Immigration Bill

Baroness Barker Excerpts

Wednesday 12th March 2014 Lords Chamber

[Lord Taylor of Holbeach]

I thank the noble and learned Lord for that advice—free legal advice to the Government is considered to be very valuable. I hope that I have been able to explain what the legislation is intended to do and have reassured noble Lords on that point. Beyond that, I can commit to go back to look at the wording of the clause to see whether the intention could be made more explicit. That I will seek to do.

[Baroness Barker (LD)]

Perhaps I may help the noble Lord. Noble Lords understand that there are now NHS treatments and services for which charges are made and that people who are resident in this country pay those charges, as do visitors. What is perplexing about the clause is, given that that is the case, what is the Government’s intention? Is it to reach a point in future where different categories of people have to pay for identical services? If the Minister could write to noble Lords and give us some examples of what scenario the Department of Health envisages under the legislation, that would be extremely helpful.

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[Lord Rosser]

This amendment also relates to Clause 33. The only comment I make to start with is that if all the verbiage in Clause 33 does is give the power to charge one rate to students and another to everybody else, it seems unbelievable that it cannot be made simpler and more explicit. I hope that the Minister will bear that in mind when he reflects on the debate that took place on the previous amendment.

Clause 33 provides the Secretary of State with a power by order to require certain migrants to pay an immigration health charge. It relates only to people who are seeking immigration permission; it does not relate beyond that. The charge would be paid by someone who was applying for leave to enter or to remain in the UK or for entry clearance. The amount, the method of payment and the consequences of non-payment will be set out in secondary legislation although, as has been said on a number of occasions, we understand from the Government that the amount of the charge will be £200 a year and £150 for students and that paying the charge will be a precondition of entry.

We agree with the principle of the charge. It is right in our view to require migrants who are here for a limited period to make a contribution to the NHS. We also agree that the test of ordinary residence is fairly generous. At the moment it is satisfied by many new and temporary migrants almost immediately and covers many people, including newly arrived family members.

We have tabled only one amendment to this clause, Amendment 61, which requires the Government to provide information to Parliament on the sums collected under Clause 33. Obviously, in large part the amendment is to find out a little more about the Government’s intentions on this score. The amendment asks for a review of the sums that are to be collected and how they are to be disbursed. The Bill states that the money will be paid into the Consolidated Fund or be applied in such other way as the order may specify. At Second Reading, in response to a question from my noble friend Lady Smith of Basildon, the Minister said that,

“on 20 January the Chief Secretary to the Treasury confirmed to departments and the devolved Administrations that the money that is collected by these charges … will go directly to health services”.—[Official Report, 10/2/14; col. 524.]

Where will this be set out, and where is the guarantee of it?

There are further questions. Will hospitals that treat a high proportion of foreign nationals get an appropriate or proportionate share of it and how will the money be shared with the devolved Administrations? What is the definition of the words “health services”? Could the money go to the private healthcare sector, for example? If the money is to go to health services, why not say so in the Bill and end any doubts on that score? Will the money from the charge be in addition to the money that the Government provide for the NHS or for health services, or will it be used to reduce the amount that the Government would otherwise have provided? In other words, is it extra money or is it simply going to be used to reduce the amount that the Government themselves provide? Some response to that point would be very helpful.

I want to ask about the implementation of the provisions, because in the consultation document the Government indicated that the migrants’ biometric residency permit would be endorsed to show that they were entitled to NHS treatment without further charge. How will hospitals and doctors be made aware of that? I ask that in the context—I understand that I may well be wrong, and I am sure that if I am I will be corrected—that the Department of Health will publish a full implementation plan—indeed I may be told that it has already done so—which will include plans to develop a new NHS registration process for the identifying and recording of patients’ chargeable status. If that has not already been produced, will the Minister confirm when it might be available? We also want to ensure that there is no disincentive for people who bring benefits to this country. One category is students. How will that charge be kept under review to ensure that it does not act as a disincentive for people who we would wish to come here to do so?

