Motion to Approve
My Lords, as we have all witnessed during this pandemic, our National Health Service is one of our country’s greatest assets. It has been a shining beacon of hope in this time of need and we could not be prouder of it. For those who live in the UK, it is the contributions made over the course of their lives that enable our NHS to continue its fantastic work.
We value the contribution of everyone who comes to the United Kingdom. It is a simple fact, however, that temporary migrants will not have built up the same contributions as a permanent resident of the UK. We therefore believe it is right that they make a fair contribution to the NHS’s sustainability. That is why we introduced the immigration health charge in April 2015. The charge is currently paid by non-European Economic Area temporary migrants who apply for a visa for more than six months. It also applies if they wish to extend their stay in the UK for a further limited period. The charge is separate from the visa fee and is paid up front and in full for the length of leave granted.
From their point of arrival in the UK, a charge payer can access NHS services in broadly the same manner as permanent residents. This can be without ever having made any tax or national insurance contributions in the UK. They pay only those charges a UK resident would pay, such as prescription charges in England. They may also be charged for assisted conception services in England, should they choose to use them. To date, the charge has raised more than £1.5 billion for the NHS. This much-needed income is shared between the health administrations in England, Scotland, Wales and Northern Ireland, using the formula devised by Lord Barnett.
As noble Lords will all be aware, next year the new points-based system will be in place. This means that all migrants to the UK will be treated the same and will pay the charge if staying for longer than six months. The current exemptions, including for certain vulnerable groups, will continue to apply.
The Government recognise the value and importance of migration. We welcome talented individuals and are immensely grateful for the contribution they make to this country. However, it is only right that migrants contribute to the wide range of NHS services available to them.
Last year, the Government’s manifesto committed to increasing the annual amount of the charge to a level that would broadly reflect the cost of treating those who pay it. In line with that commitment, this order amends Schedule 1 to the Immigration (Health Charge) Order 2015. The Department of Health and Social Care has estimated that the cost to the NHS of treating charge payers in England is £625 per person, based on analysis carried out in April 2019, which used 2017-18 NHS England data. To support the administration of the charge, the new level would be set at £624 per person per year. As before, students, dependants of students and youth mobility scheme applicants would pay a discounted rate. This would increase from £300 to £470 per person.
The Government are aware the charge has a greater financial impact on family groups than on individual applicants. To support families, a new, lower rate would be introduced for those under the age of 18. This would be set at £470 and would be in line with the rate for students and those on the youth mobility scheme.
The Government are committed to supporting our NHS and health and social care workers, not least because of the vital role they have played during this pandemic. In May, the Prime Minister asked the Home Office and the Department of Health and Social Care to work together to exempt these workers from the immigration health charge. This order amends Schedule 2 to the principal order to provide an exemption for tier 2 general health and care visa applicants and their dependants. The tier 2 general health and care visa is for eligible health professionals, including doctors, nurses and allied health workers. These are people working in the NHS, for organisations commissioned by the NHS to provide essential services and in the adult social care sector.
The visa was launched on 4 August. It is a fast-track visa, offered with reduced application fees. Until such time as a formal exemption is in place for this group, the Secretary of State has waived the requirement to pay the health charge. In addition, tier 2 migrants who paid the health charge on or after 31 March 2020 but who would have qualified for the new health and care visa had it been in operation at this time, are being refunded.
Migrants who work in the NHS and wider health and care sector and who paid the charge on or after the 31 March, but who do not qualify for the health and care visa, may be eligible for reimbursement of the charge. On 15 July, the Minister for Health announced that this scheme will be launched in October. More details will be published by the Department of Health and Social Care shortly.
Now, more than ever, we need to ensure that the NHS is properly funded. The health charge is designed to benefit the NHS and to support its long-term sustainability. We are indebted to overseas health and care professionals and it is right that they are exempt from the charge or have their payment reimbursed. For those migrants who come to the UK to work in non-healthcare related roles, it is only right that they should continue to pay towards our health service through the health charge. The government manifesto, as voted for by the public, committed to increasing this charge. The order delivers that commitment and I commend it to the House. I beg to move.
Amendment to the Motion
At the end, insert “but this House regrets that the Order increases the immigration health charge; and fails to exempt key workers outside the scope of the Health and Care Visa, and National Health Service and social care staff already working on the frontline in the United Kingdom during the COVID-19 pandemic, from being required to pay the charge upfront.”
