Draft Immigration (Health Charge) (Amendment) Order 2020
(Limited Text - Ministerial Extracts only)
Read Full debateThe Committee divided: - Ayes: 8 / Noes: 7 - Question accordingly agreed to.
The Parliamentary Under-Secretary of State for the Home Department (Kevin Foster)
I beg to move,
That the Committee has considered the draft Immigration (Health Charge) (Amendment) Order 2020.
It is a pleasure to serve under your chairmanship, Mr Robertson. The immigration health charge was introduced in April 2015. Its aim was to ensure that temporary migrants—those with a limited period of leave in the United Kingdom—made a direct contribution to the NHS services available to them during their leave, subject to some specific exemptions.
The charge is currently paid by non-European Economic Area migrants who apply for a visa of more than six months’ duration. It also applies if they wish to extend their stay in the UK for a further defined period, although those who receive indefinite leave to remain do not need to make the payment once they have achieved ILR. The charge is paid up front as part of the immigration application process, and is separate from the visa fee.
From their point of arrival in the UK, a charge payer can access the comprehensive range of services that the NHS provides in broadly the same manner as permanent residents of the UK—that is without having made any prior tax or national insurance contributions. They pay only the charges that a UK resident would pay, such as prescription charges in England. They may also be charged for assisted conception services within England. To date, the charge has raised more than £1.5 billion for the NHS. That income is shared between the health administrations in England, Scotland, Wales and Northern Ireland, using the formula devised by Lord Barnett, with which Members will be familiar.
Under the new points-based system, which comes into force on 1 January 2021, all migrants to the UK will be treated the same. They will pay the charge if staying for longer than six months, unless exemptions, such as being eligible for the health and care visa, apply. The Government recognise the value and importance of migration to the UK. We welcome talented individuals and the contribution they make to our economy, our communities and our public services. However, it is right that migrants contribute to the comprehensive and high-quality NHS services available to them from the moment they arrive.
This draft order amends schedule 1 to the Immigration (Health Charge) Order 2015. In line with the Government’s manifesto commitment, it will increase the annual amount of the charge to a level broadly reflecting the cost of treating those who pay it. The Department of Health and Social Care has estimated that the cost to the NHS of treating charge payers in England is roughly £625 per person, based on analysis carried out in April 2019 using 2017-18 NHS England data. However, to support the administration of the charge, the new level is set at £624 to make it easier to divide.
Mr Alistair Carmichael (Orkney and Shetland) (LD)
In reaching the figure that the Government now bring forward, what account has been taken, especially for those renewing their visas, of the tax and national insurance contribution made by those working in our economy?
Kevin Foster
To be clear, the eligibility for the charge is based on the immigration status, rather than what tax or national insurance people have paid. We were clear in our manifesto, which was firmly endorsed in the December general election, that we would base it on the average cost of treating charge payers. Of course, when they come to achieve indefinite leave to remain, they are no longer liable to pay the charge. As I say, it is subject to the £1 discount, because £624 is more divisible than £625.
Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)
A quick question: is the working for the £624 estimate available anywhere? I cannot see where to find it.
Kevin Foster
My understanding is that that has been published, but I will certainly be happy to write to the hon. Gentleman and the rest of the Committee with more details about how the DHSC arrived at that figure.
Students, dependants of students and youth mobility scheme applicants will continue to pay the discounted rate, which will increase from £300 to £470 per person. The Government are aware that the charge has a greater financial impact on family groups than on individual applicants. To support families, therefore, the charge for children under 18 at the date of application will also be set at £470, in line with the discounted rate set for students and the youth mobility scheme.
In specifying the new amount of the charge, the Government have considered a range of health services available without charge to those given immigration permission to be within the United Kingdom, and, as I have touched on already, have considered the cost to the NHS across the four nations of treating those who pay the charge. Also considered is the valuable contribution that migrants make to our economy and the need to ensure that the UK remains an attractive destination for global talent.
I turn to the exemption for tier 2 health and care visa applicants. On 21 May, the Prime Minister asked the Home Office and the Department of Health and Social Care to work together to exempt NHS and health and care workers from the immigration health charge. Consequently, this order amends schedule 2 to the principal order to provide exemption for tier 2 (general) health and care visa applicants and their dependants.
The tier 2 (general) health and care visa was launched on 4 August, and a large number of applications were received and permissions granted. It is a fast-track visa offer with a reduced application fee for eligible health professionals, including doctors, nurses and allied health workers. It covers not only people working in the NHS directly but those working for organisations commissioned by the NHS to provide essential services and those in the relevant professions who work in the adult social care sector, which is the basis of their application and their visa. Until a formal exemption is in place for that group, the Secretary of State has waived the requirement for them to pay the health charge.
Mr Carmichael
The Minister is being generous with his time. Those who are not included in that exemption include people working in the social care sector and non-medical NHS staff such as porters and cleaners. Why is their contribution not valued in the same way?
