Immigration Bill

Debate between Baroness Barker and Lord Taylor of Holbeach

Wednesday 12th March 2014 Lords Chamber

[Lord Taylor of Holbeach]

I thank the noble and learned Lord for that advice—free legal advice to the Government is considered to be very valuable. I hope that I have been able to explain what the legislation is intended to do and have reassured noble Lords on that point. Beyond that, I can commit to go back to look at the wording of the clause to see whether the intention could be made more explicit. That I will seek to do.

[Baroness Barker (LD)]

Perhaps I may help the noble Lord. Noble Lords understand that there are now NHS treatments and services for which charges are made and that people who are resident in this country pay those charges, as do visitors. What is perplexing about the clause is, given that that is the case, what is the Government’s intention? Is it to reach a point in future where different categories of people have to pay for identical services? If the Minister could write to noble Lords and give us some examples of what scenario the Department of Health envisages under the legislation, that would be extremely helpful.

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[Baroness Barker]

As someone who is not a chartered accountant, I thank the noble Lord for the free advice. If I were to redraft the clause, I would include that in it.

[Lord Taylor of Holbeach]

My Lords, I welcome the general support offered by the noble Lord, Lord Rosser, for the surcharge. Indeed, I felt that there was support around the House for the surcharge in principle; it is just on implementation and the practicalities that the Government are quite properly being challenged.

The Home Office, which is responsible for administering the health charge, but not for spending the money, will be open and transparent about the operation of the surcharge. As my noble friend Lord Howe set out in his letter to all noble Lords last week—I hope it helped; it was designed to try to put these changes to the law in the context of wider health service reforms—the surcharge income will be allocated directly to the National Health Service across the UK. Allocation will be in accordance with the Barnett formula.

The dear and much-loved noble Lord is not in his place, but much as he seeks to see the end of his legacy in establishing the formula, it is still widely used in government and it seems the most appropriate way of ensuring that the money goes to the NHS. It will go to the NHS—the National Health Service—not to any other agency offering healthcare in this country. How the NHS spends it is for the Department of Health, of course, and the devolved Health Ministers, because health services are a devolved matter. The allocation of the money will be made by affirmative order, so we will have control here in Parliament of how this is finally resolved.

I note what my noble friend Lady Barker said in speaking to her amendment. While the Home Office already has a well established procedure through which it is accountable to Parliament, I appreciate that this House would benefit from the means to scrutinise the impact of the surcharge. I am therefore prepared to make a Statement to this House to provide information about the Home Office’s administration of the surcharge within 12 months of it going live. I hope that that will give some assurance to noble Lords on how the surcharge is working.

It may include details such as the number of migrants who pay the surcharge and the total amount of surcharge collected and directed to the National Health Service. I believe that this sort of transparency is important, and the Statement will provide proper transparency and provide the House with the necessary flexibility in scrutinising the surcharge scheme. Furthermore, any future changes to the core operating principles of the surcharge, including the amount to be paid, will have to be agreed by both Houses under an affirmative resolution procedure.

On Amendment 66, tabled by the noble Baroness, Lady Meacher, we intend to do our utmost to ensure that visa applicants understand the purpose of the surcharge and how it might apply to them. We will make the information available to individuals, including through our website and visa application centres. Indeed, the visa application form is where most people encounter this surcharge because it is directed only at those applying for a visa for a stay of six months or more. The form itself will explain it.

My noble friend Lord Attlee has pointed out in conversation that universities themselves might like to promote the student surcharge as being a very competitive offer at £150; it certainly is a bargain in global terms. However, it would be most unfair to ask migrants to pay a surcharge that they know nothing about. Both the reasons it is being charged and what it gives migrants access to are very important.

The noble Lord, Lord Rosser, asked when the Department of Health will publish its detailed implementation plan for patient registration and identification. If I say “shortly”, he will know that that word is used regularly enough. We do not have an exact date, but it will be shortly. He also asked how the transitional provisions would be set out and how a hospital will know if a person is a transitional case. This will be done in the order implementing the surcharge. We will use the patient registration system to flag people who have paid the surcharge. We will consider doing so also for those who benefit from the transitional arrangements. The simple production of a visa or biometric residence permit—BRP—that is current and valid will give evidence of free entitlement to the NHS, and transitional cases will be identifiable because their entry clearance or BRP will be dated before the commencement of the surcharge scheme, which will be known.

My noble friend Lady Barker asked about the costs of implementing the health charge and whether we have done a cost-benefit analysis. We have indeed. The Home Office has produced a full impact assessment on the Bill. It is available on the Immigration Bill page of the gov.uk website.

