Baroness Barker
Main Page: Baroness Barker (Liberal Democrat - Life peer)Department Debates - View all Baroness Barker's debates with the Home Office
(10 years, 9 months ago)
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Baroness Barker (LD)
My Lords, I will briefly address Amendments 66A, 66B, 66C and 66D and leave my noble friend Lady Hamwee to address Amendment 66E.
Amendment 66A stands in the name of my noble friend Lady Williams of Crosby. It is a shame that she is not here because, as Members of this House will know, among her many areas of expertise is an encyclopaedic knowledge of the United States. She and I talked a lot, particularly during the passage of the Health and Social Care Bill, about the comparisons and contrasts between our health system and that of the United States. One of the most graphic contrasts is in A&E. When Americans go to A&E they are there for a very long time because they ask every conceivable question they can and fill their pockets with everything that is going. Millions of them do not have any healthcare cover at all. By contrast, we do. Per capita we spend about a third of what they spend in the USA but study after study shows that our health outcomes are better. Our systems are better because, by and large, we get people at the right place at the right time—and most people, because they have access to a GP and a certainty that they will be treated, present themselves early.
The amendments in this group are not about trying to gain exemptions for one group of people and putting some kind of moral case that puts them in a different category from other people; they are about saying what is the most effective National Health Service for everybody—those who live here permanently and those whose leave to remain is as yet uncertain.
I do not see the purpose in making a charge for A&E. There may be some belief on the part of the Government that if they charge people for being seen in A&E it will somehow have the effect of pushing them to go to their GP. I would love to see the evidence for that; I do not think that people are either that calculating or that logical about the way in which they use the NHS, particularly A&E. I would be grateful if the Minister could set out the case on which the Government have based the proposal to charge people for turning up in A&E.
What discussions have they had with the College of Emergency Medicine about how this will work? I have recently been a member of the committee of your Lordships’ House reviewing the Mental Capacity Act. When we talked to representatives of the College of Emergency Medicine, they were in no doubt. We talked to them about advance statements and how much they found out about people’s wishes and so on, and they just said, “If somebody’s ill, you don’t do that; you just treat them”. It is naive to assume that they will change their entire practice for thousands of people who come through their doors on a weekly basis just because somebody happens to fall into a different immigration category; that is perhaps wishful thinking.
Amendment 66C poses a very simple question: are we going to charge people for diagnostic tests and, if so, on what basis will we do so? Frankly, I cannot see the incentive for somebody to go and see a GP if the consultation is free but they then have to pay for any diagnostic tests. That is what most GPs do above anything else; they run a set of diagnostic tests and they look at them. There is also a public health implication here. The issue that we have with a number of conditions is trying to persuade people to be tested so that we can then make plans for their individual health and also plot the health of the community. What exactly are the proposals on diagnostic tests?
Perhaps the most important and relevant amendment in this group is Amendment 66D. My understanding, and that of the people and organisations which have briefed us, including the National AIDS Trust, is that, should the Bill remain unamended, the Department of Health will have the power to levy charges for mental health services outside those provided by hospitals. Clearly, it will not be able to charge people who are detained under the Mental Health Act, and I doubt that if somebody was sufficiently ill to be receiving mental health treatment in a hospital they would be charged for that—I may be wrong—but community and primary care service mental health treatments could be charged for.
On that, we should follow the point made firmly by the Academy of Medical Royal Colleges in its response to the Department of Health consultation: that access to primary mental health services is a public health issue. We should not leave mentally distressed people to get to the point where they become a danger to themselves and to others. This measure would fly in the face of the intentions of the most recent Mental Health Act to go through this House, in which there was an emphasis on ensuring that people were subject to compulsory treatment in the community. I have no wish go back over some of the worst legislation that we have ever passed in your Lordships’ House, but this measure seems to undermine that considerably. I would like a full statement from the Minister on exactly what the Government’s intentions are on mental health services.
Lord Taylor of Holbeach
That is why I am going to try to address some of these matters. It is right to seek to do so, allowing for the limitations of my knowledge in this area, which I hope that noble Lords will understand.
This House has a good reputation for debating these sorts of things not, if I may say so, through the statutory instrument process so much as generally. I am absolutely certain that my noble friend Lord Howe would be quite prepared to come at a suitable point during the consultation to discuss the basis of changes that would be made. I am sure that I am not losing a friend for life by committing him to do just that.
As if to show that I need to brush up a little bit, apparently I may not have said, through mis-speaking or a slip of the tongue, that the Home Secretary announced the review of the NRM. I thought that I had implied that, but if I had not, I should have done so. Let us hope that I do not fall out with another friend for not crediting the Home Secretary.
The noble Baroness, Lady Meacher, asked about training for the enforcement of new NHS rules, and also about the Modern Slavery Bill which, as noble Lords know, is in pre-legislative scrutiny. The Department of Health will publish its implementation plan on the health service rules during the course of this year. The Modern Slavery Bill will be a fourth Session measure. I must not anticipate the Queen’s Speech, but the fact that that Bill is going through pre-legislative scrutiny rather suggests that it will be in the fourth Session legislation.
The noble Baroness, Lady Finlay, asked about a victim of FGM who has infected wounds. Under the NHS charging regulations and policy, immediate necessary treatment is not held up because of charging. I think that the noble Baroness has enough experience of how the health service operates charging principles, and I do not think that that is likely to change. GP care is not charged for, as I have said. The Department of Health is reviewing provisions for vulnerable individuals under these NHS regulations.
