Adult Dependent Relative Visas

Rachel Maclean Excerpts

Wednesday 3rd November 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for the Home Department (Rachel Maclean)]

It is a pleasure to serve under your chairmanship, Ms Bardell. I thank the right hon. Member for East Ham (Stephen Timms) for securing this debate. I also thank the other Members who contributed. I recognise the strength of feeling on the topic, as the right hon. Gentleman so eloquently articulated. I will respond to his points as best I can in the time I have, but it will be helpful if I set out some background on adult dependent relative visas.

The family immigration rules were reformed in July 2012 to ease the burden on the taxpayer, promote integration and tackle abuse, thereby ensuring family migration to the UK is fair to migrants and the wider community. Costs associated with cases under the route for adult dependent relatives can be significant. The Department of Health and Social Care has estimated that a person living until the age of 85 costs the NHS on average about £150,000 in their lifetime, with more than 50% of that cost arising from the age of 65 onwards. It is important to note that this figure does not take account of any social care costs met by local authorities.

Under the rules, adult dependants must demonstrate that they require, as a result of age, illness or disability, a level of long-term personal care that could be provided only in the UK by their sponsor here, and without recourse to public funds. They must apply from overseas and not while in the UK as a visitor. The rules in place before July 2012 in essence provided an expectation of settlement in the UK for a parent or grandparent aged 65 or over where they were financially dependent on their UK sponsor, subject to the provision by the sponsor of a five-year undertaking that they could maintain and accommodate the adult dependent relative without access to public funds. They also enabled a parent or grandparent under the age of 65 and other adult dependent relatives of any age to apply to settle permanently in the UK in the most exceptional compassionate circumstances, as the right hon. Gentleman said. The old rules allowed an application to be made in the UK, including while here as a visitor, as well as overseas.

The current rules for adult dependent relatives seek to ensure that only those who need to be physically close to and cared for by a close relative in the UK are able to settle here. Those who do not have such care needs can be supported financially in the country in which they live by their relative in the UK. Those in most need of care remain those most likely to qualify, compared with those who have a preference to come to live in the UK with a relative here. The lawfulness of the rules was upheld by the Court of Appeal in May 2017.

[Mr Mahmood]

Does the Minister understand that this is not just a question of finances and money? This is an issue of relationships, of parents, children and grandchildren, and of building and understanding a family. We can support someone on their own abroad, but we cannot have that family linkage growing.

[Rachel Maclean]

Yes, I fully understand the hon. Gentleman’s point, but the Government’s duty is to formulate rules that are fair to the British taxpayer and the NHS, and that ensure a fair system. I will come on to the specific issues about the health service to which the right hon. Member for East Ham alluded, but it is vital that our immigration policies do not place an unfair burden on the taxpayer.

We want to ensure that people here legally are welcomed and celebrated—which we do in this country—as part of a fair and sustainable immigration system. All family migration to the UK, including that of adult dependent relatives, must be on a properly sustainable basis that is fair to both migrants and the wider community.

Our position on adult dependent relatives remains that we have rules in place to support those who are most in need, but we are clear that the rules cannot provide a route for every parent to join their adult child in the UK and to settle here. It is simply not sustainable for the economy or the health service for there to be a routine expectation of settlement in the UK for parents and grandparents aged 65 or over. Therefore, only those who require long-term care that cannot be delivered in the country in which they live should be eligible to settle here.

We fully understand that such cases provoke strong feelings, as Members have articulated, and they can result in difficult choices for individuals, but it is essential that the rules are fair and balanced for the taxpayer, given the significant NHS and social care cost that can arise when those adult dependent relatives settle in the UK. Failure to maintain that balance puts the legitimacy of the entire system at risk.

I now turn to the issue of the NHS. Of course, we are hugely grateful for the vital contributions of all NHS staff, in particular during the pandemic. The Government have no intention whatever of punishing that group. By contrast, we have introduced a range of unprecedented measures to ensure that the health and care sector is supported fully. However, it is only fair that I address the points that have been made.

The impact of medical professionals potentially leaving the NHS was an issue that was raised five years ago and considered as part of the Home Office review of the adult dependent relative rules published in December 2016. That report considered the number of NHS staff who support adult dependent relatives overseas. It is likely to be a small proportion of the total population of professionally qualified clinical staff.

Furthermore, there is no evidence to show that significant numbers of medical professionals have left or been deterred from applying to work in the UK since the revised rules were implemented. It was concluded that, while some who might sponsor someone to come to the UK might choose to leave as a result of the revised rules, including some in skilled employment, the impact remains proportionate to the policy aim.

The latest figures show a 19% increase in skilled worker visas in the year ending June 2021, and that the majority of that increase was due to the new health and care worker visa, which saw 45,722 grants, accounting for 44% of the total skilled worker visas granted. In fact, such was the demand of overseas doctors and nurses wanting to work in the UK, in 2018 the Government lifted the cap on doctors and nurses. The Health Secretary at the time said:

“Overseas staff have been a vital part of our NHS since its creation 70 years ago. Today’s news sends a clear message to nurses and doctors from around the world that the NHS welcomes and values their skills and dedication.”

