My Lords, I support the amendment on domestic violence in the name of my noble friend Lady Smith of Basildon. She has made the case for it, so I will not repeat that, other than to point out that this amendment is totally consistent with the Government’s own action plan on domestic violence and builds on the destitute domestic violence concession. It is a very modest amendment, which would simply guarantee a period of safety, with access to services and benefits, after the breakdown of a relationship because of domestic violence. I hope I am not being naive when I say that I am confident that the Government will support this amendment, given that it is so consistent with their own policy.
I also support Amendment 60, in the name of the noble Lord, Lord Patel. I am very glad that he introduced an amendment on children to remind us of the potential effects on children of some of these changes. I draw noble Lords’ attention to what the Joint Committee on Human Rights, of which I am a member, had to say on this matter. It referred to the concerns that,
“arise about the possible impact on children of the provisions in the Bill which extend charging for NHS services … Extending charging to migrants not previously charged for accessing health services, and extending the range of services for which charges apply, are likely to have a deterrent effect on accessing health care, which in turn is likely to have a particularly detrimental effect on the children of such migrants”.
I will not go into the full detail but our recommendation was that to meet these concerns,
“about the impact of extended charging for health services on children’s health, we recommend that new guidance be issued specifically on the s.11 Children Act duty”,
which applies to the NHS,
“explaining to front-line decision-makers in the health sector exactly how that duty applies in the context of extended charging for NHS services”.
I should therefore be grateful if the Minister would say what the Government’s response is to that.
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I want to go on to talk about a number of amendments that relate to pregnant women. I will not make the health case because it has already been made so well
by people who are much better placed than I am to make it. I want to reflect on some of the comments made by Ministers in response to concerns raised at Second Reading. In his letter, the noble Earl, Lord Howe—the noble Baroness, Lady Barker, referred to this issue—singled out,
“those seeking maternity treatment as the most prominent among so-called health tourists”.
I am glad that he used the words “so-called” in front of “health tourists”, because it is a horrible term. He talked of “widespread evidence”. Like the noble Baroness, I should be grateful if the noble Lord could clarify what that evidence is. My understanding is that no primary research has been undertaken. If he was referring to the Department of Health’s research, noble Lords should bear with me while I quote from the report of the Joint Committee on Human Rights, which noted:
“Given the very wide range of the estimates it has produced”—
the noble Baronesses, Lady Barker and Lady Cumberlege, referred to these “very wide” estimates—
“we caution against ascribing too much weight to the Department of Health’s research when assessing whether the Government has demonstrated an objective and reasonable justification for the differential treatment to which the health charging provisions in the Bill give rise”.
The letter therefore seems to ascribe too much weight to not very firmly based evidence—it is not research, as such.
The Minister, the noble Lord, Lord Taylor, in his helpful response to issues raised at Second Reading, reassured us in his usual soothing way that, following representations from Maternity Action and the Royal College of Midwives about the harmful effects on pregnant women among illegal migrants, short-term visitors, failed asylum seekers and visa overstayers, the proposals in the Bill did not apply to them. However, Clause 34 extends the reach of NHS charging provisions to migrants not currently covered. Will the proposals not therefore increase the likelihood of a pregnant woman falling into this category, and is it possible to consider the Bill separately from the parallel healthcare changes being proposed?
If we really are all barking up the wrong tree with our concerns about pregnant women, I hope that the Minister can give us a firm assurance that not one pregnant woman who would not be charged under the current rules will not be charged as a result of the Bill and the related health changes. If he cannot give that assurance, I hope that noble Lords will support this range of amendments that exempt pregnant women.
Finally, the claim at the end of the noble Earl’s letter that, taken together, the changes will,
“maintain safeguards to ensure necessary treatment is not denied”,
ignores the extent to which necessary treatment is already being denied. That point was ably and well made by the noble Baroness, Lady Cumberlege. The letter denies the extent to which pregnant women are deterred from accessing services, even though they would not be charged until afterwards, for fear of the implications of being charged, reported or whatever, or for fear of misapplication of the rules. A report of
the Joint Committee on Human Rights, going back to long before I even joined your Lordships’ House, referred to the evidence on this. It said:
“The arrangements for levying charges on pregnant and nursing mothers lead in many cases to the denial of antenatal care to vulnerable women. This is inconsistent with the principles of common humanity and with the UK’s obligations under ECHR Articles 2, 3 and 8 ECHR. We recommend that the Government suspend all charges for antenatal, maternity and peri-natal care. We recommend that all maternity care should be free to those who have claimed asylum, including those whose claim has failed, until voluntary departure or removal from the UK”.
That recommendation was never accepted. That was a few years ago but my understanding from Maternity Action and the Royal College of Midwives is that pregnant women are still deterred and the rules are still misapplied. The Bill is taking us in the diametrically opposite direction to that recommended by the Joint Committee on Human Rights back in 2006-07.
I also look forward to what the Minister has to say in response. I hope that he can genuinely reassure us this time, because I was not reassured by his response when these issues were raised in at Second Reading.