Adult Dependent Relative Visas

Khalid Mahmood Excerpts

Wednesday 3rd November 2021 Westminster Hall

[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.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

I thank my right hon. Friend, who has done terrifically well to secure this very urgent debate. Coming from Birmingham, I know both the associations he referred to. To train a junior doctor costs about £230,000 and to train a GP or consultant costs about £500,000. Every time we lose one of those consultants or GPs, or even a junior doctor, it is a huge cost to us. Should the Government not understand when they are looking at value for money that these people are well paid and able to support the parents they bring over, and will contribute towards the health insurance that they have already agreed? This would give them peace of mind. They are hugely stressed at the moment and most are still thinking of leaving at a time when we need their expertise.

[Stephen Timms]

My hon. Friend is absolutely right. Having invested so much in their training, we need to keep those experts here, not force them to leave the country. There are more than 96,000 non-UK graduates on the General Medical Council register. The evidence of the potential loss to the NHS if these restrictions stay in place is enormous. We simply cannot afford that loss. The investment made in their training is a very important point; I am grateful to my hon. Friend for raising it.

This is a real threat, not a theoretical worry. The Association of Pakistani Physicians of Northern Europe said that

“in many cases, highly trained and competent”

members of staff are leaving the UK to return to their home country or go somewhere else where the rules are more accommodating in order to care for their elderly family members.

Of course, these rules will apply to EU citizens arriving to live in the UK post Brexit. They will deter skilled doctors from European countries from working here, as they are forced to opt instead for countries with a less hostile and more accommodating policy. I remind the House that adult dependent relative entry clearance applications to the UK are among the most expensive type of visas that there are. The cost of a visa application for an adult who requires care from their relative here is £3,250. The Government say these rules are to avoid burdening the NHS; I wonder whether the Minister can put a figure on the cost of a more accommodating policy. What is the estimate that we are talking about? What will be the cost of losing all these highly trained staff who are forced to leave to fulfil their family responsibilities?

The British Medical Association represents and negotiates on behalf of all doctors and medical students in the UK. In January, together with other leading medical bodies, it wrote to the Home Secretary asking her to remove this restrictive adult dependant rule for doctors. Soon after its letter, I wrote to the then Immigration Minister asking him to meet to discuss the issue. He declined my request to meet and simply told me,

“those most in need of care remain the most likely to qualify.”

The problem is that enormous numbers are not able to come. According to the Home Office, just 70 adult dependent relative visas were issued in 2020. The Government need, at least, to review their application process to determine just why so few applicants succeed. I am certain the Minister will have received representations from the Health Secretary about this issue, and I hope they will undertake a review.

The BMA has consistently raised concerns about the potential impact on patient care and on the wider NHS if doctors have to move because of these rules. Ministers do not seem to take much notice of the urgent concerns of those working on the frontline of our health service, but it is time to start taking notice before serious harm is inflicted on the NHS. Doctors must not be kept waiting any longer. There is no justification for forcing committed, dedicated NHS doctors to choose between their work and their home in the UK, and their deeply felt duty to their elderly parents to support and care for them in difficulty and old age.

Will the Minister commit today to review this unfair policy? Why have so few applicants been successful in the past nine years? Why are Ministers weakening the NHS in order to prevent elderly relatives from joining their key worker families here in the UK?

[The Parliamentary Under-Secretary of State for the Home Department (Rachel Maclean)]

It is a pleasure to serve under your chairmanship, Ms Bardell. I thank the right hon. Member for East Ham (Stephen Timms) for securing this debate. I also thank the other Members who contributed. I recognise the strength of feeling on the topic, as the right hon. Gentleman so eloquently articulated. I will respond to his points as best I can in the time I have, but it will be helpful if I set out some background on adult dependent relative visas.

The family immigration rules were reformed in July 2012 to ease the burden on the taxpayer, promote integration and tackle abuse, thereby ensuring family migration to the UK is fair to migrants and the wider community. Costs associated with cases under the route for adult dependent relatives can be significant. The Department of Health and Social Care has estimated that a person living until the age of 85 costs the NHS on average about £150,000 in their lifetime, with more than 50% of that cost arising from the age of 65 onwards. It is important to note that this figure does not take account of any social care costs met by local authorities.

Under the rules, adult dependants must demonstrate that they require, as a result of age, illness or disability, a level of long-term personal care that could be provided only in the UK by their sponsor here, and without recourse to public funds. They must apply from overseas and not while in the UK as a visitor. The rules in place before July 2012 in essence provided an expectation of settlement in the UK for a parent or grandparent aged 65 or over where they were financially dependent on their UK sponsor, subject to the provision by the sponsor of a five-year undertaking that they could maintain and accommodate the adult dependent relative without access to public funds. They also enabled a parent or grandparent under the age of 65 and other adult dependent relatives of any age to apply to settle permanently in the UK in the most exceptional compassionate circumstances, as the right hon. Gentleman said. The old rules allowed an application to be made in the UK, including while here as a visitor, as well as overseas.

The current rules for adult dependent relatives seek to ensure that only those who need to be physically close to and cared for by a close relative in the UK are able to settle here. Those who do not have such care needs can be supported financially in the country in which they live by their relative in the UK. Those in most need of care remain those most likely to qualify, compared with those who have a preference to come to live in the UK with a relative here. The lawfulness of the rules was upheld by the Court of Appeal in May 2017.

[Mr Mahmood]

Does the Minister understand that this is not just a question of finances and money? This is an issue of relationships, of parents, children and grandchildren, and of building and understanding a family. We can support someone on their own abroad, but we cannot have that family linkage growing.

[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.