Immigration (Health Charge) (Amendment) Order 2020

Baroness Williams of Trafford Excerpts

Wednesday 23rd September 2020 Lords Chamber

Moved by

[Baroness Williams of Trafford]

That the draft Order laid before the House on 21 July be approved.

Relevant document: 24th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, as we have all witnessed during this pandemic, our National Health Service is one of our country’s greatest assets. It has been a shining beacon of hope in this time of need and we could not be prouder of it. For those who live in the UK, it is the contributions made over the course of their lives that enable our NHS to continue its fantastic work.

We value the contribution of everyone who comes to the United Kingdom. It is a simple fact, however, that temporary migrants will not have built up the same contributions as a permanent resident of the UK. We therefore believe it is right that they make a fair contribution to the NHS’s sustainability. That is why we introduced the immigration health charge in April 2015. The charge is currently paid by non-European Economic Area temporary migrants who apply for a visa for more than six months. It also applies if they wish to extend their stay in the UK for a further limited period. The charge is separate from the visa fee and is paid up front and in full for the length of leave granted.

From their point of arrival in the UK, a charge payer can access NHS services in broadly the same manner as permanent residents. This can be without ever having made any tax or national insurance contributions in the UK. They pay only those charges a UK resident would pay, such as prescription charges in England. They may also be charged for assisted conception services in England, should they choose to use them. To date, the charge has raised more than £1.5 billion for the NHS. This much-needed income is shared between the health administrations in England, Scotland, Wales and Northern Ireland, using the formula devised by Lord Barnett.

As noble Lords will all be aware, next year the new points-based system will be in place. This means that all migrants to the UK will be treated the same and will pay the charge if staying for longer than six months. The current exemptions, including for certain vulnerable groups, will continue to apply.

The Government recognise the value and importance of migration. We welcome talented individuals and are immensely grateful for the contribution they make to this country. However, it is only right that migrants contribute to the wide range of NHS services available to them.

Last year, the Government’s manifesto committed to increasing the annual amount of the charge to a level that would broadly reflect the cost of treating those who pay it. In line with that commitment, this order amends Schedule 1 to the Immigration (Health Charge) Order 2015. The Department of Health and Social Care has estimated that the cost to the NHS of treating charge payers in England is £625 per person, based on analysis carried out in April 2019, which used 2017-18 NHS England data. To support the administration of the charge, the new level would be set at £624 per person per year. As before, students, dependants of students and youth mobility scheme applicants would pay a discounted rate. This would increase from £300 to £470 per person.

The Government are aware the charge has a greater financial impact on family groups than on individual applicants. To support families, a new, lower rate would be introduced for those under the age of 18. This would be set at £470 and would be in line with the rate for students and those on the youth mobility scheme.

The Government are committed to supporting our NHS and health and social care workers, not least because of the vital role they have played during this pandemic. In May, the Prime Minister asked the Home Office and the Department of Health and Social Care to work together to exempt these workers from the immigration health charge. This order amends Schedule 2 to the principal order to provide an exemption for tier 2 general health and care visa applicants and their dependants. The tier 2 general health and care visa is for eligible health professionals, including doctors, nurses and allied health workers. These are people working in the NHS, for organisations commissioned by the NHS to provide essential services and in the adult social care sector.

The visa was launched on 4 August. It is a fast-track visa, offered with reduced application fees. Until such time as a formal exemption is in place for this group, the Secretary of State has waived the requirement to pay the health charge. In addition, tier 2 migrants who paid the health charge on or after 31 March 2020 but who would have qualified for the new health and care visa had it been in operation at this time, are being refunded.

Migrants who work in the NHS and wider health and care sector and who paid the charge on or after the 31 March, but who do not qualify for the health and care visa, may be eligible for reimbursement of the charge. On 15 July, the Minister for Health announced that this scheme will be launched in October. More details will be published by the Department of Health and Social Care shortly.

Now, more than ever, we need to ensure that the NHS is properly funded. The health charge is designed to benefit the NHS and to support its long-term sustainability. We are indebted to overseas health and care professionals and it is right that they are exempt from the charge or have their payment reimbursed. For those migrants who come to the UK to work in non-healthcare related roles, it is only right that they should continue to pay towards our health service through the health charge. The government manifesto, as voted for by the public, committed to increasing this charge. The order delivers that commitment and I commend it to the House. I beg to move.

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[Baroness Williams of Trafford (Con)]

My Lords, I thank all noble Lords who contributed to what was quite a quick debate; nevertheless, they were thoughtful and insightful contributions. The health charge remains an attractive offer for migrants. It provides near comprehensive access to NHS services without further charge, regardless of the amount of care needed. It is not there to reduce migration, as the noble Lord, Lord Paddick, attests; moreover, it ensures that migrants do not need to worry about meeting the cost of unexpected treatment or arranging health insurance, which, for some people with health conditions, must be costly.

