In a bombshell move, the UK Government has announced it is to terminate its reciprocal health agreement with the Isle of Man.

The 6,500 patients referred to the UK each year for treatment will be unaffected and the Manx Government will pick up the tab as before at a cost of about £6 million annually.

But both Island residents visiting the UK and UK residents visiting the Isle of Man are being urged to take out travel insurance to avoid them facing a potentially very large bill for ongoing medical treatment if they have an accident or incident that requires their emergency admission to hospital.

The termination of the reciprocal agreement, which is unlikely to come into effect before 2010, will also blow a £2 million hole in the finances of the Island's already overstretched DHSS.

Island residents who require emergency or immediate necessary treatment while visiting the UK currently have it provided free of charge and funded by the UK.

When the agreement ends, while their initial treatment in the UK will remain free, any resultant admission to hospital for inpatient treatment or surgery will have to be paid for by the patient.

Similarly, UK residents visiting the Isle of Man will receive free initial emergency or immediately necessary treatment but will be required to pay if they are admitted to hospital. Currently the DHSS gets an allowance of £2 million from the UK government to cover this treatment.

This could have major implications on the TT as visiting bikers who have a serious accident while in the Island to watch the races could potentially face a medical bill running to many thousands of pounds unless they take out travel insurance.I

The Isle of Man was only officially notified of the change on Thursday afternoon - and Health Minister Eddie Teare admitted there was less flexibility than had been hoped.

A working party consisting of Chief Minister Tony Brown, Treasury Minister Allan Bell and Health Minister Eddie Teare has been set up to look at the implications of the ending of the reciprocal deal including at what point free treatment ends.

Mr Teare: 'This is another major challenge. But we do have time to react because these proposals are unlikely to come into effect before 2010.

'I am greatly reassured, however, that the most important element of our relationship with the UK - referrals to the UK NHS for treatment we cannot provide on the Isle of Man - is unaffected by the UK's decision.'

It is understood that Manx students on courses in the UK will continue to receive free treatment but this is yet to be clarified.

People will be treated as Manx or UK residents depending on where their permanent home is and where they are registered with a GP.

HOW WILL THE CHANGES AFFECT YOU?
Send your comments to newsviews@newsiom.co.im

YOUR COMMENTS

The UK Government are more than happy to recruit on the Island for its armed forces and send local teenagers in to battle on there behalf, but suddenly we are not good enough to be treated if in an accident in the UK which requires further treatment other than A&E. At what point will the Isle of Man Government wake up and open there eyes and say " What do we really need from the UK". With more and more people from the UK coming here to live why don't we break all ties with the UK Government implement our own taxes on Petrol, Coal, Gas and have it shipped direct here and not via the UK where it is taxed first and then taxed again here. We benefit nothing from the EU but we are expected to give percentage of the gross national income to overseas Aid which will rise to 7 to 8 million pounds by 2011. Why not leave this money here and use it on the DHSS and other departments helping to pay for more nursing staff and doctors. I am sure if we did this there would not be a single pensioner scared to turn there heating on this winter or go hungry. We pay a small fortune to the UK Government and what do we get out of it! some silly man sent over by the Queen to govern us. We pay for his and his Food, Transport, Heating and accommodation and on top of that a very very good salary, yet again another waste of Manx Tax Payers Money. But there is the bigger picture here we must not forget and that is if we do go down the road of full independence there will be no more OBE's, MBE's or knighthood for are hard working Government Ministers. It must be nice to travel to the UK, dine with the chancellor and all a long knowing that the local tax payers are paying for it.
PETE, Onchan

