Questions for 20^th October 2009

20. The Hon Member for Michael (Mr Cannan) to ask the Minister for Tourism and Leisure –

Whether his Department will be advising tourists in the holiday brochure that the Reciprocal Health Agreement is cancelled with effect from 1st April 2010 and that thereafter visitors will require travel insurance no matter how brief their visit?

Questions for 17^th November 2009.

15. The Hon Member for Michael (Mr Cannan) to ask the Minister for Health and Social Security –

(1) Whether he is aware of the NHS publication “Entitlement to NHS Hospital Treatment to Non-Resident UK citizens”;

(2) why was this document not made available to Members of Tynwald in advance of last month’s debate on the Reciprocal Health Agreement;

(3) why has he failed to negotiate the confirmation of the Reciprocal Health Agreement with the United Kingdom whilst other countries such as Azerbaijan, Belarus, Croatia, Russia, Ukraine etc, continue to have Bilateral Agreements covering their nationals and UK nationals only; and

(4) whether he will re-open negotiations with the United Kingdom for a Bilateral Agreement for Reciprocal Health Care for the Isle of Man?

16. The Hon Member for Garff (Mr Speaker) to ask the Minister for Health and Social Security –

What negotiations have taken place with the Scottish Government to establish a reciprocal health agreement with the Isle of Man; and what progress has been made so far?

Questions for 15^th December 2009.

6. The Hon Member for Garff (Mr Speaker) to ask the Minister for Health and Social Security -

(1) Whether his Department has yet established if legal powers exist to negotiate separate reciprocal health agreements for the Isle of Man with Scotland, Wales and Northern Ireland; and

(2) when the Health Ministers of Scotland, Wales and Northern Ireland were last contacted about entering such agreements?

Reciprocal health agreements with Scotland, Wales and Northern Ireland

805 Negotiation powers

The President: Question 6. Mr Speaker.

825 Department of Health for a reply on 15th October, on 4th November we still awaited an answer to the crucial

question of whether or not the devolved jurisdictions can enter into reciprocal health agreements with the Isle

of Man. My officers have again pressed the DoH for a response, most recently earlier this month. It is evident

that the UK DoH is pressing the Ministry of Justice for an answer, due to this matter being of significant

constitutional concern.

830 Given the uncertainty over the constitutional ability of the devolved jurisdictions to enter into agreements

with us, I have not made any further contact the Health Ministers of Scotland, Wales and Northern Ireland;

nor will I do so until the legal position is clear, sir.

The President: Mr Speaker.

840 The President: Mr Teare.

845 continuing for such a long time.

 The President: Hon. Member, Mr Karran.

Mr Karran: Eaghtyrane, a supplementary.

Would the Shirveishagh explain his stance on this issue, which appears to be like a dog 850 in the manger over

it, when allowing for the fact that, as Member for Health, we negotiated a holiday dialysis arrangement with

the Republic of Ireland back in the late 1990s and the Channel Islands as far as having a reciprocal health

agreement for those unfortunate persons who need dialysis because of kidney failure, so that they could get

off this Island, as far as that situation is concerned?

855 Would the Shirveishagh not agree that his attitude on this situation seems to be the attitude of determining

to have a situation where we will not negotiate as far as this issue is concerned, just looking after those who

are well, those who have got the money, and forgetting the rest of the community? Does he not feel that the

issue is that he should now make representations to the different devolved parts of the United Kingdom and

let them put the pressure on, instead of acting like something that has been savaged by a dead sheep?

860

865 UK; he was talking about the Republic of Ireland and the Channel Islands. There is a different issue here. We

are asking whether the devolved assemblies have the vires to enter into these negotiations and to reach an

agreement. He said that we will not negotiate. I cannot see how we can negotiate when the people we are

negotiating with cannot be satisfied that they have the power to negotiate and to reach any conclusion, or

indeed any agreement. To do so would, in effect be, I would suggest, sir, not a productive use of anybody’s

870 time.

880 The President: Mr Teare, Hon. Member.

890 The President: Hon. Member for Rushen, Mr Watterson.

895 Bach, has the Chief Secretary’s Office been asked to put pressure on the Ministry of Justice in order to get

hold of the legal advice that is required? As a result, would he consider highlighting this matter to the Justice

Committee who are looking into the relationship between the MoJ and the Crown dependencies at the

moment?

900 The President: Mr Teare, Minister for Health

905 The President: Mr Karran, Hon. Member.

Mr Karran: Would the Shirveishagh not agree that it should be an awful lot more difficult to be able to

negotiate with the Irish Republic? If, as Member for Health, we could come around with an agreement with

the Irish Republic, with their strange health services, in order to create a reciprocal agreement as far as a

dialysis holiday club between the Isle of Man and the Irish Republic, then he, as the Minister 910 for the DHSS,

should be able to make representations to the individual authorities of Scotland, Wales and the Irish Republic

and let them also argue that point with the United Kingdom Government in order to strengthen the position as

far as being able to do it?

Would he also not agree that the issue is that we all sympathise with the tremendous pressure that his

915 Department is under as far as this issue is concerned, but that does not excuse him from using some initiative

in order to actually get on to the devolved governments to see whether they are prepared to make

representation in order to speed up the impasse over this most important issue for our people?

The President: Mr Karran, that is the same question you asked previously.

925 Mr Karran: If you had given me a decent answer, I would not be having to repeat it.

935 of getting this question answered by London?

