Asylum Detention Centres: Safety

Baroness Barker Excerpts

Tuesday 29th November 2016 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government, in the light of the report by the UK Lesbian and Gay Immigration Group and Stonewall published on 27 October No Safe Refuge, what plans they have to make detention centres safer for LGBT asylum seekers.

[The Minister of State, Home Office (Baroness Williams of Trafford) (Con)]

My Lords, the Government remain committed to continually improving the asylum process for all persons claiming asylum, including those who claim on the basis of their sexual orientation and gender and those in detention while their claim is considered.

[Baroness Barker (LD)]

I thank the noble Baroness for that Answer. Incarcerating lesbian and gay asylum seekers with people who threaten them with exactly the same violence and intimidation from which they are fleeing is a uniquely severe punishment. These people pose a very low flight risk. Why are we spending upwards of £36,000 a year keeping them locked up?

[Baroness Williams of Trafford]

My Lords, I can reassure the noble Baroness that there is actually a presumption against detention. On that note, the Government commissioned Stephen Shaw to do a review into the detention of vulnerable individuals. The noble Baroness and I had a very brief chat before we came into the Chamber. A new category, “adult at risk”, has been introduced, with the clear presumption that people at risk should not be detained, and this includes transsexual and intersex people. Stephen Shaw will carry out a short review next year to see how the actions he suggested have been implemented.

Orlando Terrorist Attack

Baroness Barker Excerpts

Monday 13th June 2016 Lords Chamber

[Lord Ahmad of Wimbledon]

My Lords, I thank the noble Lord. I am sure his sentiments and his unequivocal condemnation of this heinous crime resonate across the House. On the issue of community cohesion, we celebrate Britain for its diversity and the strength of its people of all backgrounds, races and faiths and of different sexual orientations, who come together and who celebrate and define what Britain is today. The Government are totally committed to ensuring that we continue to protect that so we can continue to celebrate what Britain stands for in the modern world today.

On the question of firearms, as noble Lords will be aware, the UK has some of the toughest gun laws in the world and we are determined to keep it that way. The Policing and Crime Bill will introduce changes to firearms legislation, including a new offence of unlawfully converting imitation firearms into firearms, and tightening definitions on, for example, antique firearms. The UK is also co-operating with Europe to prevent the movement of people and weapons linked to terrorism.

On the noble Lord’s final point about the LGBT community and issues relating to Gay Pride, as I said in the Statement, UK police forces will be further reviewing plans for large-scale and other public events over the coming days and weeks. While that remains an operational matter for the police, they are not advising any organisers to cancel or even postpone any LGBT-related events.

[Baroness Barker (LD)]

My Lords, earlier today on Twitter, David Morgan said this:

“If you’re not gay you might not know how rare it can be to feel welcome and safe in a space. To be gunned down in one of them is horrific”.

That is why today members of my community are shocked and we mourn, just as we did 17 years ago when the Admiral Duncan pub was bombed. What have the security services and the Government learned in the intervening period about how to prevent hate crimes being perpetrated on minority communities?

Will the Government consider convening a meeting with leaders of faith groups and the LGBT community so that we might begin a dialogue about how the many millions of moderate members of religious groups can be assisted to detect and prevent the radicalisation and hatred to which some members of their communities are sometimes vulnerable, so that as a result of that work we might have communities that are diverse, inclusive and safe for all?

[Lord Ahmad of Wimbledon]

The noble Baroness makes a very valid point. On the issue of recognising current threats, I fully respect and appreciate that many people within the LGBT community are feeling vulnerable. I know that in the UK we have seen certain attacks against people of particular sexual orientations or from communities defined by particular faiths, with a rise in anti-Semitism and Islamophobia. It is perhaps only those communities that truly recognise what they live under. That said, I recognise also that Britain remains a place where people feel safe and secure. It is the Government’s responsibility to ensure the security of every citizen, and we will continue to do so. Let me be clear: irrespective of who you are and your cultural background, faith background, sexual orientation or gender, Britain celebrates its diversity. That is a strength of our nation and we will protect it.

