The EU and the NHS: the long arm of Brussels

Yesterday we had two reminders of how far the EU's power reaches into the workings of member states. In this case, we're talking about the National Health Service.

MPs debated the impact of the Working Time Directive on the NHS - an issue we looked at here.

Charlotte Leslie MP, who organised the debate, sums up the problems in an article in the Times this morning:

"Doctors warn that the European Working Time Directive, which limits medics to working a 48-hour week, is having a devastating effect on patients’ treatment, doctors’ training and the expertise of future consultants. It was brought in to stop people working 100-hour weeks. But combined with the last Government’s complicated New Deal contract, the directive has put a straitjacket on doctors’ ability to train and to care for patients.

It imposes a 'clock-on-and-off' shift system that means junior doctors no longer get enough quality training with a consultant and patients become products on a conveyor belt. The lack of continuity means things go wrong.

Matters have been made worse by two European Court of Justice rulings. First, on-call time is counted in working hours even if the doctor is asleep in hospital accommodation. Second, if doctors have to go beyond their allotted shift time, they must take compensatory time off immediately. This all costs."  

During the debate, Ms Leslie said that the UK had to look at radical steps to deal with the issue and recognising the depth of reform needed added, "we must ask why we are in this situation, and we must look at the treaties." She cited our recent research on EU social policy, which includes the WTD, saying:

"Open Europe has suggested an interesting double-lock mechanism for negotiating our way out of what was the social chapter and creating a situation in which we are not bound by the rulings of the European Court of Justice. Those are big, radical steps and will take time, but it is something that we should look at.”

Unsurprisingly, the minister present at the debate ruled out the UK taking unilateral action to protect the NHS from the directive. 

Meanwhile, on the same day, we had the European Commission calling on the UK to drop an allegedly unlawful restriction stopping unemployed EU citizens who want to reside in Britain from claiming the NHS as their “sickness insurance”. Such insurance is a condition to reside in other member states under EU free movement rules. UK officials argue that the NHS cannot be seen as an insurance policy to EU citizens without health insurance and that the controls are essential to ensure the NHS is not overburdened with bills for treating non-UK citizens who are not working or economically active. The Commission has threatened the UK with legal action at the ECJ if the rules are not changed.

To put it simply, Article 7 of the EU’s Free Movement Directive states that for EU nationals to have a right of residence in the UK for more than three months and if they are not working they must:

"have sufficient resources for themselves and their family members not to become a burden on the social assistance system of the host Member State during their period of residence and have comprehensive sickness insurance cover in the host Member State;"

The Commission’s complaint is that the UK doesn’t consider access to the NHS to be sufficient to meet this requirement.

From the UK’s point of view, the concern is that EU nationals would have the right to treatment on the NHS but with no means for the NHS to be reimbursed for the care. If the EU national does not have his/her own health insurance or a European Health Insurance Card (EHIC), the NHS would be left with no one to invoice for the treatment.

As we've said before, EU free movement comes with benefits to Britain but it needs to be managed with extreme care and, in order for it not to lose all support from the public, the UK and other member states need some discretion in protecting their welfare and public health systems from abuse and/or being overburdened.

Given the UK public's attachment to the NHS, the EU's interference in this area could lead to powerful forces being unleashed.