Immigration Bill

Debate between Lord Clement-Jones and Baroness Williams of Crosby

Monday 3rd March 2014 Lords Chamber

[Baroness Williams of Crosby]

My Lords, the hour is late and there is much to say, but I will be brief in my remarks. Let me begin by declaring an interest as a member of the court of the University of Hertfordshire, which is very like what the right reverend Prelate had to say about the University of Bedfordshire—a very young, growing but exciting and expanding university in a part of the world which, rather surprisingly, has not got as many universities as exist around Oxford and Cambridge and London.

Let me be quick and say the following. I would like first to add one other distinguished name to the list given by my noble friend Lord Maclennan. It is a name worth thinking about for a moment, and it is of course that of the new President of Iran. He holds a postgraduate degree from Glasgow Caledonian University, and one has to ask oneself whether his much more enlightened view of global relationships has nothing whatever to do with the fact that he is one of the very few senior figures in Iranian society who has spent substantial time outside his own country, speaks good English and is interested in what is happening elsewhere. That is the kind of benefit, one which cannot be listed economically, that a country like ours gets from the very wide spread of its students from all over the world who, over the last generation, have attended universities in this country. Out of that has grown an abiding affection both for their university and for the country in which it happens to be located.

Let us be honest: there is a profound division of opinion within the Government on this issue. We all know that the department for business enthusiastically supports the idea of a substantially greater expansion of British universities. That department includes some able Ministers with considerable knowledge of higher education, and it knows one important thing. The important thing that it knows is that you can grow out of a university relationship a whole range of relationships with other businesses, public services and so forth across the front. The noble Lord, Lord Tugendhat, pointed to the effect of this kind of relationship on global attitudes. It allows us to extend our acquaintances and friendships all over the world.

I shall put this very particularly because the noble Lord, Lord Hannay, said something less dramatic than I am about to say. He pointed out quite rightly that the National Union of Students study, based on a careful poll conducted at the end of last year of more than 3,000 students in this country, is the best figure that he could get; it is a figure showing what undergraduates think. Some 51% of undergraduates have said that they think that this country is not welcoming to overseas students. The more drastic figure—more drastic for the reasons given by my noble friends Lady Hamwee and Lady Benjamin—shows that 66% of postgraduate students, people who have spent some time studying here, take the view that this country is unwelcoming to overseas students. These are the very men and women to whom the noble Lord, Lord Tugendhat, was referring when he talked about relationships with scientific, medical and cultural groups in this country. They have a valuable contribution to make, but increasingly they are being somewhat frozen out.

One of the worst examples of this is the playing around with visas, which means that students suddenly find themselves without a visa a matter of months before they are due to start their course, and no one repays them for the work they have done to get that visa in the first place. British visas are among the most expensive to be found in any country offering higher education in the whole of Europe. Our visa expenses are something like three or four times higher than those of our major competitors. Now we are going to add to that cost health surcharges, decisions about tenancies and a whole range of things, all of which are off-putting and not welcoming. I agree with my noble friend Lady Hamwee that this country has to make a great effort to retain this huge asset value in one of the few areas in which we still lead the world. It is to my mind almost totally irrational to make it harder and harder for our most effective industry, that of higher education, to expand, grow, root itself and be there for the distant future.

The reason for all this is that we have become so obsessed with immigration numbers that we can no longer see the larger picture. The great bulk of students, over 95%, who come here to study go back to their own countries, having fostered friendships and relationships with us. I shall give only one example before I stop. In this country we suffer considerably from a long increase in waiting times for people getting into, for example, A&E to look after accidents and injuries that they have. We used to have a substantial number of junior doctors serving in A&E, particularly those who came from countries like India, but elsewhere as well, who gained great knowledge of medicine and of our hospitals and made a huge contribution to a National Health Service that ran smoothly. Increasingly, those numbers are no longer there. In two years’ time we shall see A&E waits rise, and we shall ask, “How did this come to happen?”. The answer is right here and now. It comes to happen if we turn off the young medics who would like to come here, who would like to learn about how we work and about how our health service works and then go back to their own countries and spread that knowledge more widely.