945 other party may not have the vires or the legal ability to enter into. It is as simple as that, sir.

The President: Mr Teare.

The President: Mr Cannan, Hon. Member for Michael.

Mr Houghton: Hear, hear.

980

9. The Hon Member for Malew and Santon (Mr Cregeen) to ask the Minister for Health and Social Security -

With which countries does the Isle of Man have a reciprocal health agreement?

1145 New Zealand, Russia, Serbia, Montenegro, Turkestan, Turkmenistan, Uzbekistan, and also Ukraine. At

present, these arrangements include the Isle of Man.

The Department intends to make available, before 1st April 2010, an authoritative list of which

agreements remain in force, if any, and what they may mean in real terms to Manx residents travelling abroad.

This latter point is very important, as the existence of an agreement has the potential to mislead people into

1150 thinking that treatment in the partner country will be free, which is highly unlikely to be the case. The

Department’s strong advice is therefore likely to remain that anyone travelling off Island should take out

adequate insurance to include the cost of repatriation, regardless of whether or not a reciprocal agreement

exists.

1155 The President: Mr Cregeen.

1160 the debt for people in the Hospital? Does he bring debt agencies into it? How will he deal with that?

The President: Mr Teare.

1180 The President: Mrs Christian, Hon. Member of Council.

1185

1190 reciprocal agreement with a country like (A Member: Uzbekistan.) Uzbekistan – thank you, Hon. Member –

it means that the health service will be provided free at the point of delivery. You will not get exactly what

you would be accustomed to in your own country.

The President: Mr Speaker.

1200

1210 needs to make representation with the Council of Ministers to start smelling the coffee, as far as the UK and

their loyalty is concerned?

Would be also not agree that allowing for the fact that they were given an extra year to negotiate an

alternative arrangement, that his Department and the Council of Ministers have been shameful as far as the

lack of any motive and will he go back and consider the issue of creating a small levy run by a private

1215 insurance company, in order that we can cover Manx residents leaving this Island and tourists coming to this

Island so that we would have some sort of health cover for those who are vulnerable and would not be able to

afford insurance? Is that not the right way forward?

The President: Mr Teare.

1225 I do not see it as shameful, we have entered into negotiations and I will make this abundantly clear once

again. Even if people have the vires to talk to us and enter into an agreement, an agreement will only be

entered into if we feel it is beneficial to the Island. Nothing more, sir.

The President: Mr Cregeen, Hon. Member.

1235

1245 way the Isle of Man is being treated, will he and will the Council of Ministers step up the lobbying with the

political contacts that have been painstakingly built up over the years, which we seem to unfortunately not

have been utilising to full advantage over the past year? Will the Minister now recognise that this is a changed

situation? There are many in Westminster who are our allies and with whom we could work to get this

Agreement ending overturned.

1250

The President: Mr Callister, Hon. Member of Council.

1265 The President: Mr Teare.

1270 health authority that they fulfil those criteria. In addition to having lived in the UK for 10 years, they would

have to be a state pensioner as well, sir.

1275

For Written Answer:

20. The Hon Member for Douglas North (Mr Houghton) to ask the Minister for Health and Social Security -

Further to his written answer to my Keys’ question on 1st December 2009 –

(a) whether his Department intends to charge those Island residents who have paid UK National Insurance contributions for more than 10 years or others in receipt of a UK State pension if they are sent off-Island for specialist treatment to prevent their condition from becoming acutely exacerbated;

(b) whether he is going to review the position in respect of Island residents who do not qualify for medical insurance, when they visit the UK and who are hospitalised there; and

(c) whose interpretation he is relying upon to support his assertions?

Answer: In answer to the Question from the Hon. Member for Douglas North, Mr Houghton, I can advise

that there is no intention for my Department to levy any charges against Island residents who are sent off-

Island for specialist treatment.

If I may quote from the Written Answer I gave to him on 1st December, 2009, in relation to the Bilateral

Agreement between the Department of Health and Social Security and the UK Department of Health, and I

130 quote:

STATEMENT BY THE CHIEF MINISTER RE RHA  AND QUESTIONS RE STATEMENT  20TH JANUARY 2010 

45 therefore wish to place on record my appreciation to the current Secretary of State, The Rt. Hon. Andy

Burnham MP, for agreeing to the meeting held in London yesterday, which provided me and my colleague,

the Minister for Health and Social Security, with the opportunity to make representations on behalf of the

Island directly to Mr Burnham, to raise the concerns of our Government, Hon. Members, and many in our

community, over the decision by the United Kingdom to end this long-standing Agreement.

50 The Secretary of State was very understanding of our position and conscious of the Island’s relationship

with the United Kingdom. However, he made it very clear to us that it was the firm policy of the United

Kingdom government not to fund the cost of healthcare, either for Island residents visiting the United

Kingdom, or for UK residents travelling outside the United Kingdom. Therefore, the decision to terminate the

Reciprocal Health Agreement between our two countries would not be re-opened. He went on to confirm that

55 the United Kingdom Department of Health had determined that the Reciprocal Health Agreement between the

Isle of Man and the United Kingdom, as well as the agreements with the other Crown dependencies, no longer

represented value for money for the UK taxpayer – a view, Mr President, which the United Kingdom

Department of Health has consistently expressed throughout the deliberations on this matter since their

decision was made to terminate the Agreement with the Island in June 2008.