In probing what the Government’s intentions are and how they see this operating, I want to ask about transitional arrangements. The Minister has confirmed to us in a letter that affected migrants who are already in the United Kingdom at the time when the policy is implemented will not be liable to pay a surcharge and will not be charged for healthcare for the remainder of their leave if they were previously exempt from NHS charges. However, once their leave expires, the migrant will be required to pay the surcharge as part of any further immigration application unless they are applying for IDR. Will the Minister confirm where this will be set out in the legislation and how people will be made aware of it? In that scenario, how will a GP know whether someone who should pay the charge is covered if for that patient the charge becomes payable only when they apply for an extension of leave to remain? If a GP refers to hospital a patient who should have paid the charge, will the hospital also have to check that that patient has paid—a double check—or can the hospital accept that the GP making the reference will have done a check and rely on that?

The Minister said on Monday, in a discussion on the issue of the charge, that there would be no transitional arrangements. I ask him not to confirm that there will be no transitional arrangements, because that is clearly in black and white in Hansard, but to confirm that that also means that there will be no transitional costs relating to the bringing in of this payment. It would be helpful to have clarification on that.

I have raised a number of questions: what the Government’s intention are; how this will operate; where the money will be going; whether it will be used to reduce the amount that the Government provide to the health service or whether it will be additional money; what the definition is of “health services”; and whether the money could go to the private sector. I have also raised queries about the position of GPs and the checks that they have to make, and in particular whether there is a double check if they refer someone to a hospital or whether the hospital can take it that the GP will have done the checks and that is the end of the matter. I beg to move.

[Baroness Barker]

My Lords, I shall speak to my Amendment 66F in this group. Following the consultation in 2013, the Department of Health said that,

“while there is a great deal of speculation about the numbers of visitors and short-term migrants using the NHS, robust data are very limited”.

That is the point that I wish to address. I have no problem with the Government’s intention to introduce a health levy, and I have no problem with them seeking to have different rates for different groups of people. However, I want to be sure that when this House makes a major change to a fundamental policy that we have held in this country for over 60 years, that it does so on the basis of sound evidence.

Back in 2006, noble Lords will remember that proposals of this kind came before this House from the then Labour Government but then disappeared, principally because someone went back to the department and worked out that the cost of implementing the proposals far outweighed any benefit. It is simply good business practice to have done a cost-benefit analysis of a major change before one implements it. The Government are wedded to doing this—fair enough, and I have no doubt that they will go ahead—but it is only right that if they go ahead they should do so on the basis that its implementation will be thoroughly analysed, so that we do not find ourselves back here in five years’ time responding yet again to an agenda that has been set by various media organisations and political groupings on the basis of nothing more than speculation.

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[Lord Leigh of Hurley]

Perhaps I should declare an interest as a chartered accountant. As such, I looked at Amendment 66F with care. I agree that it is important to have a proper review, analysis and evidence of real costs, but the trouble with the proposed new clause is that it asks for a calculation of the total charges paid, among other things, but it does not look for an assessment of the cost against those charges. For the proposed new clause to be meaningful and for the assessment of the health charge to be made, one would have to look at the costs incurred by the National Health Service for the £200 or £150.

[Baroness Barker]

As someone who is not a chartered accountant, I thank the noble Lord for the free advice. If I were to redraft the clause, I would include that in it.

[Lord Taylor of Holbeach]

My Lords, I welcome the general support offered by the noble Lord, Lord Rosser, for the surcharge. Indeed, I felt that there was support around the House for the surcharge in principle; it is just on implementation and the practicalities that the Government are quite properly being challenged.

The Home Office, which is responsible for administering the health charge, but not for spending the money, will be open and transparent about the operation of the surcharge. As my noble friend Lord Howe set out in his letter to all noble Lords last week—I hope it helped; it was designed to try to put these changes to the law in the context of wider health service reforms—the surcharge income will be allocated directly to the National Health Service across the UK. Allocation will be in accordance with the Barnett formula.

The dear and much-loved noble Lord is not in his place, but much as he seeks to see the end of his legacy in establishing the formula, it is still widely used in government and it seems the most appropriate way of ensuring that the money goes to the NHS. It will go to the NHS—the National Health Service—not to any other agency offering healthcare in this country. How the NHS spends it is for the Department of Health, of course, and the devolved Health Ministers, because health services are a devolved matter. The allocation of the money will be made by affirmative order, so we will have control here in Parliament of how this is finally resolved.

