Lord Rosser
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(10 years, 9 months ago)
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Lord Leigh of Hurley (Con)
My Lords, I attended some of the debate on Monday and heard my noble friend Lord Bourne refer to the £200—or £150 because he was talking about the student rate at about £3 a week—as being very reasonable and fair. As he said,
“it is the cost of a Sunday newspaper”.—[Official Report, 10/3/14; col. 1605.]
It seems sensible that there is some flexibility in this health charge.
The cost to the National Health Service for an individual between the ages of 15 and 44—presumably young enough to be in reasonably good health normally —is £700 a year. Of course, that rises for older people. As your Lordships may be aware, Professor Meirion Thomas has written extensively about the abuse of health tourism. Because we are not in the Schengen visa system, people do not need compulsory health insurance to come to the UK and as a result he has identified many instances of abuse by healthy people and particularly by people who are not well and pregnant women coming to this country to get health treatment without any coverage of costs.
It is true that the National Health Service has charged such “health tourists” some £300 million but it is also true that it has managed to collect only 16% of the amount it has invoiced. Other countries, such as America, Canada and Australia, have much more severe restrictions on people coming in without health insurance and consequently we get more than our fair share. I would argue for flexibility in the health charge and clarification, as the noble Lord, Lord Patel, requested, of the parts of the health service to which it applies.
Lord Rosser (Lab)
My Lords, I would hope that if the intention of the words that the amendment seeks to delete is as the noble Lord, Lord Leigh of Hurley, speculated, the Minister will stand up in response and say it loud and clear to get it on the record.
I did not intervene in the debate on Monday. I read Hansard subsequently and I, too, was left somewhat confused as to the Government’s position. So I looked at the Explanatory Notes, and they do not explain the significance or purpose of the words,
“and different amounts may be specified for different purposes”,
which rather seems to defeat the primary objective of a document headed “Explanatory Notes”. The notes refer only to what is in Clause 33(3)(f), which is a reference to a “reduction, waiver or refund”. I then looked at the Home Office factsheet on Clauses 33 and 34, which also remains silent on the intention of the words, except to say that those who have paid the surcharge will be able,
“to access free NHS care to the same extent as a permanent resident, subject to some exceptions for particularly expensive discretionary treatments”.
I then looked at the letter we all received from the noble Earl, Lord Howe, dated 6 March, in the hope that the Department of Health might be able to throw some light on this, but the letter provides no help on the purpose or intention behind these words, which this amendment seeks to delete—although obviously the amendment has been tabled with a view to getting an explanation from the Minister as to what this means.
I then looked at what the Minister said on Monday. I came to the conclusion that the Minister, too, was unable to tell us why these words are in Clause 33. He said on Monday that those who have paid the levy will be allowed the same access to all health services,
“as is available to a permanent resident”.—[Official Report, 10/3/14; col. 1573.]
As the noble Lord, Lord Avebury, pointed out, Clause 33(4) states:
“In specifying the amount of a charge under subsection (3)(b) the Secretary of State must … have regard to the range of health services that are likely to be available free of charge to persons who have been given immigration permission”.
The Minister also said on Monday that when the Bill was initially implemented, it was the Government’s,
“clear policy intention that there will be no further charges for treatments”.—[Official Report, 10/3/14; col. 1572.]
But the Minister accepted that this policy stance was not in the Bill. He said that the Government,
“will clarify the position on implementation”.—[Official Report, 10/3/14; col. 1575.]
Frankly, the Government should be clarifying what their Bill means today. Will the Minister now indicate what the words,
“and different amounts may be specified for different purposes”,
are actually intended to mean, and will he give some concrete examples? What different amounts and for what different purposes do the Government have in mind? Is Clause 33(3)(b) simply some sort of ghost paragraph that the Government think may come in handy at some time in the future for purposes about which they are currently unclear? Can the Government’s present position on why and at what stage these words in the Bill will be applied best be summed up as, “Don’t know where, don’t know when”?
I hope that the Minister can today give us clear reasons—which is what the noble Lord, Lord Patel, asked him to do—as to why these words are needed in the Bill and clear up the confusion that I think a number of Members of the Committee, both those who intervened in the debate on Monday and those who subsequently read Hansard, feel exists at present.
Lord Rosser
“(4A) The Secretary of State will, within 12 months of the passing of this Act, lay before the House a report on the sums collected under this section and the expenditure thereof.”
