Immigration and Social Security Co-ordination (EU Withdrawal) Bill (Eighth sitting)

Debate between Kate Green and Eleanor Smith

Thursday 28th February 2019 Public Bill Committees

[Eleanor Smith (Wolverhampton South West) (Lab)]

I wish to speak to new clause 12, which states:

“Any EEA or Swiss national, or family member of an EEA or Swiss national, resident in the United Kingdom shall be deemed ordinarily resident for the purposes of section 175 of the National Health Service Act 2006.”

When charging for non-residents was first introduced under section 175, it was not meant to add excess costs for that group of people accessing our healthcare. In 2015, costs were introduced that started at £200 for most applicants and £150 for certain groups—for example, students. The fee has now doubled. That means that a family of four would have to pay about £1,000 each in IHS costs in addition to their visa costs.

I am pleased that the Minister confirmed in November that EU citizens who are resident in the UK before it leaves the European Union in March 2019 will not pay the charge, and that the Government have come to an agreement with Switzerland, Norway, Iceland and Liechtenstein that during the transition period their citizens’ rights will be protected. However, it is still unclear what will happen after the transition period has come to an end in 2021 or in the case of a no-deal scenario, After December 2020, a new visa system will be in place that could mean that EEA citizens and Swiss nationals have to pay the immigration health charge.

It seems to be forgotten that most of the EEA citizens and Swiss nationals in the UK are currently employed and are already paying for the NHS through their taxes. Extending the immigration health surcharge to them would mean that they were being charged double for NHS care, which would seem to me an unfair contribution.

That leads me to the issue of the NHS. More than 60,000 NHS workers are EU nationals and, without settled status, they could face the possibility of paying the increased surcharge as well as for their tier 2 work visa. The new system could add further pressures for the NHS, which is currently struggling to recruit the number of healthcare professionals needed to meet the country’s demand.

Labour’s intention is to level rights up, not down. We hope that, after a new immigration system applying to nationals from across the world is introduced, none will be required to pay these charges.

[Kate Green]

I wish to speak to amendment 37, which has my support, as do the new clauses in this group. I would like to say a few words about one particular aspect of NHS charging, which is in relation to maternity care. Under the current charging rules, non-urgent care must be paid for in advance, but “urgent” or “immediately necessary” care must be provided whether or not a person can pay in advance. The guidance from the Department of Health and Social Care and the statutory regulations make it clear that maternity care is to be regarded as immediately necessary, so it must not be refused or delayed if a woman is unable to pay in advance, although she will still be charged for it. However, because of confusion about the charging regime and misapplication of the rules, pregnant women who are not UK nationals have already been denied maternity care, told that they must pay in advance of receiving treatment or told that their appointments may be cancelled if they fail to pay. Extending the charging regime to EU nationals, including pregnant women, would multiply such injustices in a system that is already making serious mistakes.

Charges for NHS maternity care start at approximately £4,000 and can rise into the tens of thousands for more complex care for women or additional care for new babies. Those charges are significantly higher than what NHS trusts would normally be paid for providing such care, because the regulations require them to charge 150% of the relevant NHS tariff. In practice, the rules mean that some hospitals have sent bills demanding immediate payment of thousands of pounds from vulnerable post-partum women. Women have received letters threatening referral to debt collectors, local counter-fraud specialists or the Home Office; in one appalling case, a woman was issued a bill of almost £5,000 for treatment following a miscarriage.

Research by the charity Maternity Action has found that the charging regime has resulted in women avoiding essential antenatal care and missing appointments because they fear incurring a debt that they cannot pay or being reported to the Home Office. That includes women with health conditions that require effective management to protect the health of both mother and baby. Antenatal care is intended to pick up and treat problems as early as possible, increasing the chances of a safe and healthy birth. Missing midwifery appointments means that high blood pressure and gestational diabetes are left untreated, the window for HIV prophylaxis is missed and minor infections are allowed to develop into serious health conditions.

Migrant women who are entitled to free NHS care are also affected by charging policies. Maternity Action regularly encounters women, including EEA citizens, who have been wrongly assessed as chargeable and have received bills for their care. In some cases, the women affected by the rules have children and spouses who are British citizens. Surely that was not the intention of the policy.

In December, the royal colleges issued a joint statement calling on the Department to suspend the charging regulations pending a full independent review of their impact on individual and public health. The Royal College of Midwives has expressed

“enormous concern…that vulnerable women are missing out on essential…care.”

Given the harm that charging for NHS maternity care is already causing to women’s physical and mental health, the fact that many women are simply unable to repay bills, the clear lack of regard being given to children’s best interests, the risks to public health and the potential for the charging regime to be extended to all EEA nationals, is it not time to consider the arguments for immediately suspending all NHS charging for maternity care?

Immigration and Social Security Co-ordination (EU Withdrawal) Bill (Second sitting)

Debate between Kate Green and Eleanor Smith

Committee Debate: 2nd sitting: House of Commons
Tuesday 12th February 2019 Public Bill Committees

[Eleanor Smith]

Q What impact will the Bill have on migration to the UK post Brexit?

Jodie Blackstock: It is very unclear, because the power to arrange the post-exit scheme is left to the Minister. That is our concern. Its impact could be profound or negligible, depending on what policy process the Government put in place.

The proposals for the temporary leave to remain scheme would enable someone to go through a process of application if they wanted to settle in this country, for work or otherwise. The proposals in that scheme, which I have not looked at so cannot assess, ought to be within the Bill, so that the Committee can scrutinise them properly. The problem is that by enabling everything to be done using such a broad delegated power, you are not in a position to know.

With the way we are going, this will be left until post exit to be scrutinised, with the Bill proposing using the affirmative process for the first set of regulations, which we think is wholly inadequate, for the reasons we have given. If the scheme is already proposed, in draft or otherwise, it should be in the Bill, not left until the last minute to be announced, at which point it will not be possible to propose amendments to it. Our view is that it is a very simple step for the Government to bring forward their proposals for scrutiny, and they ought to do so for something that will create such a significant change.

[Kate Green]

Q I would like to ask you about social security rights. To what extent does the Bill protect, or fail to protect, the existing social security rights of EU nationals in the UK? Given that those rights and the arrangements that apply are reciprocal, what are the implications of the legislation for UK citizens living elsewhere in the EU?

Jodie Blackstock: The Bill does not protect those rights, because it does not set out the principles by which it will do so. It simply provides the structure for the removal of all current reciprocal arrangements. As with the discussion we had on clause 4, it creates the power for not only a Minister but an appropriate authority to replace those current rights with an alternative arrangement.

For us, clause 5 is the most concerning clause in the Bill, as if clause 4 was not concerning enough. Our view is that the clause ought to be entirely deleted, and we say that for a few reasons—not just the extraordinary breadth of power that it creates, but the fact that the provision to remove the co-ordination regulations and replace them is already provided for by way of section 8 of the European Union (Withdrawal) Act 2018. Indeed, there are four regulations that have already been laid, pursuant to that Act, before Parliament and that comply with what are perhaps broad powers, but at least are curtailed far more than the power here; and, because they have been laid, it is possible for them to be scrutinised by Parliament.