Statement of Changes in Immigration Rules

Lord Avebury Excerpts

Wednesday 9th November 2011 Grand Committee

[Lord Rosser]

First, I apologise for the absence of my noble friend Lord Hunt of Kings Heath. He is involved in the health bill and does not know how long the issue being discussed in the Chamber will last. It may well be brief, in which case he will be required in the Chamber.

The statement of changes to Immigration Rules has been the subject of consideration by the Merits of Statutory Instruments Committee. The Merits Committee, of which I am a former chairman, drew the changes to the special attention of your Lordships’ House on the grounds that they give rise to issues of public policy likely to be of interest to the House. However, in its conclusion, the Committee also stressed the importance of providing appropriate levels of explanation and visibility for Parliament.

The statement of changes makes a number of amendments to the Immigration Rules, but the most significant is a provision that a person subject to immigration control who has failed to pay NHS charges of £1,000 or more in respect of NHS treatment charges should normally be refused permission to enter or remain in this country, or have their leave cancelled.

The Merits Committee states that the consultation on this issue produced important comments from stakeholders. It noted that the document on the United Kingdom Border Agency website, giving the results of the consultation, provided a relatively full and balanced account of the consultation outcome. However, the Committee went on to say that it was regrettable that this was not matched in the Explanatory Memorandum laid before Parliament, and that furthermore, given the importance of some of the issues raised in the consultation, Parliament could reasonably expect the United Kingdom Border Agency to have used the Explanatory Memorandum to provide greater reassurance that the policy will achieve its objectives.

It would be helpful if the Minister could explain why the Explanatory Memorandum did not match up to the level and standard of information on the consultation outcome provided on the website. Or is it his view that this is not the case and that, as far as Home Office Ministers are concerned, the Merits Committee is being unreasonable? That might well be the view of Home Office Ministers, bearing in mind this is by no means the first time that the Merits Committee has been less than impressed with the quality and completeness of information provided to them by the Home Office, and so far there appears to be an inability by Home Office Ministers to rectify the situation.

The Merits Committee was not alone in expressing its concerns on this point. The committee received a letter from the British Medical Association about the change in respect of outstanding NHS charges, which stated that it had submitted a detailed response to the Department of Health consultation and raised some general points by letter to the United Kingdom Border Agency in response to its parallel consultation.

The British Medical Association said that it had concerns with respect to the way comments relating to the proposed legislation had been represented, particularly in the Explanatory Memorandum accompanying the statement, which it did not think had adequately represented the balance of comments it had submitted. The Explanatory Memorandum states that the British Medical Association supported the proposals in principle and that,

“the introduction of changes to the Immigration Rules to promote payment of NHS debt seems reasonable”.

The letter from the BMA went on to say that it had raised significant concerns, in particular over the detrimental impact such changes could have on the engagement of vulnerable groups with health services, which were not reflected in the Explanatory Memorandum. Significantly, the Merits Committee went on to say that it shared the BMA's concerns about the United Kingdom Border Agency's representation of the BMA's position in the Explanatory Memorandum. Is the Minister, too, concerned about the representation of the BMA's position in the memorandum, or will he go on the record as saying that the memorandum adequately represented the balance of comments submitted by the BMA—contrary to the views of both the BMA and the Merits Committee?

The Merits Committee report makes it clear that in order to get a better understanding of how the consultation fed into the policy development process, the committee had to seek further information from UKBA about concerns raised during the consultation, as well as about any risks and remaining dissatisfaction with the proposed changes. That further inquiry elicited information that was not contained in the Explanatory Memorandum: namely, that concerns have been expressed, including by the BMA, that an unintended consequence of the rule change might be that it would act as a deterrent for migrants to seek necessary medical care, and that three organisations had raised issues of confidentiality and/or of data protection. The issue of confidentiality was most actively highlighted by HIV/AIDS representative groups because in their view HIV/AIDS is a stigmatised condition.