Cyclists: Road Traffic Laws

Baroness Barker Excerpts

Monday 18th April 2016 Lords Chamber

[Lord Keen of Elie]

The Government are investing considerable sums, in excess of £100 million, to improve the road network for the use of cyclists and walkers. That is part of our commitment. On the increase in the number of incidents and the number of casualties, that is always to be regretted. However, I think that the noble Baroness should bear in mind that there has been a marked increase in the number of cyclists on the roads in the past years as well, which is not inconsistent with the increase in the number of incidents.

[Baroness Barker (LD)]

My Lords, following the publication of the cycling and walking strategy, will the Minister say whether the Government support a number of cycling and pedestrian organisations which have called for joint training for cyclists and vehicle drivers about each other’s experience of using shared space in an organised attempt to promote a greater understanding of how shared spaces on roads can be used safely for the benefit of all?

[Lord Keen of Elie]

At present the Government’s commitment is to the Bikeability programme, which is training young people in the use of cycles and making them aware of the position of motorists as well.

Cycling

Baroness Barker Excerpts

Wednesday 10th February 2016 Lords Chamber

[Baroness Barker (LD)]

My Lords, I take my inspiration this evening from my former colleague Julian Huppert, who was largely responsible for the Get Britain Cycling report.

The noble Lord, Lord Young of Cookham, referred to Holland. Last year I went to northern Italy. There is some true inspiration to be found there. I was at Lake Garda and the image of a man cycling up an Alp—a gradient of eye-watering proportions—while talking to his mate on his mobile phone will stay with me for a long time. But what was more impressive was the city of Parma. It has a medieval heart but it is a heavy industrial city with lots of big lorries, and it is a city in which cycling, motoring and walking are fully integrated. People of all ages coexist at junctions—on Italian roads. I commend it. I do not know why the people of Parma have cracked this and we cannot, but they have.

I will talk briefly about funding. There is a real problem at the moment with the Local Sustainable Transport Fund coming to an end and the access fund coming into being from 2016. The Minister and I had an exchange about the amount of money yesterday but the key problem is that the staff employed by local authorities to teach cycle safety to children, but also at weekends to adults, are likely to be lost because of the uncertainty of funding from March this year. As a woman who after 30 years of inactivity got back on a bike, it was going along to my local authority training scheme that gave me the confidence to get back on a bike and to cycle in London.

It is not that there are not sources of funding. There are lots of different pots of money. There is the Highways England cycling fund, Bikeability, the cycle city ambition grants, the access fund and the Local Growth Fund. What there is not is any clarity about how they all fit together and how local authorities can best access them. I wonder whether the Minister can give some clarity on that.

Secondly, will the Minister accept that for those local authorities, particularly outside London, that really do want to make progress on this, getting access to top design and to information about what works is very important, particularly these days when local authority budgets are stretched? Although there are good examples—TfL and the Welsh Assembly have come up with really good designs—getting national guidelines that would bring down the cost of implementing good design and good practice around the country is quite difficult for local authorities. I wonder whether across the many government departments that have responsibility for this there might be some joined-up thinking.

I agree with the many noble Lords who have said that it is only when people feel safe that they will cycle. In some cases that means bringing in dedicated cycle lanes. In some cases that is not possible and it is about ensuring that cyclists, HGV drivers and car drivers all understand how best to preserve the safety of everybody on the roads.

Following the Olympics, we really do have a legacy for cycling in this country. We have the ability to make a small investment that will reap great rewards, not least for the National Health Service in terms of the health gain that will come from it. All we need from this Government is a bit of joined-up funding and leadership to enable those local authorities that want to work on this to do so, and to take inspiration so that we can continue to beat the Italians at the Olympics.

Walking and Cycling

Baroness Barker Excerpts

Tuesday 9th February 2016 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government what plans they have to invest in promotion of walking and cycling.

[The Parliamentary Under-Secretary of State, Department for Transport and Home Office (Lord Ahmad of Wimbledon) (Con)]

My Lords, the Government have made clear their intention to make this country a cycling nation and are committed to producing a cycling and walking investment strategy setting out our objectives, activities and funding available for cycling and walking in England in the long term. The strategy will be published in the summer and will include details of how the £300 million committed in the recent spending review will be invested to support both cycling and walking.

[Baroness Barker (LD)]

My Lords, from April 2016 the Government have reduced the revenue funding for local authority cycling and walking safety training from £78 million a year to £20 million a year. That will inevitably lead to a reduction in the number of trainers available for schoolchildren and adults. Given that the Department of Health is having to put together a strategy to combat the epidemic of obesity in adolescents, does the Minister not believe that this is a false economy?

