Immigration Bill

Lord Patel Excerpts

Monday 10th March 2014 Lords Chamber

My Amendment 63 is carefully drawn. It identifies women who should not pay charges but does not restrict the Secretary of State adding to the categories, should he wish. It also gives him flexibility through guidance, and it gives discretion to providers of services in identifying whether there are reasonable grounds about whether charges should apply in certain circumstances. My concern is that, in trying to deter pregnant women from health tourism, the ultimate result will be that we will be left with a higher bill to pay nationally and will cause considerable misery on the way. I look forward to my noble friend’s reply.

[Lord Patel (CB)]

My Lords, I shall speak to Amendment 59, which stands in the name of the noble Baroness, Lady Cumberlege, and to Amendment 60, which stands in my name. I have added my name to Amendment 59. I also strongly support Amendment 63, which stands in the name of the noble Baroness, Lady Cumberlege, and other noble Lords. I would have added my name to it, but another Lord Patel—the noble Lord, Lord Patel of Bradford—beat me to it. I think the priorities were wrong there, but never mind. It just shows that Amendment 63 has wide, cross-party support in the House.

I declare my interests. I am on the specialist register of the General Medical Council as an obstetrician. I also hold the position of professor of obstetrics at the University of Dundee. The noble Baroness, Lady Cumberlege, gave a long list of reasons why pregnant women should be seen early in pregnancy, and I could add another 500 or more, but I do not want to recite a textbook of obstetrics and antenatal care. It is important that every pregnant woman is seen as early as possible during pregnancy if we are to prevent problems occurring later in pregnancy for her and her child’s well-being. It is important that she is seen early so that problems that are occurring are identified early and can be treated early to prevent serious complications developing later. As the noble Baroness, Lady Cumberlege, said, in maternal mortality reports, it is the women who are seen late in pregnancy who develop the most complications and even die. Hence anything we do that will prohibit or prevent women from being seen early in their pregnancy will be wrong.

As for health tourism, the visitors are not part of this levy or these charges. It is likely that the so-called childbirth tourism occurring here, often referred to by some hospitals as the “Lagos shuttle”, is about visitors and not those seeking to enter this country on different visas. I therefore hope that the Minister will look again at why pregnant women are included in the levy and charges.

My Amendment 60 includes not only persons who are pregnant but also children. To clarify, I included children under 18 because, currently, children under 18 in this country are exempt from NHS charges. Of course, I realise that, in terms of risk, children under five years old are different from children aged five to 12 or, for that matter, 12 to 18. As no other noble Lord is likely to speak about children, although the noble Earl, Lord Listowel, referred to them briefly, I intend to speak at length only to demonstrate how important children are and what harm the levy, or imposing charges on children, could possibly do.

My amendment would exempt children from the migrant health levy when they apply or are included as dependants in an application for leave to enter or remain. The levy is to apply generally to visa applicants who are students, workers or families, but not visitors. Currently, it is intended that payment of the levy will provide the applicant with free access to all NHS services for the duration of his or her visa. As the noble Baroness, Lady Smith, said, we need clarification about whether the levy means that they will get all NHS services free of charge. There is a lot of confusion about that. For instance, Clause 33(4) makes it clear that there is no guarantee that restrictions on access to particular services will not be introduced. Clause 33(3)(e) includes a power for the Secretary of State to make exemptions from the levy. However, it is not clear in the Bill what the consequence of such an exemption would be. Without more, it appears that a charge would be made where a child exempted from the levy needed to access NHS services, save for any services which regulations may exempt from charging.

As to which services charges will apply, the intention is that this will include primary and secondary care services, including accident and emergency services. GP consultations will be free, although it is unclear whether any treatment that may be delivered by or via the GP will be free. Treatment for specified communicable diseases and sexually transmitted infections will be available. It is yet to be decided whether any, or how many, mental health services will remain free. There is a great deal of doubt.

The Department of Health response to last year’s consultation on migrants’ access to NHS services recorded,

“widespread support for exempting all children, not just those in local authority care, from charging”.

However, the Government then concluded:

“We do not intend to establish an exemption for children as we believe this poses a significant risk of abuse by visitors seeking treatment for children … Vulnerable children, such as victims of trafficking, those seeking asylum, and migrant children in local authority care currently receive free healthcare and will continue to do so. We will listen to arguments about how best to cover other vulnerable children who might otherwise be denied treatment”.