The committee also received a submission from the National Aids Trust saying that the new rules would have a serious impact on public health by dissuading migrants with HIV from accessing testing and treatment. The National Aids Trust was also of the view that the rules might lead to unlawful discrimination against disabled migrants and indicated that it may mount a legal challenge on these grounds. Will the Minister say if the Government considered whether the new rules could be regarded as constituting unlawful discrimination in relation to any groups or categories of individuals?

Since UKBA said that the rule change was drafted so that an NHS debt would not result in a mandatory immigration refusal, and that the new rule would be applied on a case-by-case basis, the Merits Committee also wrote to the Minister seeking a full explanation of how the new rule relating to NHS charges of £1,000 or more being applied on a case-by-case basis would operate. The committee has now reported on the reply from the Minister responsible for immigration. In the light of that reply, its latest report states:

“The Committee notes that the guidance for decision makers seems to suggest that these medical cases will result in an immigration refusal in all but rare and extreme circumstances”.

Will the Minister say whether he considers that to be a fair interpretation by the Merits Committee of the response from the Minister for immigration?

The Merits Committee undertakes valuable work on behalf of your Lordships' House, considering instruments and drawing them to the special attention of the House where necessary, in line with its terms of reference. Its report on the statement of changes to Immigration Rules raises serious issues about the Explanatory Memorandum and also makes it clear that the committee had to pursue further issues in writing because the level of explanation was less than it should have been. I hope that the Home Office and Home Office Ministers take seriously the work of the committee. If future reports contain further critical observations about the quality, accuracy and extent of the information provided by the Home Office, no doubt there will be more debates of the kind we are having today. The Minister has not been in his position for long. I hope that he will be determined to address the concerns raised by the Merits Committee in the report that we are considering, as well as the not dissimilar concerns raised in previous reports. I beg to move that the Committee do consider the statement of changes in Immigration Rules.

[Lord Avebury]

My Lords, before coming to the statement, I will say that as we get material changes to Immigration Rules at such frequent intervals and there is invariably a prayer tabled against each one, they ought to be made subject to the affirmative resolution procedure. I would be grateful if my noble kinsman will let us have his views on that matter.

We are considering this statement against the backdrop of several major crises hitting UKBA at the same time. There is the saga of the passport checks and the suspension of three top officials for the unannounced dropping of our guard against terrorists, money launderers and drug merchants—which now appears to have been the bright idea of the Home Secretary. Then there was the robust criticism by the chief inspector of the management of foreign national prisoners, with 1,600 being detained in January at the end of their sentences for an average length of 190 days, costing the taxpayer as much as if they had stayed in the Savoy hotel. A third of them appealed successfully against their deportation, meaning that if UKBA had made the correct decisions, it would have saved the taxpayer millions of pounds. There was the sudden revelation that the agency had discovered another 124,000 legacy cases to replace the 300,000 cases it was supposed to have dealt with over several years ending in July 2011. It is about time that we had a full-scale debate on all the catastrophes that keep engulfing UKBA, including an examination of whether the agency should be put out of its misery and its functions resumed by the Home Office. At least there would then be no question of where the buck stops.

The next general point I want to make is that this instrument, like others in the past covering changes to the Immigration Rules, is being debated after it has come into effect. Parliament cannot be seen to exercise control over legislation in these circumstances because however valid the criticisms we make, they could be accommodated by the Government only by bringing in a further order, which is unthinkable.

Turning to the statement, as the noble Lord, Lord Rosser, has said, the Merits Committee focuses attention on the proposal to refuse permission to enter or remain in the UK to anyone who has failed to pay NHS charges of £1,000 or more and to cancel any outstanding leave to remain for a patient who has run up that level of indebtedness to the NHS. Although the BMA supported the idea in principle, there are serious concerns over making it mandatory, irrespective of the patient's means or the nature of the illness for which she needed treatment. UKBA told the Merits Committee that it would be applied on a case-by-case basis, as the noble Lord pointed out, but has not yet received an answer to the request that the Minister should provide a full explanation of how discretion is to be exercised. I hope we are going to hear something about that from the Minister this afternoon.