I turn to some of the specific issues that were raised. As set out in our manifesto, the Government believe that the health charge rate should broadly reflect the cost of treating those who pay it. However, the rates for students and those eligible for the youth mobility scheme will continue to be discounted. As I said, a new discounted rate for children will be introduced. The increased surcharge will continue to represent a very good deal for migrants who pay it, given the range of NHS services that can be accessed without further charge. The cost compares favourably to private medical insurance here and abroad, which is a common requirement for individuals wishing to migrate to many other countries.

We are really grateful to our essential workers and key workers who have performed such a public service throughout this pandemic, including emergency service workers, transport workers, teachers, delivery drivers, supermarket workers and many others. However, it is only fair to expect people arriving in the UK who work in non-healthcare roles to make a contribution to the full range of NHS services they can access from the point of arrival.

I will talk a bit about the reimbursement scheme, because the noble Lord, Lord Rosser, touched upon it. Tier 2 migrants who paid the health charge on or after 31 March 2020, but who would have qualified for the new health and care visa had it been in operation at this time, are being refunded. Migrants who work in the NHS and the wider health and care sector and who paid the charge on or after 31 March but who do not qualify for the health and care visa may be eligible for reimbursement of the charge. In July of this year, the Minister for Health announced that this scheme would be launched in October. As I said earlier, more details will be published by the Department of Health and Social Care shortly.

Volunteers have been raised today and previously, and we absolutely pay tribute to the contribution they make to our communities. The Department of Health and Social Care is considering who will be eligible to apply for the surcharge reimbursement scheme and will publish that information shortly.

On tier 2 refunds, tier 2 migrants and their dependants who paid the health surcharge on or after 31 March of this year are, as I said previously, being refunded. Those who believe they are eligible for a refund on this basis may contact the Home Office; the relevant contact details are available on the GOV.UK website.

The noble Lord, Lord Rosser, and others talked about the impact on families and young people and the total cost of the applications people are faced with paying. I am absolutely aware of concerns regarding the combined costs—I think the noble Lord, Lord Paddick, raised this—of both the health charge and the visa fees, and the impact that this might have on families and young people in particular. The Government are committed to ensuring that the surcharge remains affordable for family groups and intend to provide, through this draft order, a reduced surcharge rate for children. The Government are clear, however, that migrants must pay the charge when they make an immigration application and should plan their finances accordingly.

The noble Lord, Lord Rosser, talked about those in a vulnerable situation, perhaps facing destitution. There is a fee waiver in place for those making specified human rights applications who are destitute or at risk of imminent destitution. Where the fee is waived, the requirement to pay the health charge is accordingly waived also. If you can demonstrate that you do not have adequate accommodation or any means of obtaining it, or cannot meet other essential living needs, that would be considered destitution.

The noble Lord, Lord Paddick, asked what cut the Home Office takes of the £624. I do not know if the Home Office does take a cut; he is asserting that it does. I do not have the answer today, and I will find that out for him. However, as to how the Government estimate the cost to the NHS of treating the charge payers, that was produced by the Department of Health and Social Care. Not to buck-pass, but the cost was produced by the DHSC, based on analysis it carried out in April 2019 using—the noble Lord is absolutely right—2017-18 NHS England data. I do not know how that data differs from the following year, but I will find out, and therefore get a more up-to-date picture for the noble Lord. The small increase from the previous analysis was mainly driven by health inflation and updated data. Mindful of the need to ensure that the surcharge is not set above cost recovery, the Government have decided to set the surcharge at £624 per person per year.

The noble Lord, Lord Mann, asked about recharging. It is something that has exercised me in the past: we pay ever so much and we get so little back. I do not know what the up-to-date figures are—he tells me £49 million versus £600 million, which is quite a gap indeed—but clearly it is a matter for the NHS to collect the money. The noble Lord is nodding in an exasperated way—he knows that. If I can, I will get him more information on what the up-to-date figure might be.

The noble Lord, Lord Rosser, asked how we are targeting people affected by the change. We are looking to engage as many eligible people as possible through various means of communication.

The noble Lord, Lord Blunkett, talked about other people who may not be eligible but who have played their part in tackling the pandemic. While currently a subcategory of the tier 2 immigration route, the health and care visa offer will form part of the future skilled workers route. We intend to review the list of eligible occupations that can benefit from the offer to reflect the introduction of the expanded skills threshold, ensuring that those health and care professionals who meet the skills threshold can benefit from this offer.

I hope that I have answered all the questions. If I have not, I will follow up in writing.