My Lords, this has been a very full discussion about all aspects of healthcare and healthcare charging, some of which lie within the provisions of the Bill and some of which lie way beyond it and are actually part of the Department of Health’s consultation. I guess there are two ways of dealing with this debate: I can give either the short answer or the long answer. I have chosen to give the long answer—I hope that noble Lords will indulge me—in the hope that I will be able to disabuse them of some of their anxieties and reassure them. I am very mindful of the kind words from the noble Baroness, Lady Lister, but I am also slightly anxious as a result of the description of my noble friend Lord Howe. I am equally concerned to try to be as upfront as I can be about what the Bill provides for and to reinforce my noble friend’s letter, which noble Lords will have received, which seeks to place measures in this Bill in the context of wider health service charging.
Perhaps it would be helpful to provide a brief reminder of the intentions behind Clauses 33 and 34. I will refer to my noble friend Lord Howe’s letter because it sets out the context for these provisions, which is the Department of Health’s wider programme of work on migrant access and financial contributions to the NHS. Likewise, I want to reassure noble Lords that, first and foremost, the NHS is, and will remain, free at the point of delivery for permanent residents. But it is a national service, not an international health service. We believe that migrants should have a form of access to the NHS that is commensurate with their immigration status. That is our policy position.
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As my noble friend Lord Avebury said, we have perhaps one of the most generous health services in the world. Temporary migrants with leave of more than six months currently qualify for free care almost immediately after their arrival in the UK. In effect, this means that only tourists and illegal immigrantsare generally chargeable for healthcare in the UK. I ask noble Lords to bear that in mind when we come to discuss the detail of the amendments.
Temporary, non-EEA migrants will be required to pay an immigration health surcharge. Our policy is that this will provide them with generally the same free NHS access as permanent residents. This will cover treatments including maternity services. I remind noble Lords that this is not a charge to be paid when they go to the doctor or to hospital; this charge is paid on application for a visa to come to this country. It is a charge that is part of the package and is designed to give those people—who, I agree, could be vulnerable—the same status as citizens and permanent residents of this country.
As my noble friend Lord Howe set out in his letter, in itself the Bill will not make any changes to NHS structures or remove the ability of the Department of Health or devolved health ministries—we must remember that while immigration is UK-wide, the administration of healthcare is devolved—to exempt certain groups or treatments from overseas visitor charging on health grounds. Short-term visitors—those here for less than six months; that is, people who are not provided for in this Bill—and illegal immigrants will continue to be liable to NHS charging, as they are now. There is no change proposed by the Bill.
Decisions on what services should and should not be exempt from this charging regime are set out in the NHS charging regulations, which are laid before Parliament, where matters such as those raised by many noble Lords today could be discussed. The regulations are a matter for the Department of Health and the devolved Administrations for health purposes and not part and parcel of immigration legislation.