My Lords, I thank the Minister for her explanation of the content and purpose of this SI, which, as she says, increases the amount of the immigration health charge to £624 for adults and £470 where the applicant is aged under 18 at the date of application, or is a student or dependant of a student. The order also provides an exemption from the charge for migrants who apply for the new tier 2 general health and care visa.
The Immigration (Health Charge) Order 2015 was made under the Immigration Act 2014, and required a person who applies for entry clearance to the United Kingdom for a limited period of more than six months, or for limited leave to remain in the United Kingdom, to pay an immigration health charge. The amount of the charge was set at £200, apart from for students and dependants of students, for whom it was £150. The charge was doubled by the Immigration (Health Charge) (Amendment) Order 2018 to £400 and £300 respectively, so that for a family of four staying here for two years the cost would be £3,200.
The immigration health charge is currently payable by non-EEA nationals and enables them to access NHS services free of charge apart from those charges that UK residents must pay. It is, though, a matter of regret that the Government find it necessary to increase the immigration health charge at the present time, when we are in a public health crisis and access to healthcare is essential. It is an increase that will apply to those already in the United Kingdom. Yesterday’s announcement of a tightening of restrictions, to try to contain a second wave of Covid-19, simply emphasised how serious the situation remains and how it is likely to continue for many months, well into next year. Surely, this is not the moment to be increasing the immigration health charge on the argument that now, in the middle of a public health pandemic, is the very time for it to reflect the full cost of use.
It is a time when many people affected may well be struggling financially in vulnerable and precarious work and may also be facing the prospect of unemployment. These are people who could also be key workers who have paid into the system and worked hard, working on farms or in shops for example. Increasing the costs substantially for those already here who might be changing jobs or extending their stay, which means paying the fees again whether or not they will be reimbursed, is not what we should be doing now. This is surely not the time to be increasing the immigration healthcare charge by what appears to be over 50%.
We support the intention in the SI to exempt from the fees those who plan to come to the UK on the new health and care visa. However, that simply highlights the fact that this SI does not also offer automatic exemption from the immigration health surcharge to migrants currently working in health and social care. These migrant workers still have to pay the charge, with the promise of a refund at some date and within a timescale at present unspecified. They have put their own lives on the line, and continue to do so, to help us combat coronavirus. They have displayed the truly British qualities of commitment and stepping up to the mark in a time of need and crisis. In the care sector in particular, these key workers are on rates of pay that do not reflect the significant contribution that they make and the value of the work that they do—a reality that the Government appear to have just woken up to.
All those working in health and social care should be exempt from the immigration healthcare charge and should not have to pay the fee. The Government will issue refunds to those who are not automatically exempt under the tier 2 visa—a sizeable number of social care workers. But what will be the cost of administering these refunds? How will the Government ensure that all those to whom they should be paid receive such refunds? Why does it have to be done in this way? Why do we have to have refunds at all, rather than exemptions, when those affected will still have to find the money initially to pay the immigration health charge?
Last May, the Prime Minister pledged to abolish the immigration health charge for health and care staff as soon as possible, yet the reality for many migrant workers in health and social care is that they will have to continue to pay not just the existing fee but an increased fee if they move jobs and their sponsor changes, or if their period of time in this country is extended. Owing to their immigration status, some have no recourse to public funds so are not eligible for any state aid, such as free school meals or child benefit, yet will still have to pay the immigration health charge up front and face the financial pressure that that will involve.
The Government told us at the start of the pandemic that we were all in this together, a sentiment repeated by the Prime Minister in his broadcast last night. It is clear from this SI, though, that the Government’s togetherness does not appear to extend to many migrant workers who have shown true grit and determination in the invaluable, and at times life-saving, work that they have done and continue to do in our country during the pandemic. I beg to move.
The original question was that the draft order laid before the House on 21 July be approved, since when an amendment has been moved by the noble Lord, Lord Rosser, to insert the words as set out on the Order Paper. The question I therefore have to put is that this amendment be agreed to.
My Lords, I rise to support my noble friend Lord Rosser in his amendment. I shall not delay the House for long because the Minister has heard me before on this issue. It was just a couple of weeks ago, when I was trying to point out the contradictions of a policy that encouraged people to go into the residential care sector and to progress, only to find that we are encouraging, enabling and supporting people who are coming in at a higher level—at management level as well as higher care levels—but not those who come in at the lower levels. We have the contradiction of expecting domestically resident employees to stick at the lower levels of residential care while we encourage migrants to come and take the more highly skilled parts of the health and residential sector. As I always do from the Minister, I felt I got an ironic smile when she said that she understood that this area and the world we are working in are full of contradictions.