[Lord Ahmad of Wimbledon]

Over the past five years the spending on cycling per person in England has actually gone from £2 per person to £6 per person. If we look at the priority cities, £10 is being spent on each individual. The noble Baroness talked about safety. The Government are investing a further £50 million in the excellent Bikeability scheme, which ensures that our next generation of cyclists are avid cyclists but also learn the importance of safety in cycling.

Overseas Domestic Workers Visa

Baroness Barker Excerpts

Monday 25th January 2016 Lords Chamber

[Lord Bates]

That is one route. We are on the same track as the broad thrust of what James Ewins has put forward. He identifies some gaps in the data, and we recognise that that needs to be worked on. We need to consult, across Government, about the right approaches. However, there are some areas where we have a problem that we would like to focus on further. Our view is that the national referral mechanism is the correct vehicle for dealing with someone who is found to have been abused under the overseas domestic workers visa scheme. That ensures that the individual gets the help they need and that the National Crime Agency finds out who the perpetrator is, so that appropriate action is taken. However, we are on the same page on the broad thrust.

[Baroness Barker (LD)]

In light of this review, will the Minister tell us if, when an application is made, embassy or consular staff have the power to interview the person on whose behalf the application is made, outwith the presence of their employer, in the country of origin, before they reach the United Kingdom?

[Lord Bates]

We are trying a pilot on this in west African countries, which is not necessarily proving conclusive either way. Very importantly, we have instituted that a model contract should be in place governing the terms and conditions of employment, working hours, what holidays these workers would get and what rights they have when they are in the United Kingdom. That model contract must be in place before the visa is granted. It is also very important that people reporting abuse report it to the authorities here in the UK, so that if a person who has been guilty of abuse then applies for a further overseas domestic workers visa, that information will be known to the authorities.

Immigration Bill

Baroness Barker Excerpts

Wednesday 12th March 2014 Lords Chamber

If the Government are to make good their commitment to protect public health, plans to extend the Home Office radar screen in this way should be reconsidered. I hope my noble friend will do that and perhaps not pursue these plans. I look forward to his reply.

[Baroness Barker (LD)]

My Lords, I will briefly address Amendments 66A, 66B, 66C and 66D and leave my noble friend Lady Hamwee to address Amendment 66E.

Amendment 66A stands in the name of my noble friend Lady Williams of Crosby. It is a shame that she is not here because, as Members of this House will know, among her many areas of expertise is an encyclopaedic knowledge of the United States. She and I talked a lot, particularly during the passage of the Health and Social Care Bill, about the comparisons and contrasts between our health system and that of the United States. One of the most graphic contrasts is in A&E. When Americans go to A&E they are there for a very long time because they ask every conceivable question they can and fill their pockets with everything that is going. Millions of them do not have any healthcare cover at all. By contrast, we do. Per capita we spend about a third of what they spend in the USA but study after study shows that our health outcomes are better. Our systems are better because, by and large, we get people at the right place at the right time—and most people, because they have access to a GP and a certainty that they will be treated, present themselves early.

The amendments in this group are not about trying to gain exemptions for one group of people and putting some kind of moral case that puts them in a different category from other people; they are about saying what is the most effective National Health Service for everybody—those who live here permanently and those whose leave to remain is as yet uncertain.

I do not see the purpose in making a charge for A&E. There may be some belief on the part of the Government that if they charge people for being seen in A&E it will somehow have the effect of pushing them to go to their GP. I would love to see the evidence for that; I do not think that people are either that calculating or that logical about the way in which they use the NHS, particularly A&E. I would be grateful if the Minister could set out the case on which the Government have based the proposal to charge people for turning up in A&E.

What discussions have they had with the College of Emergency Medicine about how this will work? I have recently been a member of the committee of your Lordships’ House reviewing the Mental Capacity Act. When we talked to representatives of the College of Emergency Medicine, they were in no doubt. We talked to them about advance statements and how much they found out about people’s wishes and so on, and they just said, “If somebody’s ill, you don’t do that; you just treat them”. It is naive to assume that they will change their entire practice for thousands of people who come through their doors on a weekly basis just because somebody happens to fall into a different immigration category; that is perhaps wishful thinking.