So I end simply by saying that we have a profound schizophrenia in this country on this issue. I do not understand why it is not clearly seen to be of such advantage to us, to our own people and to those who come. We do not recognise that we should have the strength to face up to looking again at this extraordinary conflict that we look at all the time between different departments, different people and different individual political attitudes. We should look at it and say to ourselves that this is something that we do very well, something for which we have been admired, something which benefits the world and benefits us, and decide to get on with it and make our universities the core of one of our most rapidly rising and highest reputation industries.

[Lord Clement-Jones (LD)]

My Lords, I shall briefly add my support to both Amendment 26 and my noble friend’s Amendment 80. The fact is that overseas students are temporary migrants. They should be both treated and reported differently. These two amendments reflect that approach.

This debate is very timely. Last week, the net migration figures were published and none of the media coverage disaggregated the figures. I do not know what the Government’s original press release stated, but it seems that by publishing in that form they are simply creating a rod for their own back. Amendment 80 at least is an attempt to make sure that for some purposes, the student visa figures are clearly and publicly disaggregated.

The obsession with the original pledge to reduce net migration to tens of thousands seems to me and to many others in the university sector to be totally counterproductive in terms of its impact on our ability to attract foreign students. I and many others made clear on Second Reading that we are in danger of an adverse impact both in economic terms and in terms of the soft power to which the noble Lord, Lord Hannay, and my noble friend Lord Maclennan referred. As we heard from the noble Lord, Lord Hannay, the total number of international students coming to the UK fell for the first time last year.

The number of voices that we have heard over the past two years, not just in this House, has been legion in that respect. In 2012, 68 representatives of universities wrote to the Government urging that these figures should be disaggregated for public policy purposes. The Business, Innovation and Skills Select Committee did likewise. The noble Lord, Lord Hannay, referred to the five chairmen of Select Committees. All the aforementioned are powerful voices recommending that for domestic policy purposes, overseas students should not be counted against the overall limit on net migration.

Contrary to that, the Government’s response to the Business, Innovation and Skills Select Committee’s report stated that they were following the same practice as the US, Canada and Australia, our main higher education competitors. That is simply not the case. Those countries do exclude students, treating them as temporary migrants for domestic policy development. It is high time that we did likewise—failing which we are going to find that we are in grave difficulties over our ability to attract these students in future.

Health and Social Care Bill

Debate between Lord Clement-Jones and Baroness Williams of Crosby

Thursday 15th December 2011 Lords Chamber

[Lord Clement-Jones]

My Lords, I shall intervene briefly before my noble friend Lady Williams sums up on her amendment. What the Minister just said about this relationship between governors and directors and the advancement of the principal purpose of a foundation trust added another dimension. It is not so much the question of the majority of income or of patients coming from the private or the public sector that is important. That is simply a test for competition law purposes. The issue is whether the principal purpose of the foundation trust remains within a social purpose. The element of solidarity established by FENIN is there and it is therefore at less risk of falling totally within EU competition law as an undertaking.

The Minister’s comments bear considerable study, but what he has said does not completely take us out of the risk area. I know he does not use the word “risk” in relation to EU law applying further, but that is certainly the mindset of a number of us looking at these provisions, particularly in relation to the cap. It is the question of social purpose and solidarity that is crucial in law, and the question of whether what my noble friend has done to date is sufficient. I will obviously read his comments carefully but I do not think we are quite there yet.

[Baroness Williams of Crosby]

I am happy to withdraw the amendment, but I would like the Minister to consider very carefully the words of my noble friend Lord Clement-Jones because my impression is rather the same as his, although on a much weaker basis of expertise. On the one or two occasions when I visited the Commission to discuss this matter, I had a strong sense that social purpose is one of the main criteria that they look at in deciding whether something counts in the area that captures competition law in the EU. I cannot speak about the Competition Commission in England because I do not have enough expertise to do so, but I hope that the Minister will consider what my noble friend has said because I believe that it is a crucial factor for the EU Competition Commissioner.