It is a matter of great regret that we have chosen to provide the exemption just for the tier 2 health and care visa for higher skilled workers but not for those who are doing the grinding jobs. On a previous occasion, I asked the Minister for the staff turnover rate in residential and nursing homes. She was good enough to come up with a figure that I think was accurate—41%—which is staggering. It does mean that, over the months ahead, there will be substantial numbers of vacancies in work that supports those who are often at the most critical part of the care journey they are undertaking.
I also want to draw attention to the contradiction in relation to the increased charges for students and their dependants. At the moment, universities are on tenter- hooks. While, thank the Lord, domestic undergraduate recruitment has been better than was previously predicted, we are still uncertain about the recruitment of overseas students, particularly for postgraduate taught courses and postgraduate research. This recruitment is crucial not only to maintaining funding for universities, which has been so badly hit, but also for cross-subsidy with other elements of the system, including vital research. By increasing these charges, we are discouraging people who are part of a cohort that draws down less on health services than other groups of the population simply by the nature of their demographic and well-being. At the same time, we are sending a message that, at a moment of crucial investment for both universities and the future for those individuals—as well as the soft power that that brings to the United Kingdom—we would like to charge them more. That is a matter of considerable regret.
My Lords, I welcome the Government’s proposal, which seems sensible and appropriate. It has always been rather baffling that our welfare system is based on the principle of contribution and that our NHS is not in a position to get full and fair funding from all sources—particularly from those coming to this country from abroad. Having looked at the systems in Germany, France and Switzerland, for example, I can see that they are very different because they have that principle built in. Of course, they benefit from having ID cards. If Parliament had listened to the noble Lord, Lord Blunkett, when he was Home Secretary, that sensible proposal might have made it much easier at an earlier time. Indeed, some of our history might have been rather different if we had brought in identity cards.
One reason why identity cards would have been helpful is this. I uncovered some data from 2016; I have not seen it openly published since, although I am sure that it has been published somewhere. When I uncovered the figures, I found them quite extraordinary. They showed the differential between this country and other countries in terms of recharging for healthcare; that is, not recharging the individual, but for those European countries with which we have reciprocal agreements, we were recharging the sum of £49 million for their citizens to use our NHS, whereas through the British Government the British taxpayer was being charged—directly to the Government, not to individuals —£651 million. The deficit with Ireland was more than £200 million, while the figure for Spain, where there appears to be a significant number of British citizens who are often elderly and therefore use the Spanish healthcare system, was also a deficit. In other words, with all the Brits living in Spain and using the health service there, we were still in a deficit situation.
The Minster may not be able to do so at the moment but it would be useful for him to state afterwards in writing what the current situation is. There is no reason why our NHS should not be recouping those sums; they do not come from the individual but from the Government. Some £600 million a year, broken down into individual hospitals, is pretty much what the NHS deficit was running at until the current crisis. All that would be required is the presentation of some form of identity including nationality for that automatic process to be easily followed. A cultural barrier is holding this back, which is also why I am so supportive of this contributory initiative, of which the Attlee Government would have been proud and probably should have thought of at the time.
Let us have fairness in the system. It would be helpful if the Minister could take this issue back to her ministerial colleagues to ensure that we are charging back foreign Governments, not individuals, for their health treatment here. If not, perhaps there should be an explanation of where weaknesses in the system remain, so that some of us can pursue them with vigour.
My Lords, as the Minister has said, the 2019 Conservative Party manifesto contained a commitment to
“increase the health surcharge to ensure it covers the full cost of use”.
As a result, this statutory instrument, as the noble Lord, Lord Rosser, has said, increases the full immigration surcharge to £624 a year. However, in April 2019, the Department of Health and Social Care, using 2017-18 data, estimated the cost to the NHS of treating immigration health surcharge payers at £624 per year—the amount that the SI increases the charge by—but re-ran that estimate using 2018-19 data, putting it at £646 a year. Why are the Government using the old estimate and not the current one?
My understanding is that the Home Office takes a cut of the £624 charge to cover its costs. The amount therefore paid to the NHS is even less than the outdated £624 a year. What does the Home Office take out of the £624 allegedly taken to fund the National Health Service? Taking those two factors into account, the Government are falling short of their manifesto promise to cover the full cost of use.