60 At the meeting I took the opportunity to express very fully the Island’s concerns regarding the termination

of this Agreement, given the close historical and social ties between our two communities. I particularly

emphasised our concerns relating to certain categories of residents, such as persons with chronic illnesses or

disabilities, who believe they may encounter real difficulties in obtaining health insurance to travel to the

United Kingdom. We also raised the concerns of Island residents who have served, or are serving, in the

65 British forces, many of whom have written to the United Kingdom government. The Secretary of State agreed

that officials at the UK Department of Health would clarify the position in respect of these people, and indeed

other categories of persons resident in the Island who may be exempt from charges under the UK regulations.

During the meeting I also took the opportunity to remind the Secretary of State that the Isle of Man

Government currently spends in excess of £8 million annually in hospital treatment through hospitals in the

70 United Kingdom for Island residents referred to the UK for treatment. In response, the Secretary of State

appreciated this position and confirmed that the option of such referrals would continue to be available to the

Isle of Man after the Reciprocal Health Agreement ends on 31st March 2010. The Secretary of State stated

that, since the Agreement was first drawn up in 1948, political and economic circumstances had moved a long

way from the principles of the original concept and that, as such, such an agreement was no longer acceptable

75 to the United Kingdom government, especially as it did not represent value for money for the United

Kingdom and its taxpayers.

However, during our discussions, it was agreed to jointly monitor and review the impact of the ending of

the Reciprocal Health Agreement to the residents of both countries in 12 months’ time, with an interim

evaluation being taken six months after the termination becoming effective.

80 Another matter we raised and sought clarification on was regarding the health agreements the UK had

with a number of European countries who are outside of the EU. It was confirmed that many of these

agreements have been in place for a considerable period of time and provided only very limited healthcare. It

was further confirmed that such agreements were also under scrutiny by the Department.

Mr President, I think it is fair to say that were left in no doubt that the United Kingdom government’s

85 responsibility to look after the interests of the UK taxpayers was paramount and never more so than in the

current challenging economic situation being faced by the United Kingdom. Quite simply, therefore, the

United Kingdom government is no longer prepared to fund the provision of healthcare for its own residents

who travel outside the United Kingdom. In the case of a reciprocal health agreement between our two

countries, we have to accept that the United Kingdom government no longer wants such an arrangement with

90 the Isle of Man, and at yesterday’s meeting that was, again, firmly reiterated, this time directly to me and to

the Minister for Health and Social Security by the United Kingdom Secretary of State.

Thank you, Mr President.

The President: Mr Houghton.

100

105 relation to the Isle of Man, but also in relation to other jurisdictions.

As far as the review, I think that is helpful, in terms that whilst we were going to review and keep an eye

on what happened in the Isle of Man, I think it is very helpful that we also keep an eye on that and the United

Kingdom as to the impact on their residents as well, so that we can cross reference information, and if there is

a real problem, identify it and discuss how we may be able to overcome it, sir.

110

115

130 That is what has happened in this case, whether we like it or not, and can I again remind Hon. Mr Speaker

this Hon. Court, by a big majority, in fact approved what would go forward in terms of recognising that that

Agreement has actually ceased.

The President: Mr Cannan, Hon. Member.

140 control and a medical condition, to either obtain insurance or alternatively are unable to afford insurance?

Does he intend to offer some solution to this not insignificant number of people who fall into the category I

have just stated?

The President: We are in danger, Hon. Members, of moving away from the Statement. Questions should

The Chief Minister: I think the reality is that some Members are speculating, without knowing what is

available and certainly I am aware of one company in the Isle of Man, who has developed a bespoke

150 insurance health policy for Island residents, as has happened in Guernsey and Jersey, who for nearly a year

now have had this situation and I think, until we all know the basis of that scheme or schemes, we do not

really know whether there will be a number of our residents who will be in difficulty.

What I can say is that anybody who is unable to obtain insurance should, in fact, make contact with the

Department of Health and Social Security and the Minister will look at that issue and we will, as a

155 Government, consider whether there is any need for us to become involved in ensuring that such persons are

able to travel on and off the Island, sir.

Published by © the High Court of Tynwald, 2010

The President: Mr Henderson.

165 this Court to the UK authorities at such actions, in their flagrant disregard to this jurisdiction?

175 It is unfortunate. We were surprised that, in fact, it was on Manx Radio last night, but that is the way the

United Kingdom operates. I have no influence over how they operate. All I can say is, it was clear I was to

make a Statement here in Tynwald, our parliament, today sir.

The President: Mr Callister, Hon. Member of Council.

185 members of the Forces, past and present – and come forward with some kind of sensible policy that will

satisfy the people of the Island?

The President: Chief Minister.

195 whether or not the Isle of Man Government should have any involvement directly in ensuring such persons

are secured with health insurance, sir.

The President: Mr Gill, Hon Member for Rushen.

205 The President: Chief Minister.

210 interest, or because of value for money, for them to fund people from the United Kingdom who travel outside

the United Kingdom on holiday or visiting family and friends, and therefore that is why they have ended the

agreement, sir.

The President: Mrs Christian.

Published by © the High Court of Tynwald, 2010

215

220 how many people cannot obtain adequate insurance cover for journeys to the United Kingdom?

230 real – should pass that information forward to the Department of Health and Social Security in the Isle of

Man and they will then monitor that, keep a view on it and, if necessary, we will consider whether or not there

is a need for the Isle of Man taxpayer to get involved in providing support to ensure such persons are able to

still travel on and off the Island, sir.

