Adult Dependent Relative Visas

Ben Lake Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Stephen Timms (East Ham) (Lab)]

I beg to move,

That this House has considered adult dependent relative visas.

It is a pleasure to serve under your chairmanship, Ms Bardell. I want to talk about an important topic that deserves more attention than it has had, and I want to urge the Minister to change the current hostile environment policy on adult dependent relative visas, which is undermining the national health service. The immigration system should treat overseas nationals working in the UK and their families abroad more fairly than it does at the moment. I want to focus particularly on the impact on people working in the NHS.

Nine years ago, in 2012, the Government changed the immigration rules to establish their hostile environment policy. Under one of the changes, elderly parents or grandparents of British citizens are permitted to join them in the UK only if they can demonstrate that they require a level of long-term personal care that their home country cannot provide. Before 2012, a dependent relative needed to show only that they were living alone

“in the most exceptional compassionate circumstances”.

Now, the rules state that doctors are prohibited from bringing their elderly relatives to the UK from overseas unless they meet a very strict set of conditions. The problematic rules are set out in paragraphs E-ECDR.2.4 and 2.5, and I will read them. Paragraph E-ECDR.2.4 states:

“The applicant or, if the applicant and their partner are the sponsor’s parents or grandparents, the applicant’s partner, must as a result of age, illness or disability require long-term personal care to perform everyday tasks.”

Paragraph E-ECDR.2.5 states:

“The applicant or, if the applicant and their partner are the sponsor’s parents or grandparents, the applicant’s partner, must be unable, even with the practical and financial help of the sponsor, to obtain the required level of care in the country where they are living, because (a) it is not available and there is no person in that country who can reasonably provide it; or (b) it is not affordable.”

In practice, those conditions are extremely hard to meet. Home Office data shows that in the four years from 2017 to 2020 inclusive, 908 visa applications were made under the adult dependant rule. Only 35 were approved at the first attempt. Over 96% of them were refused. Some were subsequently granted after the difficulty and expense of an appeal. In 2017, I understand the Home Office did not issue a single adult dependent relative visa. Before the rule changes, thousands were approved.

What is the justification for the change? Ministers have argued that the rules are to stop adult dependent relatives from entering the UK and burdening taxpayers. Other ways to avoid any burden on the NHS and local authorities do not appear to have been considered. The existing immigration health surcharge could be incorporated into adult dependent relative applications—Canada, Australia and New Zealand have that sort of model in their schemes for elderly migration—or applicants could be required to have private medical insurance. Instead, we have made it virtually impossible for elderly relatives to come.

Over the past two years, we have all been reminded just how important the national health service is. I know I speak for all of us when I say how grateful we are for the extraordinary efforts of doctors, nurses and other NHS staff to protect and care for all of us throughout the pandemic. They should be rewarded for their hard work and dedication. Instead, many are being punished with these hostile immigration policies.

One doctor, a British national based in Birmingham, told me about the impact on him. He came from India to train as a GP in 2004. The UK is now his home. He studied here, he is working here, he is bringing up his children here. Sadly, he lost his father to covid in India earlier this year. Now, his 70-year-old mother wants to join her son and his family in the UK, but she is not allowed to do so, because of these rules. He tells me that

“no matter how much I earn and pay in taxes, my inability to look after my mother makes me feel incomplete and unfulfilled.”

He also feels his children are being denied a proper relationship with their grandmother. He says that

“my children should not be penalised for a decision I took 17 years back to move to the UK.”

[Ben Lake (Ceredigion) (PC)]

I thank the right hon. Gentleman for raising such an important issue. His account from the doctor echoes that of a constituent of mine, a British national of Indian birth. She faces the same very difficult personal dilemma of having to consider, on the one hand, her patients and her service to the local NHS and, on the other hand, her parents in India. Does the right hon. Gentleman agree that when we discuss this difficult issue, we should bear in mind not only the potential impact on the NHS, but also the tragic personal stories and the trauma that it inflicts?