I strongly disagree with the noble Lord, Lord Mann, not just on ID cards but on the statutory instrument. The flaw with the immigration health surcharge is that it takes no account of income tax, national insurance contributions and VAT, which are funding sources for the National Health Service paid by working migrants who also have to pay the IHS. The difference between the UK and most other countries with which the noble Lord was making a comparison is that they do not have health services that are free at the point of need, as we have in this country.
Analysis by Oxford Economics for the Migration Advisory Committee estimated that in 2017-18, the average non-EEA migrant made a net fiscal contribution of £310 more than the average UK adult. The average EEA migrant made a net contribution—that is, paid more in tax than they received in benefit from the state; for example, in healthcare, education and benefits —of £1,940 more than the average UK adult.
This analysis shows that migrants already pay more than the average UK adult towards government services, including the National Health Service, so why should they pay the immigration health surcharge on top? Even if we ignore the baseline figure, surely a further option the Government should have considered is discounting non-EEA migrants working in the UK by £310—the amount they contribute in addition to that contributed by the average person in the UK—and exempting EEA migrants altogether. Surely, this would cover the full cost of the use of the NHS. Or, why not charge migrants who do not work and not those who do?
These provisions are estimated to raise £177 million a year, a tiny fraction of the 2018-19 NHS budget of £114 billion, yet the impact on reducing the number of migrants seeking to come to the UK is estimated to be 2,500 people per year. Can the Minister confirm that the main objective of the immigration health surcharge, along with the vastly inflated sums charged for visas, is to reduce migration into the UK by pricing those least able to pay out of the market?
We then have the farcical situation whereby migrants working for the National Health Service have to pay the immigration health surcharge. Yes, there are exemptions, but these are for the more highly paid professionals such as doctors, dentists and pharmacists. Those least able to pay the IHS, such as porters and cleaners, are not exempt. NHS and social care staff from other countries—many of whom are working on the front line of the coronavirus pandemic, as the noble Lord, Lord Rosser, said—should have the right to stay in the UK without having to renew their visas or pay the immigration health surcharge. That is why Liberal Democrats in the other place have tabled legislation to give them indefinite leave to remain.
There is no justification for imposing the immigration health surcharge on working migrants, who already contribute not only more to the Exchequer than they cost it, but more—in the case of EEA migrants, considerably more—than the average person in the UK. Failing to exempt all NHS and social care workers from the IHS adds insult to injury. We support the Motion of the noble Lord, Lord Rosser, and if he presses it to a Division, we will vote with him.
My Lords, I thank all noble Lords who contributed to what was quite a quick debate; nevertheless, they were thoughtful and insightful contributions. The health charge remains an attractive offer for migrants. It provides near comprehensive access to NHS services without further charge, regardless of the amount of care needed. It is not there to reduce migration, as the noble Lord, Lord Paddick, attests; moreover, it ensures that migrants do not need to worry about meeting the cost of unexpected treatment or arranging health insurance, which, for some people with health conditions, must be costly.
I turn to some of the specific issues that were raised. As set out in our manifesto, the Government believe that the health charge rate should broadly reflect the cost of treating those who pay it. However, the rates for students and those eligible for the youth mobility scheme will continue to be discounted. As I said, a new discounted rate for children will be introduced. The increased surcharge will continue to represent a very good deal for migrants who pay it, given the range of NHS services that can be accessed without further charge. The cost compares favourably to private medical insurance here and abroad, which is a common requirement for individuals wishing to migrate to many other countries.
We are really grateful to our essential workers and key workers who have performed such a public service throughout this pandemic, including emergency service workers, transport workers, teachers, delivery drivers, supermarket workers and many others. However, it is only fair to expect people arriving in the UK who work in non-healthcare roles to make a contribution to the full range of NHS services they can access from the point of arrival.
I will talk a bit about the reimbursement scheme, because the noble Lord, Lord Rosser, touched upon it. Tier 2 migrants who paid the health charge on or after 31 March 2020, but who would have qualified for the new health and care visa had it been in operation at this time, are being refunded. Migrants who work in the NHS and the wider health and care sector and who paid the charge on or after 31 March but who do not qualify for the health and care visa may be eligible for reimbursement of the charge. In July of this year, the Minister for Health announced that this scheme would be launched in October. As I said earlier, more details will be published by the Department of Health and Social Care shortly.