Lord Rosser
This amendment also relates to Clause 33. The only comment I make to start with is that if all the verbiage in Clause 33 does is give the power to charge one rate to students and another to everybody else, it seems unbelievable that it cannot be made simpler and more explicit. I hope that the Minister will bear that in mind when he reflects on the debate that took place on the previous amendment.
Clause 33 provides the Secretary of State with a power by order to require certain migrants to pay an immigration health charge. It relates only to people who are seeking immigration permission; it does not relate beyond that. The charge would be paid by someone who was applying for leave to enter or to remain in the UK or for entry clearance. The amount, the method of payment and the consequences of non-payment will be set out in secondary legislation although, as has been said on a number of occasions, we understand from the Government that the amount of the charge will be £200 a year and £150 for students and that paying the charge will be a precondition of entry.
We agree with the principle of the charge. It is right in our view to require migrants who are here for a limited period to make a contribution to the NHS. We also agree that the test of ordinary residence is fairly generous. At the moment it is satisfied by many new and temporary migrants almost immediately and covers many people, including newly arrived family members.
We have tabled only one amendment to this clause, Amendment 61, which requires the Government to provide information to Parliament on the sums collected under Clause 33. Obviously, in large part the amendment is to find out a little more about the Government’s intentions on this score. The amendment asks for a review of the sums that are to be collected and how they are to be disbursed. The Bill states that the money will be paid into the Consolidated Fund or be applied in such other way as the order may specify. At Second Reading, in response to a question from my noble friend Lady Smith of Basildon, the Minister said that,
“on 20 January the Chief Secretary to the Treasury confirmed to departments and the devolved Administrations that the money that is collected by these charges … will go directly to health services”.—[Official Report, 10/2/14; col. 524.]
Where will this be set out, and where is the guarantee of it?
There are further questions. Will hospitals that treat a high proportion of foreign nationals get an appropriate or proportionate share of it and how will the money be shared with the devolved Administrations? What is the definition of the words “health services”? Could the money go to the private healthcare sector, for example? If the money is to go to health services, why not say so in the Bill and end any doubts on that score? Will the money from the charge be in addition to the money that the Government provide for the NHS or for health services, or will it be used to reduce the amount that the Government would otherwise have provided? In other words, is it extra money or is it simply going to be used to reduce the amount that the Government themselves provide? Some response to that point would be very helpful.
I want to ask about the implementation of the provisions, because in the consultation document the Government indicated that the migrants’ biometric residency permit would be endorsed to show that they were entitled to NHS treatment without further charge. How will hospitals and doctors be made aware of that? I ask that in the context—I understand that I may well be wrong, and I am sure that if I am I will be corrected—that the Department of Health will publish a full implementation plan—indeed I may be told that it has already done so—which will include plans to develop a new NHS registration process for the identifying and recording of patients’ chargeable status. If that has not already been produced, will the Minister confirm when it might be available? We also want to ensure that there is no disincentive for people who bring benefits to this country. One category is students. How will that charge be kept under review to ensure that it does not act as a disincentive for people who we would wish to come here to do so?
In probing what the Government’s intentions are and how they see this operating, I want to ask about transitional arrangements. The Minister has confirmed to us in a letter that affected migrants who are already in the United Kingdom at the time when the policy is implemented will not be liable to pay a surcharge and will not be charged for healthcare for the remainder of their leave if they were previously exempt from NHS charges. However, once their leave expires, the migrant will be required to pay the surcharge as part of any further immigration application unless they are applying for IDR. Will the Minister confirm where this will be set out in the legislation and how people will be made aware of it? In that scenario, how will a GP know whether someone who should pay the charge is covered if for that patient the charge becomes payable only when they apply for an extension of leave to remain? If a GP refers to hospital a patient who should have paid the charge, will the hospital also have to check that that patient has paid—a double check—or can the hospital accept that the GP making the reference will have done a check and rely on that?
The Minister said on Monday, in a discussion on the issue of the charge, that there would be no transitional arrangements. I ask him not to confirm that there will be no transitional arrangements, because that is clearly in black and white in Hansard, but to confirm that that also means that there will be no transitional costs relating to the bringing in of this payment. It would be helpful to have clarification on that.
