Health Bill [HL]

I will respond to Amendments 130 and 132 together, as they are clearly related. First, I emphasise that we recognise and respect our duty to ensure that the provision of healthcare is fully compliant with human rights principles. That is why immediately necessary and urgent treatment for any medical need, including HIV and AIDS, must never be denied or delayed, irrespective of a person’s right of abode or ability to pay. Decisions about need are always clinical and are made solely by a clinical professional. I think I am going to repeat that: decisions about need are always clinical and are made solely by a clinical professional. The suggestion made by the noble Baroness, Lady Tonge, the right reverend Prelate and others that this is not the case is somewhat unfair. The regulation to which Amendment 130 refers already ensures that people seeking asylum or refuge have full, free access to healthcare throughout their application, including any appeals. This should already capture most human rights applicants, and we are currently reviewing whether any other genuine applicants are being excluded. I met the noble Baroness and my noble friend Lord Dubs, who is interested in this issue, to discuss that review. It is taking place now, and that is at the heart of what I have to say. The amendment would extend this so that anyone who had made an application for leave to stay in the UK, either as an asylum seeker or under the human rights convention, would be exempt from charges, even if that application had been decided and, indeed, rejected. In other words, he would continue to receive free treatment indefinitely, even if it was established that he was not in need of the protection or sanctuary of the UK. In deciding whether such a significant extension is appropriate, we must, while still paying due regard to human rights principles, also take account of other factors. The NHS, which is free at the point of need, is one of the most generous provisions that any country provides. We legitimately need to ask whether we can provide all healthcare free of charge to people who are not legitimate residents in the UK. Also, might such an amendment not encourage applications under the human rights convention, particularly for chronic conditions? I am dubious about that, and I share the questions of the noble Baroness about that. I am not saying that any of these arguments should justify the denial of human rights in the provision of healthcare. However, decisions on the extent of free NHS provision must consider all these factors, such as public health, clinical costs and cost implications. In terms of retrieving revenue, it is the case that NHS trusts are obliged to charge and then seek repayment. However, if it is then obvious that the people whom they are trying to retrieve from have no funds, they are not required to pursue it. On Amendment 132, HIV/AIDS is one of the world’s most significant medical and human challenges. Although the number of new diagnoses of HIV in the UK appears to be stabilising, HIV continues to be a major global health concern with 2.5 million new infections in 2007. Once diagnosed, a patient requires lifelong treatment. I have already said that nobody should be denied clinical treatment if it is urgent or immediately necessary, nor should it be delayed, irrespective of their ability to pay. However, this amendment would make all treatment for HIV/AIDS free, creating a number of risks that we would have to take into consideration. First, what is the capacity of the NHS to provide for a demand for clinical provision that its likely to be significant? What would the additional financial burden be, and is it affordable? Those are legitimate questions. The approach that the Government are taking is an international one. We provide support to countries with high HIV prevalence to improve their own facilities and resources to combat HIV. The Department for International Development provided over £1.5 billion between 2005 and 2008 for this purpose, and its AIDS strategy, published last year, included a further funding commitment of over £6 billion over the next seven years to strengthen healthcare systems. I am not saying that any of those arguments rule out extending free NHS provision, but we do have to consider those factors. Both the amendments raise complex issues, which is why the review of access to the NHS for foreign nationals has been set up. Both amendments fall within the review’s scope; its recommendations will be put to a full formal consultation and agreed changes will be subject to the appropriate parliamentary process. I should make a procedural point that the regulations to which these amendments refer are secondary, not primary, legislation, so the proposed means of amendment through this Health Bill is not appropriate. However, I am pleased that the amendments have provided the Committee with the opportunity to debate these issues and for those views to be taken into consideration in the review. I hope that with those reassurances about our ongoing work to tackle those issues the noble Baroness will feel able to withdraw the amendment.