[Stephen Timms]

The hon. Gentleman is absolutely right. We are putting these dedicated public servants in an impossible position. I received an email yesterday referring to

“yet another consultant who has left the NHS (to live in Oman so that his mother could be with the family again).”

Six thousand doctors left the NHS to go overseas in the five years from 2015 to 2020. We do not know the reasons why they all went, but a significant number went for this reason.

The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—a former Secretary of State, of course—pointed out to the Prime Minister at Prime Minister’s questions today that

“there are now severe shortages in nearly every specialty.”

The policy we are debating this afternoon is part of the problem. We should be bending over backwards to keep doctors here. Instead, we are forcing them to leave the country. Many doctors feel very strongly, as the hon. Member for Ceredigion (Ben Lake) has just reminded the House, that they are being denied a family life. The emotional toll increases the risk of burnout.

In August this year, the British Association of Physicians of Indian Origin and the Association of Pakistani Physicians of Northern Europe carried out a survey of nearly 1,000 doctors in the UK, and 90% reported feelings of anxiety, stress and helplessness because of this issue. Is that really how the UK should treat doctors who have risked their lives to care for us throughout the pandemic?

The rules also have a severe impact on children in the families affected, not least through making it very difficult for them to have a relationship with grandparents. Equally, the Joint Council for the Welfare of Immigrants sampled a group of professionals in the UK. Of the 121 children affected, 20% came from families living in lower-income households, more likely single-earner households. It points out that having a grandparent who can help with childcare will enable parents to work in cases where childcare costs would rule that out.

The Government have said that the rules on adult dependent relatives are in place to protect the NHS. They are actually undermining it. Medical professionals have busy, stressful lives, even more so in the pandemic. Those with vulnerable relatives abroad often have to take leave, sometimes extended leave, and travel overseas often to arrange care for their elderly parents, at a time when the NHS needs them here, and we need them here more than ever. Some doctors have been forced to leave the UK altogether. In the survey I referenced a moment ago, eight in 10 respondents were looking at leaving due to these rules.

--- Later in debate ---

[Rachel Maclean]

Yes, I fully understand the hon. Gentleman’s point, but the Government’s duty is to formulate rules that are fair to the British taxpayer and the NHS, and that ensure a fair system. I will come on to the specific issues about the health service to which the right hon. Member for East Ham alluded, but it is vital that our immigration policies do not place an unfair burden on the taxpayer.

We want to ensure that people here legally are welcomed and celebrated—which we do in this country—as part of a fair and sustainable immigration system. All family migration to the UK, including that of adult dependent relatives, must be on a properly sustainable basis that is fair to both migrants and the wider community.

Our position on adult dependent relatives remains that we have rules in place to support those who are most in need, but we are clear that the rules cannot provide a route for every parent to join their adult child in the UK and to settle here. It is simply not sustainable for the economy or the health service for there to be a routine expectation of settlement in the UK for parents and grandparents aged 65 or over. Therefore, only those who require long-term care that cannot be delivered in the country in which they live should be eligible to settle here.

We fully understand that such cases provoke strong feelings, as Members have articulated, and they can result in difficult choices for individuals, but it is essential that the rules are fair and balanced for the taxpayer, given the significant NHS and social care cost that can arise when those adult dependent relatives settle in the UK. Failure to maintain that balance puts the legitimacy of the entire system at risk.

I now turn to the issue of the NHS. Of course, we are hugely grateful for the vital contributions of all NHS staff, in particular during the pandemic. The Government have no intention whatever of punishing that group. By contrast, we have introduced a range of unprecedented measures to ensure that the health and care sector is supported fully. However, it is only fair that I address the points that have been made.

The impact of medical professionals potentially leaving the NHS was an issue that was raised five years ago and considered as part of the Home Office review of the adult dependent relative rules published in December 2016. That report considered the number of NHS staff who support adult dependent relatives overseas. It is likely to be a small proportion of the total population of professionally qualified clinical staff.