Amendment 66C poses a very simple question: are we going to charge people for diagnostic tests and, if so, on what basis will we do so? Frankly, I cannot see the incentive for somebody to go and see a GP if the consultation is free but they then have to pay for any diagnostic tests. That is what most GPs do above anything else; they run a set of diagnostic tests and they look at them. There is also a public health implication here. The issue that we have with a number of conditions is trying to persuade people to be tested so that we can then make plans for their individual health and also plot the health of the community. What exactly are the proposals on diagnostic tests?

Perhaps the most important and relevant amendment in this group is Amendment 66D. My understanding, and that of the people and organisations which have briefed us, including the National AIDS Trust, is that, should the Bill remain unamended, the Department of Health will have the power to levy charges for mental health services outside those provided by hospitals. Clearly, it will not be able to charge people who are detained under the Mental Health Act, and I doubt that if somebody was sufficiently ill to be receiving mental health treatment in a hospital they would be charged for that—I may be wrong—but community and primary care service mental health treatments could be charged for.

On that, we should follow the point made firmly by the Academy of Medical Royal Colleges in its response to the Department of Health consultation: that access to primary mental health services is a public health issue. We should not leave mentally distressed people to get to the point where they become a danger to themselves and to others. This measure would fly in the face of the intentions of the most recent Mental Health Act to go through this House, in which there was an emphasis on ensuring that people were subject to compulsory treatment in the community. I have no wish go back over some of the worst legislation that we have ever passed in your Lordships’ House, but this measure seems to undermine that considerably. I would like a full statement from the Minister on exactly what the Government’s intentions are on mental health services.

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[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.

Immigration Bill

Baroness Barker Excerpts

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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[Lord Rosser]

This amendment also relates to Clause 33. The only comment I make to start with is that if all the verbiage in Clause 33 does is give the power to charge one rate to students and another to everybody else, it seems unbelievable that it cannot be made simpler and more explicit. I hope that the Minister will bear that in mind when he reflects on the debate that took place on the previous amendment.

Clause 33 provides the Secretary of State with a power by order to require certain migrants to pay an immigration health charge. It relates only to people who are seeking immigration permission; it does not relate beyond that. The charge would be paid by someone who was applying for leave to enter or to remain in the UK or for entry clearance. The amount, the method of payment and the consequences of non-payment will be set out in secondary legislation although, as has been said on a number of occasions, we understand from the Government that the amount of the charge will be £200 a year and £150 for students and that paying the charge will be a precondition of entry.

We agree with the principle of the charge. It is right in our view to require migrants who are here for a limited period to make a contribution to the NHS. We also agree that the test of ordinary residence is fairly generous. At the moment it is satisfied by many new and temporary migrants almost immediately and covers many people, including newly arrived family members.

We have tabled only one amendment to this clause, Amendment 61, which requires the Government to provide information to Parliament on the sums collected under Clause 33. Obviously, in large part the amendment is to find out a little more about the Government’s intentions on this score. The amendment asks for a review of the sums that are to be collected and how they are to be disbursed. The Bill states that the money will be paid into the Consolidated Fund or be applied in such other way as the order may specify. At Second Reading, in response to a question from my noble friend Lady Smith of Basildon, the Minister said that,

“on 20 January the Chief Secretary to the Treasury confirmed to departments and the devolved Administrations that the money that is collected by these charges … will go directly to health services”.—[Official Report, 10/2/14; col. 524.]

Where will this be set out, and where is the guarantee of it?

There are further questions. Will hospitals that treat a high proportion of foreign nationals get an appropriate or proportionate share of it and how will the money be shared with the devolved Administrations? What is the definition of the words “health services”? Could the money go to the private healthcare sector, for example? If the money is to go to health services, why not say so in the Bill and end any doubts on that score? Will the money from the charge be in addition to the money that the Government provide for the NHS or for health services, or will it be used to reduce the amount that the Government would otherwise have provided? In other words, is it extra money or is it simply going to be used to reduce the amount that the Government themselves provide? Some response to that point would be very helpful.

