Tens of thousands British expats in EU would return if they don’t get healthcare post Brexit

by Ray Clancy on June 2, 2017

The Brexit deal between the UK and the European Union should include an arrangement with all members that British expats should continue to receive health care in the country where they live, according to a new report.

Failing to do so could result in tens of thousands of pensioners moving back to the UK because they could not afford to pay for healthcare and if all expats did so it would cost the NHS an extra £1 billion a year.


Under the EU’s S1 programme, British pensioners have the right to go to any other member state and receive the same healthcare rights as the local population, paid for by their native country. Currently, some 190,000 British pensioners have chosen to leave the UK under this scheme and the British Department of Health pays around £500 million to other countries to cover their care costs.

However, a new report from think tank the Nuffield Trust, says that the costs of ending the S1 scheme could be considerably higher. The £1 billion figure has been calculated using NHS England’s estimates for the cost of different age groups, which reflect that older people tend to need more care.

It assumes that pensioners abroad have the same age structure as over 65s resident in England. It is around double the figure currently paid for the care of these people abroad. It is possible that UK pensioners abroad under the S1 scheme would be relatively healthier, and their care could cost less. However, evidence given by the Department of Health suggests they also believe costs could be close to twice as high if these pensioners were treated in the UK.

Even more difficult would be finding the staff and beds these people might need, the report adds. Looking at relative hospital demand by age group, some 190,000 people would require 900 more hospital beds and 1,600 nurses, as well as doctors, other health professionals, and support staff such as porters. This number of additional beds would be equivalent to two new hospitals the size of St Mary’s Hospital in London.

‘Unlike funding, these resources cannot simply be brought on stream at will. There are already too few nurses for existing requirements, while hospital bed occupancy is already at very high levels, especially in winter,’ the report points out.

The report also suggests that it may not be easy to continue after Brexit with reciprocal health care arrangements like S1 or the European Health Insurance Card (EHIC) that covers travellers. These arrangements fall under the EU Social Security Coordination, and are considered a part of the system of freedom of labour, from which both Labour and the Conservatives say the UK will withdraw. However, the report adds that it is in the best interests of the NHS to see if a continued deal can be agreed.

‘There is also the possibility that this might be the tip of the iceberg. While precise estimates vary, there are a total of around one million UK citizens resident in the EU. If the next Government fails to secure a deal to allow them to retain the rights they currently hold, the NHS will need to care for all those forced by law or circumstances to return,’ it adds.

Nuffield Trust spokesman Mark Dayan said that it is possible that extra funds could be found for the NHS from any cancellation of Britain’s EU membership fees. ‘But whether or not these benefits will outweigh the significant staffing and financial costs Brexit may impose on already stretched services remains to be seen. That depends largely on the NHS being recognised as a significant priority as we enter the negotiations,’ he added.

{ 2 comments… read them below or add one }

Alan Smart June 2, 2017 at 4:17 pm

It makes no sense for the UK government not to continue with
S1 reciprocal arrangement. For example the UK pays about
£300000 per year to Spain to provide health care for
UK migrants. According to the Nuffield Trust who audit
health matters in this contract it would cost something
like a billion to provide health care for them in the UK
and have profound resource implications. So its much
cheaper to keep them where they are.


David Dearn December 28, 2017 at 7:31 pm

Does this mean that if UK residents who live in Spain have to pay for healthcare then healthcare will only be free to British nationals and not any other European national. This would save our NHS probably more than the 1 billion pounds mentioned.


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