Immigration Bill

Baroness Lister of Burtersett Excerpts

Wednesday 12th March 2014 Lords Chamber

[Baroness Meacher (CB)]

My Lords, Amendment 66 requires information outlining details of health charges for health services applicable to the individual to be given at the point of an application for immigration permission or upon request. One of the biggest worries about the health service clauses in Part 3 is that they could create confusion and wrongly discourage some migrants from accessing free healthcare to which they are entitled. According to the Catholic Bishops’ Conference of England and Wales, for whose briefing I am most grateful, there is already a notable lack of understanding about how the charges for health services will work among both individuals and healthcare professionals. Even more worrying, there has also been inconsistency in how charges are implemented.

Most welcome is the exemption from charging for the treatment of diseases which present a public health risk. However, public confusion could result in delays in people presenting themselves and therefore in diagnosis. Already in 2012, 47% of adults newly diagnosed with HIV were diagnosed late. I am not sure what percentage of those late diagnoses would be attributable in any way to confusion. Overall, 81% of AIDS-related deaths in England and Wales in 2012 were attributable to late diagnosis. There is an issue about timing.

Equally, unless people are made aware of their entitlement to health treatment right at the start of their application for immigration permission or when they request it, they are likely never to sort this out or to become clear about the services to which they are entitled. From the taxpayers’ point of view, it is crucial that those entitled to free GP consultations are aware of it. The risk is that fear of being charged for a visit to the GP may result in people not doing that and later needing an A&E appointment. The cost differential between these two options is £90 per patient and could over time add up to quite a bit for the taxpayer, quite apart from the detriment to the patient.

Does the Minister agree that readily available information accompanying any changes to the healthcare charging system or to the collection of charges—I understand that is going to be much tougher in future—is essential to prevent public health risks and unnecessary costs to the Exchequer? I hope the Minister will inform the House what assessment the Government have made about the current level of public understanding about healthcare charges and exemptions for specific groups and what steps they have taken or will be taking to improve awareness among healthcare professionals and members of the public.

[Baroness Lister of Burtersett]

Following what the noble Baroness, Lady Barker, said about the importance of the evidence base, I take us back to our debate on Monday. In that debate, a number of noble Lords questioned the evidence base for the claim that there is a problem of so-called health tourism in this country. They asked the Minister what the evidence base was for that claim and questioned the Department of Health’s report on it. The Minister had an awful lot of points to make in his summing up speech and, after about 30 minutes, he quite understandably thought that he had had enough and probably everyone else had, too. Although he has already helpfully circulated a letter following our first day, I could not see anything in it that responded to the concerns raised on all sides of the House. I use this opportunity to invite the Minister to respond on that this evening.

[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.

--- Later in debate ---

[Baroness Lister of Burtersett]

Given that the Minister was able to slip out of answering this point on Monday—it did not seem fair to push him on it after he had covered so many points—perhaps I might remind him about the evidence base for health tourism. I have a snippet of information that one piece of research that the Department of Health is relying on is that, out of nearly 1,000 migrants screened by overseas visitors officers in more than 15 trusts during August 2013, only four individuals—0.4% of the sample—were identified as “health tourists”. Even if the Minister cannot now tell us what the evidence is for this claim of health tourism, I would be grateful if he could commit to write specifically on this issue, given that it kind of got left out of his last letter.

[Lord Avebury]

My Lords, when the noble Lord is replying on that point, will he deal with story of the 300 maternity patients who were alleged to have been treated at St Thomas’s hospital? When we last discussed this, the allegation was found to have been apocryphal. I would be grateful if the Minister would repudiate it.