I want to ask about the implementation of the provisions, because in the consultation document the Government indicated that the migrants’ biometric residency permit would be endorsed to show that they were entitled to NHS treatment without further charge. How will hospitals and doctors be made aware of that? I ask that in the context—I understand that I may well be wrong, and I am sure that if I am I will be corrected—that the Department of Health will publish a full implementation plan—indeed I may be told that it has already done so—which will include plans to develop a new NHS registration process for the identifying and recording of patients’ chargeable status. If that has not already been produced, will the Minister confirm when it might be available? We also want to ensure that there is no disincentive for people who bring benefits to this country. One category is students. How will that charge be kept under review to ensure that it does not act as a disincentive for people who we would wish to come here to do so?

In probing what the Government’s intentions are and how they see this operating, I want to ask about transitional arrangements. The Minister has confirmed to us in a letter that affected migrants who are already in the United Kingdom at the time when the policy is implemented will not be liable to pay a surcharge and will not be charged for healthcare for the remainder of their leave if they were previously exempt from NHS charges. However, once their leave expires, the migrant will be required to pay the surcharge as part of any further immigration application unless they are applying for IDR. Will the Minister confirm where this will be set out in the legislation and how people will be made aware of it? In that scenario, how will a GP know whether someone who should pay the charge is covered if for that patient the charge becomes payable only when they apply for an extension of leave to remain? If a GP refers to hospital a patient who should have paid the charge, will the hospital also have to check that that patient has paid—a double check—or can the hospital accept that the GP making the reference will have done a check and rely on that?

The Minister said on Monday, in a discussion on the issue of the charge, that there would be no transitional arrangements. I ask him not to confirm that there will be no transitional arrangements, because that is clearly in black and white in Hansard, but to confirm that that also means that there will be no transitional costs relating to the bringing in of this payment. It would be helpful to have clarification on that.

I have raised a number of questions: what the Government’s intention are; how this will operate; where the money will be going; whether it will be used to reduce the amount that the Government provide to the health service or whether it will be additional money; what the definition is of “health services”; and whether the money could go to the private sector. I have also raised queries about the position of GPs and the checks that they have to make, and in particular whether there is a double check if they refer someone to a hospital or whether the hospital can take it that the GP will have done the checks and that is the end of the matter. I beg to move.

[Baroness Barker]

My Lords, I shall speak to my Amendment 66F in this group. Following the consultation in 2013, the Department of Health said that,

“while there is a great deal of speculation about the numbers of visitors and short-term migrants using the NHS, robust data are very limited”.

That is the point that I wish to address. I have no problem with the Government’s intention to introduce a health levy, and I have no problem with them seeking to have different rates for different groups of people. However, I want to be sure that when this House makes a major change to a fundamental policy that we have held in this country for over 60 years, that it does so on the basis of sound evidence.

Back in 2006, noble Lords will remember that proposals of this kind came before this House from the then Labour Government but then disappeared, principally because someone went back to the department and worked out that the cost of implementing the proposals far outweighed any benefit. It is simply good business practice to have done a cost-benefit analysis of a major change before one implements it. The Government are wedded to doing this—fair enough, and I have no doubt that they will go ahead—but it is only right that if they go ahead they should do so on the basis that its implementation will be thoroughly analysed, so that we do not find ourselves back here in five years’ time responding yet again to an agenda that has been set by various media organisations and political groupings on the basis of nothing more than speculation.

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[Lord Leigh of Hurley]

Perhaps I should declare an interest as a chartered accountant. As such, I looked at Amendment 66F with care. I agree that it is important to have a proper review, analysis and evidence of real costs, but the trouble with the proposed new clause is that it asks for a calculation of the total charges paid, among other things, but it does not look for an assessment of the cost against those charges. For the proposed new clause to be meaningful and for the assessment of the health charge to be made, one would have to look at the costs incurred by the National Health Service for the £200 or £150.

[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?

--- Later in debate ---

[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

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.

Immigration Bill

Baroness Barker Excerpts

Monday 10th February 2014 Lords Chamber

[Baroness Barker (LD)]

My Lords, I have long been of the opinion that immigration law is one of the best tests of the values and principles to which any country subscribes. It is also one of the best litmus tests by which to judge a country. I therefore wish to align myself with the comments made by my noble friend Lady Hamwee earlier on this afternoon when she spoke on the Bill.

