Burden on NHS could increase after 29 March if pensioners return to UK for treatment

British nationals who have retired to EU countries including Spain and France will no longer have their healthcare covered by the NHS in the event of no Brexit deal, the government has said.

The confirmation will come as a blow to around 190,000 British citizens retired in the EU in places such as the Spanish Costas, Provence in France and Tuscany in Italy.

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It could also add to the burden on the NHS if pensioners believe they have no option but to return to the UK for treatment. The government has previously admitted it is cheaper to pay Spain and France to look after British nationals than have them fly home.

Currently pensioners can get treatment reimbursed by the NHS under an EU-wide set of reciprocal arrangements.

“It is another example of how those advocating no deal are playing with the lives of British citizens living in other EU countries,” said Colin Yeo, an immigration lawyer and freedom of movement campaigner. “Many of these politicians and pundits probably haven’t bothered to find out how their policies would actually affect such people.”

Pensioners who have paid in to the national insurance system for the qualifying number of years benefit from the “S1” reciprocal healthcare rules if they retire in EU/EEA countries or Switzerland.

An S1 certificate is available to anyone in receipt of a state pension, and to some workers who are sent overseas on a temporary basis by their UK employers.

In a little-publicised no-deal technical notice published this week, the UK government said: “An S1 certificate helps you and your dependents access healthcare in the EU/EEA country where you live. If you have an S1 certificate, it will be valid until 29 March 2019. After this date, the certificate may not be valid, depending on decisions by member states.”

Sue Wilson, who chairs the Bremain in Spain campaign group, said the change could be devastating. “All along we’ve been told our healthcare is protected. This is a big shock to everyone and our members are really, really scared,” she said.

She called on the government to agree to ringfence their rights. “We’ve been hearing about EU citizens in Britain getting settled status. Well, we have unsettled status,” she said.

The government’s “overseas healthcare” phoneline has updated its recorded messages to include a no-deal warning, telling those who are considering moving to another country within the EEA or Switzerland that their S1 application will only be processed if they apply “in the next four weeks”.

The campaign group British in Europe also said the loss could have a devastating effect on people with continuing healthcare needs. “Just think of the impact of this on a 75-year-old in the middle of vital cancer treatment on 30 March,” said Jeremy Morgan, a spokesman for health issues for the group.

The Spanish and UK governments said they were confident a bilateral agreement would be in place despite the no-deal notice.

The Department of Health said it was “working closely with countries, including Spain and France, to make sure patients can continue to access healthcare, whatever the outcome”.

The Spanish government’s Brexit advice website outlines “contingency measures” that would “guarantee healthcare provision for British citizens in Spain” in the event of no deal.

The technical notice advises retirees to investigate taking up private healthcare in the country in which they now reside, something that is likely to be come as shock to some, especially in the Costa del Sol in Spain where many have retired in order to make ends meet.

The government has suggested worried pensioners research the state healthcare system in the country where they now live and find out if they are eligible for treatment.

There are 70,000 British pensioners in Spain, 44,000 in Ireland, 43,000 in France and 12,000 in Cyprus.

A senior civil servant in the Department of Health told a select committee in 2017 that Spain charged an average of €3,500 per pensioner signed up to the S1, Ireland charged an average of €7,500 and the UK charged about €5,000.

In total, the government paid out about £500m – or £2,300 per pensioner – which he said was significantly lower than the cost of treating pensioners in the UK.