Whilst this change has a lot do with a new structure and funding of the NHS it is also part of the EU federalisation of Britain generally. Different parts of the UK are diverging. Witness the different attitude to prescriptions and care in Scotland, Wales and England. There is increasingly going to be not so much a National Health Service as a Regional Health Service. Funds and National Insurance may be the same but they will be spent differently so clearly the Island could not claim a blanket NHS coverage in the UK of which it is not a part. As we know, it has for some time had to pay for patient referral which also was once reciprocal. On the other hand, note the gradual tightening of the net! The Island's Finance Sector has undoubtedly acquired a clean image by joining in various tax and information cooperation agreements. But each one diverges the Isle of Man Government away from the UK into another's sphere of influence in certain circumstanes. The UK is washing its hands. The recent changes to the Customs and Excise Agreement, the former Common Purse, have also thrown the burden of financing the Island more and more on to the backs of Island residents. The so called Zero Tax had much the same effect. One can see maps showing the Island as part of a peripheral North Atlantic region in some form of parallel association with the EU. This latest change I suggest is part of the same trend. Making the Island pay its own way in all things before finally laying out the following offer. "Are you coming with us on the last constitutional 'bus out or are you really going to go it alone?" It will be make your mind up time. Join us or go your own way! The sentiment of England and its fifty million population to Scotland is already, "Well go and be independent if you want to and good riddance!" No one cares for this little place! You can see change happening by such "drip drip" means as ending the NHS reciprocal arrangements. It all adds up to a casting off of another colonial burden in favour of the EU in the long-term. Sadly, I think that so far the Island will not be able to issue the Green Card is it called? The one for reciprocal medical treatment in Europe. We are told that this is because the Island chose to remain outside of the EU, the EU Fiscal Area and the European Economic Area. You can see where it is all pointing!
BARRIE STEVENS, Douglas.

If you can be so self sufficient then why don't you have your own manx army or your own manx university yet. Your ok sending your kids to uk universities every year (the UK is ok when it suits you) for their education and youd be lost without them yet when UK residents come here for jobs they need a permit. C'est la vie. You support English football teams when it suits you This nationalist independent business is complete balderdash. You cant do without the UK and every law passed comes down through them first. (receives Royal Assent) You are a crown dependency and if you were ever invaded youd have no say in it and no legs to stand on. So get over it
TAM

The Isle of Man is British territory. It is part of the British state in that Isle of Man Government is a devolved form of British Government and has no legal independence outside of the British state. Tynwald is not the same as government. The Manx are British. The Queen in Privy Council is the Island's head of state. What constitutional aspect of the Island could declare independence? If you or any Manxman as a British subject choose to join the forces you take the oath of allegiance. You do not "fight for the UK", you fight for Britain, the British state of which you are a part. Though not part of the Realm! The Isle of Man is not directly part of fiscal Britain and therefore as times change cannot expect to benefit as if it were directly part of fiscal Britain. Being independent is not necessarily a bar to receiving honours. Other countries such as the Republic of Ireland cope with their citizens receiving such and take pride that another country chooses so to honour. Likewise, citizens of the RoI join the British forces and the British Army has recently conducted military funerals in Dublin. Some Commonwealth countries such as Canada do not like knighthoods and peerages but the legal validity of this has been successfully challenged as of late. Taxes such as VAT are a mutual taxation under the Customs and Excise Agreement and thus the Island gains financially when importing via the UK. Overseas Aid is a matter solely for Tynwald, neither the EU nor UK can dictate internal self-government within agreed parameters of competence and likewise the spending of taxes. Importing via the UK and vice-versa under the Customs and Excise Agreement accounts for 80% of Isle of Man Government income! This will be lost on breaking away! What does the Island get from the EU? Access to markets but mainly the UK. An independent Island might not have privileged access to the UK and the EU but does so now as it is British territory. Break away so called and a trip to Heysham will be like going to a foreign country with REAL taxes to pay and watchful Customs searching the trailers. The Island is not part of the EU Fiscal Area nor of the European Economic Area and thus comments relating Overseas Aid to the EU are erroneous. Independence? The Island's sovereignty was purchased for the Crown and is a British possession. Much land is Crown land locally administered. The Island could not declare itself independent without risking total international ostracisation. There would have to be a referendum. Remember, the Island's money and security is stashed in London! Authority to govern the Island stems from the Crown as represented by the Governor who even now remains supreme above all, his executive powers vested in Crown and External Relations Division within Government Office. This is the meaning of Crown Dependency. ie Isle of Man Government hangs pendent from the Crown. Lastly, the Island's entire existence and Finance Sector is underpinned internationally by UK Sovereign Risk. Go independent and watch the lot evaporate.
BARRIE STEVENS, Douglas

I hope the government will review national insurance contributions further to this move - I assume they are currently aligned with the UK. I agree that it must be time go ahead with full independence. We could save a fortune in payments to the UK and we can also do away with VAT at the same time, thereby finally removing that particular major advantage the channel islands holds over us. The only notional service we receive from the UK is "defence", but really what are the chances of the Isle of Man being invaded by some foreign aggressor, and even if we were the UK and others would still become involved for strategic reasons. The Isle of Man does not need the UK, and the UK does not need the Isle of Man, so lets become fully independent and at the same time turn the governors mansion in to a museum.
AC

