Draft Immigration (Health Charge) (amendment) Order 2023 (First sitting)

Tom Pursglove Excerpts

Wednesday 10th January 2024 General Committees

[The Minister for Legal Migration and the Border (Tom Pursglove)]

I beg to move,

That the Committee has considered the draft Immigration (Health Charge) (Amendment) Order 2023.

It is, of course, a pleasure to serve under your chairmanship, Mr Pritchard. The new rate of health charge replaces that agreed in 2020 by this House. Not only does it reflect the increases in healthcare expenditure, but it also utilises the latest revised assumptions of migrant use of healthcare services. Using more recent and representative data better reflects NHS service use by health charge payers. The proposed increase supports the sustainability of our NHS, ensuring vital NHS services are funded, and allowing wider NHS funding to be directed towards other priorities in the system.

The draft order amends schedule 1 to the Immigration (Health Charge) Order 2015. The full rate of the charge will increase to £1,035 per person per annum, with the discounted rate for students, their dependants, those on youth mobility schemes and under-18s increasing to £776 per person per annum. These levels are currently set at £624 and £470 respectively.

The draft order amends schedule 2 of the principal order to formalise existing exemptions from payment of the health charge for migrants applying to the statelessness immigration route, and those applying to the Ukraine schemes. I know this move will be welcomed across the House, as it places these exemptions on a legislative footing and provides clarity for applicants. It is worth remembering that the charge does not apply to those who apply to settle in the UK, recognising the strength of their long-term commitments to our country and the contributions they have made while living here.

It is important to highlight that safeguards exist in administering the health charge. The Government recognise that the cost of the charge may be unaffordable for some. On family and human rights routes, the fee waiver application can be made and a full fee waiver will be granted if it is determined that the applicant cannot afford the visa fee and the health charge. A partial fee waiver can be granted if it is determined that they can afford the visa fee but not the health charge as well.

The health charge is designed to benefit our NHS and support its long-term sustainability. Our manifesto committed to increasing this charge to NHS cost recovery levels. The draft order delivers on that commitment, and I commend it to the Committee.

[The Chair]

There is a Division in the House. I am going to suspend this sitting until the last Division has taken place. We are expecting three. There will be 15 minutes for the first and 10 minutes thereafter, so it will take about 35 minutes in total. Once the Front Benchers are back and we are quorate, which is a total of six including the Chair, we can proceed.

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[Tom Pursglove]

Let me start by expressing my gratitude for the scrutiny of this statutory instrument and for what I think is an indication from the Opposition that they will support this change to the level of the surcharge.

Before I address some of the issues and questions that have been raised, I want to make the general point that those who move to a new country expect to pay towards healthcare and that countries around the world have a range of systems in place for them to do that, in line with individual healthcare models. It is worth saying as well that since its inception the health charge has generated more than £5.1 billion for the NHS. The funds generated are shared between the health administrations in England, Scotland, Wales and Northern Ireland, using the now familiar formula devised by Lord Barnett. We think that it is right that individuals pay a contribution towards being able to access the NHS and the care that is provided. As I said, that is comparable to the level of financial contribution that others make elsewhere—perhaps through different approaches, but in terms of making contributions towards healthcare, that is what happens. We think that this is comparable and an appropriate way of going about obtaining these funds in order to support the NHS and to ensure that it is sustainable.

There were a few points that I wanted to pick up on—first, about the calculation. The shadow Minister, the hon. Member for Aberavon, asked about that specifically. As the Chief Secretary to the Treasury set out on 13 July, the health charge rates have remained unchanged for the last three years, despite high inflation and the wider pressures facing the healthcare system. The increases to the charge reflect the higher costs of healthcare provision and increases to healthcare budgets since 2020. Additionally, the assumptions on how intensively charge payers use healthcare services in different settings have been revised to use more recent and representative data, with the intention of better reflecting migrants’ use of these NHS services. Although the health charge is increasing, it is still considerably lower than the comparable average cost per capita of providing healthcare for the average UK resident, which stands at about £2,700 per person.

[Dame Meg Hillier]

The Minister talks about the average per UK resident. That was unclear from the impact assessment; I thought it referred to the average for the applicants paying the surcharge. However, the evidence is very clear, particularly for people such as students, the younger population, that they have very little purchase on the NHS when they are here, because generally they are a healthier population. Migrants tend to be younger. Therefore, has the Minister done an analysis of what the cost has been of providing healthcare to the cohort in question—that is, those who have been paying the health surcharge?

