Draft Immigration (Health Charge) (Amendment) Order 2020

Holly Lynch Excerpts

Tuesday 22nd September 2020 General Committees

[Holly Lynch (Halifax) (Lab)]

Thank you ever so much, Mr Robertson; it is a pleasure, as always, to serve under your chairmanship. I thank the Minister, in the main, for his opening remarks on the statutory instrument. It will not come as a surprise to him that we shall oppose it. Before I discuss the reasons for that, I shall take the opportunity to flag up some concerns about version control. Because of the previous publication of the SI on 19 March, superseded by the later one taking account of the health and care visa, I think I have seen two versions of the SI and, if I am not mistaken, three versions of the accompanying explanatory memorandum.

I know how hard the Table Office staff and the Clerks work, but those documents have been circulated in various combinations, and even this morning when I asked for the latest copy at the Table Office I was provided with the version published on 19 March. I just ask the Minister to consider ensuring that the Opposition have all the information we need to do our jobs properly. It would certainly assist us in the constructive dialogue that we need to engage in on important measures such as this order.

I turn to the order itself. We cannot support the increase in the health surcharge at a time when access to healthcare is essential, in the middle of a global public health crisis. We need fewer barriers to healthcare, not more. That is particularly true in relation to those already in the UK. Also, the detail of the Government’s proposals to exempt health and care workers from the fees falls a long way short of what was promised.

The Minister referred to the discussion in the Committee that considered the Immigration and Social Security Co-ordination (EU Withdrawal) Bill; he and the SNP spokesperson, the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East, will no doubt recall much of the discussion with great fondness. However, to keep tightly to debating the SI, there is a theme of measures that do not reflect the spirit of “clap for key workers” and the genuine gratitude that we feel to those on the frontline. Many of those we are landing with an increased bill will be in lower-paid but essential work as part of those efforts.

We welcome the intention in the SI to exempt from the fees those who plan to come to the UK on the future health and care visa. We passionately made that case, and the fees were described as “appalling, immoral and monstrous” by Lord Patten, a former Conservative party chairman.

The explanatory memorandum states:

“There has been strong support for those working in health and social care to be exempt from paying the Immigration Health Charge.”

That is precisely the point—that for those currently working in health and social care the SI does little to remove the burden of the health surcharge fees. It fails to offer automatic exemption from the immigration health surcharge for migrants currently working in health and social care. Migrant workers still have to pay it, and have been promised a refund only down the line. We hear about significant variations in how long it takes people to get their money back from the Home Office. Some doctors I have spoken to have stated that they have had reimbursements only after sending multiple emails to the Home Office, many of which went ignored.

The refund approach is an excessively bureaucratic measure that illustrates the disconnect between policy makers and health workers. Like everyone working in healthcare right now, migrant workers continue to face those stresses on a daily basis while their own lives are on the line to help us to combat coronavirus. Within the care sector in particular, many of those key workers are on salaries that do not begin to reflect the immense contribution and value that their work provides for us all. The statutory instrument should be clear that all those working in health and social care are exempt and simply do not have to pay the fee.

The Prime Minister’s pledge on 21 May to abolish the immigration health surcharge for health and care staff as soon as possible was met with excitement and praise. Yet the prospect for many migrant workers of still having to pay an increased fee and face the exact same financial difficulties that they were experiencing before the announcement seems an incredibly unfair and unnecessary way of going about it. I will share the experiences of some real-life migrant NHS and social care workers to make that very point.

Mary is a healthcare assistant and a Unison member from Nigeria. She and her care worker husband work all hours possible to provide for their three children, aged 13, nine and three. Owing to their immigration status and having no recourse to public funds, the family is not eligible for any state aid, free school meals or child benefit. Despite that, Mary, her husband and her three children have all had to pay the immigration health surcharge individually and have not been told by the Home Office when they will receive a refund. When the increase comes into effect, that will only get worse for families such as Mary’s.