The desperately sad thing is that we have been here before. In 2004, the Blair Government consulted on a similar proposal to exclude visitors from free primary healthcare. They did it as an excuse to try to deny failed asylum seekers access to NHS services, particularly secondary care. They never published the results of their consultation and quietly shelved the matter. Here we are again, all these years later, with another Government, under pressure from the right-wing press, coming up with the same set of proposals. It is a desperately sad reflection on the way we are asked to make legislation on this subject that we are yet again put in this position.

In July 2013, Jeremy Hunt admitted that he did not know whether health tourism was a problem at all. He said:

“The truth is that we do not know the cost”—

of unpaid NHS charges—

“which is why we are carrying out an independent audit this summer”.—[Official Report, Commons, 16/7/13; col. 908.]

The Government produced two pieces of quantitative and qualitative research to go along with these Bills. The conclusion that can be drawn from them is that there is currently no systematic data collection whatever on NHS use by migrants, chargeable or otherwise.

The quantitative data were a top-down estimate of migrant use, modelled from data that were sometimes of varying quality and from a large number of assumptions. They used, for example, the international passenger survey data. They did not give us any actual new information about use of the NHS by migrants. In the quantitative research, researchers repeatedly put caveats around the findings of their model, saying that,

“any point is just a likely value in a plausible range”.

That is to say, the much publicised figure of £1.76 billion, which has been bandied around, is about 50% likely to be wrong. I really do not think that this is a proper basis on which to bring about such a fundamental change in access to the NHS.

The quantitative survey was subtitled, “Observations from the Front Line”. It gave the impression that front-line staff in acute health services had come up with systematic observations about migrants and their use of the NHS. In fact, what it revealed was that there was no systematic observation, and that quite often people were simply asked questions on the basis of their appearance or nationality. Such a flawed basis of research is really no way in which to change the fundamental right of access to the NHS for all of us.

By creating a barrier to accessing primary care services, we open up a huge health threat to the whole population. It is entirely possible that there will be serious implications in the diagnosis and treatment of infectious diseases and in herd immunity for childhood diseases, for which we need immunisation of the whole population. There is a significant public health risk associated with restricting access to primary care, and it is not something that we should do lightly. There is not much evidence, I know, but there is one small study from Médecins du Monde—doctors of the world—which has a small clinic in Tower Hamlets that works with people who are vulnerable and do not have access to NHS services.

It is a very small study, but what MdM found was that its GP list of patients was pretty much like that of every other GP surgery. The majority of people who come to see the doctors do not require any treatment at all. A small, but significant, number of people require some minor medication and a follow-up visit. A fraction of patients require secondary care. Admittedly, this is only a small study, but rather than paying all our attention to some of the alarmist stories that we see in the press, we really ought to look at those small figures.

The biggest point that I want to make is that if we are to go ahead with anything in this Bill, we should do it solely on the basis that its implementation will be accompanied throughout by proper research and evidence-tracking, so that in future we will not be reduced to passing laws on the basis of what the Daily Mail might think is the truth.

In the time available to me, I shall pass on to one other issue. I thank the right reverend Prelate the Bishop of Leicester for his thoughtful speech. On the issue of sham marriages and civil partnerships, I understand that the Government believe that there are between 4,000 and 10,000—we are back to shaky evidence bases again. They say that in 2012 there were approximately 1,900 cases of sham marriages and civil partnerships under Section 24 of the Immigration and Asylum Act 1999. How many of those were sham civil partnerships, as opposed to sham heterosexual marriages, and what were the countries of origin of the non-EEA partners?

I understand that the proposal to extend the notification for civil partnerships and marriages from 15 days to 28 is to enable registry officials to satisfy themselves that they are genuine. Under this Bill, the Home Office will also be allowed to extend that period to 70 days for further investigation, if there is reason to believe that the marriage or civil partnership is not genuine. However, it is not clear to me whether there is any appeal process which people will be able to use if they have been wrongly adjudged to have entered into a sham marriage or civil partnership. Will the Minister enlighten us on whether there is an appeals process, what it is and how people will be enabled to use it?

Finally, I turn to one other issue. Noble Lords who read yesterday’s Observer will have seen that LGBT asylum seekers have been subjected to the most shockingly degrading line of questioning during their interviews. Does the Minister agree that demeaning and intimidating people just because they are gay has no part whatever to play in our justice system? Will he assure us that this is going to stop—and stop now? We are not Uganda. We do not treat gay people like that in this country, no matter how hard our times are.