As I said, there is no evidence that significant numbers of professionals have been deterred from applying to work in the UK since the new adult dependent relative rules were implemented, and nor is there evidence to show that professionals have left the UK.

The NHS has made significant savings since the rules were introduced. The 2016 report notes that once assumptions were taken into account, the figures suggested potential NHS savings of around £249 million over 10 years. This policy will be kept under review. We are of course sympathetic about the impacts on individuals and families, but the policy must apply fairly across our society. It would not be right to provide a more generous approach for healthcare professionals than for other groups.

[Ben Lake]

Just to elaborate and perhaps add to the considerations, there is of course an impact on the family, but there is also an impact on the community. In many rural areas, such as mine, if we lose a solitary GP, who has to go back, we will not have a GP practice for a very large area, so there is that wider impact too. We should bear in mind that even though it may be an individual example, it has quite a widespread impact.

[Rachel Maclean]

Of course, I recognise the impacts of the issues highlighted by the hon. Gentleman. On the point made by the right hon. Member for East Ham, that we have not considered other ways to avoid the burden on the NHS and local authorities, making comparisons with other countries and their systems, I advise him that we did consider other ways. The Home Office published a review of the adult dependent relatives rules in December 2016. As I said, we continue to keep that under review. The report is published on gov.uk, so I encourage him to look at that.

As part of the review, specific considerations were given to alternative methods of achieving the main aim, which is reducing the burden on the taxpayer and NHS costs. Those alternatives were mandatory medical and care insurance, amendments to the immigration health surcharge and a bond scheme, requiring up-front payment, which would be offset against the cost of any later NHS care. Particular consideration was given to how far each of those would achieve the policy intention, be feasible to administer, and continue to allow an adult dependent relative, with significant long-term personal care needs that could not be met in their home country, to join their relative.

Those options were considered to place a potentially unreasonable administrative burden on the NHS, while also raising significant concerns over affordability and discrimination. For example, mandatory private healthcare insurance was considered likely to be prohibitively expensive, especially if it was to cover NHS emergency treatment and/or social care and residential care. It would also benefit only those applicants whose sponsor had substantial means. Those without a close relative with such means would be excluded from the UK, even if they required long-term personal care that could only be provided by their relative here. There is also no guarantee that insurance taken at the date of application would not be later cancelled or not renewed, including in circumstances outside that person’s control, such as a significant deterioration in their health or a change in the financial circumstances of their sponsor making the insurance unavailable or the premiums unaffordable.

Any alternative scheme requiring an up-front payment of many thousands of pounds would, by definition, exclude those cases unable to pay it, regardless of the level of their personal care needs. Similarly, in the light of the estimates I mentioned earlier—that a person aged 65 to 74 costs the NHS £2,287 per year—such a scheme for adult dependents would likely need to be set at significantly more than its current level. That is why it was concluded that the revised rules were set at the right level to provide immediate settled status in the UK and free access to the NHS to those relatives whose care needs could not be met in their home country, while protecting the NHS and the tax burden.

[Stephen Timms]

The Minister makes the point that there is no evidence of doctors leaving the UK for this reason. We do know that 6,000 doctors left to go overseas in the five years between 2015 to 2020. She is right that we do not know the reason why they all left, but it is clear that at least hundreds went for this reason, and possibly more of those 6,000. Is she not concerned about that loss of skilled, committed doctors from the health service, at a time when—as the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), pointed out at lunchtime today—there is a shortage in nearly every speciality?

[Rachel Maclean]

I thank the right hon. Gentleman for his point. He is right to ask the question. As I said earlier, we do not have verified evidence of those numbers, and nor do we have specific evidence pointing to this specific reason. There may be a number of reasons why people choose to leave and work in another country. Moreover, I point to the evidence in front of us about the people who are choosing to take up those skilled visas to come to this country, so these rules are clearly not a deterrent. I refer to my earlier remarks about the policy intention behind introducing these changes to the rules, which is to make sure that only those people who genuinely need to come here are covered by these rules, and therefore would be able to come here under the system that we have.

In conclusion, I recognise that this is an emotive subject, and I pay tribute to the right hon. Member for East Ham for the way in which he has articulated it. Of course, I and the Government want to support the NHS. We keep our policies under review, as I have said, and we have given considerable care and consideration to the factors that he has mentioned.

[Stephen Timms]

The Minister is being very generous with her time. She has made much of the cost issue; I think she indicated that for somebody elderly arriving in the UK, we would expect health and care costs of something like £175,000, but a GP has had £500,000 invested in them. I wonder whether an assessment has been made somewhere of the value for taxpayers—the straightforward financial cost—of forcing somebody who is highly trained out of the country, versus the cost of care for their elderly relative.

[Rachel Maclean]

I can reassure the right hon. Gentleman that the costs have been considered in the round, including the costs he refers to and others. In fact, those figures I quoted at the beginning of the remarks did not include care costs, which I am sure he will agree are significantly higher than the other figures I have referred to, which are purely for treatment and costs.

Motion lapsed (Standing Order No. 10(6)).