Kevin Foster
It might be helpful to explain how the current system of immigration works in the United Kingdom. At the moment, it is not possible to get a visa under the rest of the world system for some of the jobs that the right hon. Gentleman has mentioned. Those coming to the United Kingdom to work in those roles do so under either the European economic area free movement rights, which continue until 31 December, when immigration permission and the immigration health surcharge will not be relevant, or they will have come to the UK with permission—as a dependant of a skilled worker, for example, although not a health and care worker, who will be covered by the visa offer—and have a more generic right of work in the United Kingdom that is not tied to working within the health and social care sector. Those who come with a specific job offer under the health and care visa, however, go straight into employment. That is why we will look at the refund scheme. Colleagues in the Department of Health and Social Care are working on that.
As we bring in the new system on 1 January, a much wider range of skills will be recognised, including, for example, senior care workers who, at the moment, cannot get a visa under tier 2, but will qualify under the new points-based system from 1 January. Again, we will look to expand who will be eligible in the health and care sector. People will not be tied to a specific job offer. There will be a general permission to work in the United Kingdom’s economy in any role. Again, we need to make sure that we have a route to support the NHS and social care, not a way to avoid an immigration charge.
Tier 2 migrants who have paid the health charge on or after 31 March 2020, but who would have qualified for the new health and care visa had it been in operation, are being refunded. Those who work in the NHS and wider health and care sector and who paid the charge on or after 31 March, but who do not qualify for the health and care visa and have a general ability to work in the UK, which I have just touched on, may also be eligible for reimbursement of the charge that they paid.
On 15 July, the Minister for Health announced that the reimbursement would be paid in arrears of six-month increments, and the scheme will be launched next month. More details on the scheme will be published by the Department of Health and Social Care shortly. Given the queries that have been raised, I am sure it will be read with interest by members of the Committee.
Those who move to a new country expect to pay towards healthcare. In many countries they are required to do so by securing private health insurance or by direct charges when they become unwell or need to access healthcare, yet here in the UK they can access our fantastic NHS, if necessary, from when they arrive.
The health charge is designed to benefit the NHS and support its long-term sustainability. Those NHS and other health and social care workers who are granted visas to work specifically in those roles are doing that through the important contribution that they make in their work. They are exempt from the payment, and those who contribute to the work once they have arrived, but whose right to work in the UK is not tied to the sector, will have the payment reimbursed. However, it is only right and fair that people arriving in the UK to work in non-healthcare roles should pay towards the extensive and high quality range of NHS services available to them in the United Kingdom until they are permanently settled here in the UK.
That is a point that the electorate agreed with in the December general election. When we debated the Immigration and Social Security Co-ordination (EU Withdrawal) Bill, we had the debate that we expected. The Scottish National party set out its principled objection to the charge, and I outlined why the Government believe it is right. We heard from others that they were making their minds up on what the policy should be. In commending the orders to the Committee, I look forward to getting more clarity about whether the approach is the right one—yes or no.
Kevin Foster
I thank the members of the Committee for their valuable contributions.
I will start with the comments of the right hon. Member for Orkney and Shetland. I was pleased to hear him say that it was a fair point that, when someone steps off a plane, they need to have access to the NHS if they have the type of immigration permissions that we are discussing today. That is why the measure was introduced under the coalition. To reassure him, given his comments on wider charges in the immigration system, the fundamental charging criteria are still pretty much what they were back in 2014, when agreed during his own time in Government.
To come on to some of the wider points made, the first by both the SNP and Labour spokespersons, any confusion in the supply of the explanatory memorandum is concerning. I am certainly more than happy to pick that up through my private office. When we lay statutory instruments, I am also more than happy to ensure that copies of relevant documents are sent directly to hon. Members. I am conscious that an important part of scrutiny is to have those documents easily to hand, without having to rely on the Table Office. I will ensure that that is actioned.
I will also clarify a couple of comments made on the pandemic by the hon. Member for Halifax. To be clear, anyone who needs treatment for covid-19 may approach the NHS for it. Across the United Kingdom, there is no charge for that, and whether people are able to access treatment does not in any way relate to their immigration status. As I said in the Chamber in response to a question from my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), information supplied to the NHS will not immediately be supplied to immigration enforcement. Our priority is to ensure that people feel they can approach the NHS in this country if they have symptoms of covid-19, regardless of whether they have lawful immigration status or are undocumented. I wish to very clear on that point.
I will go into some of the other issues raised. To be fair to the hon. Member for Halifax, she was specific in her wording, probably for a reason, that other countries do not require payment to the “relevant Government”—the exact words used. That rather misses the point about the situation in other countries. We all know the situation in the United States of America, where a payment may not be required to the US Government, but in reality people take a risk with their own health and of potentially crippling medical bills if they do not have medical insurance. Thankfully, we do not have such surcharges for people living here in the United Kingdom, and never will. Talking about no payment to the Government also misses the fact that to get the type of cover provided by the NHS here, people have to spend a significant amount of money. That is true in other countries, such as New Zealand, which requires foreign fee-paying students to hold acceptable medical and travel insurance as a condition of their visa. They do not have to pay the Government, but they do have to buy something specific. In addition, they still have to pay for GP practice consultations, which would be free here in the UK.