[Earl Howe]

My Lords, I am very happy to consider all these issues in the context of the discussion that my noble friend Lord Clement-Jones and I are going to have on EU competition issues generally.

Health and Social Care Bill

Debate between Lord Clement-Jones and Baroness Williams of Crosby

Tuesday 13th December 2011 Lords Chamber

[Lord Warner]

Is the Committee happy for me to continue? I consider that research evidence as is available, such as that carried out by Dr Zack Cooper at the LSE, shows the benefits of competition and supports the view that competition, when used sensibly, improves services for patients and can indeed save lives. It is perfectly possible to support both competition and integration; they are not mutually incompatible. I shall not pursue the evidence base for my views today. However, I should like to clarify briefly the circumstances in which we should be supporting the use of competition in the NHS in the best interests of patients and why it is important to tackle barriers to entry to the NHS market. It is important to recognise that we already have an NHS market in which many NHS providers do indeed compete for patients against other NHS providers. The Bill does not suddenly inject competition into the NHS but merely tries to impose some better rules and a system for regulating that competition.

There are basically three sets of circumstances in which competition could—not should—be used. The first is that, as a matter of principle, all NHS providers should be subject to market testing periodically. The second is when there is clear provider failure and it seems sensible to test the market to establish the best set of arrangements for replacing the failed incumbent. The third is where there is a set of circumstances when the NHS itself—the commissioners in practice—wish to change significantly the way in which services are provided and it is not apparent that the current incumbents can adjust quickly to the patient’s needs. The first set of circumstances has often caused a great deal of angst in the discussion of competition. I certainly do not start from that position. I believe that it is the second and third areas that I have described where we need to examine whether there are real barriers to entry by new providers, irrespective of whether those providers come from elsewhere in the NHS—from the private sector, social enterprise or the voluntary organisations.

Amendment 266 is concerned to establish much more clearly than now what the barriers to NHS market entry are. We know from the work of the collaboration and competition panel that primary care trusts have behaved in anti-competitive ways and have frustrated the best interests of patients. We know from the experience of the East Surrey nurses when they tried to set up a social enterprise how frustrated they were at changing themselves from NHS employees into a social enterprise so that they could compete for NHS business. We know that across the voluntary sector, voluntary organisations have been frustrated over their attempts to compete for NHS services over a long period of time. We also know that many private providers of services find the tendering processes for providing NHS services prolonged and excessively expensive and that they are too often frustrated by shifting political opinions about the desirability of competition.

I could go on with examples of the way in which the NHS has effectively shut the door to new entrants. Some of the most recent examples are the ways in which many primary care trusts divested themselves of their provider services without any proper system of market testing when it was clear that many of those services were extremely inefficient. We need to take the NHS out of its comfort zone in a future where it faces a huge set of demographic and financial challenges. Keeping it in the NHS family is no longer acceptable or in the public interest. We need an independent, authoritative and robust analysis of the barriers to entry to the NHS market so that we can consider what action should be taken to remove those barriers. Amendment 266 proposes that Monitor does this within a year of Royal Assent. I believe that Monitor would welcome being given this assignment but I would be more than willing to consider alternatives if the Government thought, for example, that the Office of Fair Trading was a more appropriate organisation to do the job. It is important that we get this job done as speedily as possible. I also support Amendments 278 and 287 to which the noble Lord, Lord Patel, will be speaking and to which I have added my name.

[Baroness Williams of Crosby]

My Lords, I am very grateful that Amendment 265C has somehow managed to escape from the tsunami of amendments so that I can bring it to the Committee’s attention very briefly. It is again an amendment that seeks to make sure that when competition is allowed or encouraged—the noble Lord, Lord Warner, has spoken on these lines himself—it should be because it clearly improves the quality of health and the quality of provision within society as a whole. The purpose of Amendment 265C is to make it clear that competition is welcome when it improves the quality of the service; it narrows inequalities; it ensures, in particular, that there should be a better outcome as a result of that competition; and it is, therefore, a relatively qualifying condition to permitting competition to flourish.