235 The President: Mr Karran, Hon. Member for Onchan.

240 Service, as far as Manx residents are concerned when visiting the United Kingdom, whether his officers

would support such an initiative or whether the Department, or the Minister for Health and Social Security,

would support the principle of such a proposal, so that we could still allow our people to come, administrated

by the Department, by the Manx Health Services, or by a private insurance firm?

245 The President: Chief Minister.

250 the Isle of Man travelling off-Island would be a responsibility for them and that was approved after a number

of moves to try and amend that and change direction. Can I say that, as far as I am concerned, that is where

we stand.

What we sought, and were able to get, was an absolute reaffirmation by the Secretary of State for the

Department of Health in the United Kingdom, as to the United Kingdom government stance on this matter

255 and why and we have got that clarified; and while sympathetic and understanding our position, making it very

clear why they are at the stage they are.

As far as whether insurance will be available to assist Isle of Man residents to go off-Island, again, I am

aware that at least one company has held back promoting what they are proposing, until this matter was

clarified. Therefore, information that would have come out in December, as I understand it, is now being

260 delayed until after the meeting that was held yesterday and the outcome of that meeting. I think once – and I

hope – the private company, and hopefully there will be more, comes out with bespoke insurance for Isle of

Man residents that that may well resolve all or, if not all, the vast majority of concerns that are raised by

people. The only issue then will be affordability and also whether there is a real problem for individuals who

have either chronic illnesses or certain disabilities who might find it a real problem for them and if that is the

265 case, again I repeat what I have said now on four occasions in this Court this morning, we, as a Government,

will assess that and see whether the Isle of Man taxpayer should, in fact, fund support to ensure that such

persons can travel off the Island, sir.

The President: Mr Lowey, Hon. Member of Council.

280 The President: Chief Minister.

285 United Kingdom, and they are on the Government website for anybody who wishes to know. There has also

been a leaflet drop that was sent out by the DHSS very early on – about 18 months ago or a year ago,

something like that – to every household. The Minister is working up another document which will go out,

hopefully, by the end of this month – if not, early in February – to give further advice to individuals, to

remind them of what is available, and so on. As far as timescale is concerned, I would certainly look for that

290 to be as soon as possible so that, again, we can provide clarity to individuals who have concerns.

I want to make it clear, Mr President – because there has been, I believe, an indication that the

Government and others do not care about the situation – we do care about it. We opposed the move by the

United Kingdom government on this issue. We are concerned about the change, but the reality is one party to

an agreement now wishes to end that agreement, therefore we have to get on with making sure, as far as we

295 can, that the people of the Isle of Man are informed of this and, hopefully, will be provided with health

insurance – as has happened in the other Crown dependencies, where we understand there have not been any

problems – to ensure that people in the Isle of Man are able to get health insurance so they can travel and visit

family and friends and visit the United Kingdom without worrying about whether not, if they are taken ill,

they could actually not be covered for health care.

300

305 up with Scotland, Wales and Ireland, because this is a point that you said you were waiting for clarification

from the Secretary of State? Did you take the opportunity yesterday to do that and, also, do you not think it is

rather patronising that, yes, they say it is not value for money but you can still continue to spend £8 million a

year with us! They like to take our money, but they will not give us this reciprocal arrangement.

310 The President: Chief Minister.

315 is two governments have discussed the situation. We cannot have it all ways. The issue of spending £8 million

within the United Kingdom Health Service is because we decided to do that to provide the best healthcare we

can for our residents. We are not obligated to spend there. We made that decision because we believe it is the

right decision for the Isle of Man and I do not think Members should mix up the two issues, sir.

320 The President: Hon. Members, I have deliberately taken the principle of going round asking individual

Members, so that every Member has a chance. I am very well aware that a number of Members are wishing to

come back for a second bite of the cherry. I am happy with that, Hon. Members, but remember we have

Question Time to come, when we will go over the same ground or similar ground, yet again.

Mr Houghton.

325

330 forward, sir?

The President: Mr Speaker.

345

350 best advice we can to our residents, to ensure that they understand the situation.

As far as the issue of the minutes, I am certainly content to consider that. I think that is a matter that I

would want to liaise certainly with the Department of Health over that issue, because it was a meeting

between the two parties.

I also think that the important matter, Mr President, is quite clearly that a decision has been made by the

355 United Kingdom government, for reasons that matter to them. You can lobby all the MPs you like in the

United Kingdom, with the greatest respect, but the issue is quite straightforward. Why would they support the

United Kingdom government funding healthcare for residents of the Isle of Man? They are not willing to do it

any more. That is the reality. That is why we are where we are, sir.

360 The President: Mr Cannan, Hon. Member.

365 would it not be in the interests of the taxpayer of the Isle of Man, that the costs of Manx residents visiting the

United Kingdom who needed healthcare of accident and emergency, and tourists visiting the Isle of Man with

a demand for an enhanced tourist industry… that they would not be subject to having insurance; that it was in

the interests of the Isle of Man taxpayer that the costs incurred presently by the Reciprocal Health Agreement

were taken up by the Manx taxpayer?

370

375 which causes a lot of concern for many residents, what will be available – and, again, we have just had a

classic example, where the Hon. Member has just said, you know, that they will only get accident and

emergency. No, they won’t. People will get accident and emergency provision free if they are visiting the

United Kingdom, they will get access to a GP free if they are visiting the United Kingdom.

