Immigration and Social Security Co-ordination (EU Withdrawal) Bill (Eighth sitting)

Kate Green Excerpts

Thursday 28th February 2019 Public Bill Committees

Division 10

Ayes: 9

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Labour: 7
Scottish National Party: 2

Noes: 10

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Conservative: 10
Labour: 1

[Kate Green (Stretford and Urmston) (Lab)]

I beg to move amendment 9, in clause 7, page 5, line 39, at end insert—

“(8A) The Secretary of State must carry out a gender impact assessment of the Act and lay a report of that assessment before the House of Commons within six months of the passing of the Act.”

It is a pleasure to see you in the Chair, Sir David. I am concerned that a number of provisions in the Bill and the immigration White Paper published just before Christmas, in which the Government gave a sense of the future immigration regime after the ending of freedom of movement, will discriminate against women, and that these concerns have not been adequately considered by the Government in their published policy equality statements.

I shall start with the proposed £30,000 minimum salary threshold, which in future will potentially apply to EU migrants. It is widely known that women are significantly more likely to work part time than men. Some 39% of women in employment in the UK work part time, compared with just 12% of men. The pay for part-time work is obviously prorated, so that employees are paid for only the amount of hours or days that they work. However, the minimum salary threshold of £30,000 proposed in the White Paper is not apparently prorated, meaning that a part-time worker will need to secure a job with a significantly higher rate of pay than a full-time worker in order to meet the visa criteria. An employee working three days a week, for example, would need a full-time equivalent salary of £50,000 in order to meet the threshold. That is significantly more than the average full-time salary of a woman in the UK, which stands at £26,103.

Even when prorating is accounted for, part-time workers are still paid less than full-time workers. The average hourly rate of a part-time worker is £9.36, compared with £14.31 for a full-time worker. For a part-time worker in the UK, male or female, the gross average annual salary is just over £10,000. Women who work part time often do so in order to provide care for young children or elderly relatives. Women from EEA countries seeking to come to the UK are therefore likely to be forced to work full time regardless of their caring responsibilities, unless they are earning a high salary.

Even when women are working full time they are still likely to earn less than men, thanks to the gender pay gap, which currently stands at 18%. Women account for 70% of all earners, calculated on the basis of jobs paid below the minimum wage. They also make up the majority of those in temporary employment, zero-hours contracts and part-time self-employment. That means that women will on average find it much more difficult to meet the £30,000 minimum salary threshold, and therefore to come to the UK.

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[Caroline Nokes]

I thank the hon. Lady for her intervention. I fear she made a somewhat Freudian slip when she said that women are paid less by men, but I am inclined to agree with her on that point; it is what the gender pay gap tells us.

The hon. Lady makes an important point. When we are considering the future immigration system as part of our conversations about the White Paper and as the immigration rules come forward, we have to consider these issues. However, as I have repeatedly said, this is a framework Bill; its only purpose is to end free movement. As part of our engagement on the proposals in the White Paper, we will have to look seriously at the impact on all protected characteristics, not simply gender. As the hon. Lady has pointed out, it is difficult at this stage to assess the impacts of ending free movement. For that reason, as set out in our published policy equality statement on the immigration measures in this Bill, we have committed to consider all equalities issues carefully as the policies are being developed. The policies will receive equalities impact assessments, and those assessments will be published.

The Government are committed to implementing a fair and transparent immigration system that complies with the equality duty. The social security co-ordination clause is an enabling power, allowing changes to be made to the retained social security regime via secondary legislation. Details of policy changes will be set out in the regulations that will follow, and those regulations will also be scrutinised by Parliament via the affirmative procedure. The policy equality statement on that clause was also published when the Bill was introduced. It looked at the demographics and protected characteristics of those who currently export benefits in the EEA, including their gender. In the policy equality statement, we have committed to consider the impacts throughout the policy development process. The Government will consider the impacts of any future change on the retained social security co-ordination regime in line with the public sector equality duty.

I hope that I have addressed the concerns of the hon. Member for Stretford and Urmston. I ask her to withdraw her amendment, for the reasons I have outlined.

[Kate Green]

I am grateful to the Minister for her response, and I take some reassurance from her words. She has made it clear that over the rest of this year, as part of the engagement on the White Paper, particular attention will be paid to engaging on the equalities effect of its proposals, and that equality impact assessments will be produced, published and fully available as individual policies are developed. I also take some comfort from the Minister’s words about her awareness of the need to consider the equality impact assessments, including the gender impact of the provisions of clause 5 if the delegated powers in that clause are used to make changes to the social security regulations. In those circumstances, knowing that the Minister takes these matters extremely seriously, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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[Eleanor Smith (Wolverhampton South West) (Lab)]

I wish to speak to new clause 12, which states:

“Any EEA or Swiss national, or family member of an EEA or Swiss national, resident in the United Kingdom shall be deemed ordinarily resident for the purposes of section 175 of the National Health Service Act 2006.”

When charging for non-residents was first introduced under section 175, it was not meant to add excess costs for that group of people accessing our healthcare. In 2015, costs were introduced that started at £200 for most applicants and £150 for certain groups—for example, students. The fee has now doubled. That means that a family of four would have to pay about £1,000 each in IHS costs in addition to their visa costs.

