Immigration Bill

Baroness Cumberlege Excerpts

Wednesday 12th March 2014 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, my noble friend Lady Meacher has introduced this group of amendments with great clarity. I have added my name to Amendment 62 and I will speak to Amendment 64. Other Peers who have added their name send their apologies for not speaking at this late hour. I do not want to add much more to what has been said about domestic abuse and female genital mutilation except to say that I have a major concern as to how this will actually work in practice unless these groups are exempt.

What happens if a girl comes into the country, her status is not established, and she has infected wounds? What happens to the girl who has been mutilated and has urinary and voiding difficulties or suffers chronic pain? What happens during pregnancy, when delivery can be incredibly complicated? If it is not properly managed, a woman may literally burst because scar tissue is not elastic. We recognise FGM as an absolutely awful form of abuse and it is shameful that there have not been prosecutions already. If we put these women into the charging category, we will almost reverse the message we have sent to society about this terrible act.

The other problem arises with domestic abuse. If a woman arrives at A&E with severe facial injuries including fractures to the bones of her face or her chest wall, they may be life-threatening. If her ribs have been stoved in, it may be a life-threatening injury such as a pneumothorax and treatment will have to begin straightaway. Emergency service personnel are going to be put into a terribly difficult position. Another problem is that, in the societies from which many of these women come, sadly they are not afforded the rights they have in our society, and they are not given the respect they deserve. I am fearful that there may be a tendency to blame the woman if attempts to stay fail because she is a burden on the man, thus making it more difficult for him to stay.

Amendment 64 is about people who are released from detention. Currently, people can receive treatment while they are being held in an immigration detention centre and the course of treatment will be ongoing when they leave, but this may not be the case in the future. The consequences will be particularly acute in the area of mental health. It is well documented that the experience of an immigration detention centre is damaging to the mental health of many detainees. Without ongoing support, those mental health problems will be exacerbated rather than ameliorated at the point of release. The problem we are faced with is where to set the boundary and how it will actually be implemented.

These are probing amendments, but when regulations come before the House we will not be able to amend them. We will be faced with either accepting or rejecting them. That is why we need to tease out these issues very carefully at this stage.

[Baroness Cumberlege (Con)]

My Lords, I shall speak to Amendment 66A on behalf of the noble Baroness, Lady Masham of Ilton, who sadly has another commitment that she has to honour this evening. Successive Governments have very good track records in safeguarding the public’s health. When I was a Minister, I was deeply involved in the Health of the Nation strategy, which was lauded at the time by the World Health Organisation as a model for other countries to follow. Since then, through the Labour Government and now our present Government, we have concentrated on looking after the public’s health. Indeed, Ministers were saying only in November last year that nothing will be done to worsen public health. Two years ago, this Government extended free treatment regardless of immigration status to include treatment for HIV infection. As was said at the time:

“Reducing transmission will reduce the risk of new infections in the wider UK population and … reduce … NHS costs”.—[Official Report, 29/2/12; col. 1397.]

They have confirmed that treatment for communicable diseases and sexually transmitted infections will remain free to all.

These are really welcome and important commitments but we have to be very careful that this proud record is not undermined by what we are now doing. Many noble Lords, I know, have a crystal-clear understanding of the Bill, as the noble Baroness, Lady Meacher, has explained to us this evening, but I would like to clarify some issues. First, who is actually going to be affected by these charges? I look to my noble friend to provide the clarity that I seek.

Immigration Bill

Baroness Cumberlege Excerpts

Monday 10th March 2014 Lords Chamber

[Baroness Smith of Basildon (Lab)]

My amendment is the second in this group and is the only one that deals with domestic violence. I thought that it would be helpful to include the amendment in this group rather than have a separate debate on domestic violence.

I want first to turn to the housing provisions, which require landlords to check the immigration status of those to whom they let. I said at Second Reading that we have serious concerns about these measures and we have tabled a number of amendments to the relevant part of the Bill. I shall not go into detail here because it is a separate debate for, one hopes, later today.

I want to put on record our concern about the workability and what I will refer to—I hope that this is accurate—as the unintended consequences of the provisions. The Government should be aware of the impact of the proposals on vulnerable persons, such as pregnant women and many others, as the noble Earl, Lord Listowel, highlighted. The amendments in this group highlight the concerns about those issues.

Not everybody in life is well organised, not everybody has all their documentation up to date and not all landlords will be able to fulfil—or, perhaps, even understand—all their obligations under the Bill. People can make mistakes. I think that I am a well organised person, but can I say that I have never forgotten to pay a bill or never missed my MoT date? Of course I cannot; we all make mistakes.