Volunteers have been raised today and previously, and we absolutely pay tribute to the contribution they make to our communities. The Department of Health and Social Care is considering who will be eligible to apply for the surcharge reimbursement scheme and will publish that information shortly.
On tier 2 refunds, tier 2 migrants and their dependants who paid the health surcharge on or after 31 March of this year are, as I said previously, being refunded. Those who believe they are eligible for a refund on this basis may contact the Home Office; the relevant contact details are available on the GOV.UK website.
The noble Lord, Lord Rosser, and others talked about the impact on families and young people and the total cost of the applications people are faced with paying. I am absolutely aware of concerns regarding the combined costs—I think the noble Lord, Lord Paddick, raised this—of both the health charge and the visa fees, and the impact that this might have on families and young people in particular. The Government are committed to ensuring that the surcharge remains affordable for family groups and intend to provide, through this draft order, a reduced surcharge rate for children. The Government are clear, however, that migrants must pay the charge when they make an immigration application and should plan their finances accordingly.
The noble Lord, Lord Rosser, talked about those in a vulnerable situation, perhaps facing destitution. There is a fee waiver in place for those making specified human rights applications who are destitute or at risk of imminent destitution. Where the fee is waived, the requirement to pay the health charge is accordingly waived also. If you can demonstrate that you do not have adequate accommodation or any means of obtaining it, or cannot meet other essential living needs, that would be considered destitution.
The noble Lord, Lord Paddick, asked what cut the Home Office takes of the £624. I do not know if the Home Office does take a cut; he is asserting that it does. I do not have the answer today, and I will find that out for him. However, as to how the Government estimate the cost to the NHS of treating the charge payers, that was produced by the Department of Health and Social Care. Not to buck-pass, but the cost was produced by the DHSC, based on analysis it carried out in April 2019 using—the noble Lord is absolutely right—2017-18 NHS England data. I do not know how that data differs from the following year, but I will find out, and therefore get a more up-to-date picture for the noble Lord. The small increase from the previous analysis was mainly driven by health inflation and updated data. Mindful of the need to ensure that the surcharge is not set above cost recovery, the Government have decided to set the surcharge at £624 per person per year.
The noble Lord, Lord Mann, asked about recharging. It is something that has exercised me in the past: we pay ever so much and we get so little back. I do not know what the up-to-date figures are—he tells me £49 million versus £600 million, which is quite a gap indeed—but clearly it is a matter for the NHS to collect the money. The noble Lord is nodding in an exasperated way—he knows that. If I can, I will get him more information on what the up-to-date figure might be.
The noble Lord, Lord Rosser, asked how we are targeting people affected by the change. We are looking to engage as many eligible people as possible through various means of communication.
The noble Lord, Lord Blunkett, talked about other people who may not be eligible but who have played their part in tackling the pandemic. While currently a subcategory of the tier 2 immigration route, the health and care visa offer will form part of the future skilled workers route. We intend to review the list of eligible occupations that can benefit from the offer to reflect the introduction of the expanded skills threshold, ensuring that those health and care professionals who meet the skills threshold can benefit from this offer.
I hope that I have answered all the questions. If I have not, I will follow up in writing.
I thank the Minister for her reply and thank all noble Lords who have contributed to this debate. I will be brief. I am not sure that I have really had an answer to my question. Bearing in mind that some people coming into the country under the tier 2 visa will get automatic exemption, why can that not apply to all those in the health and care sector? I asked why we had to have refunds and why there could not be an exemption for all, but I did not get a very clear answer.
I also raised the specific issue of why it is necessary to make a dramatic increase in the healthcare charge now, when we are in the middle of a pandemic? A lot of those affected will be financially very stretched, and in certain circumstances will potentially have to pay the increase. I have not had an answer as to why that increase must be brought into effect now. The Minister quoted a manifesto commitment, but manifesto commitments do not all have to be implemented immediately. I do not suppose that when the manifesto was written it was envisaged that we would be in the middle of a pandemic crisis at this time. I have not really had an answer as to why it is necessary to make these substantial increases now.
However, I will leave it at that. I have made our two points, which are reflected in the amendment. I thank the noble Lord, Lord Paddick, for indicating that if I pushed it to a vote, I would have the support of the Liberal Democrats. I do not intent to do so. It has been an interesting debate and I have made clear the basis of our regrets about this SI. I am very grateful to noble Lords for their contributions and thank the Minister for her response. I beg leave to withdraw the amendment.
Amendment to the Motion withdrawn.