Draft Immigration (Health Charge) (Amendment) Order 2020

Alistair Carmichael Excerpts

Tuesday 22nd September 2020 General Committees

[The Parliamentary Under-Secretary of State for the Home Department (Kevin Foster)]

I beg to move,

That the Committee has considered the draft Immigration (Health Charge) (Amendment) Order 2020.

It is a pleasure to serve under your chairmanship, Mr Robertson. The immigration health charge was introduced in April 2015. Its aim was to ensure that temporary migrants—those with a limited period of leave in the United Kingdom—made a direct contribution to the NHS services available to them during their leave, subject to some specific exemptions.

The charge is currently paid by non-European Economic Area migrants who apply for a visa of more than six months’ duration. It also applies if they wish to extend their stay in the UK for a further defined period, although those who receive indefinite leave to remain do not need to make the payment once they have achieved ILR. The charge is paid up front as part of the immigration application process, and is separate from the visa fee.

From their point of arrival in the UK, a charge payer can access the comprehensive range of services that the NHS provides in broadly the same manner as permanent residents of the UK—that is without having made any prior tax or national insurance contributions. They pay only the charges that a UK resident would pay, such as prescription charges in England. They may also be charged for assisted conception services within England. To date, the charge has raised more than £1.5 billion for the NHS. That income is shared between the health administrations in England, Scotland, Wales and Northern Ireland, using the formula devised by Lord Barnett, with which Members will be familiar.

Under the new points-based system, which comes into force on 1 January 2021, all migrants to the UK will be treated the same. They will pay the charge if staying for longer than six months, unless exemptions, such as being eligible for the health and care visa, apply. The Government recognise the value and importance of migration to the UK. We welcome talented individuals and the contribution they make to our economy, our communities and our public services. However, it is right that migrants contribute to the comprehensive and high-quality NHS services available to them from the moment they arrive.

This draft order amends schedule 1 to the Immigration (Health Charge) Order 2015. In line with the Government’s manifesto commitment, it will increase the annual amount of the charge to a level broadly reflecting the cost of treating those who pay it. The Department of Health and Social Care has estimated that the cost to the NHS of treating charge payers in England is roughly £625 per person, based on analysis carried out in April 2019 using 2017-18 NHS England data. However, to support the administration of the charge, the new level is set at £624 to make it easier to divide.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

In reaching the figure that the Government now bring forward, what account has been taken, especially for those renewing their visas, of the tax and national insurance contribution made by those working in our economy?

[Kevin Foster]

To be clear, the eligibility for the charge is based on the immigration status, rather than what tax or national insurance people have paid. We were clear in our manifesto, which was firmly endorsed in the December general election, that we would base it on the average cost of treating charge payers. Of course, when they come to achieve indefinite leave to remain, they are no longer liable to pay the charge. As I say, it is subject to the £1 discount, because £624 is more divisible than £625.

[Kevin Foster]

My understanding is that that has been published, but I will certainly be happy to write to the hon. Gentleman and the rest of the Committee with more details about how the DHSC arrived at that figure.

Students, dependants of students and youth mobility scheme applicants will continue to pay the discounted rate, which will increase from £300 to £470 per person. The Government are aware that the charge has a greater financial impact on family groups than on individual applicants. To support families, therefore, the charge for children under 18 at the date of application will also be set at £470, in line with the discounted rate set for students and the youth mobility scheme.

In specifying the new amount of the charge, the Government have considered a range of health services available without charge to those given immigration permission to be within the United Kingdom, and, as I have touched on already, have considered the cost to the NHS across the four nations of treating those who pay the charge. Also considered is the valuable contribution that migrants make to our economy and the need to ensure that the UK remains an attractive destination for global talent.

I turn to the exemption for tier 2 health and care visa applicants. On 21 May, the Prime Minister asked the Home Office and the Department of Health and Social Care to work together to exempt NHS and health and care workers from the immigration health charge. Consequently, this order amends schedule 2 to the principal order to provide exemption for tier 2 (general) health and care visa applicants and their dependants.

The tier 2 (general) health and care visa was launched on 4 August, and a large number of applications were received and permissions granted. It is a fast-track visa offer with a reduced application fee for eligible health professionals, including doctors, nurses and allied health workers. It covers not only people working in the NHS directly but those working for organisations commissioned by the NHS to provide essential services and those in the relevant professions who work in the adult social care sector, which is the basis of their application and their visa. Until a formal exemption is in place for that group, the Secretary of State has waived the requirement for them to pay the health charge.

[Mr Carmichael]

The Minister is being generous with his time. Those who are not included in that exemption include people working in the social care sector and non-medical NHS staff such as porters and cleaners. Why is their contribution not valued in the same way?

[Kevin Foster]

It might be helpful to explain how the current system of immigration works in the United Kingdom. At the moment, it is not possible to get a visa under the rest of the world system for some of the jobs that the right hon. Gentleman has mentioned. Those coming to the United Kingdom to work in those roles do so under either the European economic area free movement rights, which continue until 31 December, when immigration permission and the immigration health surcharge will not be relevant, or they will have come to the UK with permission—as a dependant of a skilled worker, for example, although not a health and care worker, who will be covered by the visa offer—and have a more generic right of work in the United Kingdom that is not tied to working within the health and social care sector. Those who come with a specific job offer under the health and care visa, however, go straight into employment. That is why we will look at the refund scheme. Colleagues in the Department of Health and Social Care are working on that.