The noble Baroness, Lady Meacher, asked about treatments for infectious conditions, such as HIV and TB, for example. They are free, and will remain so. It was this Government who abolished the NHS treatment charges for HIV.

I hope that I have answered most of the points. I will go through the record and see whether there are aspects that I have not addressed. The noble Baroness, Lady Lister, is looking particularly questioning. Can she remind me of what I have missed?

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[Lord Taylor of Holbeach]

The latter point is more difficult to answer positively; it is something which my noble friend Lord Howe would be in a position to reply to with authority. On the first point, I think that the wording which the noble Baroness suggested is particularly good. It sums up the policy as I have tried to describe it to the Committee.

[Baroness Barker]

My Lords, I thank the Minister for his response, which was far more helpful than I had expected. Perhaps I may press him a little further and ask whether he would be prepared to make not just a one-off Statement to the House about the introduction but perhaps to do so annually, or more than once, so that we can have comparative data in different years. That would give us a slightly more robust evidence base than we would have by having just a one-off Statement in the year after a measure has been brought in. A fair amount of information and attention would, presumably, attend its introduction.

[Lord Taylor of Holbeach]

I start from the position that an informed House is better able to make decisions and judgments on issues. Having said that, I am not sure that I could commit to making a periodic Statement on this issue, although I know that the Home Office will always respond to questions that might seek updated information of this type, and indeed there are other ways in which this House has the capacity to bring the Government to account on policy. At least by promising this Statement I am giving an indication that we are confident that this particular measure will be a success and raise money for the National Health Service, which will be to the advantage of the taxpayers of this country and a bargain for migrants to this country. I hope that my noble friend is reassured by that point.

Immigration Bill

Debate between Baroness Barker and Lord Taylor of Holbeach

Wednesday 12th March 2014 Lords Chamber

[Lord Taylor of Holbeach]

That is why I am going to try to address some of these matters. It is right to seek to do so, allowing for the limitations of my knowledge in this area, which I hope that noble Lords will understand.

This House has a good reputation for debating these sorts of things not, if I may say so, through the statutory instrument process so much as generally. I am absolutely certain that my noble friend Lord Howe would be quite prepared to come at a suitable point during the consultation to discuss the basis of changes that would be made. I am sure that I am not losing a friend for life by committing him to do just that.

As if to show that I need to brush up a little bit, apparently I may not have said, through mis-speaking or a slip of the tongue, that the Home Secretary announced the review of the NRM. I thought that I had implied that, but if I had not, I should have done so. Let us hope that I do not fall out with another friend for not crediting the Home Secretary.

The noble Baroness, Lady Meacher, asked about training for the enforcement of new NHS rules, and also about the Modern Slavery Bill which, as noble Lords know, is in pre-legislative scrutiny. The Department of Health will publish its implementation plan on the health service rules during the course of this year. The Modern Slavery Bill will be a fourth Session measure. I must not anticipate the Queen’s Speech, but the fact that that Bill is going through pre-legislative scrutiny rather suggests that it will be in the fourth Session legislation.

The noble Baroness, Lady Finlay, asked about a victim of FGM who has infected wounds. Under the NHS charging regulations and policy, immediate necessary treatment is not held up because of charging. I think that the noble Baroness has enough experience of how the health service operates charging principles, and I do not think that that is likely to change. GP care is not charged for, as I have said. The Department of Health is reviewing provisions for vulnerable individuals under these NHS regulations.

The noble Baroness asked why we were planning to charge migrants for accident and emergency services. Surcharge payers will obviously not have to pay for A&E services. The Department of Health has indicated that there is a good case for introducing overseas visitor charges for A&E, for those short-term visitors and illegal migrants who do not pay the surcharge. It is giving this detailed consideration, but will not make any changes unless it is confident that the new systems will work well without compromising rapid access to emergency care for those in immediate or urgent need, which will never be withheld or delayed pending payment. However, as I said, that is not a matter for the Bill. It is part of the review into regulations which is going on at the moment.

My noble friend Lady Cumberlege asked whether those exempted from the charges will be exempted from NHS charges. Our policy intention is that those who are exempt from the surcharge will also be exempt from subsequent National Health Service charging for health services under NHS regulations. However, obviously they will be liable for dentistry; as I mentioned before, at the moment that is not free other than in exceptional cases.

Under the Bill it is possible for surcharge payers to be charged for certain expensive discretionary treatments —I think we have discussed that already. However, we have made it clear that we intend that no such additional charges will apply when the surcharge is introduced. The Department of Health has made it clear that it would consider those in the future only in the event of any exceptional and compelling specific justification for health purposes, and, as I have already said, any changes would need to be put before Parliament.

