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David Burnside (South Antrim) (UUP): I was not aware of the problem until my hon. Friend raised it during today's debate. Does he agree that our ministerial representatives should raise the issue with their counterparts in the Irish Republic? It is disgraceful that those seeking Irish citizenship should be using the British health service and its facilities in Northern Ireland, rather than using the health service available in the territory of the Irish Republic, which by my definition, constitutionally, is the 26 counties.

Rev. Martin Smyth: I thank my hon. Friend for his question. I am sure that our representatives will be asking the question, but they get no answer other than, "We have that problem in the Republic at the moment, too." There was a referendum recently to try to change the constitution of the Republic of Ireland to debar such things, but that will not come into effect until at least the beginning of 2005, and even then I would not hold my breath. I know that people in the Irish Republic are fighting against that legislation, and with elections coming sooner or later, there may be political issues involved in trying to gather votes one way or the other.

According to the law, emergency obstetric care must be provided free of charge to anyone, and it would appear that our health budget is carrying that burden. I phoned the chief executive of the Royal Jubilee hospital group who, interestingly, acknowledged that there were such cases, but said that there were not very many. I asked my personal assistant to do some checking on the hospitals where I understood such children would be born, and the results are rather interesting. I am not thinking of emergency obstetric care for people who reside in the area—that can happen at any hospital. We specifically asked about those from overseas who have no background of living in the area.

Daisy Hill hospital tells us that there was a nil return, fascinatingly enough, on the last survey for the Irish referendum, but we do not know whether such cases have happened before or since then, because that is a localised issue. The Erne hospital says that very few people are taken into maternity without prior knowledge, but that leaves the question of whether any are taken in. Lagan Valley hospital tells us that it has no evidence of foreign nationals. I am prepared to accept that, but I cannot understand, as I know a little about north Belfast, why the Mater hospital said that there is no evidence of foreign nationals—whether in general or in particular, I do not know.
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Significantly, Craigavon hospital said that it has several foreign nationals a week. Two women recently presented for delivery who did not know each other, but they gave the same address. That confirms the pattern that I have traced. Altnagelvin hospital in Londonderry says that there is little evidence of such cases, but that they have been known to happen in the past. At the Ulster hospital in Strangford, such cases happen often. Let us remember that the chief executive said that they did not happen too often at the Royal Jubilee hospital group. Of course, he was very compassionate—I understand his compassion; the hospitals have to take anyone who comes—but according to my research, six people are presenting themselves each week.

About 300 to 400 people have presented between 2002 and the past week or so, and the tragedy is that most of them are presenting off the street. That requires medicals and blood tests because a large number of them come from Africa. With the problems of the AIDS epidemic there, extra medical attention is involved, even though the women may not remain in hospital for very long. However, we are all aware that it is the care and attention at the time of delivery that is most expensive. It is not the nursing attention later or the hospital care—the so-called hotel provision—that adds to the expense, but the procedures involved.

I wonder whether the Minister can tell us whether any of those hospitals are being given extra funds for such treatment or whether they must take the money from their budgets. She will be aware that most of the hospitals in Northern Ireland are crying out for more—even though it might be a little bit like Oliver when they cry for more because we sometimes wonder what some of them are doing with their money.

The number of people involved provides us with a challenge. I understand their aspirations; I understand that people want to improve their quality of life. I understand that Irish and British citizenship means much to people throughout the world, but I am not convinced that we should be subsidising people to make a fortune out of the aspirations of some and the miseries of others. We are aware of that when we talk about the trail of asylum seekers who manage to find their way right across the European continent, landing up in different parts our nation when someone else is raking in the money. Those people have gathered what money they have to pay off gangmasters and others. I wonder whether the Minister can tell us whether attempts have been made to investigate the issue. I can help her with one case because I know that the Police Service of Northern Ireland has been out to meet the folk in one home in my constituency—I am waiting to hear what happened.

Is anything being done beyond Northern Ireland, and in relation to the Irish Republic, to prevent this activity from happening? We must bear it in mind that the problem will multiply because, according to Irish law, people may claim citizenship through three generations. We are not considering only the circumstances tomorrow, but those for the next three decades at least.

4.20 pm

The Parliamentary Under-Secretary of State for Northern Ireland (Angela Smith): I congratulate the hon. Member for Belfast, South (Rev. Martin Smyth) on
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securing the debate. He has demonstrated his interest in the matter through his letters to me and his parliamentary questions. The situation regarding emergency obstetric care for patients from overseas worries several hon. Members, so I hope that I can reassure them on questions of care and that problems are being addressed. The hon. Gentleman rightly stated that it is set out in law that emergency obstetric care must be provided free of charge at the point at which it is needed.