Many people on the Island will fall into the exempt categories, therefore would get free health care within

380 hospital, if they had to go into hospital. As far as the issue of referrals, people who are referred by the Isle of

Man NHS for operations, whether it be heart bypasses, whatever it might be, will still be funded by the Isle of

Man Government, and there is no change on that.

What we are talking about here is people who decide, for whatever reason – and I’m one of them – to visit

the United Kingdom either on holiday, to visit family and friends, or whatever it might be, and whereas we

385 would have to fund that through insurance if we went to America, or if we went to Europe, they will now

have to fund that through insurance to travel to the United Kingdom. That is the difference that will happen

and we have already, as a Tynwald Court, made a decision on that, sir, and that decision, whilst there are six

people in this Hon. Court who oppose those moves, that decision was made very firmly in October and we are

Published by © the High Court of Tynwald, 2010

progressing through that now.

What we did was meet with the Secretary of State in an endeavour to see if there was a 390 way to ask them to

revisit this decision. The Secretary of State, as I said in my Statement, was very firm. This is a policy of the

United Kingdom government because it is now not representing value for money for the taxpayers of the

United Kingdom and it is their policy that any resident of the United Kingdom who travels outside of the

United Kingdom should provide their own health insurance, where, in fact, there is not a reciprocal agreement

395 because of their EU relationship. In fact, even when that happens, if you go on to the Foreign and

Commonwealth Office website – the United Kingdom one – you will find they still recommend insurance

because you are not fully covered for healthcare even in those countries, and certainly not for repatriation, as

is the case between the Isle of Man and United Kingdom, sir.

400 The President: Mr Gill, Hon. Member for Rushen.

405 how much money would it have taken from the Isle of Man to maintain the Reciprocal Health Agreement

with the United Kingdom Government? Was that negotiation entered into, and what figure was suggested as a

figure that would settle that, sir?

The President: Chief Minister.

415 you want to spend £3 million for those who wish to visit the United Kingdom, who voluntarily decide to go

and visit there, or £3 million in our own Health Service here on the Isle of Man to improve many other areas?

That would be the choice you would have to make.

The reality is a decision has been made by one party to an agreement. We are not overjoyed about it. Our

preference would be to retain such an agreement. The reality is the decision has been made, the reality is the

420 United Kingdom will not reverse that decision, and the reality is that Tynwald Court has accepted that that

decision has been made. We now have to move on, and the best thing we can do is ensure we can provide the

best advice possible to anyone in the Island who has problems dealing with going off the Island, where they

may have problems in relation to insurance.

The advice there, I reiterate again, would be, I hope, that Hon. Members would advise them to write to the

425 Department of Health and Social Security, or that they would write on their behalf or in support, so that we

have the information and we can deal with this issue if there is a necessity to try and overcome a problem that

may arise.

The President: Right, Hon. Members, I think we have given it a good –

435 through a blanket insurance company, the United Kingdom government would co-operate with such a

proposal, so long as it was not detrimental as far as cost, is concerned?

Would the Ard-shirveishagh not also agree that when individual Members are asking him for permission

to send a parliamentary delegation to the United Kingdom, that they do not understand the situation in a

modern democracy, where it is not the executive that gives permission to go on a parliamentary delegation? I

440 do hope he can clarify that point. It is important that we know that that door is still open.

The Chief Minister: Mr President, can I say one thing that is helpful is if Members would actually listen

to the question and listen to the answer. I was not asked for permission; I was asked would I support it, and I

said no. Again, distortion of the facts makes it sound good, doesn’t it, if you are trying to undermine our

450 democracy!

Can I just say, Mr President, the issue is straightforward. The taxpayers in the Isle of Man are not going to

fund healthcare for individuals, and the taxpayers in the United Kingdom are not going to fund healthcare for

individuals who visit each other’s countries, sir.

455 Mr Karran: So you did not raise the issues, then?

Questions for 19/20th January 2010.

 1. THE HON MEMBER FOR GARFF (MR SPEAKER) TO ASK THE CHIEF MINISTER –

(1) On what dates in 2008 and 2009 written representations over the ending of the Reciprocal Health Agreement were made by his office to -

(a) the Secretary of State for Health;

(b) the Secretary of State for Justice; and

(c) other Westminster parliamentarians, specifying which;

(2) whether he will lead the Isle of Man delegation to meet the Secretary of State for Health in London; and

(3) whether the Isle of Man Government intends to negotiate new reciprocal health agreements directly with Scotland, Wales and Northern Ireland?

The Chief Minister (Mr Brown): Mr President, as Members will recall, this matter was fully debated in

Tynwald at the October 2009 sitting, when the Report from the Department of Health and Social Security was

put before Tynwald and when Tynwald agreed with the proposal from Government.

495 That being said, I can advise that any formal communication with the United Kingdom is undertaken by

the Isle of Man Government via the Ministry of Justice, with direct political contact being with the

Parliamentary Under Secretary of State at the Ministry of Justice, with responsibility for the Crown

dependencies. So, whilst written representations were not made to Secretaries of State for Health or Justice,

there was communication between the Isle of Man and the Ministry of Justice undertaken by my Office and

500 with the United Kingdom Department of Health undertaken by the DHSS on the issue of the ending of the

Reciprocal Health Agreement throughout 2008 and 2009.