It would be completely ridiculous to have our own university as there are very few people to educate at this level. It would be impossible to get the academics and staff who are drawn to long standing universities and a place this small hardly requires its own army, particularly as so few people would join. We are already treated as international students when applying to UK universities and this means that we would be charged in the region of £10,000 a year, so higher education would be impossible if the Manx government did not cover our fees. And the UK universities are more than happy to accept us with the knowledge that they will certainly receive this money. And by the way apostrophes exist all over the UK!
ANON

Looking on the positive side the Isle of Man could end up being better off under the new arrangements. Without knowing the numbers of Island residents who have accidents and are hospitalised in the UK I find it hard to believe that it will exceed the numbers and seriousness of accidents our hospital deals with during TT and Manx Grand Prix. Treatments for such, although highly necessary are expensive and a heavy drain on our Health Services. Being able to recover part or all of the costs is surely a good thing. Admittedly extra costs will be incurred when travelling to the UK but many local people already hold holiday insurance in case of cancellations etc.
GEOFF, Douglas

Tam's statement that "If you can be so self sufficient then why don't you have your own manx army or your own manx university yet" is nothing more than I would expect from a small minded come over, happy to except the low crime and low taxes and high wages but god forbid if we say anything bad about the UK government they jump up on there high horse. All I can say is that if you are willing to voice an opinion on this matter then you need to at least make a common sense statement. The Isle of Man dose not have a large enough head of population to warrant having its own University that offers every single course needed to accommodate all students requirements, hence them going to the UK to get an education, but what Tam has forgot to mention that its not just Manx students that go to UK Uni's or colleges as they are open to all nationalities not just British and Manx, even people like you Tam. I have to admit the work permit policy dose not really work as if it did Tam would not have fallen through the cracks in the system. As for the other statement about why the Isle of Man has not got its own Army just shows how small minded this person is. It shows that Tam knows nothing about recent Manx History, if they did, he/she would know that in the 80's the Irish invaded, in the 90's the English invaded in the year 2000 the Filipino's invaded and then in 2004 the Polish invaded and we still managed to stay manx. Well those who were born here anyway.
PETE, Onchan

TAM, Try learning some English Grammar before speaking to us like that.
PG

There is only one way to go now and that's get rid of our MHKs/MLCs/EL Presidente,in fact the whole lot,and have either one MP at Westminster, or join the Republic of Ireland. Either way we would be a full member of the EU,and get all the benefits of vast sums of money to improve our roads etc,reciprocal health with all the EU,maybe we would save a lot of money with all this lot of so -called politicians who are supposed to look out for our best interests gone. If this means the thin edge of the wedge and a end to agreements with the UK,what is coming next ?,now is the time to have a referendum on which way the Isle of Man wants to go.
EORH

"TAM"s comment about UK Universities made me smile, its not as if the UK government allows Manx students into their Universities out of the goodness of their hearts, the IOM Government pays international student rates for every single student. I don't think there is anything to complain about, if you go on holiday you take out travel insurance. It should be the same for going to the UK. Just think how much it costs the IOM tax payer when people come over for the TT/MGP when they end up getting into trouble, they will have to pick up the bill too. TAM may complain about the fact that you have to have work permits to work on the Island, but at least we aren't over run with immigrants who are bleeding the UK system dry.
LN

The prospects for Manx independence remind me of that Lone Ranger and Tonto joke! Substitute a Manxmen ie Bernie Moffat-Celtic League for the Lone Ranger and Comeovers from the UK as represented by Tonto...."Tonto! Looks like this is the end for us. We're completely surrounded by hostile Indians".. (aka Native Americans)..."What do you mean WE Paleface?" replies Tonto....If the Isle of Man became independent most people would be British and EU citizens but under current arrangements the surviving 12,000 Manxmen would be foreigners in both UK and EU! Tynwald has reported on this. Most Island residents would have free access to the UK and EU but the Manx would need work permits and visas even for a trip to Heysham! The EU has already said that it does not want the Island. It has nothing to offer other than liability. Note for the pedants. Tonto was played by Jay Silverheels who was actually a Canadian Indian from Ontario.....And, "Why don't they have Manxmen on Startrek?" Because It's all set in the future!"
BARRIE STEVENS, Douglas