Helen is a nurse from the Philippines, working on a tier 2 visa. She came to the country two and half years ago on a hospital-sponsored three-year visa. She is currently on maternity leave expecting her second child, and is faced with the burden of paying the visa charges for herself, her husband and their children, including for the baby once it is born. The family have had to downsize to a one-bedroom property to be able to afford to pay the immigration health surcharge, despite the Prime Minister’s announcement. Like many, the family also has no recourse to public funds, so receives no free school meals or child benefit.

I have already raised in the House the story of Dr Ahmed Bani Sadara, originally from Pakistan. He had to pay the surcharge for his new-born daughter twice in a year—first, when she was born and again when he changed his role six months later within the NHS, in addition to paying the surcharge again for himself and his wife. We implore the Government to listen to those individual case studies and to devise a solution that offers immediate exemption of the immigration health surcharge for all migrants working in the NHS and social care.

The absence of such an exemption is just one reason why we cannot sign off on the increases. The current initiative does not work for people, and I am sceptical about whether it works for the Government or the Home Office either. Can the Minister share a sense of the administrative cost to the Home Office of issuing refunds in that way? Beyond the delivery of the exemption, we are concerned that the eligibility does not reflect the spirit of what was promised. All staff within the NHS and social care sector have played a front-line role during this crisis. Everyone from specialists in intensive care, allied health professionals, nurses and hospital porters have collectively pulled together, and as such should all be recognised for their herculean efforts.

Labour believes that every migrant worker in the NHS and social care sector should be exempt from the immigration health surcharge; however, on 15 July, the Minister told the House that only those who qualify for the new tier 2 visa will be eligible for automatic exemption, and that other health and care workers would qualify for the refund only if they had worked in the NHS for six months. The Government have failed to clarify how the refund will work in practice.

I heard the Minister say that colleagues in the Health team will provide some clarity, but it would have been incredibly valuable to have had that prior to discussing the SI. Paragraph 7.11 of its most recent explanatory memorandum merely promises the publication of another reimbursement scheme in due course. That is clearly a million miles away from what the Prime Minister promised, so we hope that the Minister can be clear with the Committee when that will be published and what the mechanism will be for delivering it.

The Minister will be aware that we face a clinical skills shortage in the NHS. Until there is a successful domestic training programme, that shortage cannot be resolved without migrant medical staff. Yet Government policy still acts punitively towards those vital workers. The UK has a world-beating system, I am afraid, for discouraging skilled migrants, which in turn threatens to compromise the quality of our public services at the time when we need them the most. The immigration specialist law firm Fragomen carried out international comparison analysis and found that out of 119 countries only the UK required an advance yearly fee payable upfront in one lump sum to the relevant country’s Government, as the SI does.

We place a significant financial burden on applicants, due to the payment of lump sums such as the immigration health surcharge. The Government should look to abate the up-front costs and could do so by making it possible for the IHS to be paid in yearly or six-month increments, rather than in one lump sum at the outset; again, that applies particularly to those who are already here.

Beyond the implications for healthcare workers, Labour rejects the proposed increase in the IHS from £400 to £624, and the rise from £300 to £470 for the discounted rates more broadly. Right now, people are in more vulnerable and precarious work than ever before—people with families, who could be key workers, who have come to the UK for good jobs, worked hard and paid into the system face uncertainty in the workplace, as almost everyone does right now.

To ramp up the costs for those who are already here, who might be changing jobs and who have to apply for a change of sponsor so that they have to pay the fees again, whether or not they will be reimbursed, and find the extra money to access healthcare, when the financial outlook is more precarious than it has ever been, is simply not the responsible thing to do in the middle of a public health crisis. It is wrong to increase the surcharge during this time, and it will further increase the financial burdens faced by lower paid migrants. Let us remind ourselves that they could include those working on farms and in shops, keeping shelves stocked and food on our tables.

This statutory instrument represents one step forward and two steps back for migrants in the UK. We agree that future tier 2 visa applicants should be exempt from the immigration health surcharge, yet the decision to make current healthcare and social care workers pay the fee and be refunded down the line is illogical and harmful, with some of them still missing out all together in the long term.