Furthermore, there is no evidence to show that significant numbers of medical professionals have left or been deterred from applying to work in the UK since the revised rules were implemented. It was concluded that, while some who might sponsor someone to come to the UK might choose to leave as a result of the revised rules, including some in skilled employment, the impact remains proportionate to the policy aim.

The latest figures show a 19% increase in skilled worker visas in the year ending June 2021, and that the majority of that increase was due to the new health and care worker visa, which saw 45,722 grants, accounting for 44% of the total skilled worker visas granted. In fact, such was the demand of overseas doctors and nurses wanting to work in the UK, in 2018 the Government lifted the cap on doctors and nurses. The Health Secretary at the time said:

“Overseas staff have been a vital part of our NHS since its creation 70 years ago. Today’s news sends a clear message to nurses and doctors from around the world that the NHS welcomes and values their skills and dedication.”

As I said, there is no evidence that significant numbers of professionals have been deterred from applying to work in the UK since the new adult dependent relative rules were implemented, and nor is there evidence to show that professionals have left the UK.

The NHS has made significant savings since the rules were introduced. The 2016 report notes that once assumptions were taken into account, the figures suggested potential NHS savings of around £249 million over 10 years. This policy will be kept under review. We are of course sympathetic about the impacts on individuals and families, but the policy must apply fairly across our society. It would not be right to provide a more generous approach for healthcare professionals than for other groups.

[Ben Lake]

Just to elaborate and perhaps add to the considerations, there is of course an impact on the family, but there is also an impact on the community. In many rural areas, such as mine, if we lose a solitary GP, who has to go back, we will not have a GP practice for a very large area, so there is that wider impact too. We should bear in mind that even though it may be an individual example, it has quite a widespread impact.

[Rachel Maclean]

Of course, I recognise the impacts of the issues highlighted by the hon. Gentleman. On the point made by the right hon. Member for East Ham, that we have not considered other ways to avoid the burden on the NHS and local authorities, making comparisons with other countries and their systems, I advise him that we did consider other ways. The Home Office published a review of the adult dependent relatives rules in December 2016. As I said, we continue to keep that under review. The report is published on gov.uk, so I encourage him to look at that.

As part of the review, specific considerations were given to alternative methods of achieving the main aim, which is reducing the burden on the taxpayer and NHS costs. Those alternatives were mandatory medical and care insurance, amendments to the immigration health surcharge and a bond scheme, requiring up-front payment, which would be offset against the cost of any later NHS care. Particular consideration was given to how far each of those would achieve the policy intention, be feasible to administer, and continue to allow an adult dependent relative, with significant long-term personal care needs that could not be met in their home country, to join their relative.

Those options were considered to place a potentially unreasonable administrative burden on the NHS, while also raising significant concerns over affordability and discrimination. For example, mandatory private healthcare insurance was considered likely to be prohibitively expensive, especially if it was to cover NHS emergency treatment and/or social care and residential care. It would also benefit only those applicants whose sponsor had substantial means. Those without a close relative with such means would be excluded from the UK, even if they required long-term personal care that could only be provided by their relative here. There is also no guarantee that insurance taken at the date of application would not be later cancelled or not renewed, including in circumstances outside that person’s control, such as a significant deterioration in their health or a change in the financial circumstances of their sponsor making the insurance unavailable or the premiums unaffordable.

Any alternative scheme requiring an up-front payment of many thousands of pounds would, by definition, exclude those cases unable to pay it, regardless of the level of their personal care needs. Similarly, in the light of the estimates I mentioned earlier—that a person aged 65 to 74 costs the NHS £2,287 per year—such a scheme for adult dependents would likely need to be set at significantly more than its current level. That is why it was concluded that the revised rules were set at the right level to provide immediate settled status in the UK and free access to the NHS to those relatives whose care needs could not be met in their home country, while protecting the NHS and the tax burden.