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?????????????????????????????????????????????????Thursday, June 1, 2017
Will expat pensioners really cost the NHS £1 billion?
By Martin Williams31 MAY 2017The claim
“The NHS could face a bill of almost half a billion pounds if retired British people currently living in other EU countries decide to return to the UK in the event that their right to healthcare in those countries is withdrawn after Brexit.” – Nuffield Foundation, 31 May 2017.
The background
A new report by
the Nuffield Trust warns of a massive bill for the NHS if
the government fails to reach a good Brexit deal and expat pensioners
return to the UK.
Under the EU’s reciprocal healthcare scheme – known as “S1” – British
pensioners living in other EU countries are entitled to local healthcare
rights, with the UK ultimately picking up the bill.
After Brexit, the concern is that the UK may not be able to continue
in this scheme. If this happens, the Nuffield Trust says pensioners
could return to the UK for their healthcare, putting added pressure on
the NHS.
It says 190,000 British pensioners live elsewhere in the EU and
the Department of Health pays around £500m to other countries to cover
their care costs. “If British pensioners lost their health care cover in
EU states and had to return to the UK in get the care they need, the
extra annual costs to the NHS could amount to as much as £1 billion
every year.”
The analysis
The Trust’s claims are confusing. The press release says the bill could increase by £500m rising to £1bn. But the report itself repeatedly refers to “an extra £1 billion a year”.
So which is it? An extra £500m or £1bn?
A spokesperson told FactCheck that they actually meant what was written
in the press release. They’re saying the bill could double from £500m to
£1 billion. The report appears to have garbled this.
Statistics on the S1 scheme are extremely difficult to pin down. Incredibly, its administration is still done on paper with “big cardboard files of papers being posted backward and forward across Europe, which people then have to process”.
Nuffield’s statistics about the current scheme originate from oral evidence given in Parliament by Paul MacNaught, an executive from the Department of Health.
“The actual amounts we pay in any given year are greatly affected by the
exchange rate, but, if we are talking in general terms, we spend about
£650m a year on the reciprocal healthcare arrangements,” he said. “Of
that, about £500m is on pensioners, so that is UK-insured pensioners, of
which there are about 190,000 in other EEA countries.”
However, the Department of Health told FactCheck that MacNaught’s
figures were merely “estimates intended to give a steer of the typical
amounts”.
In reality, the UK paid out just £429m in 2015/16 to cover the costs of
UK-insured pensioners under S1. That’s 14 per cent less than the the
£500m figure used by the Nuffield Trust.
The figures are also shaky when it comes to the number of people we’re
talking about. The Trust’s analysis says 190,000 pensioners are living
abroad and using the S1 scheme. That statistic also comes from Paul
MacNaught’s oral evidence, but again his testimony was vague, saying it
was “about” this number.
The Department of Health has not yet clarified these statistics for FactCheck, so we can’t be sure for certain. But an FOI request by the BBC in January appeared to put the number at 145,000.
If the BBC’s FOI is correct and comparable, this marks a significant
difference. If the number of British expat pensioners on the scheme is
145,000, rather than 190,000, it means the overall potential cost to the
NHS would be less than is being claimed.
We’ll update this article if we receive clarification on this from the Department of Health.
Will expats really move back to use the NHS?
Beyond the raw statistics, the Nuffield Trust’s analysis rests on a huge assumption. The figures show what would happen if all expat pensioners moved back to the UK to use the NHS if the S1 deal falls through.
But we don’t know how many would return to these shores.
How about expats who decide to stay abroad using private healthcare? Or
those who choose to apply for citizenship in the country they now live,
after Brexit? Indeed, in Spain (which is home to the largest number of
British expats in the EU), there has been a surge in the number of Brits applying to take the Spanish citizenship test.
The other assumption here is that none of these expats are currently
using the NHS in Britain at the moment. After all, government guidancesays:
“UK state pensioners who live elsewhere in the EEA will now have the
same rights to NHS care as people who live in England.”
If a certain proportion of expats are already travelling to the UK to
use the NHS, this again suggests Nuffied’s warning figures could
be inflated.
Will the S1 scheme fall through?
The scheme is considered part of the EU’s freedom of labour system,
which both main parties in the UK have said they will withdraw from.
But whoever wins the election will almost certainly try to negotiate to provide continued protection for British expats.
It seems unlikely that all healthcare rights of UK expats would be
scrapped immediately because of Brexit. After all, there are many people
from other EU countries living in Britain who depend on the NHS.
So although it’s possible that no agreement will be reached, it is in
the interest of many member states to want a negotiated resolution on
this.
The verdict
The Nuffield Trust raises legitimate concerns about Brexit’s impact on
healthcare. If no agreement is reached, returning expats could put extra
pressure on the NHS.
But the statistics they use may be shaky.
The latest figures show the UK’s healthcare bill for these pensioners was £429m, not £500m.
And, if the BBC’s research is correct, the number of people it applies to is more like 145,000, not 190,000.
Plus the analysis assumes an unlikely worst-case scenario where all expat pensions return to the UK.
What’s more, the overall billion pound figure that is reached has been rounded up from £979m.
While rounding up is standard practice, it nevertheless adds the extent
to which the billion pounds – a figure repeated across the media today
– is an inflated one.