I note what my noble friend Lady Barker said in speaking to her amendment. While the Home Office already has a well established procedure through which it is accountable to Parliament, I appreciate that this House would benefit from the means to scrutinise the impact of the surcharge. I am therefore prepared to make a Statement to this House to provide information about the Home Office’s administration of the surcharge within 12 months of it going live. I hope that that will give some assurance to noble Lords on how the surcharge is working.

It may include details such as the number of migrants who pay the surcharge and the total amount of surcharge collected and directed to the National Health Service. I believe that this sort of transparency is important, and the Statement will provide proper transparency and provide the House with the necessary flexibility in scrutinising the surcharge scheme. Furthermore, any future changes to the core operating principles of the surcharge, including the amount to be paid, will have to be agreed by both Houses under an affirmative resolution procedure.

On Amendment 66, tabled by the noble Baroness, Lady Meacher, we intend to do our utmost to ensure that visa applicants understand the purpose of the surcharge and how it might apply to them. We will make the information available to individuals, including through our website and visa application centres. Indeed, the visa application form is where most people encounter this surcharge because it is directed only at those applying for a visa for a stay of six months or more. The form itself will explain it.

My noble friend Lord Attlee has pointed out in conversation that universities themselves might like to promote the student surcharge as being a very competitive offer at £150; it certainly is a bargain in global terms. However, it would be most unfair to ask migrants to pay a surcharge that they know nothing about. Both the reasons it is being charged and what it gives migrants access to are very important.

The noble Lord, Lord Rosser, asked when the Department of Health will publish its detailed implementation plan for patient registration and identification. If I say “shortly”, he will know that that word is used regularly enough. We do not have an exact date, but it will be shortly. He also asked how the transitional provisions would be set out and how a hospital will know if a person is a transitional case. This will be done in the order implementing the surcharge. We will use the patient registration system to flag people who have paid the surcharge. We will consider doing so also for those who benefit from the transitional arrangements. The simple production of a visa or biometric residence permit—BRP—that is current and valid will give evidence of free entitlement to the NHS, and transitional cases will be identifiable because their entry clearance or BRP will be dated before the commencement of the surcharge scheme, which will be known.

My noble friend Lady Barker asked about the costs of implementing the health charge and whether we have done a cost-benefit analysis. We have indeed. The Home Office has produced a full impact assessment on the Bill. It is available on the Immigration Bill page of the gov.uk website.

The noble Baroness, Lady Meacher, asked about treatments for infectious conditions, such as HIV and TB, for example. They are free, and will remain so. It was this Government who abolished the NHS treatment charges for HIV.

I hope that I have answered most of the points. I will go through the record and see whether there are aspects that I have not addressed. The noble Baroness, Lady Lister, is looking particularly questioning. Can she remind me of what I have missed?

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[Lord Taylor of Holbeach]

The latter point is more difficult to answer positively; it is something which my noble friend Lord Howe would be in a position to reply to with authority. On the first point, I think that the wording which the noble Baroness suggested is particularly good. It sums up the policy as I have tried to describe it to the Committee.

[Baroness Barker]

My Lords, I thank the Minister for his response, which was far more helpful than I had expected. Perhaps I may press him a little further and ask whether he would be prepared to make not just a one-off Statement to the House about the introduction but perhaps to do so annually, or more than once, so that we can have comparative data in different years. That would give us a slightly more robust evidence base than we would have by having just a one-off Statement in the year after a measure has been brought in. A fair amount of information and attention would, presumably, attend its introduction.

[Lord Taylor of Holbeach]

I start from the position that an informed House is better able to make decisions and judgments on issues. Having said that, I am not sure that I could commit to making a periodic Statement on this issue, although I know that the Home Office will always respond to questions that might seek updated information of this type, and indeed there are other ways in which this House has the capacity to bring the Government to account on policy. At least by promising this Statement I am giving an indication that we are confident that this particular measure will be a success and raise money for the National Health Service, which will be to the advantage of the taxpayers of this country and a bargain for migrants to this country. I hope that my noble friend is reassured by that point.