Draft Immigration Skills Charge Regulations 2017

Caroline Johnson Excerpts

Wednesday 22nd March 2017 General Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I wonder if someone could explain to me a few things about the regulations. Before I was elected in December, I was a consultant paediatrician—a doctor—working in the NHS. My understanding of tax is that it is there to either raise revenue or change behaviour. I welcome the broad principle of the charge, which is essentially, as I understand it, to incentivise employers to employ or upskill British workers, rather than taking the perhaps easier option of employing an already skilled person from abroad.

However, I do not understand why the charge will be applied to the medical profession. I will explain. Roughly 55,000 tier 2 visas were granted in 2015, of which 3,600-ish were for doctors. I do not understand how the charge can raise revenue. As I understand it, we are asking the NHS to pay a charge. That will not increase revenue to the Treasury, but will take money from the Treasury to the NHS to the Home Office and into the Consolidated Fund, then, via some Treasury calculations, either to the Department for Education or to the devolved Administrations. Doing that will not provide us with information because we already know to whom the tier 2 visas are being granted and which particular employers are requesting them.

Does the charge change behaviour instead? I do not understand how it will do that either. We have a national shortage of doctors. According to the House of Commons Library, there are 935 consultant vacancies—I suppose I am responsible for one—and 1,560 junior doctor vacancies. The Department of Health has done a lot to improve that, and I welcome the fact that 30,000 new medical students are in training. However, with a roughly five-year training programme, that means we will be getting 6,000 new doctors a year. It will be many years before we can be reliant on home-trained doctors rather than overseas recruitment.

Grantham A&E, which serves my constituency although it is just outside it, abruptly announced last August that it would be closing to patients overnight, owing to a shortage of middle-grade doctors—those who have already spent at least nine years in training to be a doctor. Trusts are being penalised for attempting to recruit doctors from overseas to fill those gaps, but they have no control over what they are being penalised for. Unlike other staff in the NHS who are specifically trained in-post, the number of doctors being trained is governed centrally by the Department of Health, not by trusts. The trusts have no control over the making of new doctors and are not able to recruit new, British staff to train to be doctors. They also cannot change the salary, because that is set nationally as well. Doctors who have perhaps left medicine to train abroad or to go into other professions cannot be enticed back with financial incentives, because trusts are only allowed to offer them a fixed salary.

I do not understand how the charge will change a trust’s behaviour, since a trust has no control over the training of doctors. Will the Minister explain how the tax, specifically as it applies to doctors working in the NHS, will either increase revenue or change behaviour and increase the number of British doctors available?

[Kirsty Blackman (Aberdeen North) (SNP)]

Thank you for calling me in this debate, Mr Streeter. I want to start by agreeing with my hon. Friend the Member for Glasgow North East. The measure is poorly thought out and it is ideological, which is the main reason for our opposition to it. I want to talk about various things that the Minister mentioned and agree with some of the things that the hon. Member for Blackpool South mentioned.

But first I want to briefly mention the hon. Member for Sleaford and—Hykeham?

[Dr Caroline Johnson]

North Hykeham.

[Kirsty Blackman]

Sorry. It is invaluable to have the hon. Lady’s experience in this place. She talks from a knowledgeable point of view about how long it takes to train doctors. I imagine it took her many years to train to become a consultant. The Government are missing the fact that it is not just the five years to become a junior doctor that we need to consider. Some people train for 15 or 20 years to get to the positions where we have the gaps. We cannot train such people overnight. The Government perhaps overlooked that issue when they introduced this measure.

The Minister mentioned the Migration Advisory Committee. I understand that that body was set up to make recommendations to Government, but the quality of the input is at issue here. The Government asked the Migration Advisory Committee to do a wide-ranging review of tier 2 with a view to recommending proposals that would substantially restrict inflows under that route. If it is asked to do that, it will give us things that restrict inflows under that route and not what is best for the economy and for the United Kingdom as a whole. It will give us what the Government asked it to do, so we cannot say that the proposal is impartial and has fully taken account of all the representations it received, because it was given a specific brief, which it has met. That was my first concern that needed to be made clear.

I have a few issues about the implementation and the document. As the hon. Member for Blackpool South mentioned, the Government did not undertake a full public consultation. They did not do an impact assessment. They have not been clear about how the money will be invested. We have had more clarity recently, with the Government predicting that it will be £100 million and saying that it will go to the Department for Education and that there will be Barnett consequentials, but that is not enough clarity. If employers are being asked to pay this tax, they need to be able to understand where the money is going and understand the benefits to the British economy of paying it. A tax is reasonable only if people can be convinced that they should pay it. The Government have failed to do that because of the lack of information they have provided.

I welcome that the explanatory memorandum states that there will be a review after one year of the amount of money that has been brought in, but there is no mention of a review of where the money is spent and the effects it has. Also not mentioned is the impact on employers and whether that will be taken into account in any review. Basically, the Government are committed to providing us with a headline, “This is the amount that we took in”, but no further information on the impact. If the Government are to justify this to the British public, it is important that they provide us with the information we need.