My noble friend welcomed the exemptions, but those refused asylum will face charges, as will most victims of trafficking who are not recognised through the national referral mechanism. I emphasise to my noble friend that refused asylum seekers will not pay a surcharge. Health charging for refused asylum seekers is a matter for the Department of Health and the devolved health administrations within its remit. We have already confirmed that trafficking victims will not have to pay the surcharge.

The NRM is the only process by which an individual can be formally identified as a victim of trafficking and matched with appropriate support. Someone who has not been identified as a victim through the NRM and who is an illegal migrant or visitor would not be covered by the exemption for NHS charging under the existing regime. However, the NHS can write off NHS debts if individuals are subsequently identified as victims of trafficking, so there is a retrospective exemption in that regard.

The Department of Health has committed to give further thought to strengthening exemptions in the current NHS charging regulations for vulnerable groups, including victims of trafficking. We want to make sure that the NRM works effectively, which is why the Home Secretary has commissioned the review.

My noble friend asked whether those who come on a visa, pay the levy—or the surcharge, as it is properly called—and are later refused an extension will still get free NHS treatment while waiting for an administrative review decision, and asked about a period for which the paid levy has expired. This is about people and their leave to remain. Those individuals will continue to receive free NHS treatment as part of the conditions of their extant leave. Where individuals had leave, alongside which they paid the surcharge when they applied for an extension and applied for an administrative review within the specified time limit for doing so, their leave will be extended on the same conditions under Section 3C of the Immigration Act 1971 until their administrative review is decided.

My noble friend asked what would happen if their review is refused and they bring a human rights appeal. Once an administrative review is refused a migrant will be liable for NHS overseas visitor charging unless they fall under one of the exemptions set out in NHS charging regulations. That will be commensurate with their immigration status.

A number of noble Lords were concerned about GP consultations being free—I think that that is widely understood—but what about treatment? We intend for surcharge payers to receive most treatment free, as would any other UK citizen or person with indefinite leave to remain. We have made that clear in all the responses that I have given. They will be charged only for services for which permanent residents are also charged. As part of its work to reform the charging regime in England, the Department of Health has signalled an intent to extend charging for short-term visitors and illegal migrants to some primary care services, excluding GP consultations. It is carrying out a detailed analysis to inform decisions in this area, and any agreed changes will be put to Parliament.

I was asked by my noble friend Lady Cumberlege to give an assurance that the Home Office would not be permitted to use access to healthcare as a means for it to identify and take action against those subject to immigration controls. Healthcare staff are not routinely required to inform the Home Office on issues to do with individuals’ immigration status, and there is no plan to change this. However, there are circumstances where it is appropriate for the NHS to pass information to the Home Office, such as for enforcing the NHS debtors rule, which is a current rule under which migrants who have run up an unpaid debt of £1,000 or more are not given permission to enter the UK while the debt remains unpaid.

Finally, I hope that I have answered the questions posed by my noble friend Lady Barker on mental health and such matters. She made a valuable contribution to the debate.

I turn to the challenges presented by the noble Baroness, Lady Smith, who asked, “What is success?” Success might be the £2 billion surcharge income for the NHS, which is a large sum of money even in a health service budget running to several hundred thousand million pounds. An additional £500 million will be recovered in treatment charges each year through better administration, plus the surcharge, and vulnerable groups will be protected and treated. Part of the consideration of the NHS review and the provisions of the Bill are to ensure that vulnerable groups are protected. There is no adverse impact on public health, and there is a fairer set of rules and arrangements, which command public support. Those are the basic challenges that face us in seeking to reform charging within the health service.

I reiterate that the introduction of the surcharge in the Bill will give those who are obliged to pay it—and they are obliged to pay it—the peace of mind that they will receive comprehensive NHS treatment when needed. But charging for short-term visitors and illegal migrants remains the responsibility of the Department of Health, and it is not dealt with in the context of this Bill.

[Baroness Barker]

My Lords, I thank the Minister. I know that health is not his subject, but he has given an excellent response to those of us who speak fluent NHS and know all the language. I thank him for the detail of his response, but I ask him to write to me on two points. First, on my point about charging for diagnostic tests, I understand the point about people paying the levy having to pay for the same things as people who are resident and about the exemptions for some categories of people and some conditions, such as infectious diseases. But there are some conditions—for example, diabetes—where you have to have a diagnostic test. It is important that people know that they are diabetic and that healthcare workers know that those people are diabetic, because if it goes untreated there may be further consequences.

Secondly, I seek clarification on the important matter raised by my noble friend Lady Hamwee on whether initial consultations with GPs would be free and subsequent consultations would be charged for or whether all consultations with a GP practice’s staff would be free. I do not want to detain the Committee now but if the Minister could answer those two questions in writing, it would go a considerable way towards allaying anxieties in that regard.