We learnt that when the former Immigration Minister, Mr Mark Harper, had to resign. Even with all his good intentions and integrity, wanting to obey the law and trying to do so, he still made a mistake. There are great concerns about those whose lifestyles may be a bit more chaotic, or those who are here legally but do not have the right kind of documentation. That could include pregnant women and victims of domestic violence. They might end up being refused accommodation as a result of these measures because landlords do not want to take the risk of making a mistake. The danger is that that could result in them falling into the hands of rogue landlords or becoming homeless.

I hope that the Minister can be clear on whether those issues were considered when discussions were held on including the provisions in the Bill. If they were considered and the Government are aware of all those consequences for vulnerable groups, how will they address them—in particular, under this group of amendments, pregnant women and victims of domestic violence?

Most of the amendments referred to the health charges. There is a lot of confusion about the measures in the Bill and other measures announced by the Government. They must recognise that they must take responsibility for any confusion. The Government’s rhetoric and the sweeping statements that we have heard about what they call health tourism add nothing to the seriousness and quality of the debate. Again, I do not want to go into the wider issues—we will have a wider debate on health charges later, and I will raise the bulk of the questions and concerns that we have then—but I want to ask a few questions on specific issues raised by this group of amendments.

I want to be clear from the outset that we agree with the principle of a one-off health surcharge. It is not unreasonable that those who use the NHS contribute to it. My understanding is that all those who have paid the charge would then have full access to the NHS, but the Government’s consultation document then excludes a few treatments. That is not in the Bill, but it starts to cause confusion. In particular, the consultation document states:

“It may be appropriate to build in a very limited set of excluded treatments for which specific charging should still apply. These might include any or all of the following”.

One of those in the list is services for pre-existing pregnancies. As I said, that is not in the Bill, and that is why I want some clarification. As I read it, that seems to mean that women who have paid the visa charge and come to the UK already pregnant—presumably at whatever stage of pregnancy, whether they know about it or not—will nevertheless have to pay for treatment related to their pregnancy. Is that all treatment or some treatment? We just do not know, and the Bill does not provide any clarity on that. I wonder whether when those women get their visas they get a pregnancy testing kit at the same time to check whether they are pregnant.

A number of groups are to be exempt from paying the health surcharge on humanitarian grounds. We totally support that; it is absolutely right. The Department of Health said that that would include refugees, asylum seekers and victims of human trafficking—presumably, whether or not they are pregnant. I know that victims of trafficking will now be debated in a separate group, but I want to press the Minister on how this will work in practice, as there will be cases when they will present to the authorities only when they are pregnant. Trafficked women will not, by definition, have paid the charge. The UK Human Trafficking Centre suggested in its 2012 baseline survey that more than half of all trafficked victims were not referred to the relevant authorities for assessment, so how will we know who they are?

Specifically on domestic violence, what will happen to women who are trying to escape a violent relationship and who, in fleeing the home, are left without any evidence of their entitlement and no information on their immigration status? They may be UK citizens or have indefinite leave to remain but do not have the documentation. They have fled their home because of violence and to protect themselves and their children. Women who flee a violent partner often do so at the time of the most extreme circumstances that they can face. They will not have time to pack up their belongings, hunt for their passport, pack it into their bag, fold up their documents and bring those out with them. They are going to flee the home to protect themselves and their children so when they present for housing they will, if they are fortunate, be placed in a hostel or refuge. If I am correct, the Government are quite rightly exempting that. However, others will just run and, having run, will try to find suitable accommodation.

With the financial difficulties being faced by women’s aid groups across the country—I declare an interest in that I am patron of Basildon Women’s Aid—supply cannot always meet demand. What do the Government expect these women to do? How will they find accommodation? Will a sympathetic landlord be forced to turn them away if they do not have their documents and, if they are pregnant, where are they going to give birth if they have been turned away by a landlord? Where will their home be? A number of questions are being asked today, and I think that there will be many more from other noble Lords who have amendments in this group, about the implications of Clauses 33 and 34 for pregnant women and victims of domestic violence.

I have spoken to the Minister about this already, so he is aware of my concerns. However, we need far greater clarity about what is in the scope of the Bill and what has been just government rhetoric or other issues which the Government pretend they will take later. What is going to happen and how will it work in practice? I would find it quite helpful if the Minister could help me understand the position of someone who is here legally but who has not paid the visa surcharge—because they are here at present and that surcharge has not come in—and does not have permanent or indefinite leave to remain. What is their position regarding healthcare? I am assuming that transitional arrangements will make provision for that but I am not clear on how that will work in practice. If the Minister can shed any light on that, it would be extremely helpful.