I have raised a number of questions: what the Government’s intention are; how this will operate; where the money will be going; whether it will be used to reduce the amount that the Government provide to the health service or whether it will be additional money; what the definition is of “health services”; and whether the money could go to the private sector. I have also raised queries about the position of GPs and the checks that they have to make, and in particular whether there is a double check if they refer someone to a hospital or whether the hospital can take it that the GP will have done the checks and that is the end of the matter. I beg to move.
Baroness Barker
My Lords, I shall speak to my Amendment 66F in this group. Following the consultation in 2013, the Department of Health said that,
“while there is a great deal of speculation about the numbers of visitors and short-term migrants using the NHS, robust data are very limited”.
That is the point that I wish to address. I have no problem with the Government’s intention to introduce a health levy, and I have no problem with them seeking to have different rates for different groups of people. However, I want to be sure that when this House makes a major change to a fundamental policy that we have held in this country for over 60 years, that it does so on the basis of sound evidence.
Back in 2006, noble Lords will remember that proposals of this kind came before this House from the then Labour Government but then disappeared, principally because someone went back to the department and worked out that the cost of implementing the proposals far outweighed any benefit. It is simply good business practice to have done a cost-benefit analysis of a major change before one implements it. The Government are wedded to doing this—fair enough, and I have no doubt that they will go ahead—but it is only right that if they go ahead they should do so on the basis that its implementation will be thoroughly analysed, so that we do not find ourselves back here in five years’ time responding yet again to an agenda that has been set by various media organisations and political groupings on the basis of nothing more than speculation.
Baroness Williams of Crosby
If my long-suffering noble friend will be kind enough to bear with me for one minute, perhaps I may raise one further point which follows what the noble Baroness, Lady Meacher, said. I think that the Minister said in his response that it was already the case that no charges would be made under the NHS for treating infectious diseases such as AIDS and tuberculosis, and that that would still be true for those who are not permanent residents. I believe that I understood that correctly. It is therefore strange that I have had briefings, particularly from the National AIDS Trust and from bodies concerned with drug-resistant TB, asking that it should be made quite clear that there would be no charges for treatment in the cases of these wildly infectious and very frightening diseases. There is, therefore, something of a conflict of understanding which the proposal of the noble Baroness, Lady Meacher, might go some way towards meeting. However, it is troubling when a professional foundation says something quite different from what I understand we have been discussing and have been told here in this Chamber.
Lord Rosser
I, too, thank the Minister for his response. I am in much the same position as the noble Baroness, Lady Barker, in the sense that it went rather further than I thought it would go, so I genuinely thank the Minister for what he had to say in his reply. I am also sure that the Minister might wish to reflect on the number of points that have been made after he sat down. Bearing in mind that he has said that he will send a letter to pick up any points he has not covered, perhaps he will reflect further on some of the points that have been raised in the past few minutes.
I do not expect the Minister to respond to the questions now because he has said that he will write a letter. He has certainly not responded to some of the issues that I raised but I accept that he will do so in the letter. One of those issues, of course, is why it does not say in the Bill that the money will go to the NHS—why not put that in there? We are not proposing, are we, that the National Health Service will be disappearing within the next few years, so it is not the usual argument that you do not want to put this in the Bill because it might not be there for very long? Or at least I hope that that is not the point. I have not received a specific response yet, but I know that I will when the Minister sends the letter about whether this will be additional money to the National Health Service or whether it will simply be used to reduce the amount that the Government provide.
Lord Rosser
I also asked about whether there would be any transitional costs as opposed to transitional arrangements. I take it that the Minister will respond to that question, too.
The Minister will be aware that doctors and other parts of the health service have expressed a view that the kind of checks they will have to make will be an administrative burden. I asked a couple of questions about whether a hospital, if a patient has been referred to it by a doctor, can assume that the doctor has done the check and not have to do a double-check, and how a GP can know whether a patient who is already in the country, and therefore not covered by these new arrangements, requires a renewed application to remain here. I am sure that that will be picked up in the Minister’s reply.
My general point—bearing in mind that some doctors have expressed a concern about what they feel will be an administrative burden, and that the Minister has said that a Statement will be made to Parliament—is whether the Statement will also cover whether the arrangements have imposed an administrative burden on doctors. As some doctors have raised the issue, this would be one way of getting an analysis of it and discovering whether there is any substance to it, or whether their fears have not been realised. Perhaps the Minister can also comment on that point when he sends the letter. Once again I thank the Minister for his reply, and I beg leave to withdraw the amendment.