Immigration (Health Charge) (Amendment) Order 2018

Lord Russell of Liverpool Excerpts

Wednesday 28th November 2018 Lords Chamber

[Lord Russell of Liverpool (CB)]

My Lords, in the absence of the noble Lord, Lord Grocott, I feel brave enough to rise to my feet. I declare my interest as a governor of Coram, the children’s charity. I shall agree with the noble Lords, Lord Lansley and Lord Rosser, as a true Cross-Bencher should. I understand, and in principle do not disapprove of, charging those from outside the EEA for using the wonderful NHS. If it produces £220 million for the NHS, I think we would all say hurrah. For many migrants, it is undoubtedly a very good deal and a lot cheaper than insurance.

But—as the Minister knows, there is always at least one “but”—I should like to make a few points. They concern what I hope are unintended, not deliberate, consequences of the IHS. The noble Lord, Lord Teverson, asked a Written Question on 12 July about whether there would be a children’s rights impact assessment of the increase in the fee. In her reply on 23 July, the Minister said:

“A full impact assessment will be published alongside the draft Order”.


In the event, the impact assessment had been completed three weeks earlier on 3 July, but having read it extremely carefully to see whether I could find any trail within it which looked like a children’s right assessment, all I could find, at the top of page 17, in subsection F.5, was a comment about the proportion of in-country family visa applications which may be eligible for the waiver. It said that Her Majesty’s Government,

“is also considering options to mitigate the consequence an increase in Surcharge may have for applicants’ affordability”.

Given that the impact assessment says that the Government are considering options, what are those options and how far have Her Majesty’s Government gone in their thinking about them? Does the Minister genuinely think that the impact assessment before us includes anything like a full children’s impact assessment?

Secondly, when we are talking about the fee waiver system, which is extremely well intended, many of us outside the Home Office struggle to understand how it is working at all. The reason is that the Home Office has the relevant statistics and we do not. In May last year, Coram, of which I am a governor, sent a freedom of information request to the Home Office, to which the Home Office replied. The statutory response timeframe is 20 days. In this case, it excelled itself by responding nine months later. It said that roughly 7% of fee waiver applications were successful. Why was a new request for the 2017 statistics in a freedom of information request denied by the Home Office on the grounds that it would be too costly to compile it? Given what we heard earlier—that the Government, in their wisdom and munificence, are deliberately undercharging when it comes to the IHS—how can the Home Office justify not acceding to the freedom of information request?

We simply cannot judge whether the waiver scheme is working properly if we do not have the data. I am not trying to be awkward or embarrass the Minister or the Government; we simply need to know the figures so that we can come to a reasoned judgment, together with the Home Office, on whether the fee waiver system is working in the way we all know it was intended to work. It would be helpful to all sides if we were able to do that.

Thirdly and lastly, we welcome the report of the Independent Chief Inspector of Borders and Immigration. I hope he will include the effect of the IHS when he publishes his report, and we look forward to its findings. If it does not contain an analysis of the effect of the IHS, will the Minister say why not? The children we are talking about find it very difficult to have their voices heard. Frankly, we are inadequate substitutes for these children, though we do our best to communicate their raw and often very painful testimony. But they have an inalienable right to be heard, and it is in that spirit that I ask these questions—their questions—and I look forward to the Minister’s answer.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, it has been an interesting debate for me because other noble Lords have argued from points of view that I have not considered. I support the amendment to the Motion in the name of the noble Lord, Lord Rosser, simply on the basis of unfairness and injustice.

I want to take issue with some of the things said by the noble Lord, Lord Lansley. It seems to me that we do not take into account the value of immigrants in Britain, and again and again that creates a hostile environment. I shall quote a government press release:

“We welcome long-term migrants using the NHS, but the NHS is a national, not international health service and we believe it is right that they make a fair contribution to its long-term sustainability”.


That is true, but the NHS is paid for by everyone who pays tax in Britain. This includes immigrants, who overwhelmingly pay more in tax than they receive—and perhaps make the wider contributions that the Minister was thinking about when she mentioned that. They already make more than their fair contribution to the running costs of the NHS, but the Government do not seem to appreciate that, and I ask why. All the figures suggest that immigrants give more than they take, so why are the Government not recognising that?

This dog whistle rhetoric of calling it,

“a national, not international health service”,

is a particularly harsh insult to the 144,000 NHS staff whose nationality is non-British. The truth is that we do have an international health service, which runs on the hard-working dedication of so many people who move here from all over the world to look after the people who live here in the UK. It is hard at the moment to see why anybody would want to come here in view of the sorry, xenophobic state we are in, but they still do.

Not only is our immigrant workforce being blamed, yet again, for the failures of government policy, but now they are being charged £400 a year for the privilege. The same people who came here to work so hard to deliver our National Health Service are now being told that they do not deserve to have their own health needs looked after properly. If this kind of policy had been introduced in 2010, people would have been rightly disgusted. It is the kind of thing that only UKIP would have got away with eight years ago, and everyone would have thought it wrong. But somehow, in our society today, we have become so hostile, so fast, that now such policies just seem normal.

