My Lords, this has been a very reasoned debate and I am pleased that we have had a chance to return to it. It has taken us slightly further along the track than the legislation takes us, but that is a feature of where we are. We have an Immigration Bill, a Home Office measure, that is designed to provide for a surcharge, which in turn is to provide free healthcare for those covered by the surcharge, and we have the health service itself, under the Department of Health, looking at ways in which it can more effectively recover sums that are due, under current legislation, from visitors—and, for that matter, illegal migrants and the like—to see how that can fit in with all the other considerations; public health has been mentioned, as well as the vulnerability of some of the patients who present themselves who may have become victims through no fault of their own and need proper medical attention. Those two things are going on at the same time. I suspect that at bottom that is why we are finding it a bit difficult to discuss this issue.
If I may, I will turn to the Bill itself to start with, as that is the most important thing. I am aware that I speak for the Government and I cannot say, “Well, this is my dear noble friend Lord Howe’s responsibility”, so I will do my best to integrate into one proposal both the Bill and the health service reforms. I reassure noble Lords that there is nothing in the Bill that will impact on the current arrangement for migrants in any of the areas covered by these amendments that have been debated this evening. Our intention is that the payment of the surcharge, which takes place when people make an immigration application, will entitle migrants to free access to the NHS in the same way as a permanent resident. This will include treatment for injuries sustained as a result of domestic violence, which the noble Baroness, Lady Meacher, mentioned, or female genital mutilation, which was mentioned by the noble Baronesses, Lady Meacher and Lady Finlay. It will also include mental health, to reassure my noble friend Lady Barker, and maternity services, as we discussed when we were debating previous amendments. We have also committed, as the noble Baroness, Lady Smith, said, to exempting victims of human trafficking. I can say to the noble Baroness, Lady Finlay, that there is no charge for anyone in detention accessing NHS healthcare.
Secondly—this is the second element of the debate—as my noble friend Lord Howe set out in his recent letter to noble Lords, the Bill does not make any changes to the way in which short-term visitors and, for that matter, illegal migrants access medical care. Any NHS charging exemptions for health purposes for these groups are a matter for the Department of Health and, within their devolved remit, the devolved Administrations. Within the framework of government, they are not the responsibility of the Home Office.
The noble Baroness, Lady Meacher, asked me how we will ensure that NHS staff can effectively identify potential victims of trafficking. The Department of Health already identifies patients who are victims or potential victims of human trafficking in order to waive treatment charges. We will work closely with the Department of Health on this matter in order to ensure that proper
guidance and training are provided to NHS staff. I am not convinced that the amendments proposed by the noble Baroness are necessary.
I was asked why the national referral mechanism was not put on a statutory footing. It was set up to ensure that victims of human trafficking are identified and given the support they need. We want to make sure that the NRM is working as effectively and supportively as possible, and healthcare is part of that mechanism. That is why the National Health Service announced a review of the NRM on 3 December. It will commence shortly, and we await it.
The Department of Health has already confirmed that it will be exempting certain treatments from charging, including GP and nurse consultations, specified infectious diseases—we have talked about HIV and tuberculosis—and sexually transmitted infections. This will ensure that everyone has unrestricted access to prompt diagnosis and intervention and that public health is safeguarded.
The Department of Health has, however, signalled an intention to introduce overseas visitor charges for some primary care services, including A&E, as part of its extensive reform of NHS charging in England. It is carrying out detailed analysis to inform decisions in this area. I am confident that cost-effectiveness—noble Lords mentioned some of the consequences of poor primary care leading to complications that can be very expensive as a consequence—public health and the moral case for protecting vulnerable groups will remain key factors in this consideration. I can reassure noble Lords that any agreed changes will be put to Parliament in the form of revised NHS charging regulations. That is not an unusual situation. We are talking about a consultation. This aspect of health service reform is not appropriate in an Immigration Bill because it is not about immigration but the practice of charging within the health service.
Without getting involved in the argument as to whether that is the right or wrong thing to be doing, as we know, we have all been fortunate to grow up in a world in which, for most of us, all healthcare—well, not all healthcare; not dental care and things like that—has been free at the point of use. That is a remarkable privilege, but it is an expense and one has to argue whether the resources are properly justified if they are extended to visitors, for example, or illegal migrants. That is not an unreasonable position to take.
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