I also had a number of discussions with Michael Wills, Minister of State at the Ministry of Justice, along

with his successor, Lord Bach, on this matter. In addition, I raised the issue with the Chairman of the BritishPublished

by © the High Court of Tynwald, 2010

Manx All-Party Parliamentary Group and various MPs and shadow Ministers I met at the conference of the

Conservative Party and the events during that time, including written correspondence with 505 Kate Hoey MP. Mr

Speaker will recall, as I am sure other Hon. Members will, that Miss Hoey was made fully aware of this

matter and Members’ concerns when she visited the Island as guest speaker for the CPA Commonwealth

Dinner in March 2009. As I set out in my Statement, I led the Isle of Man delegation to meet the Secretary of

State for Health, accompanied by the Minister for Health and Social Security.

510 Considerations are ongoing in respect of the benefit of individual reciprocal health agreements with the

devolved administrations, although at this stage we understand that Wales and Northern Ireland do not have

the ability to enter into such agreements and the position in respect of Scotland is being assessed, but we

understand so far that it is unlikely to be possible. I would also confirm that we are very unlikely to enter into

any reciprocal agreement with any of the devolved administrations if there is a cost to the Manx taxpayer, sir.

515

520

525

530 first notified that the Reciprocal Health Agreement was to be closed? Certainly, the Government was aware of

it prior to July 2008. Would it not have been appropriate then for the Chief Minister to have immediately

sought a meeting with the UK Minister of Health?

The President: Chief Minister.

The President: Mr Speaker.

545 we have politicians: to speak to each other?

The President: Mr Karran.

560 coming to the Island for healthcare? What assurances can we have that this Government and its Department of

this Government sat on its hands on this important issue and that is why we are in the mess we are in at the

Published by © the High Court of Tynwald, 2010

moment?

The President: A statement rather than a question but, Chief Minister, do you wish to reply, sir?

570 What is important not to lose sight of is that members have had copies of that correspondence recently,

where ministers have made it absolutely clear that there is no point in meeting. It is only because of a change

of Secretary of State that we have ended up having a meeting and he was willing to do that, because he

believed it was at least courteous for him to give us the opportunity to put our case and that is what we did,

sir.

575

580 who was briefed from this end? Why were not all Members of the House of Commons contacted individually

about this issue when the matter broke and we might have got something done earlier?

The President: Chief Minister.

590 So I am in a position where I am grateful to the Secretary of State for agreeing to this meeting, albeit at

this late hour. At least he now understands our concerns. At least there is an agreement to say we will monitor

the effect of the change and, if necessary, we will consider what action should be taken. That is a step

forward. It is not the step we would want. The step we would want is to retain the Reciprocal Agreement, but

again, whether Members like it or not, he has made it absolutely clear, abundantly clear, it is the policy of the

595 United Kingdom Government not to fund healthcare for individuals who travel outside the United Kingdom

 3. The Hon Member for Michael (Mr Cannan) to ask the Chief Minister –

Whether he is encouraged by the content of the letter from the Rt Hon Andy Burnham MP to Minister Teare agreeing to a meeting, “to discuss our

respective plans for the future and to examine how we can work together to ensure that timely and accurate information required by our citizens is made available”?

 Mr Cannan: In the light of the responses to the Chief Minister’s statement, I withdraw the Question, sir.

6. The Hon Member for Douglas North (Mr Houghton) to ask the Chief Minister –

In respect of the forthcoming meeting with the UK Secretary of State for Health –

(i) whether he has prepared an agenda; and

(ii) if so what his proposals are to resolve the UK Government‟s intention to withdraw from the reciprocal agreement on 1st April 2010?

The President: Question 6 has been withdrawn, Hon. Members

12. The Hon Member for Garff (Mr Speaker) to ask the Minister for Health and Social Security –

(1) What arrangements are being made to charge visitors from the United Kingdom for the cost of NHS treatment from 1st April 2010; and

(2) whether changes to the National Health Service Act 2001 or other legislation will be necessary, and if so when public consultation will be undertaken by his Department?

14. The Hon Member for Onchan (Mr Karran) to ask the Minister for Health and Social Security –

(a) Whilst welcoming his announcement that he will be holding talks with the UK Secretary of State for Health regarding the ending of the Reciprocal Health Agreement with the UK, in those talks if he will establish why the UK is content to have reciprocal health agreements with at least twenty other countries, not including the European Union, most of which have never had any connection with the British Crown; and in particular the inconsistency of the UK having a reciprocal health agreement with Uzbekistan whilst imposing economic sanctions against that country;

(b) whether the Isle of Man has the power and authority to negotiate reciprocal health agreements with other jurisdictions, such as devolved parts of the UK, the Channel Islands, the Republic of Ireland, or other countries or groupings;

(c) with which countries his Department is currently negotiating with a view to concluding reciprocal health agreements; and if none, why not;

(d) whether it would be of great benefit to the tourism sector, especially for the TT, if he could conclude a reciprocal health agreement with the European Union; and

(e) if the various negotiations to conclude reciprocal health agreements with other jurisdictions are unsuccessful, especially with regard to the UK or EU, whether the Minister would consider introducing a simple, universal scheme based on a departure levy?

1335 important respects, they are different from the Isle of Man-United Kingdom Agreement and, once again, the

relevance of these agreements is a matter for the United Kingdom Government, sir.

Turning to part (b), whether the Isle of Man has the power and authority to negotiate reciprocal health

agreements with the devolved parts of the UK, as I have stated previously, this has been referred to the UK

Ministry of Justice and an answer is still awaited, despite promptings by my Department and External Affairs.

