My Lords, I shall speak to my Amendment 66F in this group. Following the consultation in 2013, the Department of Health said that,
“while there is a great deal of speculation about the numbers of visitors and short-term migrants using the NHS, robust data are very limited”.
That is the point that I wish to address. I have no problem with the Government’s intention to introduce a health levy, and I have no problem with them seeking to have different rates for different groups of people. However, I want to be sure that when this House makes a major change to a fundamental policy that we have held in this country for over 60 years, that it does so on the basis of sound evidence.
Back in 2006, noble Lords will remember that proposals of this kind came before this House from the then Labour Government but then disappeared, principally because someone went back to the department and worked out that the cost of implementing the proposals far outweighed any benefit. It is simply good business practice to have done a cost-benefit analysis of a major change before one implements it. The Government are wedded to doing this—fair enough, and I have no doubt that they will go ahead—but it is only right that if they go ahead they should do so on the basis that its implementation will be thoroughly analysed, so that we do not find ourselves back here in five years’ time responding yet again to an agenda that has been set by various media organisations and political groupings on the basis of nothing more than speculation.
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When we talk about this issue, we always find the Government talking about the work of overseas visitors officers and so on and claiming that there is a degree of undercharging and that the NHS budget would be helped substantially if we had a scheme such as this in place. People who work with minorities and vulnerable groups in our society have quite legitimate fears about the potential cost not just in terms of public health but of acute care if migrants and so on are deterred from seeking NHS services at an early stage. Neither side has any real, strong evidence base. This amendment seeks to build the evidence base so that we know the full cost, not just in financial terms but in terms of public health.
This amendment requires the Government to appoint an independent person to carry out a review. The amendment states that the review should cover a period of two years. Actually, I would prefer it to be three years. I do not believe that the review period of one year suggested by the noble Baroness, Lady Smith of Basildon, is long enough because it may be that there is something unusual. If this proposal had been put forward a few years ago, and we then proceeded to have a swine flu epidemic, it would have thrown the data completely. I would like to see three years’ comparative data.
The data should not be on just the simple, straight transactional costs of collecting the fee. They should be robust about the impact on public health and on the use of expensive acute services by people who have not gone to primary healthcare services because of the deterrent effect of the changes proposed in the Bill.