[Baroness Cumberlege (Con)]

My Lords, I have two amendments in this group—Amendments 59 and 63. I declare my interests, which are in the Lords’ register.

We received a very interesting letter from my noble friend Lord Howe over the weekend. His letter explains that Clauses 33 and 34 are designed to break, or perhaps put a stop to, the activity of health tourism. It is absolutely right that we should do that. Having read his letter, I understand that estimates suggest that between £70 million and £300 million of costs—it seems to be rather a large gap—are attributed to people who deliberately travel to England to get free healthcare because their treatments are so expensive in their country of origin. In no way should we entertain health tourism; it should be detected and the individuals suitably charged. The NHS, as we know, is enormously generous and supported by us all through our taxes. The whole purpose is that we should contribute, through our taxes, to the well-being of our own country’s health.

I have had a long-time interest in maternity services. As the noble Earl, Lord Listowel, indicated in introducing his proposed new pregnancy and maternity clause, there really are few things more important to a woman than bringing a new life into the world. It is a journey of dramatic physical, psychological and social change; of becoming a mother, of redefining family relationships and in taking on the long-term responsibility of caring for and cherishing a newborn child. If the needs of child-bearing women and their babies are ignored, then not only are the physical, social and psychological long-term effects damaging to those concerned but the economic implications for the country are considerable.

--- Later in debate ---

[Lord Taylor of Holbeach]

I have to say that we are not looking to put people in that situation. Indeed, one would hope—this is the reason for the provision—that if people are here for a period of time, they have got cover for their healthcare. That is the whole point of the charge in the first place. If people come as temporary visitors then that is a slightly different position, but they make that choice. They make the choice to come here, and they carry the responsibility to do so.

Perhaps I may turn to some of the amendments. It is good that we have had this chance to talk about the principles behind the charging and I hope that it has clarified the position to some degree. However, there are points here that I think I need to clear up. The first is that the restrictions to services set out in Part 3 are designed to protect our services from illegal immigrants—people who are remaining here outside the law. Many of these provisions will have no impact at all on pregnant women who are in the UK lawfully. The Government are committed to ensuring that the new restrictions and charges in Part 3 are appropriately targeted and do not impose a disproportionate burden on either service providers or migrants.

I should like to address some other points regarding Amendments 59, 60, 63, 64A and 65, which seek to exempt pregnant women from the health surcharge or the NHS treatment charges. I fear that there has been a misunderstanding about the purpose of the surcharge and the manner in which it will operate. As I say, the surcharge will be paid by legal, temporary migrants who come to the UK for more than six months. Our policy intention is that those who pay the surcharge, including pregnant women, will not be subject to most other NHS treatment charges. That will include both antenatal and postnatal care. They will be charged only for services that a UK resident might also be expected to pay for.

Amendment 60 also seeks to exempt children under the age of 18 from the surcharge. This would undermine the general principle that temporary migrants should contribute to the NHS, commensurate with their immigration status. Children are as likely to need NHS care as anyone else. It is therefore reasonable to expect parents—and it would be parents—to make this contribution on behalf of their child.

We have seen the headlines about health tourism. I am afraid that Amendments 63 and 65 would exacerbate the problem of maternity tourism. They would allow any pregnant woman to use the NHS free of charge. The NHS is not equipped to supply free maternity services for the rest of the world, and I do not think that that is an unreasonable thing for a government Minister to say.

[Baroness Cumberlege]

Amendment 63, which I tabled, proposes four new subsections. Proposed new subsection (1A) states:

“Notwithstanding subsection (1), any pregnant woman shall be treated as ordinarily resident”,

and proposed new subsection (1B) states:

“However, subsection (1A) shall not apply where there is evidence the woman has entered the UK for the purpose of obtaining healthcare”.

I think that is quite clear. I am saying that people who apply here simply for the purpose of obtaining healthcare should normally have to pay. Perhaps the Minister will clarify that. I am still very concerned about the three examples I gave. Will he address them? The first is a woman who came in with her husband and the relationship has broken down. Is she now exempt from these charges? The second example is a woman who is destitute and living on the streets. If she becomes pregnant as a result of a sexual assault, is she exempt? The third is a woman who is married to a British man and has submitted an immigration application to the Home Office who becomes pregnant and gives birth while the application is being assessed. Is she to be charged? It is not just maternity services; it is the other services being introduced in this Bill, such as prescriptions, dental care and A&E.