Immigration and Social Security Co-ordination (EU Withdrawal) Bill (Eighth sitting)

Debate between Maria Caulfield and Kate Green

Thursday 28th February 2019 Public Bill Committees

[Kate Green]

I wish to speak to amendment 37, which has my support, as do the new clauses in this group. I would like to say a few words about one particular aspect of NHS charging, which is in relation to maternity care. Under the current charging rules, non-urgent care must be paid for in advance, but “urgent” or “immediately necessary” care must be provided whether or not a person can pay in advance. The guidance from the Department of Health and Social Care and the statutory regulations make it clear that maternity care is to be regarded as immediately necessary, so it must not be refused or delayed if a woman is unable to pay in advance, although she will still be charged for it. However, because of confusion about the charging regime and misapplication of the rules, pregnant women who are not UK nationals have already been denied maternity care, told that they must pay in advance of receiving treatment or told that their appointments may be cancelled if they fail to pay. Extending the charging regime to EU nationals, including pregnant women, would multiply such injustices in a system that is already making serious mistakes.

Charges for NHS maternity care start at approximately £4,000 and can rise into the tens of thousands for more complex care for women or additional care for new babies. Those charges are significantly higher than what NHS trusts would normally be paid for providing such care, because the regulations require them to charge 150% of the relevant NHS tariff. In practice, the rules mean that some hospitals have sent bills demanding immediate payment of thousands of pounds from vulnerable post-partum women. Women have received letters threatening referral to debt collectors, local counter-fraud specialists or the Home Office; in one appalling case, a woman was issued a bill of almost £5,000 for treatment following a miscarriage.

Research by the charity Maternity Action has found that the charging regime has resulted in women avoiding essential antenatal care and missing appointments because they fear incurring a debt that they cannot pay or being reported to the Home Office. That includes women with health conditions that require effective management to protect the health of both mother and baby. Antenatal care is intended to pick up and treat problems as early as possible, increasing the chances of a safe and healthy birth. Missing midwifery appointments means that high blood pressure and gestational diabetes are left untreated, the window for HIV prophylaxis is missed and minor infections are allowed to develop into serious health conditions.

Migrant women who are entitled to free NHS care are also affected by charging policies. Maternity Action regularly encounters women, including EEA citizens, who have been wrongly assessed as chargeable and have received bills for their care. In some cases, the women affected by the rules have children and spouses who are British citizens. Surely that was not the intention of the policy.

In December, the royal colleges issued a joint statement calling on the Department to suspend the charging regulations pending a full independent review of their impact on individual and public health. The Royal College of Midwives has expressed

“enormous concern…that vulnerable women are missing out on essential…care.”

Given the harm that charging for NHS maternity care is already causing to women’s physical and mental health, the fact that many women are simply unable to repay bills, the clear lack of regard being given to children’s best interests, the risks to public health and the potential for the charging regime to be extended to all EEA nationals, is it not time to consider the arguments for immediately suspending all NHS charging for maternity care?

[Maria Caulfield]

Having had experience of looking after migrants in the health service, I have some sympathy with the hon. Lady’s argument, but who will pay for their care? Will it be the UK taxpayer, or will migrants have to make some contribution to their own healthcare needs?

[Kate Green]

I very much respect the hon. Lady’s expertise in these matters; I also appreciated her important comments during the Committee’s oral evidence sessions. I echo the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East. Clearly, there is a balance to be struck between the costs to the UK taxpayer and what is right for the health and wellbeing of anyone living in this country, in whatever circumstances. Like him, I would strike the balance on the side of health, wellbeing and the protection of life when we have to make those difficult choices.

As the hon. Gentleman said, there are things that we could do. One possibility, although personally I do not favour it, would be to apply the health surcharge in some circumstances in which it might not otherwise apply. However, the evidence is that because these women are unable to pay the debts anyway, most of the money will in fact go uncollected. The NHS is not really gaining financially. All the charges seem to do is deter women from seeking the care they need for themselves and their babies, and that is a false economy down the line. If the women are legitimately in this country, as they are, the need for further emergency care and primary care will pile up if they have not had the proper antenatal and maternity care that they should have had to meet their best interests and that of their children.

I know that the Minister takes these matters seriously. Will she use her good offices to ask her colleagues in the Department of Health and Social Care to publish the Department’s 2017 review of the impact of amendments to the NHS charging regulations? I am told that it engaged with those involved in the maternity care of women, including the Royal College of Midwives, but the outcome of that review has not been published and placed in front of us. If the Minister can do anything to persuade her colleagues to make that information publicly available, it would be much appreciated.

Immigration and Social Security Co-ordination (EU Withdrawal) Bill (Fourth sitting)

Debate between Maria Caulfield and Kate Green

Thursday 14th February 2019 Public Bill Committees

[Maria Caulfield]

Could you give me an example?

Professor Smismans: In some countries, it will create problems in getting access to public services if people are not registered. Under EU law, they could be there for three months without registration. Some countries say that after those three months, you have to register. If you have not done that, and you want access to welfare benefits, they would say, “Well, you haven’t registered.”

It has always been the case that countries could do that. The UK could have done that, but has not done that. Having people who are not registered now creates a difficult problem for the future, because non-registration will have the immediate effect that you become illegal. Even in the EU, it is not, “If you haven’t got registration, you aren’t legal.” You might not have access to certain services, but you are not illegal and you are not deported on that ground.

[Kate Green]

Q May I ask you about the provisions in the Bill relating to social security? What are your views about the powers in clause 5?

Professor Smismans: They are very wide. These are the essential rights of people who have built up pension rights, sometimes in several countries. EU rules allow that rights built up in several places can be aggregated. We do not know what will happen with that. If there is a withdrawal agreement, it will be guaranteed. If there is no withdrawal agreement, we do not know. The promise so far, which is not yet set out in a legal text, is that rights built up until now will still be recognised, but rights built up after Brexit will not be recognised. That is obviously a problem. You are saying, “Okay, you have built up these rights until now; be happy with that,” but that means that people cannot move any more. If I have built up pension rights here, having been told, “We will recognise them and we will recognise the pension rights you have built up in Belgium, France and Italy,” but from now on I am told, “We will recognise only what you do in the UK”, that means that I cannot move back to Belgium if I want to or if I have to go and take care of my mother. I cannot do that, because my pension rights will have been building up until this moment in time.

That is why there should be limitations on how these rights can be affected and undermined by secondary legislation. Ideally, this is set out in the withdrawal agreement; it should be guaranteed in primary legislation. The withdrawal agreement is important for this issue, because it includes elements of co-ordination between countries. You can never resolve it unilaterally, because there are always aspects of co-ordination of information. You have to know what has been done on the other sides. And actually there are already proposals for statutory instruments that say, “If we don’t get the information from the other country, we are not obliged to take these rights into account.” There are already statutory instruments—proposals for that—that are undermining our rights.

There is a tendency in the first proposal for statutory regulation to forget about the 3 million already here. It is all set out: “We are going to change the rules on free movement for the future.” It is a kind of generic approach: forget about the 3 million who have built their lives on these rights. So there are no guarantees there. These guarantees have to be set out in primary legislation.