Concern for dialysis patients who wish to travel in Europe after Brexit

Kidney Care UK believes that every patient should be able to travel but if we do not have a reciprocal healthcare arrangement with the EU post-Brexit this will be severely curtailed. There is no insurance available for dialysis treatment, which is currently covered through European Health Insurance Card (EHIC) arrangements. If there is no withdrawal agreement, and no reciprocal healthcare deals are made with EU countries before the end of October 2019 then UK dialysis patients will not be able to travel in Europe unless they pay about £300 per session for the 3 treatments per week which they need to maintain life.

With less than two months until the UK is scheduled to leave the EU, Kidney Care UK and the University of Sheffield has published a report outlining the impact a ‘No Deal’ Brexit would have on dialysis care for kidney patients visiting EU countries.

The report underscores that without comprehensive reciprocal arrangements either with the EU or individual member states, patients would need to rely on the domestic legislation of EU countries to access healthcare. This legislation is often time limited and frequently only addresses the rights of residents. As such, it cannot be seen as a substitute for reaching comprehensive reciprocal healthcare arrangements.

Kidney Care UK policy director, Fiona Loud, said "As the UK’s leading kidney patient support charity, we urge the Government to address the issue of reciprocal healthcare as a priority. Without comprehensive agreements, most of the 25,500 UK patients relying on haemodialysis, will no longer be able travel to the EU due to the crippling costs of treatment".

If you feel strongly about this, write to your MP and also please contact Fiona Loud at Kidney Care UK on 01420 541424 or by email at [email protected] as we will be lobbying Parliament, Ministers, and the Prime Minister over the next 2 months.

You can find your MP on the UK Political info website by typing in your postcode.

Impact of Brexit

Should a Withdrawal Agreement be reached, the EU law upholding UK citizens’ rights to access cross-border healthcare will continue to support dialysis patients until 31 December 2020[1] - or longer if the transition period is extended.

However, a ‘No Deal’ Brexit means UK patients will immediately lose their rights in EU law to access treatment in EU countries. While the UK has indicated it wishes to continue with reciprocal healthcare agreements, this has not been accepted by the EU given its current negotiating mandate.[2]

If bilateral agreements on reciprocal healthcare with individual member countries are likewise not agreed, UK patients would need to rely on the domestic laws of the countries they visit.

Looking specifically at five EU member states dialysis patients visit regularly: France, Greece, Ireland, Italy and Spain, each has passed some domestic legislation in the case of a ‘No Deal’ Brexit. Please note that this should not be taken as legal advice and patients should always check before travelling:

• France – France’s legislation contains measures relating to social rights but only for UK citizens residing in France, not those visiting. As it stands, dialysis patients will have no entitlement to cross-border healthcare in France following a ‘No Deal’ Brexit.
• Greece - Reciprocal healthcare for UK citizens and their family members legally residing in Greece until the end of 2019 has been passed in Greece. UK temporary visitors will also continue to be able to access healthcare in Greece until 31 December 2019.[3] The Greek Healthcare Minister has the power to extend this date unilaterally. However, to date, this has not been done.
• Ireland – Laws governing the relationship between the UK and Republic of Ireland which are outside of EU law, enable dialysis patients with British citizenship to access the Irish national healthcare free of charge. However, practically, due to capacity challenges in Ireland patients may still struggle to access care.
• Italy – In March 2019, Italy published a ‘No Deal Decree’[4] providing for the continuation of reciprocal healthcare until 31 December 2020 for residents, on the condition of reciprocity. However, at present there is no domestic law which provides dialysis patients’ entitlement to care when visiting Italy.
• Spain – Spain’s no deal legislation covers reciprocal healthcare and although its focus is on ensuring residents in Spain have the same rights previously enjoyed, it does include access to Spanish state healthcare for UK dialysis patients visiting the country. This is encouraging. However, these rights are dependent on the UK reciprocating for Spanish citizens within two months and it is unclear if the UK’s arrangements for provision of healthcare following Brexit will be considered reciprocal.[5] Moreover, this Spanish legislation is time limited, lasting only 21 months following Brexit.

The latest guidance from the government on healthcare when travelling is available on the government website

Notes: The Economic Social Research Council has researched Health Governance after Brexit to provide an indication of the situation for dialysis patients in 5 EU countries and we gratefully acknowledge grant ES/S00730X/1, the University of Sheffield’s SURE programme and the work of Prof Tamara Hervey and Darcy Foster from the University of Sheffield. Please be aware that this should not be treated as legal advice and is subject to change.

See the full report and illustrative scenarios.

[1] Withdrawal Agreement, Article 127. "Scope of the transition 1. Unless otherwise provided in this Agreement, Union law shall be applicable to and in the United Kingdom during the transition period."

[2] 'Reciprocal Healthcare' (Nhsconfed.org, 2018) accessed 19 June 2019.

'Healthcare (European Economic Area And Switzerland Arrangements) Bill - Hansard' (Hansard.parliament.uk, 2019) accessed 17 June 2019.

[3] Law 4604/2019, Article 125(1)(b)'Brexit GR: British Citizens Who Live In Greece' (BREXIT GR) accessed 14 June 2019. Per Regulation (EU) 2019/500.

[4] From the official journal of the record of the Italian government

[5] Royal Decree-Law 5/2019, Article 2 Paragraph 1