drafting of these regulations, in conjunction with the Office of the Attorney General, over the coming weeks. Officials from my Department are also working with the HSE, in tandem with drafting the detailed regulations, to finalise the development of an application process that can take account of the administrative, operational and validation aspects necessary to deliver on the Government's objective.
The provision of benefits similar to those available under EHIC to eligible residents of Northern Ireland has been identified by Government as a clear priority in the context of contingency planning for a no-deal Brexit. I greatly appreciate, therefore, the urgency this Bill is being dealt with and I thank Senators in advance for facilitating the smooth passage of the Bill.
From a healthcare perspective, the purpose of the Brexit omnibus legislation passed by this House and the Lower House in April was to ensure that the reciprocal arrangements could continue North, South, east and west. In many ways, this legislation is going one step further because it is not just looking at the reciprocal arrangements North, South, east and west but also at the rights and eligibility of people in Northern Ireland when they travel to the EU outside of Ireland for the purpose of healthcare. That is very welcome. It is this State stepping up to the mark in making sure that we look after people in Northern Ireland if and when the UK leaves the EU. That is even more important in the context of the Good Friday Agreement and in the context of the fact that a majority of people in Northern Ireland did not vote to leave the European Union. I commend the Bill to the House.
I welcome the Minister back to the House to discuss this legislation that all of us hope will never have to be used. Fianna Fáil will support this Bill, which seeks to maintain provision of certain health benefits to eligible residents of Northern Ireland and to make provision for British citizens to access the affordable childcare scheme on the same basis as Irish citizens in the event of a no-deal Brexit.
The reimbursement of medical expenses to eligible residents of Northern Ireland is a provision which is being proposed under the spirit of the Good Friday Agreement. The EHIC is one of the EU programmes where access for citizens in Northern would be affected in the absence of an agreement on UK withdrawal, and this Bill aims to address that particular situation. Under this proposed legislation, it is envisaged that the EHIC-equivalent benefits will be available to Irish, EU and British citizens living in Northern Ireland who require necessary healthcare when visiting EU or EEA member states or Switzerland. EHIC allows EU residents to access health provision in any EU country and in Switzerland, Iceland, Liechtenstein and Norway if they become ill or are injured while on a temporary stay in this country. Currently, one can only apply for an EHIC from the Irish health authority if one is ordinarily resident in Ireland and not receiving a social insurance payment from another EU state or paying another EU state's social insurance or one is not the dependant of such a person.
The term "necessary care" was defined under decision 194/2003 by the Administrative Commission on Social security for Migrant workers. That decision defines "necessary care" as benefits granted to prevent an insured person being forced to return home to their member state and to enable them to continue their temporary stay in another member state under safe medical conditions. The decision specifically states that it does not cover people who travel within Europe to get treatment in another country. What happens to the EHIC in the future will be decided as part of the negotiations on the future EU-UK relationship.
Fianna Fáil, for its part, welcomes the introduction of the national childcare scheme which we, and the parents of Ireland, have been waiting on since the single affordable childcare scheme, as it was then known, was first announced in the budget in 2017. It will provide much-needed support to parents for whom childcare costs have become similar in scale to having a second mortgage. Fianna Fáil is disappointed, however, at the overall way in which these childcare measures have been handled. As matters stand, the affordability and sustainability of childcare in Ireland leaves much to be desired.Despite the high cost to families, many childcare providers still struggle to maintain the service. The current system does not work for anyone. We are concerned that the scheme is not income progressive and, as a result, is unfair to low and middle income families. In fact, the subsidy will subsidise demand for childcare places. It could increase childcare costs across the board and will make childcare even more expensive for low and middle income households.
The Bill will restrict the mode of childcare that parents can choose for their child. Parents will have no choice or flexibility. They cannot opt to use a mix of centre-based care and-or informal care at home such as a childminder or relative. That issue should be addressed and I ask the Minister to respond on that.
I welcome the Minister back to the House. I will try to be concise and constructive in the few words that I have to say about this Bill.
