What a ‘no deal’ Brexit would mean for healthcare of British pensioners in Spain

One thing that matters enormously to UK voters is the NHS. A “battle bus” emblazoned with a claim that the NHS would receive £350m a week if the UK left the European Union was crucial to the victory of the Leave vote in the June 2016 referendum – despite the fact that this central claim was widely debunked.

What a 'no deal' Brexit would mean for healthcare of British pensioners in Spain
Time’s up on the sunshine? Photo: AFP

Among the challenges Brexit poses to the NHS, and there are many, is that it needs to get ready to receive a group of people whose healthcare is currently being paid for by the UK in other EU countries. Many are pensioners, and large numbers of them live in Spain. There are at least 100,000 retired UK citizens in Spain, according to official figures, though local estimates suggest it could be double that, or more.

In January, the prime minister, Theresa May, declared that “no deal is better than a bad deal” on Brexit. So it would be prudent to prepare for that “no deal Brexit” – the worst case scenario.

And when we analysed the legal position of British citizens in Spain we found that, although the situation is complex, it’s ultimately clear that if the UK leaves the EU with no deal, the NHS needs to gear up for many of them to return.

How Spain’s healthcare works for UK citizens

Healthcare within the EU works on a reciprocal basis. It relies on the legal principle that people can move around the EU and take their social security, pension, and healthcare entitlements with them.

If the UK leaves the EU with no deal, the position of UK citizens in other EU countries that rely on reciprocal healthcare arrangements will be determined by the law of the country in which they reside.

Everyone has the right to emergency care in Spain. Photo: AFP


The Spanish health system guarantees emergency care to everyone, even if they are not EU citizens. This will not change after Brexit.

Yet the legal rights to non-emergency healthcare of people who are not EU nationals in Spain depends on their residency entitlements and their association with some kind of health insurance. A 2003 Spanish law (significantly amended in 2012) sets out who is covered by the Sistema Nacional de Salud, the Spanish NHS.

At the moment, UK citizens living in Spain are able to show permanent residency entitlement by reference to their EU citizenship, and to secure medical treatment as if they were Spanish by virtue of having paid UK tax and national insurance.

Like Spanish citizens, pensioners with annual incomes of over €100,000 pay 60% of prescription charges, capped at €60 a month, with lower co-payments (the amount that a patient contributes to the cost of their prescriptions) and lower caps for less wealthy pensioners.

Even if they have not paid tax and national insurance anywhere else, these UK pensioners are still covered by the Spanish NHS if their income is below a certain threshold, as are Spanish nationals, and other foreigners who are authorised to reside in Spain.

It is currently very easy for British citizens in Spain to enforce their EU law rights, and administrative formalities are relatively light: that’s the whole point of the EU’s reciprocal healthcare system.

What happens if there’s no deal

If Britain leaves the EU without a deal, UK citizens living in Spain would be entitled to receive medical care as “foreigners authorised to reside in Spain” under the 2003 Spanish law. But in practice, to fall under the protection of the Spanish law, they will have to show their residency entitlements. As foreigners, they will only be able to secure a residence permit if they also have a work permit. Without that, pensioners will not be protected.

Photo: AFP

By contrast, at the moment all they need is the S1 form, which shows that they are entitled to healthcare in another country within the European Economic Area, provided under the reciprocal healthcare arrangements of EU law. S1 forms are currently given automatically by the UK, and are easy to secure.

Under the administrative formalities surrounding the 2003 act, foreigners must also prove that they enjoy coverage under some kind of health insurance. There are three ways they could do this. One would be to continue accessing the Spanish NHS by a special agreement – which costs €157 a month for over 65s and €60 a month for under 65s, and involves paying 100% of prescription charges. The second would be to use a private scheme, which will cost more, and will only really be practical for people who are healthy. The third would be to rely on their home state’s health system if it is recognised by Spain in an international agreement – but in a no-deal Brexit, this won’t apply.

The British pensioners living in Spain are – by and large – not wealthy people. They have made their homes in Spain trusting that the entitlements of EU law, and the administrative simplicity that follows, will remain in place. Kelly Hall at the University of Birmingham has been conducting interviews with some British pensioners who currently live in Spain. One man told her that he could not possibly contribute even a small amount towards his healthcare, and feels he will be forced to return to the UK.

Spain is the host EU country with the largest number of such retired UK citizens. But there are significant numbers in other countries too: Ireland, France and Italy in particular. The British NHS should prepare to welcome them home.

Tamara Hervey, Jean Monnet Professor of European Union Law, University of Sheffield and Joaquin Cayon-De Las Cuevas, Associate Professor of Health Law, University of Cantabria

This article was originally published on The Conversation. Read the original article.


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Brits in Europe won right to vote for life in UK but questions remain

After years of campaigns and promises British citizens living abroad finally won the lifelong right to vote in UK general elections in April 2022. But campaigners say more needs to be done to allow all those Britons abroad to be able cast their votes easily.

Brits in Europe won right to vote for life in UK but questions remain

What’s in the law?

The Elections Act 2022 introduced several changes to the current legislation on electoral participation. Among these, it removed the rule by which British citizens lose their voting rights in the UK if they have lived abroad for more than 15 years

The new rules also abolished the requirement to have been previously registered in the UK electoral roll to become an overseas voter. In addition, the registration in the electoral roll will now last up to three years instead of only one year.

It is estimated that these changes could increase the number of overseas voter registrations by some 3 million. But the way new measures will be applied in practice is still to be defined.

READ ALSO: ‘Mixed feelings’ – British citizens in Europe finally get right to vote for life

Defining the practicalities

Under the new law, Britons living abroad will have to register to vote in the last place they were registered in the UK. This means that people who have never lived in the UK will be ineligible to vote, regardless of how long they have been overseas, while those who left when they were children will be able to use a parent or guardian’s address.

But given that the UK does not require residents to register with local councils, how to prove previous UK residence? “Typical documents accepted as a proof of residence are Council tax or utilities bills, but not everyone will have them or will have kept them in an international move,” says Fiona Godfrey, co-founder of the British in Europe coalition.

Ballot papers are pictured in stacks in a count centre as part of the 2019 UK general election. (Photo by ANDY BUCHANAN / AFP)

Other questions concern how people will effectively cast their ballot. UK citizens overseas will be able to vote by post or by proxy or in person at their polling station if they are in the UK at the time of the election. However, few people are likely to travel to the UK for an election and in the past there have problems and delays with postal voting.

The Electoral Commission has recommended that overseas electors appoint a proxy to vote on their behalf. But who could that be for people who have been away from their constituency for a long time?

New secondary legislation will have to answer these questions, defining how to be included in the electoral roll and how to exercise the voting right in practice.

According to British in Europe, the government should present draft legislation in the first half of the year so that the parliament can adopt it before summer and registrations of overseas voters can start in the autumn.

British in Europe survey

British in Europe are currently running a survey to understand the difficulties UK citizens abroad may face in the registration and voting process, as well as their intention to participate in elections.

The survey asks for instance which documents people can access to prove their previous residence in the UK, what problems they had voting in the past, and if and how they plan to vote in the future.

“We need to get an up-to-date picture of British citizens living around the world and have information to make recommendations to the government, as it prepares secondary legislation,” Godfrey said. “If millions of people will exercise their voting rights, there will be consequences for council registration offices, post office and authorities that will manage the process, among other things” she argued.

The right to vote concerns only UK parliamentary elections and national referendums, not elections in the devolved administrations of Scotland, Wales and Northern Ireland, or at local level.

The survey is open to UK citizens living anywhere in the world and is available at this link.