We would also welcome much greater clarity from the Government on who will be eligible in the future for exemption, and we make the case once again that the exemption must be extended to all healthcare and social care workers, as well as their dependents. We oppose the rise in the immigration health surcharge for all other migrants to the UK. At the start of the pandemic, the Chancellor stated that we are all in this together, but measures such as this SI suggest that some people are more in it than others. As a consequence, Labour will vote against it.

The Minister referred to some of the discussions that we had at the Committee stage of the Immigration Bill. He knows that what I said then was that Labour is engaging in a huge amount of work to make sure that we have a radically different approach to immigration in the future. Of course, there are cost implications, and we are not in a position just yet to outline all of them the Minister, but he knows that work is under way and I look forward to sharing the results of it with him in the not-too-distant future.

--- Later in debate ---

[Kevin Foster]

I thank the members of the Committee for their valuable contributions.

I will start with the comments of the right hon. Member for Orkney and Shetland. I was pleased to hear him say that it was a fair point that, when someone steps off a plane, they need to have access to the NHS if they have the type of immigration permissions that we are discussing today. That is why the measure was introduced under the coalition. To reassure him, given his comments on wider charges in the immigration system, the fundamental charging criteria are still pretty much what they were back in 2014, when agreed during his own time in Government.

To come on to some of the wider points made, the first by both the SNP and Labour spokespersons, any confusion in the supply of the explanatory memorandum is concerning. I am certainly more than happy to pick that up through my private office. When we lay statutory instruments, I am also more than happy to ensure that copies of relevant documents are sent directly to hon. Members. I am conscious that an important part of scrutiny is to have those documents easily to hand, without having to rely on the Table Office. I will ensure that that is actioned.

I will also clarify a couple of comments made on the pandemic by the hon. Member for Halifax. To be clear, anyone who needs treatment for covid-19 may approach the NHS for it. Across the United Kingdom, there is no charge for that, and whether people are able to access treatment does not in any way relate to their immigration status. As I said in the Chamber in response to a question from my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), information supplied to the NHS will not immediately be supplied to immigration enforcement. Our priority is to ensure that people feel they can approach the NHS in this country if they have symptoms of covid-19, regardless of whether they have lawful immigration status or are undocumented. I wish to very clear on that point.

I will go into some of the other issues raised. To be fair to the hon. Member for Halifax, she was specific in her wording, probably for a reason, that other countries do not require payment to the “relevant Government”—the exact words used. That rather misses the point about the situation in other countries. We all know the situation in the United States of America, where a payment may not be required to the US Government, but in reality people take a risk with their own health and of potentially crippling medical bills if they do not have medical insurance. Thankfully, we do not have such surcharges for people living here in the United Kingdom, and never will. Talking about no payment to the Government also misses the fact that to get the type of cover provided by the NHS here, people have to spend a significant amount of money. That is true in other countries, such as New Zealand, which requires foreign fee-paying students to hold acceptable medical and travel insurance as a condition of their visa. They do not have to pay the Government, but they do have to buy something specific. In addition, they still have to pay for GP practice consultations, which would be free here in the UK.

[Holly Lynch]

That was a series of points about the fact that the way we ask people to make that fee—up front, in advance and in one lump sum to the Government—is very unusual. Even comparing it with insurance, which is slightly different but it is the point that the Minister is making, I would imagine there would be different payment plans to make it a bit more manageable for people if that financial contribution, up front and in one go, is a challenge and a barrier to healthcare. Can he reflect on that point?

[Kevin Foster]

Again, some of those costs are up front, then followed up by having to pay for healthcare treatment. One thing that is unusual and which is really good about this country is the level of free-at-point-of-need healthcare that we have across the nations of the United Kingdom, dating back to 1948 and the introduction of the NHS. That is not replicated in many other countries, where there is either a social insurance system or there is still co-payment for many areas.

Ireland was another example given and we have had a quick look at the position for someone who has moved there. In my understanding, there is a charge levied more generally, not just on migrants, where people pay €100 if they attend an accident and emergency department without a referral letter from the doctor. Again, we do not have those sorts of charges here and neither will we look to have them. Similarly, there can be charges for being an in-patient in a hospital in Ireland. Again, that would not apply to someone here who has paid the immigration health surcharge or who has indefinite leave to remain and therefore is exempt.