Draft Immigration (Health Charge) (Amendment) Order 2020

Stuart C McDonald Excerpts

Tuesday 22nd September 2020 General Committees

[Kevin Foster]

To be clear, the eligibility for the charge is based on the immigration status, rather than what tax or national insurance people have paid. We were clear in our manifesto, which was firmly endorsed in the December general election, that we would base it on the average cost of treating charge payers. Of course, when they come to achieve indefinite leave to remain, they are no longer liable to pay the charge. As I say, it is subject to the £1 discount, because £624 is more divisible than £625.

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

A quick question: is the working for the £624 estimate available anywhere? I cannot see where to find it.

[Kevin Foster]

My understanding is that that has been published, but I will certainly be happy to write to the hon. Gentleman and the rest of the Committee with more details about how the DHSC arrived at that figure.

Students, dependants of students and youth mobility scheme applicants will continue to pay the discounted rate, which will increase from £300 to £470 per person. The Government are aware that the charge has a greater financial impact on family groups than on individual applicants. To support families, therefore, the charge for children under 18 at the date of application will also be set at £470, in line with the discounted rate set for students and the youth mobility scheme.

In specifying the new amount of the charge, the Government have considered a range of health services available without charge to those given immigration permission to be within the United Kingdom, and, as I have touched on already, have considered the cost to the NHS across the four nations of treating those who pay the charge. Also considered is the valuable contribution that migrants make to our economy and the need to ensure that the UK remains an attractive destination for global talent.

I turn to the exemption for tier 2 health and care visa applicants. On 21 May, the Prime Minister asked the Home Office and the Department of Health and Social Care to work together to exempt NHS and health and care workers from the immigration health charge. Consequently, this order amends schedule 2 to the principal order to provide exemption for tier 2 (general) health and care visa applicants and their dependants.

The tier 2 (general) health and care visa was launched on 4 August, and a large number of applications were received and permissions granted. It is a fast-track visa offer with a reduced application fee for eligible health professionals, including doctors, nurses and allied health workers. It covers not only people working in the NHS directly but those working for organisations commissioned by the NHS to provide essential services and those in the relevant professions who work in the adult social care sector, which is the basis of their application and their visa. Until a formal exemption is in place for that group, the Secretary of State has waived the requirement for them to pay the health charge.

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[Stuart C. McDonald]

Thank you for calling me to speak, Mr Robertson; it is a pleasure to see you in the Chair. I also thank the Minister for his introduction to the debate.

I echo the concerns raised by the hon. Member for Halifax regarding the miscommunication about which statutory instrument we are debating today, because there was a chance that if I had missed an email this morning, I would have come here with absolutely no idea at all that we were discussing the healthcare workforce. Such things do not happen very often, but it is important to try to make sure that we learn from them and put in place processes to stop them from happening again.

Nevertheless, we are where we are, and of course I absolutely agree that NHS workers should not pay the health surcharge. It is welcome that the Government have moved some way towards what campaigners and the Opposition have been saying in that regard. However, for the reasons outlined by the hon. Member for Halifax, there is still further to go. We also welcome the fact that in this draft SI, children will be charged at a reduced rate—basically a frozen rate—instead of the full increased rate. If the Government were to bring back an SI with those features alone, then fine. However, if my amendments to the Immigration Bill had been accepted, no NHS worker would have to pay the health charge and no child would have to pay the health charge, because it would have been scrapped all together. So no teacher, firefighter, shop worker or distribution worker would have had to pay it either.

That is because, as the Minister alluded to, we as a party object much more fundamentally to this monstrous fee. We object on a point of principle, we continue to oppose the charge and we certainly oppose the 50% increase that is being pushed through today. An exemption for one group of workers cannot be justified by whacking thousands of pounds in extra charges on all sorts of other workers. I do not need to repeat everything I said on this topic during the passage of the Immigration Bill, but in short we regard this surcharge not as a charge at all, but as a double tax. It is also a poll tax, and an extortionate one at that.

The fact that this charge is a double tax is confirmed absolutely by the impact assessment that all Members received with their other papers. Deep in annex four, there is reference to the many thousands of pounds that the migrants subject to this charge contribute in the form of direct and indirect taxes every year, and those thousands of pounds dwarf the estimate of the cost of providing them with NHS care that the Minister referred to. That same impact assessment says, in its “key assumptions” section,

“This analysis looks at the impact on the health costs of migration, without considering the scope to offset these costs with fiscal revenue raised from migrants (e.g. income tax).”

In short, we are handing out a bill for the average cost of treating people on the NHS, but not giving those people any credit for the taxes they pay. Anyone wanting to apply a degree of fairness would take into account the tax that people are paying.

The question then arises: why are the Government sticking to just an NHS charge? I share the views of the chair of the Migration Advisory Committee, who told the Select Committee on Home Affairs that he did not think that made sense. Why not have a policing surcharge, a transport surcharge and an education surcharge, so that migrants are contributing to all those services as well? The answer, of course, is that they already pay tax for those services. Exactly the same principle should apply in relation to the NHS. This charge is a poll tax, because an international celebrity coming to work here on a multi-million-pound salary will make precisely the same contribution as a junior doctor coming to shore up the NHS, and it is particularly brutal in its application to families for whom Britain is home and who get put on the 10-year road to settlement. Kids who have known no other country will have this fee levied against them year after year for a decade.