It might be helpful if I give some background to the situation. When the Jubilee maternity hospital was situated at Belfast City hospital, only a small number of women—about four a month—travelled from overseas to give birth there. In the past four years, since the Jubilee joined the Royal maternity hospital to form the Royal Jubilee maternity service, the numbers have steadily increased. As the hon. Gentleman said, the situation affects other maternity units, albeit to a lesser extent. Those units are in the Mater, Ulster, Causeway, Antrim, Craigavon and Erne hospitals.

Women arriving at hospitals in Northern Ireland are generally at an advanced stage of their pregnancy, and most will present to the hospital at around 38 weeks gestation. As the hon. Gentleman said, they have generally travelled to Northern Ireland via England. In Belfast, the women appear to stay at a small number of addresses in the south and east of the city. The women mainly originate from China, but they are also known to have travelled from Algeria, Nigeria, Syria, Sudan, Uganda and Libya.

My next point relates to the hon. Gentleman's question about the difficulties with the statistics that we have. The majority of the women who arrive will have visited a general practitioner and will have an address in Northern Ireland, so they will have secured temporary resident status and a health service number. It is then routine for them to be referred to a maternity unit to book a confinement. Others will have no GP, and they will arrive directly at the maternity unit to be booked into what are called emergency booking slots. A very small number of women arrive at the maternity unit already in labour.

The RJMS, where most women attend, is managing the situation by using an emergency booking clinic, which is led by one of the consultants. Four slots are set aside each week for overseas women, although generally at least another two are also seen. The use of the clinic ensures that proper medical histories can be taken and that clinical tests can be carried out prior to labour. Additionally, a Chinese interpreter is provided as required. The RJMS has stressed that the women receive exactly the same care as local residents.

Through the establishment of the emergency booking clinic, the RJMS is better able to manage its maternity service and provide the best possible care both to local women who have already booked maternity care and to overseas patients who arrive at a late stage of pregnancy. When there has been a capacity issue at the RJMS, some women from overseas have been transferred to receive maternity care at the nearby Mater hospital.

As the hon. Gentleman said, figures on the exact number of women who are treated are not collected centrally. There are several reasons why the hospitals have had difficulty collecting data, but the main one is
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that many women from overseas have a health service number and appear as health and social services board residents. The data available on non-EU residents therefore mask the true picture because those who use Northern Ireland addresses are registered as temporary residents.

Nevertheless, the trusts have produced some statistical evidence, and I can report that the RJMS, which treats the vast majority of the women, reports that about 24 overseas women a month give birth at the unit. Other units vary from fewer than one a month to about three a month.

The hon. Gentleman raised a number of issues that I shall try to address in turn. It is estimated that the average cost of a birth at a hospital in Northern Ireland is around £2,000. Health and social services boards fund on the basis of the number of births in their area. The boards provided some £12.5 million to fund maternity care at the Royal Jubilee in 2004–05. The women who stay at Northern Ireland addresses are classed by the health service as temporary residents and are counted in the number of births to residents in a board area, thereby receiving funding. No separate allocation has been made for designated non-EU citizens. That represents a significant spend on services to a client group whose right to be in the UK may be subject to review by other parts of the Government. Nevertheless, under current legislation and guidance to GPs, emergency obstetric care must be administered free of charge.

The hon. Gentleman also spoke about why the women come to Northern Ireland to give birth. There may be some confusion on that. The primary reason, as he said, appears to be to secure Irish citizenship for the child. As hon. Members are aware, current Irish legislation means that a baby born in Ireland or Northern Ireland—anywhere on the island of Ireland—is entitled to Irish citizenship. Women who travel to Dublin from overseas to give birth have been a major problem and a significant issue in the Republic of Ireland for some time. A referendum was held last year to make residency and nationality changes to the relevant sections of the Irish constitution, thereby stopping wide-scale abuse of the system. In the referendum, 79 per cent. favoured change.

The Bill has not been passed and is at its first stage. Although it will have an impact, it is difficult to anticipate that the number of women coming to Northern Ireland to give birth for that reason will reduce until it comes into effect. We think that the legislation will be passed by the end of this year or the beginning of next year. From then on, there will be no gain for women giving birth in Northern Ireland to gain Irish citizenship and it is likely that the number of women coming to Northern Ireland for that reason will decline. I take the point that it will not decline immediately because the information has to get through to those women.

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