My Lords, I thank the noble Baroness for her explanation. It is helpful to have a bit more detail than there is in the order. Again, I struggled trying to tie up the information in the impact assessment, because there seems to be a range of figures. I think that the noble Earl was being complimentary when he referred to me as forensic, although I am not sure he is always trying to be complimentary when he says that. I struggled when I tried to understand some of the figures in the impact assessment, especially when I compared them with the figures in the impact assessment of the previous order that we have just debated.
First, I should like to put on record that we do not oppose the principle of the health charge, which the noble Baroness will recall from the many long debates we had on the Bill. We understand that those who use the system should contribute to it and that remains our position; it has not changed at all. However, the noble Earl said that we should ensure that the charge is properly and appropriately implemented and that the evidence on which decisions are based is robust. The Minister will have seen the report from the Secondary Legislation Scrutiny Committee which questioned whether the order created perverse incentives and questioned the level of the charge.
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I have a few questions for the Minister to enable me to understand how the order will work in practice and to ascertain some of the figures. First, on the level of fees, the legislation and the order do not talk about an absolute figure, but say what it is likely to be in the region of. Does she have any certainty about the level of fees? Are they likely to be significantly higher than those that have been discussed previously? Are there any projections of when those may be reviewed? What consideration and consultation will take place?
Page 6 of the impact assessment refers to a Department of Health publication on those migrants using the NHS who did not pay for the services they received, and those who received healthcare for which they may not have qualified. Part B, entitled “Rationale”, on page 6 states:
“Underlining these concerns, the Department of Health published, in 2013, the findings of a comprehensive study into migrant use of the NHS. The study estimated the total cost of EEA and non-EEA visitors”—
both are included in the study—
“and temporary migrants accessing NHS services in England alone to be between £1.9 billion and £2 billion per year”.
I think the figure for non-EEA persons is around £950 million.
The table on page 4 of the impact assessment indicates that the Government estimate the total income from surcharges to be around £195 million. However,
the summary of the benefits on page 2 of the impact assessment seems to provide a different figure altogether, but perhaps I am misunderstanding something—I have struggled to understand the different figures provided. Page 2 refers to the key monetised benefits of the main affected groups. I am particularly interested in the evidence behind these figures. Income to government from an immigration health surcharge is estimated at around £1.7 billion. Reduction to public service and welfare provision is put at around £172 million. Increased employment opportunities for UK residents is put at around £29 million and reduction in Home Office processing costs is put at around £4 million. So there must be built into the figures an assumption that a number of people will not pay the health surcharge and therefore will not receive visas—otherwise, how could there be increased employment opportunities for UK residents and a reduction to public service and welfare provision? Therefore, that must be built into the assumptions that are made, but I am not sure on what evidence those assumptions are based. Indeed, the Secondary Legislation Scrutiny Committee talks about a perverse incentive. Is there a perverse incentive given that those who are unlikely to want medical treatment may feel that they have to pay a lot of money whereas those who think they are likely to need medical treatment may think that they are getting a better deal? That is a strange situation and it is difficult to ascertain the correct figures.
Coming back to the point about evidence, table 8 on page 18 of the impact assessment refers to the average cost per year per migrant of public sector spending, including education and social services, and gives figures for tiers 1, 2, 4 and 5 and for families and others. However, the figures in table 14, on page 27 of the previous impact assessment for the fees order seem very different from the figures in this impact assessment. I appreciate that they are two different orders and two different impact assessments. The source of one table is national population projections based on the statistical bulletin for the Office for National Statistics and the other one is a Home Office analysis. I think that it would be helpful to have one consistent approach to providing information on what the costs of individual migrants are or are likely to be. I found it quite difficult to have two tables looking at the same kinds of issues but giving completely different figures in different ways—one from the Home Office and one from the Office for National Statistics.
The impact assessment talks about the costs. A lot of migrants paying the health charge will of course be working and paying tax. Is that factored in? Are those tax payments and national insurance payments factored in to any of the calculations, for example, on employment? If we look at the assessment of the amounts, we see that the increased employment opportunities for UK residents will be worth around £29 million. Does that take into account any tax or national insurance no longer being paid by migrants?
We support this order and did not oppose the principle of the policy when it came before your Lordships’ House in the Bill. However, we need to be clear that we are making assumptions; I appreciate that they are assumptions, but there should be robust
evidence behind them. If we are looking at enormous sums of money going to the NHS, which are then going to be distributed around the country according to the Barnett formula, we have to ensure that we have the correct figures and that the evidence is robust.