Background information on ceasation of Reciprocal Health Agreement with the Isle of Man

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Communications via the GSi may be automatically logged, monitored and/or
recorded for legal purposes.

Thank you for your email.

Where a reply is appropriate we aim to send one within 20 working days.

If your enquiry is about a medical matter, please contact NHS Direct on
0845 4647 or visit [1]NHS Choices, or contact your GP surgery.

For the latest on swine flu, please visit [2]the National Pandemic Flu
Service (NPFS) or call 0800 1 513 100.

For general health information you may also find it helpful to refer to
[3]Directgov, the UK Government's Official information website, or the
Department of Health website's [4]Frequently Asked Questions.

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Communications via the GSi may be automatically logged, monitored and/or
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References

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2. http://www.direct.gov.uk/pandemicflu/
3. http://www.direct.gov.uk/en/index.htm
4. http://www.dh.gov.uk/en/FAQ/index.htm

Dear Mr Williams

I am closing this request as you have subsequently asked us to proceed
with only the third of your enquiries, (previous reference: DE469739, new
reference: DE474439):

"Please detail the mechanism by which payments under the Reciprocal Health
Agreement with the Isle of Man are calculated".

We will respond in due course.

Regards

Lynn Swyny

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Communications via the GSi may be automatically logged, monitored and/or
recorded for legal purposes.

Dear Mr Williams,
Thank you for your email of 22 January requesting an Internal Review on the
outcome of your Freedom of Information (FOI) request. We have received
your request and it is now being processed.
Kind regards,
FOI Team
Department of Health

Mr Williams
<request-24897-89
c82129@whatdothey To
know.com> FreedomofInformation/OIS/DOH@DOH
cc
22/01/2010 23:31
Subject
Internal review of Freedom of
Information request - Background
information on ceasation of
Reciprocal Health Agreement with
the Isle of Man

Dear Ms Swyn,

Thank you for your email. You will also have noted that I
separately emailed to remind you of your Section 16 duties to
advise and assist.

Your response indicating that the aggregate request would be too
costly to complete lacked any detail as to why, or by what degree,
or what refinements or limits on the scope of the request would
cause the requests to fall within the limit.

You did not even mention that any of the individual requests could
be proceeded with without exceeding the limit.

As time is relevant to this request, I wished to proceed
immediately with one part of the request, but the others still
stand pending on your advice, and should not be considered closed
at present.

You may find referring to the Decision Notices and Information
Tribunal rulings relating to Section 16 helpful in clarifying the
Department of Health's legal responsibilities under the Freedom of
Information Act.

In the meantime, please consider this email to be a formal request
for an Internal Review of your failings in this area.

I look forward to your early response.

Yours faithfully,

Mr Williams

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Dear Mr Williams

Thank you for your email of 22 January asking for an internal review of our
handling of your recent FOI requests, the response to which is below.

Response
To : [FOI #24897 email]

Subject : Your FOI requests, refs: DE468878, DE469738 and DE469739

Dear Mr Williams

Thank you for your three email requests which asked, under the Freedom of
Information Act, for correspondence held by the Department of Health
relating to the Reciprocal Health Agreement between the UK and the Isle of
Man.

You sent three requests:

1) Dated 21 December, our reference: DE468878

“In relation to the decision made to cease the reciprocal healthcare
agreement with the Isle of Man, the Department of Health has stated that it
believes the agreement to be now out-of-place due to "the wide availability
of travel insurance", and that there is "little robust data to justify the
business case". Furthermore, the Department of Health stated that the
decision to end the agreement was consistent with the "UK's legal
oblications"

Please provide the background papers behind these statements, in
particular:

1) research as to the availability of health insurance for UK residents
visiting the Isle of Man

2) research as to the availability of health insurance for Isle of Man
residents visiting the UK

3) the data that is available for determining the business case

4) what the terms of the business case were believed to be

5) what advice was obtained in relation to the UK's legal obligations on
this matter”

2) Dated 29 December, reference: DE469738:

“Please supply the dates, times and lengths, agendas, job titles of
attendees, and minutes of meetings held (in the calendar year 2009) between
officials or ministers of the UK Department of Health and any official or
political member of the Isle of Man Government.

Please also provide any similar records made for telephone calls between
the DoH and IOMG on this subject in the same time frame”.

3) Dated 29 December, reference: DE469739

“Please detail the mechanism by which payments under the Reciprocal Health
Agreement with the Isle of Man are calculated”.

Section 12(4)(a) of the FOI Act provides that where two or more requests
for information are made to a public authority by one person, the estimated
cost of replying to the requests is to be taken to be the estimated cost of
complying with all of them.

We have estimated that the cost of complying with this body of requests
would be substantially in excess of the limit of £600 laid down under the
FOI Act, and we will therefore not be proceeding further with these
requests. You might therefore consider submitting a revised request, which
focuses on a specific area relating to the Reciprocal Health Agreement
between the UK and the Isle of Man, or suggesting narrower timeframes.
However, it is also possible that searches might identify material which
proved to be exempt from the duty to disclose under one or other of the
provisions of the FOI Act.

Internal Review Request
In your request for an internal review, you observed that:

‘You will also have noted that I separately emailed to remind you of your
Section 16 duties to advise and assist.

Your response indicating that the aggregate request would be too costly to
complete lacked any detail as to why, or by what degree, or what
refinements or limits on the scope of the request would cause the requests
to fall within the limit.