One thing that is not clear—I do not think it has been made clear to businesses—is whether there will be refunds. Let us say somebody is employed in the United Kingdom for one year and the company pays the upfront cost. What if they pitch up, they are here for a month and then they drop down dead or they toddle back off to the country that they came from because they decided it was too cold here? Will the Government give those companies a refund if they have not employed that person for a full year? That has not been clear in any of the information I have seen. I apologise if it has been made clear; I have not yet seen it. Certainly, a number of businesses do not understand the possible implications, so it has obviously not been discussed or publicised widely enough.

The points about the NHS have largely been covered by the hon. Member for Sleaford and—I will not attempt to say the second part of her constituency again—and by the hon. Member for Blackpool South. In saying that there has been plenty of time, the Minister does not recognise the fact that it takes a very long time to train people to fill some occupations. The hon. Member for Blackpool South mentioned the numbers that the BMA got in touch about and the particular cost of this measure to the NHS.

One thing that is not clear is how much of the money that is taken in will go towards infrastructure funding to support the training of doctors and nurses. For example, will the size of lecture theatres and the number of tutors who train doctors and nurses be increased? Why was that not done five or 10 years ago to ensure that we did not have the shortages we have today? Businesses and public service bodies that are asked to pay this money as of April will not have the opportunity to fill those gaps that they needed to fill five or 10 years ago, in terms of the teaching frameworks that we have.

There is a particular issue around very highly skilled occupations in which we have very few experts. We have had issues in my constituency with recruiting senior doctors who are experts in gender reassignment surgery, and gender reassignment generally, because there are so few of them across the world. Whatever we do today, we will still not have those people in post tomorrow or next week; it will take a long time to get those specialists. I do not think the Government have made enough allowances for the most specialised occupations.

If the Government had done this in a more sensible way, they would have looked at the shortage occupation list that is already in use and applied that, rather than coming up with a new list. That would have been a more sensible way to do this. We have previously argued against some of the things on the shortage occupation list, particularly because it does not take account of specific geographic issues and the lower salaries in Scotland.

The proposal poses a specific issue for the Scottish economy for a number of reasons. We have a high proportion of rural communities and communities that are relatively highly reliant on one industry or business that employs most of the people in a village, for example. Even though it employs most people in the village, there may only be 20 or 30 employees and it may still be a relatively small business that is not generating a huge amount of profit. Despite the lower costs for small businesses, they will still be expected to pay the charge.

It can be particularly hard to attract people in specialist occupations to the most remote areas of Scotland, where there is maybe not much access to services or a big supermarket. It is hard enough to attract those people anyway. If companies now have to pay extra money to attract them, that will be a real issue, particularly in the most rural areas where there is not a devolved settlement. I cannot imagine the Department for Education prioritising training in a small, rural community in the north of England in order to have one person filling one role. That would not be cost-effective for the Government, but this measure will cost such small businesses a huge amount of money.

I specifically raised those issues around rural communities. The other thing about Scotland is that our economy relies more heavily on small businesses than England’s, which is partly because of the rural nature of much of Scotland. From the information the Government have provided, I cannot tell the differential impact that the charge will have on small businesses; the Government have simply not provided that much information. They have provided information on how much money they think they will get in total, but there has been no breakdown of the impact on different sectors or communities. That highlights how poorly thought out this is.

The Scottish Government wrote to the UK Government and asked for information about the impact on Scotland but were not provided with it. If the UK Government intend to implement charges such as this across the whole of the United Kingdom, they need to be clear about the impact on Scotland and answer our request for information about that.

The last thing I want to touch on is something I have brought up in relation to immigration in a number of other settings, and I will continue to do so. The UK Government are setting out their stall—that it will be “global Britain”, trading across the world. I have previously raised the issue of trading with Commonwealth partners, given our massively high refusal rates of visitor visas for people coming from Nigeria or Pakistan, for example. If we want to have influence with those countries, have them look favourably upon us and sign free trade agreements with them, we need to be nicer to them than we currently are. There is a major issue with visitor visas.

This charge will be a major issue as well. If we are saying to people in other countries, “We would love you to sign a free trade deal that will allow us to export lots of stuff to your country—but by the way, we don’t want any of your people to come to our country,” that will be a real issue in the negotiation of free trade agreements. What I can see coming down the line is that once we have implemented the regulations, and once doctors being trained in India are less likely to be able to take up a post in the United Kingdom, that will affect our ability to strike decent, favourable deals for the UK.

I have spoken to Ministers before about soft power. Britain is not putting itself in a positive position on the world stage by the behaviour it is exhibiting on immigration. If we want to have better influence and the “global Britain” panacea being suggested to us by some of those who are most in favour of Brexit, we need to change the attitude of this Government.