Immigration (Health Charge) (Amendment) Order 2023

Lord Coaker Excerpts

Tuesday 12th December 2023 Grand Committee

[Lord Coaker (Lab)]

My Lords, as always, this SI is important. Many of the debates that led to the current system took place elsewhere. We need to seek to understand the instruments that are then put in place to make a reality of other government policies. I agree with much of what the noble Baroness, Lady Brinton, helpfully outlined. I also thank the Minister for his introduction.

This SI increases the charge payable by some migrants to access the NHS. The headline figure, for those people paying the main rate, will increase from £624 to £1,035—a large increase of 66%, compared with the 25% rise in NHS costs over the same period. There is a reduced rate for those under the age of 18, which increases from £470 to £776. Like the noble Baroness, we do not necessarily oppose the increases, or an increase, but what is the Government’s justification for such a large increase, which is well above the NHS rate of inflation over the same period? We are comparing 25% to 66%, which is quite a significant disparity. The Minister will need to justify to the Committee why the Government have seen fit to do that. Can the Minister say any more than he has done about what happens to those who cannot afford the charge? Can he confirm that it is a one-off charge, not an ongoing one? I assume it is, but I would be interested in that being clarified.

What updated evidence are the Government using to justify this figure? What assumptions do they use in their papers regarding the use of services argument? The Government explain that they believe the increase will help to deter some migrants applying to enter or remain in the UK. Again, where is the evidence for that? Is it the right policy to use health charges to try to deter migrants coming into the UK? If the Government believe that it will deter them, have they made any estimates of the numbers that will be deterred, or is it just a statement that some will be deterred without any estimate? Do any working papers in the Home Office give us an assessment or understanding of what that will be? The noble Baroness asked some of these questions. Have the Government made any assessment of the impact of these changes on business?

What is the Government’s answer to the Secondary Legislation Scrutiny Committee’s criticism that they used questionable methodology in determining and justifying the increase? Why is that committee wrong in its assessment of some of the methodology the Government used?

It is important to understand the figures. What is the Government’s estimate of the number who pay the charge currently and how much it raises, alongside future projections? I think the Minister said that it currently raises £1.7 billion, if I understood what he said. What is the projected figure over the next period?

The Explanatory Memorandum outlines and clarifies various exemptions. The Minister and the noble Baroness said something about some of the exemptions to paying the health charge. Can the Minister outline for the record what some of these clarifications and exemptions mean? How many actually receive any sort of waiver? As the noble Baroness pointed out, it appears from the charts as though hardly anybody receives a waiver or an exemption. Some clarity on that would be helpful.

Paragraph 2.2 of the Explanatory Memorandum talks about a number of different things that it would be helpful for us to understand. It talks about those on the Ukraine and statelessness immigration routes. I understand what the Ukraine immigration route is, but what exactly is the statelessness immigration route? It then talks about exemptions for “certain NHS workers”. Who are those “certain NHS workers”? Has this changed at all with this instrument—in other words, has the exempted list of certain NHS workers been extended or reduced?

It also talks about exemptions for “specified protection cohorts”. Can the Minister outline what a specified protection cohort is? One of the problems with migration, immigration and asylum is that sometimes it all gets mixed up—including in my own mind. Just to be clear, what is the status of Afghans, those from Hong Kong and others who come here under various schemes?

We have accepted the principle of immigration health charges and do not necessarily oppose this SI but, as the noble Baroness, Lady Brinton, and I have said, a number of questions need answering. Health charges need to be fair both in the level they are set at and in how they operate. The justification for such a large increase and the operation of the scheme alongside it are of extreme importance, which is why we have put various questions to the Minister.

[Lord Sharpe of Epsom (Con)]

I thank both noble Lords for their contributions to this shortish debate. I will do my very best to answer all their questions and commit to write if there are any that I cannot answer.

Those who move to a new country expect to pay towards healthcare. Countries around the world have a range of systems in place to do this, in line with individual healthcare models. It is right that we continue to prioritise the sustainability of the NHS and that temporary migrants make a financial contribution to NHS services available to them in the UK. Payment of the health charge provides near-comprehensive access to our health service, regardless of the amount of care needed, even for those with pre-existing health conditions.