An example that was given in the Merits Committee report, which has already been referred to by the noble Lord, Lord Rosser, is of patients with HIV/AIDS. This was raised by three organisations in the consultation, one of which was the National AIDS Trust, from whom your Lordships have now heard further. It believes that this proposal is immensely discriminatory and will have an immensely harmful impact on public health. It will cost the NHS far more in the long run because HIV-positive migrants will avoid treatment and become ill and HIV will spread within and beyond migrant communities at an estimated lifetime cost of £280,000 for each new patient becoming infected. The National AIDS Trust says the groups most affected will be asylum seekers, visa overstayers and those without papers who have often been living in the UK for years without lawful residence, not visitors who come here with the deliberate intention of getting free medical treatment.

There is nothing in the statement to cover migrants who simply could not afford to pay large medical bills. Let us take as an example a student on an English-language course lasting under six months who is involved in an accident and needs surgery and a week's hospitalisation. She could easily run up a bill of £1,000. Are we saying that her leave to remain should be abruptly terminated and her future career possibly ruined because of this accident?

If the proposal had been confined to certain categories, such as tourist visitors, who should take out medical insurance when they come to the UK, as our tourists do when they go to the US, for example, I could understand it. The impact assessment says that health and other professionals are travelling to the UK specifically to access NHS services and that in many cases they leave without paying. This means that they are identified by the NHS provider as persons who are ineligible for free medical treatment, and they could be asked to pay for it in advance.

There are a lot of other changes, most of which it seems are to correct errors in previous instruments, but some, whether acknowledged or not, are to accommodate judgments of the courts. It has been suggested that the amendments dealing with the evidence that has to be produced by tier 2 migrants and work permit holders was inspired by the case of Pankina. Although that is not stated to be so, perhaps my noble friend will confirm that it is so. There are amendments dealing with spouses and civil partners, among which is one to reinsert a paragraph that was accidentally knocked out in a previous statement that was considered earlier this year. I am sure that that is not the whole story because paragraphs do not get knocked out by accident and it would be useful if my noble friend could probe this further with UKBA to avoid any repetition of that event, at a time when it is so accident- prone.

--- Later in debate ---

[The Minister of State, Home Office (Lord Henley)]

My Lords, I thank the noble Lord, Lord Rosser, for introducing this debate and also my noble kinsman Lord Avebury for his comments. I start with the Merits Committee and its complaints about this. Many years ago, I was a member of what is still, I think, called the Joint Committee on Statutory Instruments, which is a relatively toothless body as regards considering the merits of particular statutory instruments. When I was a member of the Government led in this House by my noble friend the then Lord Cranborne—who is now the noble Marquess, Lord Salisbury—I was very proud that we brought in the Merits Committee precisely so that it could look at the merits of statutory instruments. That was some time in the mid-1990s, and a very good job it has done over the years. Therefore, we are very concerned about complaints relating to orders that we have put forward and we take them very seriously. The complaints on this occasion are largely about the Explanatory Memorandum, whether we think that was adequate and whether it misrepresented the position of various others. I thought that that Explanatory Memorandum was adequate, but if complaints have been made about it by the Merits Committee we will have to take that seriously. We will have to up our game and no doubt make sure that we do better in the future.

I was grateful that the noble Lord, Lord Rosser, referred to the letter from my honourable friend Damian Green, which was sent to the Merits Committee after its 40th and 41st reports on this matter and dealt with many of those complaints. I am grateful that it has now been made available to the House and is published on the Merits Committee’s website. As I have said, we will obviously take these matters seriously and will look at the criticisms that it made.

My noble kinsman Lord Avebury also objected to the fact that the statement of changes was subject to the negative procedure and not to the affirmative procedure. I am afraid that we will have to go back in time to the original legislation that created them as negative resolutions rather than primary. I do not know when that was but if we want to change that, it would obviously be a matter for primary legislation. I do not think that there is any Henry VIII power for me unilaterally to change them. That is why I say to my noble kinsman that one of the reasons why very often one has to debate these matters after they have come into effect is that the order comes into effect on a certain date and there should be time for Members of both Houses either to pray against them or to have a debate of this sort in the Moses Room.