We have heard a number of very well informed speeches in the House, not least from the noble Baroness, Lady Meacher, to the effect that in some situations competition can clearly encourage innovation, can improve new approaches and can help in providing the NHS a way forward to deal with the huge problems that we all recognise exist. However, in large part we are also very worried about the idea of competition as the ruling principle of the health services in this country, and we heard a very moving set of evidence from the noble Lord, Lord Owen, and the noble Baroness, Lady Thornton, about the devastation that unrestrained competition can exercise on a health service.

However, having spent 10 years of my life in the United States, I absolutely corroborate that. I know far too many people, one or two of whom are National Health Service refugees to this country, of outstanding talent, who are not in a category where they can afford the huge prices that are charged for complex and chronic conditions in the United States. How do we achieve this difficult balance so as to have competition that improves the quality of the health service but does not bring about the devastation of a great many human beings because they simply cannot afford the cost of complex operations or looking after the chronically ill? The situation of the chronically ill in the United States is pathetic in very many cases.

Therefore, this amendment and several others in this group would enable us to walk this delicate line in a way that permits competition, but competition that is in the interests of the patients of the health service and not competition that could devastate the health service itself.

[Lord Clement-Jones]

My Lords, I wish to speak to Amendment 287B. In his speech at the outset of today’s debate, the Minister said that there were four areas where he was considering amendments to Part 3, which deals with Monitor. If memory serves, he said there were areas where the Bill had not been completely amended to conform to the Future Forum report. This is a particular example of that.

Clause 96, the supplementary conditions, says it is possible for Monitor to include conditions that require,

“the licence holder to do, or not to do, specified things or things of a specified description … within such period as may be specified in order to prevent anti-competitive behaviour in the provision of health care services for the purposes of the NHS”.

Of course, that mirrors the duties of Monitor as set out in Clause 59, which says:

“Monitor must exercise its functions with a view to preventing anti-competitive behaviour”—

so far, so good. However, Monitor also has a duty to,

“exercise its functions with a view to enabling health care services provided for the purposes of the NHS to be provided in an integrated way where it considers that this would”

improve quality and so on. There is no mirror of that particular duty in the supplementary conditions in Clause 96, which is why this amendment adds the following wording:

“or for the purposes of encouraging the integration of services in the interest of people who use such services”.

A number of other examples are the subjects of amendments as well and will no doubt come up in the course of the Bill. It seems to me that the equal and opposite to the anti-competitive duty of Monitor, which is enshrined in the ability to set conditions and so on, is not mirrored in the integration of services, and this is an extremely good example of that. I very much hope that the Minister will be able to indicate that it is simply an oversight and it should be included in the Bill.

Health and Social Care Bill

Debate between Lord Clement-Jones and Baroness Williams of Crosby

Tuesday 13th December 2011 Lords Chamber

[Baroness Williams of Crosby]

I would like to address just one of the amendments in this group, which is in my name and that of my noble friend Lord Marks of Henley-on-Thames. Unfortunately my noble friend has been taken ill and is unable to be here. He extends his profound apologies to the Committee.

This amendment is significant in strengthening the general approach towards competition under Section 3 of the Bill, by making it quite plain that the requirements that have to be met, which we will come to in Part 4, must also apply to licence holders. I am in a slight difficulty, as my noble friend Lord Howe will appreciate, as the Government have tabled amendments on aspects of foundations trusts which will arise at a later stage in the Bill, particularly under Clause 161, which are related to the amendment to which I am now speaking. I will therefore do my best to navigate around Clause 161 in so far as I can. However, I may have to make limited reference to it in order to make clear what my own amendment is about. My own amendment is essentially one that would support, and indeed further improve, the proposals put forward in this particular amendment. They should therefore be read together with Clause 161 and Amendments 299ZA and 299AZA in the name of the Government.