This change is a continuation of the Government’s obsession with blaming all the country’s problems on immigration. As a Green, I strongly resist any measure of hostility based on where in the world a person was born. In particular, I ask the Government to consider whether it is particularly unfair to charge an NHS surcharge to people who work in the NHS. I am dubious about the amount that the Government claim they will raise. I would like the Minister to confirm that amount, because it would be interesting to see later whether it is realised.

Finally, do the Government agree that the best way to fund the NHS is to invest in it properly? Only the Government can do that.

--- Later in debate ---

[Baroness Williams of Trafford]

I am glad to have a former Health Secretary standing behind me to put noble Lords—and me—absolutely right.

[Lord Russell of Liverpool]

Will the Minister come back to the point I raised about the inadequacy of the information we have about how effective the fee-waiver system is?

[Baroness Williams of Trafford]

I will. I will not give him an adequate response, but I will tell him why; if that is okay.

The noble Lord, Lord Rosser, asked why the charge was set below cost recovery levels. I think I have answered that. He asked why the estimate in 2015 of £800 per person is so different from what we have now. It is because in 2015 it was just that, an estimate. We can now give an actual figure, given that people actually use the health service. The noble Lord also asked why we decided to double it on the basis of Department of Health and Social Care analysis. He will know that we made a commitment before the 2017 general election to triple the surcharge. We have not; we have doubled it. It was because we had made a manifesto commitment that we did not consult on the issue.

The noble Lord also asked about EU citizens. We are in the process of negotiating reciprocal healthcare arrangements with the EU. We have reached agreement on citizens’ rights that will protect EU citizens and their family members who are resident in the UK by the end of the planned implementation period on 31 December 2020. We have made it clear that the immigration health surcharge will not apply where EU citizens make immigration applications during the implementation period after the UK leaves the EU. We will set out our plans for the future border and immigration system in a White Paper later this year, which, noble Lords will work out, has not long left. Another noble Lord asked that question. I will not pre-empt or trail the White Paper with further detail at this stage.

We have been through the double taxation argument. I do not think that the noble Lords who asked about it agree with me, but I have made the point that the charge is fair not only to migrants but to UK national and permanent residents who have or will make a greater contribution to the NHS over their working life.

The noble Lord, Lord Paddick, and the noble Baroness, Lady Jones, talked about the compliant environment. This is nothing to do with the compliant environment. The charge is intended to ensure that temporary legal migrants make a fair contribution to the cost of their healthcare in the UK. In contrast, the compliant environment is a suite of compliance, deterrence and data-sharing measures that form part of our overall approach to deterring and tackling illegal migration and protecting public services.

The noble Baroness, Lady Lister, asked why children do not feature in the impact assessment. This is because it is at a macro level rather than an individual level. I know she does not like that answer but individuals are fully catered for in the system of fee waivers and exemptions, and a child is as likely to need healthcare as an adult.

[Baroness Williams of Trafford]

I take the noble Baroness’s point because in everything we do with law, we have to consider the rights of the child. That is a basic requirement on the Government. It may be implied, it may not be, but I entirely take the noble Baroness’s point.

The noble Lord, Lord Rosser, asked me about undocumented children having to make four applications over 10 years at over £10,000. These applicants fall within the scope of specified human rights applications for which fee waivers are available—we have gone over that point—but, of course, parents may apply for the fee waiver for the child.

We have produced the policy on equalities assessment and will provide it to Peers who have spoken in this debate and place a copy in the House Library. I cannot stand at the Dispatch Box and say that it includes children. I suspect from what the noble Baroness says that it does not, so I go back to my previous point.

The noble Baroness asked about the chief inspector’s report and when it will be published. The immigration fees and the surcharge are obviously two separate things. The Government made a manifesto commitment to increase the surcharge and it is important that we deliver on that.

The noble Baroness also asked about the proportion of applicants receiving a waiver—this goes to the point made by the noble Lord, Lord Russell of Liverpool—but we have not published that information. However, we are reviewing the process because, as time goes on, these issues necessarily become more complex. I know that does not answer entirely the point made by the noble Lord, Lord Russell, and the noble Baroness, Lady Lister, but we will be reviewing that.

[Lord Russell of Liverpool]

On the point I made that in the impact assessment there is a reference to the Government considering options for families who are experiencing hardship, what options are the Government considering and where are they in their thinking?

[Baroness Williams of Trafford]

I cannot give the noble Lord any more information on that at this point but I am sure it will be released in due course. He also asked about the Coram freedom of information request. The first response was based on management information from a live database which is subject to variations as the year progresses. The second was not answered because of a policy to release only published information. Government departments often do not release information if it is not published information, although I have given management information with caveats before. The Government are seeking to resolve this issue.

[Lord Russell of Liverpool]

Does the Minister accept that it is extraordinarily difficult for us to try to work out the effects and the effectiveness of the fee-waiver system in the absence of any reliable or up-to-date data? How can the Government make decisions about it if they do not have the data? If they do have the data, please can they share it with us?

[Baroness Williams of Trafford]

We do not share management information data because it is purely that—management information. As I understand it, we are seeking to resolve this issue with Coram Children’s Legal Centre, and when we do I will be happy to write to the noble Lord with the outcome.

I hope that noble Lords are satisfied with my response, although I suspect they are not, and that the noble Lord will feel happy to withdraw his amendment.