Immigration (Health Charge) (Amendment) Order 2017

Lord Rosser Excerpts

Thursday 9th February 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I welcome the noble Baroness to her new role. We welcome the exemptions and clarifications that she has just outlined. I should like to use this opportunity to express some concerns and ask some questions about the Government’s policy of charging foreign nationals for the use of the NHS, and how this will work.

It is right that those who are not entitled to the free use of our NHS should pay for their treatment—or it should be paid for by their insurance or their Government. Some hospitals have already introduced the policy successfully but, irrespective of its merits, the focus on collecting the equivalent of 0.5% of the NHS’s annual spend reflects the Government’s skewed priorities. It ultimately serves to mask the main challenge facing the health service—a lack of cash.

The principle that those not eligible for free NHS care should pay up front for non-urgent treatment is sound. However, there must be clear safeguards in place to prevent profiling of people who have surnames that sound “not British”, and to protect vulnerable people such as the homeless who cannot prove their right to treatment by providing the correct documents. We must also guard against any temptation to extend this policy to urgent treatment. How do the Government plan to ensure that this does not happen?

Health tourism should be properly addressed, but it is not particularly significant in terms of the overall funding of the NHS. The recent government announcement cannot mask the refusal to address the serious failures of care which are now routine across the NHS as a result of impossible financial pressures. Only this week we have heard about increases in waiting times for operations, and in unexplained deaths among those with mental health problems. One hospital trust in Kent has halted all non-urgent operations until the end of the financial year. The Government need to tackle important problems such as staff shortages and retention and a lack of social care. Recent statements reflect a warped sense of priorities. I hope that my right honourable friend Norman Lamb MP’s cross-party meeting with the Prime Minister last week will lead to a genuine consensual process to deliver a long-term settlement for the NHS and social care.

Ultimately, the NHS must not lose the humanity and compassion that are the hallmarks of an institution of which this country is rightly proud. Doctors do not see their jobs as being border guards or revenue collectors. Can the Minister assure us that clinical staff will never be expected to collect money? This would completely change the relationship between doctor and patient. Can she also assure us that hospital administrators will get funding for extra help, and if they do, will the policy be cost-effective? Talking of capacity, I heard a Minister on the radio recently whom I felt was actually encouraging people to come from abroad to use our NHS—as long as they paid for it. As waiting lists and queues in A&E and for GP appointments get longer, I would have thought the last thing we should be doing is encouraging more customers from abroad. Can the Minister say whether hospitals are charging a full cost-recovery amount—or more, or less? Does the hospital keep the money, or does it go straight to the Treasury like the rebate on drugs?

[Lord Rosser (Lab)]

My Lords, this is the first opportunity I have had to welcome the Minister to her new role. I thank her for the explanation of the purpose and thinking behind this order which we support. It brings into effect amendments to the Immigration (Health Charge) Order 2015. That order led to an annual immigration health charge, introduced, as the Minister said, on 6 April 2015, being imposed on non-EEA nationals applying for leave to enter or remain in the UK for a limited period. Those who pay it can access NHS services free of charge, apart from payments in respect of treatments or prescriptions for which UK residents have to pay.

The Minister has set out the reasons for making the amendments provided for in this order which, in essence, remove the immigration health surcharge exemption of intra-company transferees and their dependants, extend the human trafficking exemption to include victims of modern slavery and provide greater clarity in the interpretation of some rules in the Immigration (Health Charge) Order 2015.

I have two brief points. One of the amendments in respect of ICT workers has emanated from a recommendation of the Migration Advisory Committee. Are there any committees or other bodies looking at issues that might lead to further amendments to the Immigration (Health Charge) Order 2015? Or have we now reached the stage where the Government can confirm that they have no reason to believe that further amendments will be needed in the foreseeable future—and certainly not prior to our departure from the European Union?

In the House of Commons the Government said, as the Minister has reiterated today, that the immigration health charge collected £164 million for spending on the NHS in its first year of operation. These amendments could provide an additional minimum amount of £136 million for the NHS over 10 years. Can the Government give an assurance that the money raised from the immigration health charge represents additional money for the NHS which would not have been available had the charge not been in existence? The money raised must not simply be used to enable the Government to reduce the amount they provide to the NHS by the sum raised by the health charge.

[Baroness Vere of Norbiton]

My Lords, I thank noble Lords for their contributions. I shall address the specific issues raised where I am able to do so.

I say to the noble Baroness, Lady Walmsley, that I do not think this is a case of skewed priorities. It is, indeed, right and fair that we look to overseas visitors to make a contribution to the cost of the National Health Service when they use it. The noble Baroness seemed to imply that this was not a particularly large problem. However, overseas nationals using the NHS cost the NHS £2 billion a year, which I do not think is an insignificant sum. Non-EEA migrants cost the NHS £950 million a year. Again, that is not an insignificant sum. The cost for non-EEA temporary migrants, for example, amounts to £800 per person per year, which is quite a lot.

As regards the other issues raised by the noble Baroness, I am responding on behalf of the Home Office, not the Department of Health. Therefore, I hope that noble Lords will forgive me if I refer certain issues to the Department of Health for that department to answer their questions on those issues. However, I can address certain issues. The surcharge is collected by the Home Office but the NHS is currently, and will be, responsible for ensuring that charges are collected from the right patients. However, there will also be safeguards to ensure that no vulnerable patient is denied care when they need it.

The noble Lord, Lord Rosser, asked whether there were any other committees or bodies that might make further changes to the order. Removing the exemption for intra-company transferees was a recommendation of the Migration Advisory Committee, as was mentioned. The Government are not aware of any forthcoming committees or commissions that will make recommendations in connection with the surcharge. However, as with all government policies, the health charge is kept under regular review. The noble Lord also asked whether this money was additional cash for the NHS. I can confirm that the surcharge brings in additional money to the NHS to be spent in England, Wales, Scotland and Northern Ireland. The surcharge is an important source of new income for the NHS, which is shared by the NHS across the country using the Barnett formula.

The amendments bring intra-company transferees in line with other temporary migrants and provide an important clarification in respect of victims of modern slavery. The health charge helps the NHS remain sustainable, with migrants making a fair contribution to our health services while ensuring that our country remains the destination of choice for the brightest and the best. On that basis, I commend the order to the House.