The Isle of Man is tied into the National Insurance agreement with the UK and cannot simply make changes as your correspondent suggests - that is why it is National Insurance (NI). It can leave the reciprocal agreement on NI but cannot, as I believe, amend it such as charging a different rate whilst still remaining within the agreement. It certainly would need permission of the UK as reciprocal partner. The Island was threatened with total cut off from the NI agreement when the UK changed Unemployment Benefit to Jobseekers Allowance. Someone came over and told the Island its fortune and we have had JSA ever since. Now it seems as if Double JSA is going or gone already! The Island has benefited in that its portion of NI was some years ago repatriated as a lump sum to be locally managed and invested. Furthermore, when a resident has been here a year they are regarded as a new resident and their NI portion is ascribed to the Isle of Man. The five years qualification relates only to Work Permits. Under the present arrangements, unemployed or whatever Island residents and native Manx can return or transfer to the UK and their NI follows them so that they do not miss out on benefits. The same works in reverse. The UK also pays the pensions of Manx pensioners in the UK and vice versa. Both governments then settle the bill with each other. It is not that the Island has to pay UK pensioners out of its NI funding. There is a refund. I note that the recent Double Taxation Agreement relieves tax on pensions passing between the two jurisdictions.
BARRIE STEVENS, Douglas

I have to disagree with the idiotic statements of TAM. We pay UK Universities real cash to use their services for Manx students - this is good for the university who get additional funding and good for the IOM. To suggest we are somehow free loading when we are paying our way just shows your total ignorance of the subject. Also with work permits - you are likely also ignorant of the fact that genuine Manx workers have no right to work in the EU so why should we not have a permit system to safeguard Manx jobs? The truth is people like you TAM come to work here because taxes are low and the economy (currently) is buoyant - having worked in the UK I can attest that it is a much easier ride here (as you probably know). Also after you've been here a few years the Manx taxpayer will pay for your kids to go to Uni which puts you many thousands of pounds a year better off than your UK counterparts. It will also pay your dole if your unemployed, and enhance your pension in old age if you live here long enough. With this move the fact is that for the IoM it seems that there is no longer any point in being a British Crown "Dependency" as they clearly don't want any of us to be "dependent" on Britain at all.
PAUL

The Isle of Man does not "pay a fortune to the UK" as alleged by your correspondent. It receives a fortune via the UK and this fortune accounts for 80% of Government income. The Customs and Excise Agreement with the UK bulks out the revenue as it takes account of cross-trade and also the notional amount the Island residents spend in the UK. Hence the decennial survey. Assuming that this still takes place following recent change. Of course much has recently changed because the formula meant that the UK paid the Island more than its fair share and was the underpinning factor behind the film industry. Companies took a little subsidy from the Film Commission and set up a temporary Isle of Man company. Their spending when making the movie then artificially bulked out the VAT taxable circulation of money and thus gave the Island many, many millions more than it was intended to receive. The Manx company was then dissolved and it was VAT and tax refunds all round! In short, the UK has been subsidising the Island until this loophole was recently blocked. Not bad for high horsemen and colonial oppressors heh? The Channel Islands does not have a hold or advantage over the Island. It is the other way round! Does nobody read the Isle of Man Examiner? The Customs and Excise Agreement underpins the semi-mythological zero corporate tax rate whereby non-resident beneficiaries pay no tax on the Island. The VAT shared with the UK permits this to happen and so far has served to at least stop the Finance Sector moving elsewhere following various information exchange and double-taxation agreements. Does nobody read the Isle of Man Examiner? The drawback is that the Island has less of a golden goose to collect the eggs from and that is why we are all paying more for services and why the DHSS is struggling and has had to cut back on such as care homes. It's all in your Isle of Man Examiner! The Channel Islands had no such agreement with the UK to fall back on and the recent information disclosure treaties, together with other agreements, caused such a sharp drop in government revenue that Jersey for one is in severe deficit. It did introduce its own local sales tax but it has not plugged the gap. The Isle of Man was twittering when it realised that the Channel Islands were asking for the same VAT deal as the Island because they feared that the UK would not favour the Island but cut the agreement off entirely thus crashing the economy! Join the UK? Who says? There would need to be a referendum in respect of this and independence. The UK does not want the Island other than as a federal peripheral entity in an EU context. As the Manx are an endangered species akin to the Blue Whale I would not like to try it! The Isle of Man has made its own bed and must lie in it. Barred from the EU as a sole entity, unwanted by the UK. It is a Crown Dependency caught in the web of irrevocable international agreements freely entered into by a Chief Minister and members of the Council of Ministers, they drawing empowerment from the Crown via the Governor. It is part of a relatively new grouping called The British Islands and is notionally set down as a peripheral part of the EU's North Atlantic Region. I have long-since checked with the European Commission . The Island's European-related status would change only when the UK decided what to do with the Isle of Man. My money's on being part of a federal Britain whereby the UK itself ceases to exist in its present form.
BARRIE STEVENS, Douglas