You did not even mention that any of the individual requests could be
proceeded with without exceeding the limit.

As time is relevant to this request, I wished to proceed immediately with
one part of the request, but the others still stand pending on your advice,
and should not be considered closed at present.

You may find referring to the Decision Notices and Information Tribunal
rulings relating to Section 16 helpful in clarifying the Department of
Health's legal responsibilities under the Freedom of Information Act.

In the meantime, please consider this email to be a formal request for an
Internal Review of your failings in this area.

Internal Review

Through interviews with policy officials, we have established that our
initial response was fundamentally erroneous and misleading, that our
reliance on S12 should indeed have been fully explained, and advice given
as to how a future request for information in this field might have been
framed, and have concluded that your complaint should be upheld in full.
For the sake of clarity, we reproduce the response again below, annotated
with the amendments that must be made to ensure an accurate response and to
take account of your observations.

21 December, our reference: DE468878

“In relation to the decision made to cease the reciprocal healthcare
agreement with the Isle of Man, the Department of Health has stated that it
believes the agreement to be now out-of-place due to "the wide availability
of travel insurance", and that there is "little robust data to justify the
business case". Furthermore, the Department of Health stated that the
decision to end the agreement was consistent with the "UK's legal
oblications"

Please provide the background papers behind these statements, in
particular:

1) research as to the availability of health insurance for UK residents
visiting the Isle of Man
2) research as to the availability of health insurance for Isle of Man
residents visiting the UK

Our answers to Q1 and 2: further investigation has established that this
information is not in fact held in a recorded form by the Department of
Health. Officials had concluded that it was the case that travel insurance
was widely available, and in particular, far more so than was the case in
1948, when the agreement was first put in place. The correct response from
the Department should therefore have been that this information was not
held, with an explanatory note as above.

3) the data that is available for determining the business case
4) what the terms of the business case were believed to be
Our answers to 3 and 4 should have confirmed that there is no single
business case document. Officials concluded that as travel trends have
changed beyond recognition since the agreement was first put in place, and
the fact that travel insurance is available, there was no longer the
rationale to pay the Isle of Man an allocation of £2.8m (current
allocation). A correct response should have explained that this
information was not contained in any documentation and was thus legally not
held for FOIA purposes, and an explanatory note included, as above.

5) what advice was obtained in relation to the UK's legal obligations on
this matter
A full and accurate response should have confirmed that this information is
not held. Officials concluded that the decision to terminate the agreement
was consistent with all of the UK’s legal obligations. Government
departments are not obliged to seek the opinion of an independent legal
practitioner where the issues in question do not give rise to concern about
legal compliance. It is worth noting in this context that the agreement
was voluntary in nature and contained a notice period of six months, and
that the UK Government exercised that right. We should, however, also have
noted in our response that had such advice been obtained, it would have
been exempt from the duty to disclose under S42 of the FOIA.

2) Dated 29 December, reference: DE469738:

“Please supply the dates, times and lengths, agendas, job titles of
attendees, and minutes of meetings held (in the calendar year 2009) between
officials or ministers of the UK Department of Health and any official or
political member of the Isle of Man Government.

We have confirmed that one meeting took place during that period, on the 28
th Janaury 2010. The meeting, which was at official level, was held in
London and lasted approximately two hours. No formal agenda was agreed in
advance as it was accepted that the meeting was to discuss the ending of
the agreement in its entirety. No formal minutes were taken, but a follow
up letter reflecting the meeting was sent by the Department of Health to
the Isle of Man Government subsequently. I have enclosed this letter for
your information. The job titles of attendees are shown below:

Head of overseas healthcare, UK Department of Health
Head of Policy, overseas healthcare, UK Department of Health
Financial controller, Health services, IOM
Director of Health Strategy and Performance, Health Services, IOM

In addition, I have enclosed a copy of the meeting note between the
Secretary of State for Health and a delegation from the Isle of Man
Government, held in January 2010, for your information.

Please also provide any similar records made for telephone calls between
the DoH and IOMG on this subject in the same time frame”.

We can confirm that this information is not held.

3) Dated 29 December, reference: DE469739

“Please detail the mechanism by which payments under the Reciprocal Health
Agreement with the Isle of Man are calculated”.

We can confirm that the current mechanism dates back to 2004/05. At that
time, the Isle of Man Government provided the total costs for treating UK
visitors for that year. The total amount, £2.2m, was used to form the
basis of an additional allocation to the Isle of Man for elective treatment
in the UK. This figure has typically been uprated by 6% annually since
then and no further data has been exchanged. Prior to 2004/05, the
allocation was uncapped.

This internal review is now complete, and its findings have been
communicated to policy officials and colleagues in the FOI team, in order
to inform and encourage good practice. If you are not content with the
outcome of the FOI aspects of your complaint, you may apply directly to the
Information Commissioner’s Office (ICO) for a decision. Generally, the ICO
cannot make a decision unless you have exhausted the complaints procedure
provided by the Department. The ICO can be contacted at:

Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

I hope that this information is helpful.

Colin McDonald
FOI Casework Manager

(See attached file: FOI IR468878 Williams IOM (1).pdf) (See attached
file: FOI IR468878 Williams IOM (2).pdf)

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not the intended recipient, any reading, printing, storage, disclosure,
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and may be unlawful. If you are not the intended recipient, please notify
the sender immediately by using the reply function and then permanently
delete what you have received.

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communications. For more information on the Department of Health's e-mail
policy click here http://www.dh.gov.uk/terms

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