I should now like to turn to the substantive questions on the statement of changes to the Immigration Rules and set out our case because it would be useful for the Committee to know why we are doing what we are doing. As all will be aware, the National Health Service is the national health service and its resources in these straitened times are limited. It is right that it should be shielded against misuse by those who incur and fail to pay charges in compliance with law.

The NHS debtors rule is being introduced for a number of important reasons. First, it will deter overseas visitors from misusing the NHS; that is, to deal with the problem of health tourism. Secondly, it will ensure that overseas visitors understand their need to meet their obligations to pay for the NHS services they use. Thirdly, it will reassure the public that we are determined to operate fair and robust controls on migrants’ access to public benefits and services. Finally, it will enable other patients to benefit indirectly from the recovery of NHS resources. That, again, is an important point and we must always remember that those resources are finite.

The rules must also be seen in the context of the joint UK Border Agency and the Department of Health review of migrant access to health services. Following this review and public consultations by the Department of Health and the border agency last year, the NHS charging regulations for England have been amended. This amendment provides extra protection for potentially vulnerable groups, including failed asylum seekers supported by the United Kingdom Border Agency and children from overseas who are in the care of a local authority. They are no longer liable for NHS charges.

I recognise concerns raised that the new rules may deter migrants from seeking necessary medical care. I must stress that although these rules relate to the entire United Kingdom, those relating to the NHS will vary in the four different parts of the UK. In England, primary care as provided by GPs, treatment in accident and emergency departments, and most treatments carried out on public health grounds are free of charge. Furthermore, urgent or immediately necessary treatment must not be delayed over the question of payment.

The United Kingdom Border Agency also has an important role to play in protecting the economy and publicly funded services and their lawful users from the consequences of inappropriate access. The equality statement that was published with the laying of the rules outlines the Government’s view that the rules are a proportionate measure in pursuance of this legitimate policy objective. Nevertheless, all cases will be considered on their individual merits with decision-makers afforded discretion to take account of exceptional compassionate factors and obliged to apply human rights legislation, as we always do, and equality legislation. Applicants will remain able, as now, to raise any compelling compassionate circumstances which they consider pertinent to their application, and these will be considered, as is current practice.

The noble Lord, Lord Rosser, suggested that these changes were discriminatory and raised the question of treatment for HIV. I have made it clear that the underlying policy objective, that of protecting publicly funded services for those with a lawful claim to them, makes this a proportionate response. Medical information will not be shared between the NHS and the UKBA. However, it will remain open, as now, for applicants to raise any compassionate or medical factors that they consider pertinent to their applications. We will review the question as to whether people living with HIV and not ordinarily resident here should be exempted from their charges for HIV treatment.

I believe that we need robust controls to protect our public services, just as we need robust controls in other aspects of the control of our borders, as was made clear by the responses in another place to the Statement made by my right honourable friend the Home Secretary and in this House when I repeated that Statement earlier this week. Not only do we need to protect public services, it is also right that if someone does not pay the charges they incur for treatment, they should normally be refused any further immigration applications until they have paid their debt.

I hope that that deals with most of the questions that have been raised. I understand the concerns and I go back to the complaints made by the noble Lord, Lord Rosser, quoting from the report of the Merits Committee about our Explanatory Memorandum. As I said, if we got that wrong, we will try to do better in the future. With that assurance, I hope that the noble Lord will accept that this is a satisfactory and proportionate response to these issues.

[Lord Avebury]

As my noble friend is dealing with the question of NHS charges, does he have a reply to my question about whether, under the Olympics rules, GFMs will be exempt from them?

[Lord Henley]

My Lords, if I may, I would prefer to write to my noble kinsman on that point. My understanding from discussions I had earlier with officials is that we are all right under the IOC rules, but if I am wrong on that, I will write to him.