I shall try to address all the issues raised. The health charge should broadly reflect the cost of treating those who pay it. However, the rates for students and their dependants, applicants to the youth mobility scheme and children under 18 will remain discounted. The increased rate of the health charge is comparable to the cost of private medical insurance here and abroad, which is a common requirement for individuals wishing to migrate to many other countries.

I think both noble Lords referred to the Secondary Legislation Scrutiny Committee. We thank it for considering the order and providing a detailed report on the legislation. Before I go into the methodology, I reassure the Committee that the Government have undertaken robust and detailed analysis of the annual cost to the NHS of treating health charge payers to determine the increased cost of the health charge. Increases to the health charge are based on the most recent data representing charge payers’ use of NHS services, more accurately determining the current cost to the NHS of treating health charge payers. The Government acknowledge the delay in providing responses to the Secondary Legislation Scrutiny Committee. Unfortunately, this was unavoidable, due to factors such as the changes in ministerial teams and the need for assurances of the responses between departments.

I turn to the methodology and the DHSC calculation. As set out by the Chief Secretary to the Treasury on 13 July, the health charge rates have remained unchanged for the last three years, despite high inflation and wider pressures facing the healthcare system. The increases to the charge reflect the higher costs in healthcare budgets since 2020. Additionally, the assumptions for how intensively charge payers use healthcare services in different settings have been revised to use more recent and representative data intended to better reflect migrants’ use of these NHS services. While the health charge is increasing, it is still considerably lower than the comparable average cost per capita of providing healthcare for the average UK resident, which currently stands at approximately £2,700 per person per annum.

I am aware of concerns around the combined cost of the health charge and visa fees and the impact that this may have on families and young people. The draft order maintains the reduced health charge rate for children, but the Government remain clear that migrants must pay the health charge when they make an immigration application and should plan their finances accordingly. The cost of the health charge and application fees are available online and should not come as a surprise. However, it is also recognised that, in some instances, people who are required to pay the health charge may not be able to afford it. In such instances, on family and human rights immigration routes and where it is backed by clear and compelling evidence provided by the individual, the health charge may be waived.

Where a fee waiver application is successful, the application fee and the health charge will be waived. Migrants who are granted a partial fee waiver are required to pay the application fee only; the health charge is waived in full. All the information about fee waiver applications is publicly available on GOV.UK and has been for a long time.

Evidence suggests that migrants are aware of the fee waiver process due to the volumes of migrants on eligible routes utilising fee waiver applications. For example, in the year ending September 2023, there were 46,470 visa fee waiver applications, which I would argue does not constitute “hardly any”. The Government are also committed to supporting vulnerable cohorts; there are a range of exemptions from the payment of the health charge, including for individuals in protected cohorts. That includes asylum seekers, looked-after children and victims of modern slavery and trafficking. This draft order extends the range of exemptions to migrants applying to the statelessness immigration route and to the Ukraine regime. In answer to the question from the noble Lord, Lord Coaker, about the statelessness route, it is basically for migrants who are unable legally to reside in any other country—so very similar to refugees.

[Lord Coaker (Lab)]

The Minister has just correctly defined statelessness and protected cohorts. To those who wrote the Explanatory Memorandum, all this is perfectly obvious, but for people like me and many others who read it, it would be extremely helpful if, instead of putting “protected cohorts”, they could add “such as” and do the same for “statelessness”. It would be helpful if that was done sometimes in an Explanatory Memorandum.

[Lord Sharpe of Epsom (Con)]

The noble Lord makes a very strong case for footnotes, and I hope that my officials are paying attention to that.

On the questions raised by the noble Baroness, Lady Brinton, about the deterrent effect on migrants, the UK continues to welcome talented individuals from around the world who want to study and work here. It is difficult to isolate the impact of the health charge increase on visa demand, due to the 2020 increase coinciding with the Covid pandemic and EU exit, but evidence from visa applications over the period following the increase to £624 does not suggest any significant impact on application volumes. Visa application volumes are monitored and there remains a substantial demand for visas across the majority of the immigration routes. All fee levels across the immigration system, including the health charge, are kept under review and evaluated where appropriate.

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