1340 Part (c): in response to the third part of the Hon. Member’s Question, we have had discussions with the

devolved administrations, but these are on hold, pending clarification of their views. I must caution the Hon.

Member, however, that it would be counter-productive to enter into any reciprocal agreements with any other

jurisdiction, unless it is clear that it is in the best interests of the people of the Isle of Man that we should do

so. As I have said before, in other forums, reciprocal agreements have to be fair to both sides, and I would not

1345 expect any other jurisdiction to enter into a reciprocal agreement which they felt was unfair. For example, it

would not be sensible for us to enter into a reciprocal agreement which might save a small number of

individual Manx residents incurring charges when they visited a country, but only at the expense of a huge

cost to the Isle of Man Health Service for the treatment of residents of that country on the Isle of Man.

Part (d): in relation to the fourth part of the Hon. Member’s Question, concluding a reciprocal agreement

1350 with the entire European Union would potentially expose the Isle of Man Government and taxpayer to a

considerable cost for treatment of non-UK residents, who currently have to pay for their treatment. In effect,

the Hon. Member is suggesting that not only UK residents might obtain free treatment in the Isle of Man, but

so, too, would residents of EU countries who currently have to pay for healthcare. Not only that, Manx

residents visiting EU countries will still have to pay for their treatment on the same basis as a resident of the

1355 country that they are visiting. The effect of any reciprocal agreement with the European Union would

therefore be simply to dramatically increase the costs to the Isle of Man Health Service at no appreciable

benefit to Manx residents. There would also be considerable effort and expense incurred for no overall benefit

to our population – quite the reverse.

Turning now to the fifth and final element of the Hon. Member’s Question, the will of this Hon. Court on

1360 the possibility of the introduction of a levy was clearly expressed in the October 2009 Tynwald, where the

Hon. Member’s amendment to my motion failed to attract a seconder, sir.

The President: Mr Karran.

1370 Agreement on the basis that what we should be negotiating is the issue of travelling between both our

countries for this cover?

Furthermore, would the Shirveishagh not also agree that the fact is in his replies to (b) and (c) it gives the

impression that the real agenda has been to sit on your hands and to look at potential ways of saving money

for a Department of Health and Social Security that has always overspent, and would he not agree that he

1375 would be far better either putting this issue to bed now or coming clean with this Hon. Court that that is the

Published by © the High Court of Tynwald, 2010

real reason?

Finally, would the Shirveishagh explain, has he looked at other alternatives: has he looked into the issue of

the European Health Insurance Card Scheme; has he got any views on article 13 of the European Social

Charter; and does he have any ideas, as far as looking at the European Convention on Social and Medical

Assistance and its protocol? Would the Minister not agree that in his response, as a 1380 former Member for

Health, the reality is, when people came to this Island for the TT or whatever, whether they came from the

United Kingdom or anywhere else in Europe, they were covered as far as their healthcare was concerned?

The President: Minister Teare.

Going back on the historical basis, 1948: yes, you are quite right, it was established, with the

establishment of the National Health Service. The Agreement was reviewed in 2004, when it was quite clear it

1395 Despite all that, and as I have made it clear, people who travelled to the UK still needed insurance. So

despite the concern now, which I understand and I do empathise with, they should have had insurance in place

before, because there is no repatriation cover. I strongly refute the Hon. Member’s suggestion that the real

agenda was to sit on our hands. If you sit on your hands, it can be very uncomfortable. We need to move

forward.

1400 To make the assertion that the Department is always overspent, I would just like to refresh his memory –

there seems to be a short-term memory problem – last year, the Department did not overspend; this year we

have serious issues and I have made that clear. He also mentioned the European Health Card Insurance

certificate. That only provides a level of cover up to that provided to a resident of the country in which the

person, the holder of the card, falls ill. Now, Hon. Members will be aware that the provision of health service

1405 differs greatly through various countries in the European Union. As such, patients, on occasions – in fact, the

vast majority of occasions – have to pay a substantial charge towards the cost of their treatment.

He has also brought up the European protocol on emergency medical assistance. That is still going to be

provided. The comment that he made about us already providing free treatment for visitors outside the UK

who fall ill once they are on their holiday in the Isle of Man is patently not correct. They are charged for it.

1410

1415 willingness to have further discussions with the Isle of Man Government, and given that we have been

waiting since September of last year for Ministry of Justice officials’ permission to talk further about the

issue, can I ask him, when he was in London, whether he took the opportunity to get this long-awaited answer

from the Ministry of Justice, for which we have been waiting since last September? Did he try and unblock

the situation when he was down?

1420 Can I also ask whether he has not himself contacted Minister Nicola Sturgeon in Edinburgh direct, to see

if she would help in unlocking this situation which has been in place since last September, where we are

waiting for permission to talk further to the Scottish Government?

The President: Mr Teare.

1430 were with the Ministry of Health, sir.

Mr Karran: Eaghtyrane, would the Shirveishagh not agree that he might find it uncomfortable sitting on

his hands, but it is better than his hands being somewhere else – or his head? Would he 1435 not agree that the

situation is that he has sat on his hands, as far as this issue is concerned? We had an extra year of negotiation,

we should have explained the situation as far as the present setup and separated the other functions, as far as

medical care, from referrals from the Isle of Man to the United Kingdom?