Can we know what this group of “other vulnerable children” will be? To me, all children of a certain age are vulnerable.

--- Later in debate ---

[Baroness Smith of Basildon]

I apologise for interrupting the Minister, and I am grateful for his response to my queries. I am still slightly confused on the issue of pregnant women. I think that he said that the Bill allows for such charges but there is no intention to make them. If I have that wrong, perhaps he could clarify it for me. The only reason it has been flagged up is that the public health consultation mentioned additional charges. I want to be absolutely clear that if a woman has paid the surcharge, there is no additional charge to be made. I may have misunderstood, but what he said seems slightly contradictory.

The other point is on transitional arrangements. If someone is already here legally, my question is about the practicality and workability of the measures. How will we be able to distinguish between someone who has paid the surcharge but is here illegally and someone who is here legally but has not paid the surcharge?

[Lord Patel]

If the Minister will allow me, before he answers the noble Baroness, can I make something clear? We keep confusing surcharge with levy. Let us talk about the levy that will be imposed on people coming here who are not visitors. Once that levy has been paid, it will allow them to access all health services. Is that quite clear?

[Lord Taylor of Holbeach]

Yes, that is exactly right. They will have the same access to health services as is available to a permanent resident. That is the whole purpose. It is administratively a tidy arrangement; it is straightforward and easy to police; and people will be paying it at the same time as they apply for their visa. Their visa application will show that they have those rights, so if anyone seeks to charge such a person, they will not be chargeable because they will have a clear right to free healthcare, just as the noble Lord and I would.

It is really important to emphasise that point, because the whole point of having the levy, the charge or whatever we call it, is to provide a contribution from people who stay here and may impose some cost on the health service but to avoid asking them for payments for services provided or to take out an insurance policy before they come here to cover any chance that there will be health costs. It will be an asset to the health service in the sense that it will provide money to support the health service. It also regularises the position of the individuals involved. I hope that that satisfies the noble Lord.

[Lord Patel]

It does, but I wonder whether this is new policy thinking, because much in the Bill, particularly in this part, implies that the Government want to be able to impose charges for other things.

[Lord Taylor of Holbeach]

I do not think so. I think that the Bill’s provisions are purely about health service charging for those who come here for a fixed term of six months or more and who are not here as visitors. It clearly differentiates between those who are here legally and with proper documentation and those who are illegal, so it will make it more difficult for those people who are here illegally to avoid the implication of their illegal presence here in the United Kingdom. We should remember that most people who are here illegally are overstayers; they are not people who have come in but people who should have gone home. That is one thrust behind the legislation.

--- Later in debate ---

[Lord Taylor of Holbeach]

They will have access currently, as the noble Baroness will understand. When they make an application to come here from now on, they will have to pay the health surcharge on top of the visa that they are currently applying for. I hope that I have made that clear. At the same time, it has been suggested from the Box that I ought to make it absolutely clear that the surcharge will be paid when a person applies for a visa and for leave to remain when they are in the UK and extending their leave. I think that was what I said, but the Box obviously thought that it is such an important point that everyone should understand that.

[Lord Patel]

My Lords, what the Minister said in response to my question is clearly recorded, so we can all read it. As I understood it, I thought he said that once the health surcharge—let us say it is £200—is paid, for the duration of their legitimate stay in this country all health services will be available to them.

[Lord Taylor of Holbeach]

It is a per annum charge, so if they are here for three years and are not a student it will be three times £200. But yes, that is exactly right.

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.

Health: Animal Testing

Lord Patel Excerpts

Tuesday 4th October 2011 Lords Chamber

[Lord Henley]

My Lords, I think that the noble Lord speaks for the entire House. I endorse what he and my noble friend Lord Willis have said, along with others. We must continue to maintain the highest standards, both in terms of the licensing we do here and in making sure that we continue with research at the level that we do.

[Lord Patel]

I am sure the Minister is aware that the Academy of Medical Sciences produced a report on research on animals containing human material, which is an important part of research, and asked the Government to consider setting up a national body to regulate research on animals containing human material. Would he like to comment?

[Lord Henley]

I am grateful to the noble Lord for those remarks. That is something that we will be looking at in due course. I cannot comment at this stage.