Holly Lynch
That was a series of points about the fact that the way we ask people to make that fee—up front, in advance and in one lump sum to the Government—is very unusual. Even comparing it with insurance, which is slightly different but it is the point that the Minister is making, I would imagine there would be different payment plans to make it a bit more manageable for people if that financial contribution, up front and in one go, is a challenge and a barrier to healthcare. Can he reflect on that point?
Kevin Foster
Again, some of those costs are up front, then followed up by having to pay for healthcare treatment. One thing that is unusual and which is really good about this country is the level of free-at-point-of-need healthcare that we have across the nations of the United Kingdom, dating back to 1948 and the introduction of the NHS. That is not replicated in many other countries, where there is either a social insurance system or there is still co-payment for many areas.
Ireland was another example given and we have had a quick look at the position for someone who has moved there. In my understanding, there is a charge levied more generally, not just on migrants, where people pay €100 if they attend an accident and emergency department without a referral letter from the doctor. Again, we do not have those sorts of charges here and neither will we look to have them. Similarly, there can be charges for being an in-patient in a hospital in Ireland. Again, that would not apply to someone here who has paid the immigration health surcharge or who has indefinite leave to remain and therefore is exempt.
Stuart C. McDonald
I am happy to have this debate, but I will say two things. First, can we see the analysis that I referred to earlier that the Department of Health and Social Care has done on this point so we can have the debate in full knowledge of that? Secondly, in terms of Ireland, migrants there are being charged on the same basis as local residents, but here people are being asked to pay the tax—as local residents do—and the dreamed-up £600-odd fee, for which we have are yet to understand the full basis.
Kevin Foster
We are happy to supply how we come to the costings. As we said in our manifesto, it is the cost of treatment to those who are covered by the health charge element. I think the situation is different. We rightly have got a social contract in the UK that those of us who are long-term residents or who have been here for a period of time pay taxes year in, year out. That is not dependent on whether we have been ill and not dependent on how much we have needed to use the NHS; we all pay that fee.
It is not unreasonable to ask those who have moved to the United Kingdom specifically at a point in their lives, who will not necessarily have that long-term payment of tax and other contributions, to make their contribution for the period, as some of them will have limited leave. Then, when they make the commitment that indefinite leave to remain represents—that is, permanent settlement—they become exempt. That has been the basis.
I appreciate that the Scottish National party has a very different view on this particular area despite its having produced £120 million of funding for Scotland’s NHS in its period of operation—and it will continue to produce income for Scotland’s NHS. We believe it is the right approach that when someone has just arrived, they make a payment that reflects the fact that others who have been here—permanent UK residents—have made contributions over a period of time, on average.
I heard the comments by the hon. Member for Streatham. The basis is that some need it more or less. That is, of course, the basis of how the NHS, which is taxpayer funded, works. We would not want to link that to how much someone uses the NHS, although I accept that in other countries people face direct healthcare charges, including those who are permanent residents and sometimes those who may not have built up the level of social insurance payments of a longer-term resident. As for the expression that it is unique to a certain Government, it is certainly not unique for those migrating to other nations to face either up-front charges or the prospect, if they become unwell, of having to find money to fund their treatment. That is a prospect they will not be facing here in the United Kingdom.
As for further details on reimbursement, I mentioned in my speech that the Department of Health and Social Care intends to launch that in October and to publish the figures shortly. That is for those who are not automatically exempt as a result of qualifying for the health and care visa and, similarly, those who are applying to renew their migration status.
The hon. Member for Halifax used the example of how a doctor can seek to apply—if they are on tier 2 —for the health and care visa if their migration status is coming up for renewal. She also made points about when sponsors change. To reassure her, we are looking to make some changes under the new points-based system from 1 January to make it slightly easier for people to move between sponsors if they are doing fundamentally the same job. That also partly responds to legitimate concerns about ensuring that employees are not wholly tied to one employer.
Obviously, the NHS overall is a unique organisation, but if someone is absolutely tied to one employer for their migration status in the United Kingdom, that can present some challenges. We will make it slightly easier for people here in the United Kingdom to move between employers, subject to the workplace role still being fundamentally what their status was based on.
The debate has been a useful opportunity to scrutinise the order. It sounds like, in the Labour party’s immigration policy, I have some Christmas reading to look forward to from the hon. Member for Halifax. I very much recommend that she bases it on the policies the Government put out on 13 July. There will be further details about the new points-based system, which will be a very firm base. The hon. Member for Streatham has her view on whether the immigration health surcharge should in principle be part of the immigration system in the future, and I look forward to hearing the view of the hon. Member for Halifax.
The order is the right approach, based firmly on our manifesto commitment and on reassuring the UK taxpayer that, as a whole, our migration system exists to support our health services and make a contribution to them. I commend the order to the Committee.
Question put.