Would he also not agree… how does he know, as the Minister of Health, that individuals who are not

1440 resident in the United Kingdom are not getting medical treatment in hospitals at the present time? Would it

not be more honest or factual with the truth, if he would explain that he does not know that point, as far as that

is concerned?

Finally, allowing for the fact that the Council of Ministers and the Government of the Isle of Man has no

game plan, will he now support removing the block vote, so that we can debate the issue of a universal levy

1445 for everybody on our commitment with the Council of Ministers, of having an inclusive society looking after

the weak, the poor and the sick, allowing for the fact there is a proposal on the table now for less than a £2

levy, that we can cover that and the repatriation of the people in the United Kingdom back to the Isle of Man?

Will he review this or will he sit on his hands, as far as this issue as well, and allow vanity to be allowed to

occur in this Chamber, instead of sanity looking after our people?

1450

1455 visiting the Isle of Man, have not been charged for it. I have to say that is not my perception, sir, but if the

Hon. Member has firm evidence then I would certainly like to hear it.

As far as the universal levy, which I feel he means a travel surcharge, I feel that this has already been

floated. The reaction from the public was quite strong and they felt that they would be, in some

circumstances, paying twice because some people already have health insurance cover for whilst they are

1460 travelling, through contents insurance on their house or, indeed, a financial product from a financial services

provider.

The President: Mr Karran.

1470 Service, believe that we should shoulder the responsibility and be glad that we are not sick, we are not elderly,

and that we should be looking at a surcharge, as he says, on travelling, which I see as a levy as part of the

commitment that we now see the United Kingdom Government doing away with, so that we can get on with

protecting those people who cannot get adequate travel insurance at a reasonable level?

1475 The President: Mr Teare.

1480 reaction to the proposal which was floated by the Hon. Member. In many respects it does seem simple, it

seems straightforward, and I do concede that, but the reality is there was very strong adverse public reaction

to it, sir.

16. The Hon Member for Michael (Mr Cannan) to ask the Minister for Health and Social Security –

(a) Whether he personally dealt with the negotiations with the United Kingdom Department of Health when notification was first received in March 2009 that the Reciprocal Health Agreement would be cancelled as from 1st April 2010; and, if not,

(b) who in the Department was personally responsible for the on-going negotiations?

The Minister for Health and Social Security (Mr Teare): Thank you, Mr President.

The initial notification that the Reciprocal Health Agreement would be cancelled as at 1st April 2010 was

not made in March 2009, but on 1st July 2008. It emerged during a routine meeting between officers of the

Isle of Man Health Service and officers of the UK Department of Health.

1560 Such meetings take place regularly at officer level. I was not present at the meeting, nor should I have

been. The officers concerned reported the matter to me within minutes of the ending of the meeting and, since

then, discussions on this matter have been led by myself or the Chief Minister, as appropriate. The Hon.

Member will be aware, of course, that no negotiations as such have taken place until very recently, as the UK

had made it very clear that the matter was closed, apart from discussions on matters of detail at officer level.

1565

For Written Answer.

30. The Hon Member for Rushen (Mr Watterson) to ask the Minister for Health and Social Security –

In his negotiations with the UK Government, if he will ascertain how much money the UK Government feels that it is losing as a result of having a reciprocal health agreement with the Isle of Man; and how this relates to other health agreements that the UK has?

285 of emergency in-patient treatment provided to Manx residents in UK hospitals

 Questions for 16^th February 2010.

9. The Hon Member for Douglas North (Mr Henderson) to ask the Chief Minister –

Whether the House of Commons Justice Committee which is currently looking into the relationship between Crown Dependencies and the Crown is to widen its remit and examine the termination of the Reciprocal Health Agreement; if so, who is to give evidence to the Committee on behalf of the Isle of Man; and whether he will ensure that the evidence represents as many interested parties on the Isle of Man, such as:

(i) all Ex-service Personnel Associations;

(ii) Manx Blind Welfare Association and Friends of the Manx Diabetic Centre;

(iii) Manx Foundation for the Physically Disabled; and

(iv) other healthcare associations and organisations including those responsible for care of the elderly?

10. The Hon Member for Douglas North (Mr Henderson) to ask the Chief Minister –

Whether the Council of Ministers will do everything within its power to advise the House of Commons Justice Committee members when they visit the Island about the negative effects of termination of the Reciprocal Health Agreement; and if he will highlight the stance the UK has had towards the Island in respect of the re-arranging of the VAT sharing arrangements which together would appear to have severed the Isle of Man’s relationship with the UK?

For Written Answer.

37. The Hon Member for Garff (Mr Rodan) to ask the Chief Minister –

Whether the Ministry of Justice has yet concluded its deliberations on the legal competence of the Isle of Man entering into separate reciprocal health agreements with Scotland, Wales and Northern Ireland; and if not, whether the Isle of Man Government considers it acceptable that this matter remains outstanding from September 2009?

40. The Hon Member for Garff (Mr Rodan) to ask the Chief Minister –

Whether the requests for meetings with the UK Government to discuss the ending of the reciprocal health agreement which were refused, were made directly to the Secretary of State for Health – Rt Hon Alan Johnson MP (until June 2009) and Rt Hon Andy Burnham MP from June 2009); and if he will state the dates such meetings were requested?

Questions and Answers in the Keys 9th March 2010

BIPA vote to defer Reciprocal Health Agreement cancellation

Thanks to Mr MacKinlay MP and Hon. S C Rodan SHK