The noble Baroness asked why we were planning to charge migrants for accident and emergency services. Surcharge payers will obviously not have to pay for A&E services. The Department of Health has indicated that there is a good case for introducing overseas visitor charges for A&E, for those short-term visitors and illegal migrants who do not pay the surcharge. It is giving this detailed consideration, but will not make any changes unless it is confident that the new systems will work well without compromising rapid access to emergency care for those in immediate or urgent need, which will never be withheld or delayed pending payment. However, as I said, that is not a matter for the Bill. It is part of the review into regulations which is going on at the moment.
My noble friend Lady Cumberlege asked whether those exempted from the charges will be exempted from NHS charges. Our policy intention is that those who are exempt from the surcharge will also be exempt from subsequent National Health Service charging for health services under NHS regulations. However, obviously they will be liable for dentistry; as I mentioned before, at the moment that is not free other than in exceptional cases.
Under the Bill it is possible for surcharge payers to be charged for certain expensive discretionary treatments —I think we have discussed that already. However, we have made it clear that we intend that no such additional charges will apply when the surcharge is introduced. The Department of Health has made it clear that it would consider those in the future only in the event of any exceptional and compelling specific justification for health purposes, and, as I have already said, any changes would need to be put before Parliament.
My noble friend welcomed the exemptions, but those refused asylum will face charges, as will most victims of trafficking who are not recognised through the national referral mechanism. I emphasise to my noble friend that refused asylum seekers will not pay a surcharge. Health charging for refused asylum seekers is a matter for the Department of Health and the devolved health administrations within its remit. We have already confirmed that trafficking victims will not have to pay the surcharge.
The NRM is the only process by which an individual can be formally identified as a victim of trafficking and matched with appropriate support. Someone who has not been identified as a victim through the NRM and who is an illegal migrant or visitor would not be covered by the exemption for NHS charging under the existing regime. However, the NHS can write off NHS debts if individuals are subsequently identified as victims of trafficking, so there is a retrospective exemption in that regard.
The Department of Health has committed to give further thought to strengthening exemptions in the current NHS charging regulations for vulnerable groups, including victims of trafficking. We want to make sure that the NRM works effectively, which is why the Home Secretary has commissioned the review.
My noble friend asked whether those who come on a visa, pay the levy—or the surcharge, as it is properly called—and are later refused an extension will still get free NHS treatment while waiting for an administrative review decision, and asked about a period for which the paid levy has expired. This is about people and their leave to remain. Those individuals will continue to receive free NHS treatment as part of the conditions of their extant leave. Where individuals had leave, alongside which they paid the surcharge when they applied for an extension and applied for an administrative review within the specified time limit for doing so, their leave will be extended on the same conditions under Section 3C of the Immigration Act 1971 until their administrative review is decided.
My noble friend asked what would happen if their review is refused and they bring a human rights appeal. Once an administrative review is refused a migrant will be liable for NHS overseas visitor charging unless they fall under one of the exemptions set out in NHS charging regulations. That will be commensurate with their immigration status.
A number of noble Lords were concerned about GP consultations being free—I think that that is widely understood—but what about treatment? We intend for surcharge payers to receive most treatment free, as would any other UK citizen or person with indefinite leave to remain. We have made that clear in all the responses that I have given. They will be charged only for services for which permanent residents are also charged. As part of its work to reform the charging regime in England, the Department of Health has signalled an intent to extend charging for short-term visitors and illegal migrants to some primary care services, excluding GP consultations. It is carrying out a detailed analysis to inform decisions in this area, and any agreed changes will be put to Parliament.
I was asked by my noble friend Lady Cumberlege to give an assurance that the Home Office would not be permitted to use access to healthcare as a means for it to identify and take action against those subject to immigration controls. Healthcare staff are not routinely required to inform the Home Office on issues to do with individuals’ immigration status, and there is no plan to change this. However, there are circumstances where it is appropriate for the NHS to pass information to the Home Office, such as for enforcing the NHS debtors rule, which is a current rule under which migrants who have run up an unpaid debt of £1,000 or more are not given permission to enter the UK while the debt remains unpaid.
Finally, I hope that I have answered the questions posed by my noble friend Lady Barker on mental health and such matters. She made a valuable contribution to the debate.
I turn to the challenges presented by the noble Baroness, Lady Smith, who asked, “What is success?” Success might be the £2 billion surcharge income for the NHS, which is a large sum of money even in a health service budget running to several hundred thousand million pounds. An additional £500 million will be recovered in treatment charges each year through better administration, plus the surcharge, and vulnerable groups will be protected and treated. Part of the consideration of the NHS review and the provisions of the Bill are to ensure that vulnerable groups are protected. There is no adverse impact on public health, and there is a fairer set of rules and arrangements, which command public support. Those are the basic challenges that face us in seeking to reform charging within the health service.
I reiterate that the introduction of the surcharge in the Bill will give those who are obliged to pay it—and they are obliged to pay it—the peace of mind that they will receive comprehensive NHS treatment when needed. But charging for short-term visitors and illegal migrants remains the responsibility of the Department of Health, and it is not dealt with in the context of this Bill.
Baroness Barker
My Lords, I thank the Minister. I know that health is not his subject, but he has given an excellent response to those of us who speak fluent NHS and know all the language. I thank him for the detail of his response, but I ask him to write to me on two points. First, on my point about charging for diagnostic tests, I understand the point about people paying the levy having to pay for the same things as people who are resident and about the exemptions for some categories of people and some conditions, such as infectious diseases. But there are some conditions—for example, diabetes—where you have to have a diagnostic test. It is important that people know that they are diabetic and that healthcare workers know that those people are diabetic, because if it goes untreated there may be further consequences.
Secondly, I seek clarification on the important matter raised by my noble friend Lady Hamwee on whether initial consultations with GPs would be free and subsequent consultations would be charged for or whether all consultations with a GP practice’s staff would be free. I do not want to detain the Committee now but if the Minister could answer those two questions in writing, it would go a considerable way towards allaying anxieties in that regard.