Finally, I have a couple of requests of the Minister. I say again that we urgently need to see analysis of the impact of extending the surcharge to EEA nationals. We should have seen that when the immigration Bill was being debated, and we certainly should have seen it before today, before we started discussing increasing the fee that the Government want to extend to EEA nationals. As of next year, if a business in my constituency wants to employ somebody from Germany or Italy, they are going to have to pay thousands of pounds in health fees to recruit that person, whereas a business in Ireland or Denmark will not have to pay a penny. That is going to have a profound effect on my constituents, never mind the people of Northern Ireland. Businesses there will have rival companies just a few miles down the road that will be able to recruit people from all across Europe free of charge, yet we are going to be levying fees of thousands and thousands of pounds on those people. We need to know what assessment the Government have made of the impact of that.

The Minister alluded today, as he has before, to the argument that the surcharge is comparable to the cost of health insurance in other countries. Of course, it is fair that people going to countries with insurance-based systems pay in the same way as citizens of those countries, in a way that is related to their income. However, as the hon. Member for Halifax has also pointed out, I have seen absolutely no evidence that they are charged anything that remotely resembles the UK double poll tax on top. Again, I rather suspect that apples are being compared with oranges. The impact assessment also refers to “internal analysis by DHSC” to justify the assertion of competitiveness; I would like to see that too. Where is this DHSC research into how this operates in other countries? In short, there is a lack of fairness and a lack of transparency behind these proposals, and we in the Scottish National party continue to oppose them.

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[Kevin Foster]

Again, some of those costs are up front, then followed up by having to pay for healthcare treatment. One thing that is unusual and which is really good about this country is the level of free-at-point-of-need healthcare that we have across the nations of the United Kingdom, dating back to 1948 and the introduction of the NHS. That is not replicated in many other countries, where there is either a social insurance system or there is still co-payment for many areas.

Ireland was another example given and we have had a quick look at the position for someone who has moved there. In my understanding, there is a charge levied more generally, not just on migrants, where people pay €100 if they attend an accident and emergency department without a referral letter from the doctor. Again, we do not have those sorts of charges here and neither will we look to have them. Similarly, there can be charges for being an in-patient in a hospital in Ireland. Again, that would not apply to someone here who has paid the immigration health surcharge or who has indefinite leave to remain and therefore is exempt.

[Stuart C. McDonald]

I am happy to have this debate, but I will say two things. First, can we see the analysis that I referred to earlier that the Department of Health and Social Care has done on this point so we can have the debate in full knowledge of that? Secondly, in terms of Ireland, migrants there are being charged on the same basis as local residents, but here people are being asked to pay the tax—as local residents do—and the dreamed-up £600-odd fee, for which we have are yet to understand the full basis.

[Kevin Foster]

We are happy to supply how we come to the costings. As we said in our manifesto, it is the cost of treatment to those who are covered by the health charge element. I think the situation is different. We rightly have got a social contract in the UK that those of us who are long-term residents or who have been here for a period of time pay taxes year in, year out. That is not dependent on whether we have been ill and not dependent on how much we have needed to use the NHS; we all pay that fee.

It is not unreasonable to ask those who have moved to the United Kingdom specifically at a point in their lives, who will not necessarily have that long-term payment of tax and other contributions, to make their contribution for the period, as some of them will have limited leave. Then, when they make the commitment that indefinite leave to remain represents—that is, permanent settlement—they become exempt. That has been the basis.

I appreciate that the Scottish National party has a very different view on this particular area despite its having produced £120 million of funding for Scotland’s NHS in its period of operation—and it will continue to produce income for Scotland’s NHS. We believe it is the right approach that when someone has just arrived, they make a payment that reflects the fact that others who have been here—permanent UK residents—have made contributions over a period of time, on average.

I heard the comments by the hon. Member for Streatham. The basis is that some need it more or less. That is, of course, the basis of how the NHS, which is taxpayer funded, works. We would not want to link that to how much someone uses the NHS, although I accept that in other countries people face direct healthcare charges, including those who are permanent residents and sometimes those who may not have built up the level of social insurance payments of a longer-term resident. As for the expression that it is unique to a certain Government, it is certainly not unique for those migrating to other nations to face either up-front charges or the prospect, if they become unwell, of having to find money to fund their treatment. That is a prospect they will not be facing here in the United Kingdom.

As for further details on reimbursement, I mentioned in my speech that the Department of Health and Social Care intends to launch that in October and to publish the figures shortly. That is for those who are not automatically exempt as a result of qualifying for the health and care visa and, similarly, those who are applying to renew their migration status.

The hon. Member for Halifax used the example of how a doctor can seek to apply—if they are on tier 2 —for the health and care visa if their migration status is coming up for renewal. She also made points about when sponsors change. To reassure her, we are looking to make some changes under the new points-based system  from 1 January to make it slightly easier for people to move between sponsors if they are doing fundamentally the same job. That also partly responds to legitimate concerns about ensuring that employees are not wholly tied to one employer.

Obviously, the NHS overall is a unique organisation, but if someone is absolutely tied to one employer for their migration status in the United Kingdom, that can present some challenges. We will make it slightly easier for people here in the United Kingdom to move between employers, subject to the workplace role still being fundamentally what their status was based on.

The debate has been a useful opportunity to scrutinise the order. It sounds like, in the Labour party’s immigration policy, I have some Christmas reading to look forward to from the hon. Member for Halifax. I very much recommend that she bases it on the policies the Government put out on 13 July. There will be further details about the new points-based system, which will be a very firm base. The hon. Member for Streatham has her view on whether the immigration health surcharge should in principle be part of the immigration system in the future, and I look forward to hearing the view of the hon. Member for Halifax.

The order is the right approach, based firmly on our manifesto commitment and on reassuring the UK taxpayer that, as a whole, our migration system exists to support our health services and make a contribution to them. I commend the order to the Committee.

Question put.