My Lords, it is helpful that we have had this debate; I am pleased that the noble Lord, Lord Patel, has moved the amendment. As he said, it was originally designed to supplement his amendment relating to students. I think that we have got a good story to tell in connection with students. If I may, however, I shall deal with the particular amendment, Amendment 58.
The noble Lord is right that the provision is not immediately transparent; indeed, the noble Lord, Lord Rosser, has challenged me on this point, too. I understand that the intention of the noble Lord, Lord Patel, may have been in respect of the exclusion of certain expensive discretionary treatments from the free access afforded by having paid the surcharge—I think that that was his concern. I said on Monday, and I am happy to repeat today, that no such exclusions will apply when the surcharge is introduced, and none is planned for the future either. We intend that the payment of the surcharge will provide the same access to health services as is available to a permanent resident.
I turn to the penetrating critique from the noble Lord, Lord Rosser. Both he and the noble and learned Lord, Lord Hope, felt that a degree of ambiguity lay within the clause, so perhaps I may explain why Clause 33(3)(b) states that,
“different amounts may be specified for different purposes”.
The answer is that it allows regulations to specify different amounts of surcharge for different categories of migrants—currently, there are only two amounts: the £200 rate and the £150 rate—without which we would not be able to give the discount to students, which is one of the elements of the Bill. We need this
capacity to do so. We do not have it in mind that there will be other categories, but this is the way in which the discount for students is facilitated by the legislation. It does not refer to NHS charging in the legislation.
Perhaps I may refer to the comments made by my noble friend Lord Leigh of Hurley, because we have a very different health system here from that in the USA and in Australia which requires a different solution. Health insurance requirements would be expensive and compromise our own competitive position in the international market for students and for workers, which is not what we want the Bill to do. Most EU countries do not enforce the Schengen visa health insurance requirement at their borders. A student applying to Harvard in the USA, for example—my noble friend Lady Williams of Crosby referred to Harvard and its great pull as a centre of learning for overseas students—has to pay a fee of $958 per year to access basic health services. To access Harvard’s more comprehensive health insurance plan, which is comparable to what the £150 rate gives access to, would cost a further $2,190 per year. That gives some measure of what is involved. We have already committed to this discount for students—that is what this clause is about—in recognition of their contribution to the UK, reinforcing, I hope, arguments that I am trying to make at regular intervals in our debates. They will pay just £150 instead of £200, which is 1% of the cost of coming to study in the UK and exceptional value for money, as I am sure noble Lords will agree.
Why does the Bill allow surcharge payers to be charged for further treatments? So that noble Lords are clear, I should clarify that the Bill does not prevent the exclusion of certain expensive, discretionary treatments from the free access. However, we have made it clear that we intend that no such exclusions will apply when the surcharge is introduced. The Department of Health has been clear that it will consider these in future only in the event of exceptional and compelling specific justification for health purposes; and any changes would need to be put before Parliament in the form of revised NHS charging regulations. One might say that this is for treatments which may in future emerge where it is considered that the health service quite properly should charge not just migrants but members of the UK population.
My noble friend Lord Avebury asked whether there was a problem with the drafting of Clause 33(4). The drafting purpose of Clause 33(4) is to provide a clear link in the Bill to health treatment. Without it, the clause would give an unlimited power to charge for any purpose, which is the intention neither of the clause nor of that particular subsection of it. I note what noble Lords have said about the wording of the subsection. It has been carefully drafted, but if I can provide noble Lords with an explanation of line-by-line implications, I shall do my best to do so before we get to Report. Meanwhile, I hope that the noble Lord will withdraw his amendment.