Immigration (Health Charge) Order 2015

Earl Attlee Excerpts

Tuesday 10th March 2015 Grand Committee

[Baroness Williams of Trafford (Con)]

My Lords, the NHS is one of our greatest assets and we are committed to keeping it free at the point of delivery. However, the current entitlement rules are overly generous and unfair to the UK taxpayer. Currently, all non-EEA nationals granted stay for more than six months may qualify for free access to the NHS from the day they arrive.

Use of the NHS by overseas visitors and migrants in England alone is estimated to cost up to £2 billion a year. Of this, the NHS spends nearly £1 billion a year on non-EEA temporary migrants from whom no cost is currently recovered. This facility is not generally reciprocated when our own nationals go to work or study overseas. The Government do not believe that the NHS should sustain this largesse. That is why we took action in the Immigration Act 2014 to change the legal framework in this area. This leads us to the purpose of today’s debate.

The Immigration (Health Charge) Order requires that non-EEA temporary migrants who make an immigration application to come to the UK for more than six months, or who apply to extend their stay in the UK, make a direct contribution to the NHS via payment of an immigration health charge. The Home Office will collect the charge as part of the immigration application process and payment of it will be mandatory. Temporary migrants will pay, upfront, an amount that covers the entire period of their permission to stay in the UK. Where an application is refused, rejected or withdrawn, the charge will be refunded.

In setting the amount of the charge, we have considered the range of NHS services available to migrants, the valuable contribution migrants make, and the need to ensure that the UK remains an attractive destination for global talent. Taking these factors into account, we have set the charge at £200 per annum, per migrant. This represents around 25% of the average per capita cost to the NHS of treating them. Those who pay the charge will be able to use the NHS in the same way as permanent residents.

During the passage of the Immigration Act, there was much debate in this House on the implications of this charge for international students. The Government remain committed to attracting and enabling the brightest and best overseas students to study at our world-class universities. In 2013-14, the number of full-time new entrant students from outside the EEA at our universities rose by 6%. However, we cannot overlook that international students make extensive use of the NHS, at a cost of around £430 million a year. The Government believe it is right that students should make a proportionate financial contribution.

International students and their dependants will benefit from a discounted charge rate of £150 per person, per year. This amounts to just 1% of the total cost of studying in the UK. It is also well below the price they would pay under mandatory private health insurance requirements operated in competitor countries.

In the debates in this House on the Immigration Act, a number of concerns were also raised about the potential impact on vulnerable groups. My noble friend Lord Taylor of Holbeach, in his previous capacity as Home Office Minister, sought to address these concerns. He explained that the Immigration Act provides the power to exempt certain categories from the requirement to pay the immigration health charge. He also explained the difference between the charge and the separate NHS overseas visitor charging regulations for secondary care treatment for which the noble Earl, Lord Howe, and the devolved Administrations are responsible.

Let me take this opportunity to reiterate the important safeguards in this area. Those who pay the charge will receive free NHS treatment for the duration of the lawful stay that they have been granted. The order provides various exemptions from the requirement to pay the charge. These include exemptions that reflect our obligations under EU law and other international agreements and exemptions for vulnerable groups. Visitors will be exempt from the health charge but will remain subject to the separate system of overseas visitor charges under NHS regulations in the four UK nations and must pay for their treatment. The NHS regulations contain a number of charging exemptions for vulnerable groups and particular treatments for infectious conditions in the interests of protecting public health. It is also a key principle that medical treatment which is urgent or immediately necessary in the judgment of a clinician is never withheld from anyone, irrespective of their chargeable status.

The proceeds of the charge will go directly from the Home Office to the health departments in England, Scotland, Wales and Northern Ireland. The Government estimate that the charge could raise as much as £1.7 billion additional funding for the NHS over 10 years. With that, I commend the order to the Committee.

[Earl Attlee (Con)]

My Lords, I am grateful to my noble friend the Minister for introducing the order for consideration by the Grand Committee today. As pointed out by my noble friend, the Committee will recall that the House looked at this matter in great detail when we approved the principle during the passage of the Immigration Act last year. Our task today is to ensure that the Minister is properly and appropriately implementing the legislation. I am sure that the noble Baroness, Lady Smith of Basildon, will be as forensic as she usually is.

I recall last year enjoying privately teasing some noble Lords who were involved in the higher education sector by asking them to promise me that they would not use these provisions as a selling point in their organisation’s prospectus. The plain fact is that we are capping health charges for overseas students at £150 per annum. If you tell someone that something is free, they will probably not believe you. If you tell an overseas student that their healthcare is capped at £150 per annum, they will think that it is a bargain. I think that it would help the Committee if the Minister, when she replies to the debate, would tell us how leading academic institutions in the United States of America treat healthcare costs.

A constant refrain last year was the suggestion that the Government wanted to reduce the number of overseas students by a variety of means. When I was in the Government, we were very keen on reducing the number of bogus students, but I never saw any evidence suggesting that we wanted to do anything other than encourage genuine students. Ironically, soft power is being debated in the Chamber this afternoon and overseas students are a very important component of our soft power portfolio. The Minister has already told the Committee that the number of full time, non-EEA students rose by 6%. That does not suggest that the Government’s action is deterring overseas students from coming here and, of course, they are very welcome.

[Baroness Smith of Basildon (Lab)]

My Lords, I thank the noble Baroness for her explanation. It is helpful to have a bit more detail than there is in the order. Again, I struggled trying to tie up the information in the impact assessment, because there seems to be a range of figures. I think that the noble Earl was being complimentary when he referred to me as forensic, although I am not sure he is always trying to be complimentary when he says that. I struggled when I tried to understand some of the figures in the impact assessment, especially when I compared them with the figures in the impact assessment of the previous order that we have just debated.

First, I should like to put on record that we do not oppose the principle of the health charge, which the noble Baroness will recall from the many long debates we had on the Bill. We understand that those who use the system should contribute to it and that remains our position; it has not changed at all. However, the noble Earl said that we should ensure that the charge is properly and appropriately implemented and that the evidence on which decisions are based is robust. The Minister will have seen the report from the Secondary Legislation Scrutiny Committee which questioned whether the order created perverse incentives and questioned the level of the charge.