When it comes to Brexit and related matters, Sinn Féin has supported the Government's position and given credit where it is due. For some time, we have called for a solution to be found by the Irish Government and European Union on the issue of the European health insurance card, EHIC, for people in the North. We pushed this issue repeatedly and, in fairness, the Government listened and responded. When the Government announced that it would cover people in the North or issue them with the EHIC, Sinn Féin welcomed that and, what is more, it was welcomed by people in the North. When that announcement was made people across the Six Counties contacted their Sinn Féin representatives seeking more detail. However, as the detail became clear on Monday morning, I must admit that I and many others were disappointed that the Government had decided in favour of a reimbursement scheme rather than extending the scheme to people in the North. What compounded the disappointment was the commitment given by the Government several times in recent weeks that it would extend the EHIC scheme to people in the North post-Brexit. The EHIC scheme is fantastic and people know how beneficial it is.
Having worked with Sinn Féin MEPs in Europe, I believe we need to have the EHIC attached to our passports to make things much simpler. A person lying on a beach abroad will not have the card in his or her possession. Many accidents and health problems occur when people are in the mountains or on beaches when on holiday. I was stung for an awful lot of money while abroad because I did not physically have the card with me, even though I presented a photograph of it. Let us simply matters. Participation in the scheme allows a person on holiday or a short-term break to access healthcare in another EU member state or in the European Economic Area free of charge or at a reduced cost. One of the first things people pack before they travel is the European health insurance card. They know that if they need a doctor or have an emergency, the card will provide cover. Given the importance of the EHIC, losing it has been a serious worry for people in the North since Brexit. One can imagine how reassuring it was for those in the North when the Government gave a commitment to issue them with the EHIC and all the benefits the card entails. However, the Government changed direction and decided to establish a reimbursement scheme. Perhaps the Government is more honourable than car insurance providers but obtaining reimbursement from insurance companies, particularly when one takes out car insurance abroad, is a nightmare and people often give up. We should have provided people in the North with the same scheme that people here and the rest of the European Union enjoy. Reimbursement creates many practical problems as some people may be unable to pay their bills. What will happen to people who are stranded abroad and do not have enough money to pay for treatment? They may also have to wait months to be reimbursed. It is regrettable that the Government has not kept the scheme as it was.
When the Bill comes before the Select Committee on Health in the coming weeks, Sinn Féin will propose amendments to try to deliver the European health insurance card, as opposed to a reimbursement scheme, that is available to all other citizens living in the EU and European Economic Area countries. As the Minister said, people in the North voted to remain. I acknowledge that he listened to the argument that the card is needed but the reimbursement scheme muddies the waters a little.
I fully support the legislation. As the Minister said, the Bill seeks to maintain the provision of certain health benefits to eligible residents of the North of Ireland. In the context of a Brexit deal or no-deal outcome, the card is an extremely important issue for people resident in the North. The reimbursement of necessary medical expenses to eligible residents of the North is an exceptional provision, which is being proposed, as the Minister said, by the Government in the spirit of the Good Friday Agreement. The EHIC programme is a real success story. The idea that residents of the North would be precluded or excluded from using the card, especially when they voted to remain in the EU, cannot be countenanced. Given that it is within our power to avoid such an outcome, it is good that we are doing so.
Concerns over the loss of EHIC benefit have emerged as a crucial issue for those entitled to EU citizenship and living in the North. The issue has come to represent a very tangible example of the unwanted loss of long-standing EU rights, benefits and opportunities. We cannot highlight that enough. As Senator Gallagher said, many of us harbour a hope that the legislation, and many other measures being prepared and put in place in advance of Brexit, will not be required. Achieving this objective has proved complex from a policy point of view and from the legal and operational perspectives. Officials in the Department of Health have worked intensely to progress this matter in recent months. I acknowledge the work that has been done by the Minister and his officials to get this legislation to this point so quickly.
The Government recently approved the immediate drafting of a Bill to provide for the benefits similar to those available under EHIC to residents of Northern Ireland in the case of a no-deal Brexit. The Government understands the importance placed on continued access to the benefits of EU membership, including these provisions. The legislation will provide the benefits of EHIC, albeit through a domestic reimbursement mechanism in Irish law, in line with the Government's commitment to the Good Friday Agreement. This is a clear priority in the context of contingency planning for a no-deal Brexit or a no-Brexit deal, which we would prefer.