I am pleased that the Minister confirmed in November that EU citizens who are resident in the UK before it leaves the European Union in March 2019 will not pay the charge, and that the Government have come to an agreement with Switzerland, Norway, Iceland and Liechtenstein that during the transition period their citizens’ rights will be protected. However, it is still unclear what will happen after the transition period has come to an end in 2021 or in the case of a no-deal scenario, After December 2020, a new visa system will be in place that could mean that EEA citizens and Swiss nationals have to pay the immigration health charge.

It seems to be forgotten that most of the EEA citizens and Swiss nationals in the UK are currently employed and are already paying for the NHS through their taxes. Extending the immigration health surcharge to them would mean that they were being charged double for NHS care, which would seem to me an unfair contribution.

That leads me to the issue of the NHS. More than 60,000 NHS workers are EU nationals and, without settled status, they could face the possibility of paying the increased surcharge as well as for their tier 2 work visa. The new system could add further pressures for the NHS, which is currently struggling to recruit the number of healthcare professionals needed to meet the country’s demand.

Labour’s intention is to level rights up, not down. We hope that, after a new immigration system applying to nationals from across the world is introduced, none will be required to pay these charges.

[Kate Green]

I wish to speak to amendment 37, which has my support, as do the new clauses in this group. I would like to say a few words about one particular aspect of NHS charging, which is in relation to maternity care. Under the current charging rules, non-urgent care must be paid for in advance, but “urgent” or “immediately necessary” care must be provided whether or not a person can pay in advance. The guidance from the Department of Health and Social Care and the statutory regulations make it clear that maternity care is to be regarded as immediately necessary, so it must not be refused or delayed if a woman is unable to pay in advance, although she will still be charged for it. However, because of confusion about the charging regime and misapplication of the rules, pregnant women who are not UK nationals have already been denied maternity care, told that they must pay in advance of receiving treatment or told that their appointments may be cancelled if they fail to pay. Extending the charging regime to EU nationals, including pregnant women, would multiply such injustices in a system that is already making serious mistakes.

Charges for NHS maternity care start at approximately £4,000 and can rise into the tens of thousands for more complex care for women or additional care for new babies. Those charges are significantly higher than what NHS trusts would normally be paid for providing such care, because the regulations require them to charge 150% of the relevant NHS tariff. In practice, the rules mean that some hospitals have sent bills demanding immediate payment of thousands of pounds from vulnerable post-partum women. Women have received letters threatening referral to debt collectors, local counter-fraud specialists or the Home Office; in one appalling case, a woman was issued a bill of almost £5,000 for treatment following a miscarriage.

Research by the charity Maternity Action has found that the charging regime has resulted in women avoiding essential antenatal care and missing appointments because they fear incurring a debt that they cannot pay or being reported to the Home Office. That includes women with health conditions that require effective management to protect the health of both mother and baby. Antenatal care is intended to pick up and treat problems as early as possible, increasing the chances of a safe and healthy birth. Missing midwifery appointments means that high blood pressure and gestational diabetes are left untreated, the window for HIV prophylaxis is missed and minor infections are allowed to develop into serious health conditions.

Migrant women who are entitled to free NHS care are also affected by charging policies. Maternity Action regularly encounters women, including EEA citizens, who have been wrongly assessed as chargeable and have received bills for their care. In some cases, the women affected by the rules have children and spouses who are British citizens. Surely that was not the intention of the policy.

In December, the royal colleges issued a joint statement calling on the Department to suspend the charging regulations pending a full independent review of their impact on individual and public health. The Royal College of Midwives has expressed

“enormous concern…that vulnerable women are missing out on essential…care.”

Given the harm that charging for NHS maternity care is already causing to women’s physical and mental health, the fact that many women are simply unable to repay bills, the clear lack of regard being given to children’s best interests, the risks to public health and the potential for the charging regime to be extended to all EEA nationals, is it not time to consider the arguments for immediately suspending all NHS charging for maternity care?

[Maria Caulfield]

Having had experience of looking after migrants in the health service, I have some sympathy with the hon. Lady’s argument, but who will pay for their care? Will it be the UK taxpayer, or will migrants have to make some contribution to their own healthcare needs?

[Kate Green]

I very much respect the hon. Lady’s expertise in these matters; I also appreciated her important comments during the Committee’s oral evidence sessions. I echo the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East. Clearly, there is a balance to be struck between the costs to the UK taxpayer and what is right for the health and wellbeing of anyone living in this country, in whatever circumstances. Like him, I would strike the balance on the side of health, wellbeing and the protection of life when we have to make those difficult choices.

As the hon. Gentleman said, there are things that we could do. One possibility, although personally I do not favour it, would be to apply the health surcharge in some circumstances in which it might not otherwise apply. However, the evidence is that because these women are unable to pay the debts anyway, most of the money will in fact go uncollected. The NHS is not really gaining financially. All the charges seem to do is deter women from seeking the care they need for themselves and their babies, and that is a false economy down the line. If the women are legitimately in this country, as they are, the need for further emergency care and primary care will pile up if they have not had the proper antenatal and maternity care that they should have had to meet their best interests and that of their children.

I know that the Minister takes these matters seriously. Will she use her good offices to ask her colleagues in the Department of Health and Social Care to publish the Department’s 2017 review of the impact of amendments to the NHS charging regulations? I am told that it engaged with those involved in the maternity care of women, including the Royal College of Midwives, but the outcome of that review has not been published and placed in front of us. If the Minister can do anything to persuade her colleagues to make that information publicly available, it would be much appreciated.