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Access to healthcare is a major post-referendum concern for millions of Europeans – but when you contemplate the details, you can see why most Brexiteers would rather not talk about it…..

An amicable or “soft” divorce between Britain and Europe seems to be getting less likely by the day. This sharpens the uncertainty that pervades the life of millions across the continent. The two big populations that make up this anxious army of Europeans are the EU citizens who live in the UK and the UK citizens who live in the EU.

In both settings, life is lived against the background of a constant concern over future residency rights. Many in both groups are either looking into or actively pursuing applications for citizenship in the country where they’ve chosen to live. Many others are rethinking their medium and long-term plans of work, career progression, family development or retirement. Often such thoughts include the option of going back “home”. This political situation translates into countless thousands of personal stories in which individuals, friends, couples and families find their plans thrown into disarray and their futures cruelly put on hold while the continent’s leaders struggle to come to terms with the UK’s referendum result. (A rare bright spot in this grim picture is that local attitudes can still be strikingly progressive and internationalist – such as the political actions of the town council in Jávea, Valencia.)

One of the crucial dimensions of the common European economic space from the point of view of an individual citizen is the ability of cross-border ‘migrants’ to access each other’s national healthcare systems. This is a particularly important attribute of EU citizenship for the hundreds of thousands of British people who have retired to Spain and other parts of southern Europe. That population, many of them not particularly wealthy, have the healthcare needs that you would expect in a group with their age profile. Many of these people left the UK many years ago and no longer have very strong ties or any sense of belonging to any community or locality ‘back home’. If a mass repatriation occurred it is not at all clear how it would be managed in terms of housing, health and social care.

While working on a research project on super-diversity and health a few years ago, I spent some time talking to expatriate residents in their 50s and 60s in the south of Spain. The group included both EU citizens and not. Over a convivial lunch one day, the conversation turned to health and the good quality care that was available to the EU citizens, as long as they had the language and cultural know-how to access it. The topic then arose of the high cost of the Swiss guy’s health insurance. And it was clear that those around the table who were entitled to local socialised medicine would have been horrified to have to think about funding that kind of expenditure.

That conversation took place several years before the referendum. Now, the representatives of British residents in Spain are busy trying to communicate their plight to the powers that be in the mother country. Retired British ex-pats find themselves confronted with a starkly limited range of options when it comes to planning the next few years in the context of possibly losing their rights to local care and treatment :-

  1. Hope that continued residency is allowed, hope for the best as far as health is concerned, try and stay well, and use as many local services as you can on an as-and-when basis (e.g. state emergency care, private services, alternative medicine)
  1. Hope that continued residency is allowed, bite the bullet, find the money and “go private”.
  1. Return to the UK, either because continued residency is not legal and/or because the prospect of ageing with no healthcare entitlement and no money to go private is too poor a future to contemplate.

The Europeans who currently live in England are looking at a similar range of possible futures – but crucially  they are mostly younger and fitter and mostly in work. It is much more likely that, in some cases at least, their employers will want to keep them and their residency rights and healthcare entitlement will flow from this. For those in more precarious positions in the labour market, option 1 will be much more attractive than it will be for retired Brits, because younger, fitter people need to worry less about serious illness and the attention it requires.

Even so, for those that remain in their chosen ‘foreign’ country in the context of informal or illegal residency the fear that any approach to a clinic or surgery may result in deportation will be a constantly present issue. In Britain, for example, NHS systems for checking on the immigration status of patients have been streamlined in the last few years. These arrangements were originally linked to the enforcement of residency rules, but are now also employed to collect payments. Because of these developments, the NHS finds itself ready to be used in the future identification of EU citizens if and when their entitlements changes.

However, for many if not most of the older Brits in Spain, the reality will be more like that experienced by a pair of British retirees who recently spoke to the Daily Mail’s “this is money” website :-

“Liz and Ian Stott moved to Calahonda from Cheshire three years ago, taking early retirement after former quality manager Ian, 66, suffered health problems. His medical treatment would cost 400 euros a month without the EU agreement, which, with a frozen pension, would prove a stretch too far. ‘Living here has been wonderful, but if the healthcare goes and our pensions are frozen, we will have to return to Britain,’ says Liz, 60.”

If negotiations between the UK and the EU go really badly it may even be possible that people will be forced to leave the country that they’ve been living in. They may find themselves with no legal right to continue to even be there, let alone get access to the local health care system. The murky spectre of Brits in Europe and Europeans in Britain being served legal notices to leave  is still some way off. But if such a ghastly Europe of deportations comes into being, personal and family distress and dismay will be only part of the story.

The exchange of populations will be particularly disadvantageous to the UK from a demographic/public health point of view. A young, tax paying, low-service-using European population will leave Britain. The returnees to the UK will be a group characterised by old-age, disrupted social networks, relative poverty and high levels of medical and social care need.

In this context, negotiating “the right deal for Britain” in a “positive and constructive partnership” with Europe would need to include a hefty dose of reciprocal rights. And that may not be politically possible in the ideological atmosphere currently breathed by the ‘Brexit’ movement.