As we bring in the new system on 1 January, a much wider range of skills will be recognised, including, for example, senior care workers who, at the moment, cannot get a visa under tier 2, but will qualify under the new points-based system from 1 January. Again, we will look to expand who will be eligible in the health and care sector. People will not be tied to a specific job offer. There will be a general permission to work in the United Kingdom’s economy in any role. Again, we need to make sure that we have a route to support the NHS and social care, not a way to avoid an immigration charge.

Tier 2 migrants who have 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, are being refunded. Those who work in the NHS and 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 and have a general ability to work in the UK, which I have just touched on, may also be eligible for reimbursement of the charge that they paid.

On 15 July, the Minister for Health announced that the reimbursement would be paid in arrears of six-month increments, and the scheme will be launched next month. More details on the scheme will be published by the Department of Health and Social Care shortly. Given the queries that have been raised, I am sure it will be read with interest by members of the Committee.

Those who move to a new country expect to pay towards healthcare. In many countries they are required to do so by securing private health insurance or by direct charges when they become unwell or need to access healthcare, yet here in the UK they can access our fantastic NHS, if necessary, from when they arrive.

The health charge is designed to benefit the NHS and support its long-term sustainability. Those NHS and other health and social care workers who are granted visas to work specifically in those roles are doing that through the important contribution that they make in their work. They are exempt from the payment, and those who contribute to the work once they have arrived, but whose right to work in the UK is not tied to the sector, will have the payment reimbursed. However, it is only right and fair that people arriving in the UK to work in non-healthcare roles should pay towards the extensive and high quality range of NHS services available to them in the United Kingdom until they are permanently settled here in the UK.

That is a point that the electorate agreed with in the December general election. When we debated the Immigration and Social Security Co-ordination (EU Withdrawal) Bill, we had the debate that we expected. The Scottish National party set out its principled objection to the charge, and I outlined why the Government believe it is right. We heard from others that they were making their minds up on what the policy should be. In commending the orders to the Committee, I look forward to getting more clarity about whether the approach is the right one—yes or no.

--- Later in debate ---

[Mr Carmichael]

It is a pleasure to serve under your chairmanship, Mr Robertson. First of all, I associate myself with a number of the arguments that we have heard, particularly those made by the hon. Member for Halifax about the inappropriateness of bringing forward an increase in this charge at this time and in the circumstances of the global covid pandemic. To pick up the point made by the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East towards the end of his speech, the lack of proper underpinning analysis to justify the figure is something that should make us all pause for consideration. It is not good enough for the Government to pluck a figure out of the air, as seems to have been the case here, and bring it forward in the way they have done.

The Minister perhaps has a fair point when he says that anybody stepping off a boat or a plane has immediate access to care on the NHS, but the longer that person is here, the less relevant that case becomes. Of course, as the Minister himself made clear in his contribution, this charge applies to not only those who are just arriving, but those who have been here for a number of years and are seeking to renew their visas. I am afraid that it also conforms to a pattern that we have seen before, whereby this Government seem to view visa application fees as some sort of extra cash cow—another little bonus for the Treasury. The actual application processing cost of a tier 2 visa is something in the region of £317, but the fee paid by the person making the application is £704, so we see that the Government are creaming off something in excess of 50% of the fee as pure profit—nice work if you can get it, I am inclined to say.

Let me put that into the broader context of the contribution made by those who, having come here, work in our economy. Let us be honest, that is why most people come to this country: to work and to contribute to our community. The work by Oxford Economics for the Migration Advisory Committee concluded that the average non-European economic area national made a net fiscal contribution of £310 per annum more than that of the average UK adult. The same analysis states that the net contribution of an EEA national is some £1,940 greater than that of the average UK adult. That goes to the point that was made by the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East—I wish he had a shorter constituency name—about the lack of underlying analysis and justification for the figure that the Government have brought to the Committee in support of the provisions before us.

Then of course there is the question of those who are exempt from paying the health surcharge. As I said to the Minister, it is of course welcome that healthcare and associated professionals are exempt. I am afraid, however, that it bears no scrutiny to say that when somebody works in the NHS as a cleaner or a porter—doing critical and, sadly, as we have seen in recent months, quite dangerous work—it is somehow too difficult to work out whether they work in our hospitals and care homes. The concessions that have been made are welcome, but it is almost as if they are given grudgingly. Really, I think that all those who contribute to our NHS and its success should be valued more highly than that, and are entitled to expect better for the contribution that they make to our NHS and our community in both the work they do and the financial contributions they make.

We heard the Minister talk about the rebate system, but yet again, it is being offered without any clear timeline. When will we see the details of that rebate system? Again, tabling an instrument such as this without having that detail is, I would suggest, a case of putting the cart before the horse.

The instrument is part of a bigger picture. About one in seven people who work in the NHS are foreign nationals —some 36,000 doctors, 59,000 nurses and 40,000 clinical support staff. Meanwhile, one in six of the adult social care workforce is a foreign national; that is 249,000 care workers who are not given the benefit of the exemption given to the professionals in the NHS. That is the number of people who will be affected by this approach to migration.

The instrument tabled by the Government, although it is being considered by the Committee and done through delegated legislation, is not a matter of detail or a minor accounting adjustment. It reflects a quite fundamentally objectionable principle that states that the people who help us most seem to be valued least. That is why, in the event that the Committee divides today, I shall oppose the instrument.