Note of meeting between the Secretary of State for Health and the Chief Minister
and Health Minister of the Isle of Man – 19 January 2010
Location:
Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NS
Attendees:
Rt Hon Andy Burnham MP, Secretary of State for Health
Nick Tomlinson, Deputy Director of EU Affairs, Department of Health
Mark Hughes, Head of Crown Dependencies Team, Ministry of Justice
Department of Health official, EU Affairs
Private Secretary to the Secretary of State for Health
Hon J A Brown MHK, Chief Minister
Hon E Teare, Minister DHSS,
David Killip, Chief Executive, DHSS
Della Fletcher, Director of External Relations
Time: 15:15
The Secretary of State thanked the Chief Minister and Minister Teare for travelling to
meet with him. He described how a number of MPs had raised the issue of the
reciprocal agreement with him and when the request to meet was received from
Minister Teare he felt he should accept and listen to the arguments. He described how
this was an important issue in the North West but it has wider implications for other
health agreements and he confirmed that he was not minded to reverse the decision
terminating the reciprocal agreement.
The Chief Minister thanked the Secretary of State for taking the time to meet with the
delegation. He outlined the concerns regarding the termination of the agreement
including the implications for the wider relationship given the close ties enjoyed
between the Isle of Man and the UK. He raised particular concerns about the
implications for ex-military personnel and those with chronic conditions or
disabilities. The Isle of Man had given guidance on health insurance but there was
still uncertainty over how the new arrangements would work in practice.
The Secretary of State was interested to know why the issue had recently become
more prominent and asked if there had been any change in circumstances.
The Chief Minister indicated that these concerns had always been felt but previously
they had been denied the opportunity to put the case directly to UK Ministers. When
the decision was taken to terminate the agreement representations had been made to
the UK government but requests for meetings had been turned down. He outlined how
there was much concern and anger about the change on the Island. Since the decision
to end the agreement had been confirmed the Isle of Man government had done its
best to prepare for the changing circumstances and a leaflet had been distributed to all
Isle of Man residents in March 2009.
The Secretary of State asked if the anger was primarily about the fact people would
have to find insurance and this may be costly.
The Chief Minister described how it was a deeper issue relating more to the historical
and cultural relationship. The Isle of Man has moved forward as a Crown Dependency
and had seen benefits from increased autonomy but nevertheless there were still
strong bonds with the UK.
Minister Teare outlined that similar issues had arisen in other areas where the
relationship with the UK was changing, for example in relation to VAT.
The Secretary of State described how the situation had changed since the agreement
was first initiated and that due to reductions in the number of visitors to the Isle of
Man the UK considered that the Agreement no longer represented value for money
for the UK taxpayer.
The Chief Minister agreed that circumstance s had changed over time but he and
Minister Teare described how the agreement had been adjusted in the past to take
account of changes and they were disappointed that the agreement was to end
completely.
The Secretary of State asked about residents from the Isle of Man travelling to the UK
in order to access UK health services.
The Chief Minister confirmed that over £8m of elective care was referred to the UK,
predominantly to the North West, and paid for by the Isle of Man but that for the vast
majority of people their health needs can be met by the services available on the
Island.
The Secretary of State hoped that the Isle of Man would continue to utilise NHS
services in the North West. He also recognised that the discussion had made him
aware of the symbolic importance of the agreement and how it related to wider
feelings about the relationship between the Isle of Man and the UK.
The Chief Minister agreed as he himself was first and foremost proud of being Manx
and also proud of being British; ending the agreement raised questions about the
ongoing relationship between the Isle of Man and the UK.
A representative from the Ministry of Justice commented that the Isle of Man had
developed a diversified and successful economy which included a strong financial
services centre with a high profile on the international stage. While the ending of the
agreement might have given rise to some disquiet among traditionalists it is important
to recognise that things move on.
The Chief Minister agreed that the Isle of Man had taken great steps towards
increased autonomy but that did not detract from the fact that there was a strong
preference for the reciprocal agreement to continue.
The Secretary of State recognised there were different perspectives on the agreement
and the relationship. He indicated he would like to take more advice on how to ensure
the wider relationship is preserved and provide the reassurance sought to the public.
The Chief Minister raised a number of specific issues of concern such as the impact of
the change in relation to war veterans and serving forces personnel. The Department
of Health officials confirmed that they would provide advice on the various points
that had been raised and clarify the practical implications of the changes in relation to
war veterans and other groups. This advice would include information concerning the
specifics of exemption from charges and the ways in which NHS trusts verified those
claiming exemption.
The Secretary of State agreed that it was important to work with the Isle of Man to
communicate the decision more positively and address how it is perceived. He
committed to review the situation and any possible negative consequences or
unforeseen impacts. He also recognised that there were wider implications for
relationships with other Crown Dependencies to consider. He was sympathetic to the
points made by the Chief Minister and Minister Teare and he hoped they could
continue to work together in the future. He confirmed that the decision to terminate
the Agreement was not open to renegotiation. He stood by the value for money
argument and that the situation has changed since the agreement was introduced. He
felt it would be important to clarify the situation for those with chronic illness,
veterans and others. The issue of affordable travel insurance was important and to
avoid a feeling that people would not be able to travel.
The Secretary of State thanked the Chief Minister and Minister Teare for their
attendance, for which the Chief Minister reciprocated; the meeting ended.
Time: 16:00