I agree with the suggestion made by Senator Devine that we should make it as easy as possible to avail of the card. While the roll-out of the new public services card, PSC, has not run smoothly recently, that experience speaks to the necessity of a card such as this. I have visited other countries where a considerable amount of personal information is downloaded on to a card. I understand that there are data issues but it would be great if we had a similar card for people to use when they travel. People could present the card or card number when they avail of medical services in a hospital in Ireland and thus make their information available to the people who want to provide medical care. I am a strong proponent of such a card. Again, I agree with the Senator that we should make it as easy as possible for people to use the EHIC because people do not always have the card to hand when it is required.
Given the limited timeframe available, it is crucial to ensure the speedy passage of the legislation through the Houses of the Oireachtas, as a matter of priority, to achieve enactment before the end of the month. This will ensure that arrangements are in place, if needed, from 1 November. The phrase "if needed" is the operative part of my sentence. I thank the Minister and his officials for their work on the legislation.
The Minister of State, Deputy Jim Daly, will take the remaining Stages of this legislation on my behalf. At the conclusion of Second Stage, I acknowledge, as Senator Devine rightly said, the cross-party support for these measures. Everybody in this House has been working in the national interest on the issue of Brexit. I am pleased that the Government has been able to respond and engage with political parties and civic society in Northern Ireland in trying to address these challenges.
Senator Gallagher made a point about the childcare scheme and raised a broader issue related to his views on childcare. What we are trying to do in the legislation is replicate for British citizens the entitlement Irish citizens will have under the national childcare scheme. The scheme provides for progressive income-related subsidies for families as well as universal subsidies. That is the right approach. Under the scheme, those who need more get more. I am pleased that in yesterday's budget we have provided for further enhancements to the scheme, which will support lower income parents, working parents in need of longer childcare hours and lone parents. We want to build on that in the coming years. Senator Devine's question about why it is a reimbursement scheme is a legitimate one. She is right. The initial point we would all have liked to arrive at was a point where one could effectively replicate the EHIC card. For a variety of reasons, including extensive engagement with many different stakeholders, legal advice, the European Commission and, most crucially, the very short timeframe between now and a potential no-deal Brexit on 31 October, we took the decision to go with this version because we felt it was most important to have a workable scheme in place within that timeframe. Is this scheme perfect? No, it is not. Is it the best scheme we can put forward in this very short period of time? I genuinely believe it is. I take the Senator's point, which is a fair one, but getting to this point has been extraordinarily complex. It is in that vein that we present the content of the legislation in the way we do.
I am conscious colleagues have tabled amendments on Committee Stage that have all been ruled out of order. One theme about which it would be useful for me to reassure the House in an effort to be helpful concerns the amendment from Senator Devine about the definition of who is eligible. It has been suggested that we should add Irish and British citizens who are ordinarily resident in Northern Ireland. I am conscious the House will not get to debate this because it has been ruled out of order but while I am on my feet, it is useful for the record of the House and to provide reassurance to say we do not believe the amendment is necessary because section 7(1)(b)(iv) of the Childcare Support Act 2018 provides that persons who are nationals of EU member states are eligible to apply for financial support under the childcare scheme. Irish citizens ordinarily resident in Northern Ireland are already covered in section 7, so the legal advice available to me is that there is no need to refer specifically to Irish citizens ordinarily in Northern Ireland in section 7 as they will continue to be nationals of an EU member state after Brexit. British citizens ordinarily resident in Northern Ireland are captured at section 10 of the Bill. This is because regardless of their ordinary residence, British citizens will be eligible to apply for the scheme. Therefore, there is no need to refer specifically in section 7 to British citizens ordinarily resident in Northern Ireland. I say that to be helpful and constructive rather than argumentative.
I genuinely commend this legislation to the Seanad and, ultimately, to the Oireachtas. It is a very important step forward in terms of supporting people in Northern Ireland regardless of whether they choose to be Irish or British citizens or both, as is their right under the Good Friday Agreement. This is an honest attempt to ensure that access to healthcare in the EU in emergency cases can continue post Brexit.