European Union (Amendment) Bill

I understand that we are operating under time constraints. I shall speak to amendment No. 223 in my name, which refers to our earlier debate on health. The House may well have listened with respect when my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), who used to be Secretary of State for Health, spoke about the potential effects of the health directive that was published in draft form in December last year. My right hon. Friend described the effects on the NHS as extremely damaging because the directive envisages the possibility that the single market will extend into health provision across the whole of the Union, including the United Kingdom, thereby allowing citizens to cross boundaries. Following the Watt decision in the European Court of Justice, the directive envisages that citizens of one country travelling in the jurisdiction of another may seek health care and bill back to their home country the cost of that care, whether or not their GP considered such health care urgent and necessary. The dangers of such a policy are immediately clear and I do not need to spell them out. The draft directive causes great concern. I tabled the amendment to probe the Government's position, not necessarily to press the amendment to a Division. There seem to be two competing principles at stake. I accept that the Lisbon treaty makes it clear, as have previous legal provisions, that health is a matter reserved to the home country. In some ways that is clearer in the Lisbon treaty than it was previously. However, there are other references in the Lisbon treaty that appear to give a certain degree of competence to the Commission in relation to health matters. The problem is that when the European Court is making decisions, as I remarked yesterday on another matter, it is asked to balance a number of competing principles. One of those principles is the one that we have been discussing all day—the internal market. Whenever goods or services are tradeable, as health now seems to be in the United Kingdom—lamentably, a market in the provision of health care is being created in the United Kingdom—they become subject to the principles of the internal market directorate. There are therefore two competing principles: the principle that health should be reserved to the national Government, and the principle of the internal market. Those two principles conflict. Then there is the intervention of the terrible twins—the European Court of Justice and the Commission. The trade commissioners include the former right hon. Member for Hartlepool, whom we know well. We have seen the process operate in a number of ways. First, as we discussed yesterday, the ECJ has applied the principle of the internal market above other principles. The beginning of a wedge is driven into the legal provision governing how the EU operates; the wedge is then driven further by the commissioners, particularly those responsible for the internal market. In the Watt case, a UK citizen received medical treatment abroad without having consulted her GP. The treatment was delivered and paid for; the individual must have had access to resources. She sought repayment from the NHS. The ECJ looked carefully into the matter and concluded that because health has become a tradeable service, the principles of the internal market must apply to it. That is the substance of the Watt judgment. The commissioners dealing with the internal market then said that notwithstanding the fact that health is a supposedly reserved matter for each home Government, the court had indeed ruled that the principles of the internal market must apply. A draft directive, published in December last year, was quickly withdrawn when it was realised that it might be contentious and could cause problems for the ratification of the treaty in the UK Parliament and others. Nevertheless, we have had sight of the draft directive, which extends the principles of the free market and marketisation to health. The principles of the NHS are that treatment should go first to those with the greatest need and that it should be free at the point of service. We have certainly rejected the principle of co-payment—that the patient should pay something, as well as the health service.