Immigration Bill

Baroness Barker Excerpts

Monday 10th March 2014 Lords Chamber

Imposing the health levy and other NHS charges on children and pregnant women for preventive, acute and emergency care will not fulfil the Government’s legal, moral or ethical responsibility for providing care for children, particularly emergency care. They will fail in their commitments to the UN convention. If we do not care for those vulnerable children, particularly the very young, and pregnant mothers, who do we care for? Is it only those who can afford to pay?

[Baroness Barker (LD)]

Clause 33 enables the Government to introduce a health levy. The noble Baroness, Lady Smith, said that her Benches support it in principle; on our Benches, we support it as the least worst of a number of options, none of which we particularly favour. We think that a health levy is preferable to requiring people who come to this country to take out forms of private health insurance that do not meet their needs and are considerably more expensive. However, having said that a health levy may be one way of generating income for the NHS that we can support, like other Peers we have considerable reservations about what the effect will be in practice—and, in particular, what the deterrent effect will be on people who require health services. We will go on in later groups of amendments to discuss that in greater detail, but in this group noble Lords have focused first and foremost, perhaps not surprisingly, on pregnant women and children.

The noble Earl, Lord Listowel, in his introduction was almost biblical in his references to our consideration for expectant mothers and children. I am not as spiritual as he is—I am much more practical. I would say that one of the haunting images of last year was that of the asylum seeker who drowned in the boat off Lampedusa in southern Italy, who was found to be giving birth at the time. When I listen to people talking about maternity and health tourism, time and again I go back to that woman and what must have been going through her mind, and what her life must have been like, to be pregnant and in that position. That is just my disposition towards our general discussion.

The noble Baroness, Lady Cumberlege, introduced her amendment in her characteristically thoughtful and well researched way. She, too, referred to the letter of the noble Earl, Lord Howe, of 6 March, in which he explained the thinking behind this Bill from the point of view of the Department of Health. I, too, wanted to focus noble Lords’ attention on the statement that he made. He said that there was “widespread evidence” and,

“a cost of between £70 million and £300 million from people who deliberately travel to England to get free NHS treatment—so-called ‘health tourists’”,

of which those seeking maternity treatment were most prominent. There is some difference between £70 million and £300 million. My first question to the Minister is: can he explain the range? Even if he can, £300 million in terms of the overall NHS budget is minuscule. Consequently, when we are doing our job in this House as we should, which is to consider not just the immediate cost but the overall impact of a charge, we have to do it in recognition of that fact.

I should like the Minister to explain exactly how the Department of Health arrived at that estimate, particularly as the small charity, Médecins du Monde—Doctors of the World—conducted research across the European Union and discovered that there is no higher rate of migration to this country under our current system of charges than to places such as Germany. I simply repeat, as I did at Second Reading, that I have no problem with our making a fundamental change to our health policy provided that we do so on the basis of proper evidence and not the cynical opinion of newspapers.

Amendment 64A in this group stands in my name. Other amendments in the group, which I support, refer to pregnant women. Mine refers to women who are pregnant or require postnatal treatment. We afford postnatal services to those who are ordinarily resident. We do so routinely for women who do not have problems, who also have access to health visitors to ensure that they and their children are functioning well in the first few weeks of the children’s lives. We afford these services to women who have problems which may not be very significant but which we know are important in the development of their children—for example, women who are having trouble breastfeeding or women who are suffering from postnatal depression. We also extend treatment to women who have suffered traumatic deliveries and need surgery following deliveries that have not gone well. That is what we do for our own people because it is the right and decent thing to do. I should like to think that in future, no matter who a woman is or what her financial status is, she, too, will be afforded such treatment.

Finally, I thoroughly support the amendment of the noble Lord, Lord Patel, which mentions children. I pay my taxes to live in a country where the first question that a doctor asks concerns what is wrong with a child and what treatment they need, not who their parents are. Our wish is to retain that as far as we possibly can.

[Baroness Lister of Burtersett (Lab)]

My Lords, I support the amendment on domestic violence in the name of my noble friend Lady Smith of Basildon. She has made the case for it, so I will not repeat that, other than to point out that this amendment is totally consistent with the Government’s own action plan on domestic violence and builds on the destitute domestic violence concession. It is a very modest amendment, which would simply guarantee a period of safety, with access to services and benefits, after the breakdown of a relationship because of domestic violence. I hope I am not being naive when I say that I am confident that the Government will support this amendment, given that it is so consistent with their own policy.

I also support Amendment 60, in the name of the noble Lord, Lord Patel. I am very glad that he introduced an amendment on children to remind us of the potential effects on children of some of these changes. I draw noble Lords’ attention to what the Joint Committee on Human Rights, of which I am a member, had to say on this matter. It referred to the concerns that,

“arise about the possible impact on children of the provisions in the Bill which extend charging for NHS services … Extending charging to migrants not previously charged for accessing health services, and extending the range of services for which charges apply, are likely to have a deterrent effect on accessing health care, which in turn is likely to have a particularly detrimental effect on the children of such migrants”.

I will not go into the full detail but our recommendation was that to meet these concerns,

“about the impact of extended charging for health services on children’s health, we recommend that new guidance be issued specifically on the s.11 Children Act duty”,

which applies to the NHS,

“explaining to front-line decision-makers in the health sector exactly how that duty applies in the context of extended charging for NHS services”.

I should therefore be grateful if the Minister would say what the Government’s response is to that.