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[Tom Pursglove]

What I will say to the Chairman of the Public Accounts Committee is that I am very happy to take away the various very involved, technical points that she is making and provide an update to the Committee. She will recognise that I have been in this role since the start of December. She has asked whether I have reviewed certain alternative approaches. These are all things that I am very willing and keen to have a look at. In fact, I thought that the shadow Minister made a valid point about regular review of the appropriateness of the level of charging. That is something that I would quite like to have a careful look at to consider whether there are further steps that we can take on that. I am very happy to provide a thorough update to the Public Accounts Committee about these very involved points that have been raised in the course of this debate.

[Dame Meg Hillier]

On a point of order, Mr Pritchard. We are in the middle of scrutinising a statutory instrument that will be passed or—looking at the numbers—might well be passed this afternoon, yet the Minister is unable to provide me with information and answers from what is a detailed and thoroughly worked up impact assessment. Officials are in the room. I am a patient woman: I do not need the answers this minute, but perhaps in the next 10 minutes—they were not difficult questions that I asked. They are questions that I think the Minister needs to answer before we agree an SI. I would appreciate your guidance, Mr Pritchard, on whether we can leave questions to be answered after a statutory instrument is passed. This is all from the impact assessment document.

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[The Chair]

I am grateful to the hon. Lady for her kind comments. It is a difficult one for the Chair, to be quite frank about it. I do not know whether it is the right approach, but I note what she says. More importantly, I am sure the Government have noted what the hon. Lady has said, and we all know that she will continue to pursue her point.

[Tom Pursglove]

Of course, I have not finished answering many of these points, so it is important to note that too. I have set out the position on how the charge has been calculated, and I think it is most definitely worth the Committee having an understanding of that and being able to clarify it. It is also worth saying that when it comes to the use of healthcare—I note the point that the Chair of the Public Accounts Committee made about this—evidence suggests that migrants’ use of healthcare is lower than the UK population. Differences in NHS usage are largely due to migrants tending to be younger and healthier. The modelling adjusts for the age and gender profile of migrants compared to the general population. It is also worth saying that the IHS is charged at a flat rate. We think that is fairer to all and that it takes account of the use of services. That is the basis on which historically the charge has been calculated.

Colleagues across the Committee have quite rightly raised questions about fee waivers and the ability of people to access them when they are needed. It is recognised that, in some instances, people who are required to pay the health charge may not be able to afford it. In those instances, particularly on family and human rights immigration routes, and where backed by clear and compelling evidence provided by the individual, the health charge may be waived. Where a fee waiver application is successful, the application fee and the health charge will be waived. Migrants who are granted a partial fee waiver are required to pay the application fee only; the health charge is waived in full. Evidence suggests that migrants are aware of the fee waiver process, due to the volumes of migrants on eligible routes utilising fee waiver applications. In the year ending September 2023, there were over 46,000 fee waiver applications.

The Chair of the PAC also raised a question about the modelling. She will recognise that the Home Secretary set out on 4 December the initial announcement on the net migration changes we are seeking to advance as a Government. We believe that those will, in their totality, reduce net migration to this country by 300,000 when taken together. That is the basis on which we are taking forward those proposals. However, I will very happily take away the Hansard report of this debate, and if there are outstanding points, I would be very glad to write to her to provide some additional detail.

[Dame Meg Hillier]

I thank the Minister for that helpful comment. It is helpful to get the timetable clear. This impact assessment was signed off in October, so presumably the figures—I will say this for Hansard, so that it can be picked up—reflect the situation in October, and not the policy announcement as of 4 December. That makes me ask: what will the impact assessment be now, after that policy announcement in December? It would be very helpful if the Minister provided me with updated figures.

[Tom Pursglove]

I am very happy to take that request and roll it into the update that I would like to provide. Colleagues across the House know that I am always keen to be as helpful as possible to colleagues during the course of our proceedings and in the work that we do, particularly to facilitate scrutiny by Select Committees.

In conclusion, our NHS was founded to care for every citizen in their time of need. We as a Government, and, I think, all Members of this House, feel that that principle must be cherished and preserved. Equally, it is right that migrants granted temporary permission to be in the UK make a financial contribution to the running of NHS services available to them during their stay—that is a matter of fairness. On that basis, I commend the order to the Committee.

Question put and agreed to.