I just think its very sad that the UK will soon have more heath service reciprocity with France, Germany, Belgium and other countries than it does with the British Crown Dependencies who have the Queen as their head of state, speak English and use Pounds Sterling as their currency.
MARC

Barrie, I read your letters and posts about the Isle of Man's constitutional position with a lot of interest. However, one thing I have never been able to figure out is you actual point of view. What is your preferred outcome for the Isle of Man? Independence? Full EU membership or part of the UK? What floats your boat? Expand, elucidate and explain!
TJ, Maughold

It is very worrying that we will not have a reciprocal agreement with the UK perhaps after 2010 for health care treatment, other than emergency treatment. This will mean that all Manx residents, if visiting the UK, will have to take out travel health insurance. Fine, if you are in good health but if you have a pre-existing condition which no insurance company will cover you will have to stay put here. That will be devasting for those who live here and have children and grandchildren in the UK. And believe me, there are a few people I know who cannot get cover at the moment to travel outside the UK because of their medical condition. Health insurance companies also put an age limit on cover so if a healthy 85-year-old wants to visit his/her family in the UK and cannot get cover he/she have to stay here. If you are lucky enough to get health travel insurance cover, as your age increases so do your premiums. Has anyone tried to get health insurance cover on-line? I know of 2 companies who will not deal with you once the the Isle of Man postcode is keyed in. Some insurance companies put a loading on claims of up to £50 if you do not have a European Health Insurance Card. My husband and I were unlucky enough to have our colds turn into something nastier in France and we had to pay well over £100 for a doctor's visit and antibiotics etc. None of this was reclaimable as we were, individually, liable to pay the first £50 of any claim. Had we had a EHIC we would have been able to recoup 75% of the cost. How much will the loading will be put on a health insurance policy that covers the UK as well as other countries? To visit a doctor in France costs €22 (roughly £17) and €3 euros for a nurse to administer an injection (£2.50). Will the costs in the UK be so cheap?
FRANCES, Onchan

If the UK wants to separate reciprocal agreements with the Crown Dependencies – isn't it high time that we stopped paying television licence tax to the UK too?
DAVID, Ramsey

After reading this I looked at my own travel insurance and noted that unless I stay in a hotel for a minimum of 2 nights I am not actually covered. When I travel to the UK it is usually to see family and I stay with them, saving the cost of a hotel. The cost of travelling from the Island is expensive enough. I will certainly be in touch with my insurers about this aspect and see what they have to say.
VERONICA, Onchan

I was about to mention the Insurance Policies before Veronica beat me to it. My annual insurance policy with a large well known organisation insists like Veronica said that a Trip is only classes as such only if you are in paid accommodation for two nights. The vast majority of people travelling from the Island will no doubt stay with friends or family and will not be covered. I'm Manx but am currently living in London. My insurance policy does not cover me for trips home. So basically as a Manx Man temporarily living in the UK for personal reasons will I have to pay for any treatment other than A & E should I have an accident whilst at home on the Island? This to me seriously grates. I grew up in the Isle of Man, the vast majority of my family live there and I intend to be back at home in the next 2 years. Before I left I worked full time (was never unemployed) and took little out of the system. However as a Manx person I wouldn't get treatment. How does that work? Especially as a number of people from overseas are moving to the Island, claiming job seekers and family allowance and then promptly sending the money back to where they originated from. Controversial Indeed, but a valid point all the same. Something is seriously wrong on some level and it needs to be addressed!
ANDY B