We want to make two requirements as a fundamental part of the requirements that licence holders have to meet. We appreciate that, in many ways, the licence-holding requirements are fundamental to the way in which the Bill operates, because it must be the case that providers are brought within the general structure of the Bill itself. Our amendment makes two particular points about that. The first is that the revenue from private patients, as a percentage of the licence holder’s total revenue, must be kept below 50 per cent. Secondly, and at least as importantly, the number of private patients in a foundation trust hospital must also be kept below that proportion.

The main point of this amendment—I think that it is an important one—is again to establish that we are looking at foundation trusts that are part of the provision under the NHS and that a minority of both income and patient numbers would be required for any provision made. We hope, as I think the noble Baroness said, that this set of requirements continues well beyond 2016 as part of the structure of the relationship of foundations trusts to the health services, and that this is therefore not standing alone but a crucial part of the whole strategy.

If the noble Lord, Lord Owen, were in his place, I would say that if this is not the rail track of the French railways, it is at least the rolling stock, and we need both to have an effective railway service. However, I wanted to say one other thing. The first part of the amendment tabled this morning by the noble Earl, Lord Howe, goes a very long way. We will talk about this in more detail later so I shall only sketch it out now, given the time. I think that the first part of the amendment, with regard to income—and indeed the requirement that income must exceed the costs of providing that income, and that it must be used for the purposes of patients within the health services—is a very full and useful advance. It is very close to the phrasing of the 2006 Act, which is a point that I am sure will come across to the noble Baroness, Lady Thornton, and her colleagues, but with the additional wording that makes it, if anything, even stronger.

The noble Earl, Lord Howe, will know from discussions which I and my colleagues have had with him that we would want to see this supplemented, if possible, by a reference to the proportion of patients in foundation trust hospitals. Quite broadly, that is something the public can understand, whereas references to quite complicated percentages of income, although equally important—if not more so—are perhaps less transparent and less apparent.

I will not pursue further the new amendments beyond welcoming them, but I want to advance this particular, although limited, amendment as thoroughly as I can, as I think it would ensure that licence holders were held to the same kind of requirements that we are imposing upon Monitor, the national Commissioning Board and the CCGs. It must be the case that this should be a common approach across the front.

[Lord Clement-Jones]

My Lords, I shall be brief. I wish to speak to Amendments 281A and 288ZA, to support my noble friend on Amendment 287EA and to speak to Amendment 287A.

Amendments 281A and 288ZA deal with what are clearly major decisions that will be made by Monitor. The first is the exemption from licensing, which requires notice to be given, and the second deals similarly with the particular standard licence conditions that may be modified. Currently the Bill provides for 28 days’ notice to be given, but these are major issues, and although this is a probing amendment, I hope that the Minister will be able to give a good explanation as to why this period should be so short. Obviously one does not want to have undue delays, but there are quite a number of stakeholders who are bound to be involved in this and it does look rather like a rushed job. So this amendment provides for 90 days to be the standard term for notice to be given.

I move on to Amendment 287A. This amendment simply permits—indeed, requires—the insertion of a standard condition in the licence that the licence holder should,

“abide by the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life”—

the so-called Nolan principles—and requires,

“the declaration of any financial interest the licence holder may have in a commissioning decision by a clinical commissioning group”.

Nowadays that is increasingly standard. I will not prolong the debate, as we have already had considerable discussion in the course of this Bill about conflicts of interest and the need for transparency in these circumstances. However, I would have thought that licence holders, who essentially will be providers across the whole service, should be under a heavy duty of transparency in order to ensure that they do not have a conflict of interest.

Coming to Amendment 287EA, my noble friend Lady Williams has eloquently set out the issues. What is really required in these circumstances is for the Minister to rebut the presumption that we not only need a provision about the actual total revenue, but also about the number of patients actually treated by a provider. This provision is a belt and braces against the provisions of EU competition law. It is extremely well drafted. I take no credit at all for that, it is my noble friend Lord Marks at work here. We will be discussing the Minister’s very welcome amendment later, but it does not contain the second limb of this particular amendment. It would be useful if the Minister could address this in due course, whether under this group or in the later group, as I recognise the difficulty that my noble friend Lady Williams has also recognised, that this is not grouped with Amendment 299A and probably should be.