Immigration Bill

Lord Patel Excerpts

Monday 10th February 2014 Lords Chamber

[Lord Patel (CB)]

My Lords, perhaps I may start by saying to the noble Viscount, Lord Eccles, that all Patels are brothers and sisters, and that they never do anything illegal knowingly.

To get back to more serious matters, I guess that the Minister must be heartened that we are nearly half way through.

[Lord Winston (Lab)]

We are not even half way.

[Lord Patel]

He will not have heard many supporters of this Bill and he is not likely to hear more. I will try not to repeat much that has already been said but I hope to add to it. Noble Lords must not misunderstand me: I feel strongly about the issues already raised, particularly those related to universities, students and health charges. I will also mention briefly the effect that the Bill may have on other vulnerable groups, particularly pregnant women and children.

I declare an interest: I am chancellor of the University of Dundee and, rather unusually, still hold a professorship at the same university in obstetrics. Fortunately, I have not been called on for any services to be delivered for a while.

As has already been mentioned, Universities UK, which represents vice-chancellors of bona fide universities—we are not talking about bogus universities which might be mentioned in the “Panorama” programme—feels strongly that a Bill that will,

“remove appeal rights for students and staff applying for further leave to remain … introduce a surcharge for access to NHS services … require private landlords to check the immigration status of their tenants … increase the scope for government to raise fees for visas and immigration services”,

is fundamentally flawed. It believes that,

“it would be in the wider interests of the UK to exempt international students from the effects of the Bill”.

I would add postgraduate students to that list.

It has already been mentioned that, according to government figures, international students in higher education contributed £10.2 billion to the UK economy. We have already heard that it has been recorded for the first time that there was a drop of about 1% in students in 2012-13. To give some more detailed figures, as regards the total entrants by subject from non-EU countries, in STEM subjects there was a drop in 2011-12 of 8% and a further 2% in 2012-13. These are official figures.

In some STEM subjects, for instance in veterinary science, there was a 22% drop; in medicine and dentistry, there was a 6% drop; and in computer science, there was an 11% drop. While the drop has not been as significant in some non-STEM subjects, a trend is beginning to show. It is even demonstrated in postgraduate students and, more importantly, it is now beginning to show in research students. What is fundamental is that the trend is downwards.

We have to ask why, when people like me once considered the United Kingdom to be the prime place to go for undergraduate and postgraduate education, they now are trying to go somewhere else. It is a compound effect of the visa restrictions, increased charges and now the other charges that this legislation would impose. Some 32% of post-docs are from non-EU countries. They often come with their families. This Bill will make it more expensive for them.

Much has already been said about students and I support all that, so I come now to Clauses 33 and 34, which relate to NHS charges. I fully accept that there is a need to protect the public purse by limiting access to healthcare in some circumstances and preventing the deliberate misuse of scarce resources. However, any measures we introduce should be practical, necessary, appropriate and, to borrow the words of the noble Baroness, Lady Smith of Basildon, evidence based. The Bill introduces a change to the residency criteria in Clause 34 so that eligibility for free NHS services is dependent on migrants having indefinite leave to remain. How many migrants who do not have indefinite leave to remain are working, paying tax and making national insurance contributions? Is it equitable that they should also pay the charges?

I am also concerned about the equity of these changes as there are significant variations in the time it takes for individuals to become eligible for indefinite leave to remain. The introduction of the health surcharge could also make the UK a less attractive destination for skilled workers from outside the EEA, particularly in shortage areas such as the National Health Service. Everybody here is familiar with the sight of lots of doctors and many more nurses from non-EU countries in our hospitals. They might have come here to train and remained here.

There are other issues too. The rationale given for the changes, in the impact assessment accompanying the Bill, is that the current arrangements are too generous and leave the NHS open to abuse. The Department of Health commissioned a two-phase independent audit of visitors and temporary migrants using the NHS. The Government brought in the legislation based on this. I am concerned that the Government’s proposals could create unintended drawbacks for the NHS and for patients in particular. The proposals are likely to create a complex patchwork of charging and access entitlements where some services, such as GP appointments, remain free while others, including A&E visits, will be charged for.

The Bill also introduces changes to residency criteria so that eligibility for free NHS services depends on migrants having indefinite leave to remain, as I already mentioned. However, a medical student who comes to the UK on a Tier 4 visa and remains on that visa for seven or eight years to finish the undergraduate course and then goes on to a Tier 2 visa because he needs postgraduate training would take 10 to 12 years to get indefinite leave to remain. Is that equitable? Why should he be penalised for 10 years?

I am also concerned that proposals for a health surcharge in Clause 33 risk having a negative impact on the UK’s attractiveness as a destination for skilled workers, particularly in shortage occupations where the economy cannot find sufficient workers either from the UK or the EEA workforce. In the UK, consultants in emergency medicine, haematology and old-age psychiatry are on the shortage occupation list. Non-consultants and non-training medical posts—most of the junior doctors you often see in the hospital—in anaesthesia, general medicine and psychiatry are also on the list. There are many more specialties now being added because of the shortage. The health surcharge, when combined with visa application fees and maintenance requirements, risks having an impact on the UK’s ability to attract high-quality migrants in medical jobs on the shortage occupation list. This could clearly have a negative impact on healthcare.

The Bill also includes provision for migrants who have paid the health surcharge to be able to access free NHS care to the same extent as a permanent resident. However, it also allows for exclusion from free access to be specified for particularly expensive discretionary treatments. It is not stated why, if the initial payment is considered to be fair, appropriate and comprehensive, there will also be discretionary payments for some high-risk conditions and the Bill does not state what they are. It gives the overall impression that, if you want to come to this country for study or work, it will cost you.

The issue of pregnant women was mentioned by the noble Lord, Lord Avebury. There are potential health impacts for pregnant women from Clauses 33 and 34. The proposed changes will deter some pregnant women from seeking and accessing maternity care. This will have a negative impact on the health of these women and their babies and perversely will lead to a need for more medical care at a greater cost. Charges at the point of care create risks that women will not present to the NHS, will present late in pregnancy or will be denied access because of their inability to pay. This prevents midwives and doctors from giving the appropriate health advice and treatment early in pregnancy. It cannot be right to include pregnant women.

The newspaper headlines say that the number of babies born to immigrant mothers is increasing, but the papers do not clearly define immigrant mothers. I guess anybody who is not white might be an immigrant mother. Anybody who might be white but is known to come from another European country will also be regarded as an immigrant. An exemption from NHS charges for all pregnant women and children is required in this Bill.

In short, I hope that we will see all students and postgraduates removed from this Bill before it becomes law and that NHS charges for pregnant women and children will also be removed. That is what I hope the Minister will accept and what I will be looking for in the amendments I will bring.