Mr.
Stephen O'Brien: Everything that needs to be said on the
matter has definitely been said. While some important and sensitive
issues lie behind the new clause, as well as those of equity, it does
not show real understanding of cost implications and it would premature
and difficult to include it in a legislative provision at this stage.
Were the new clause pressed to a Division, regrettably, Conservative
Members would be unable to support
it.
Patrick
Hall: I want to make it clear to my right hon. and learned
Friend the Minister that I take the issue seriously and welcome the
contributions made by the hon. Member for Romsey and my hon. Friend the
Member for Ealing, Acton and Shepherd’s Bush. I will not repeat
what they said, because there is no need to do so. In fact, while the
hon. Member for Romsey was speaking, I had the impression that some
Opposition Members regarded the matter as a waste of time and were more
interested in other things. [ Hon. Members:
“No.”] I do not want to misrepresent anyone, but that
feeling came
across. I
want to make it clear to my right hon. and learned Friend that that is
not the attitude adopted by many Labour Members. This is not a question
of dealing with such matters as quickly as possible. It might not be
suitable to add such a provision to the Bill—that is fair
enough—but I hope he will acknowledge that he, too, takes such
matters seriously and that there may be an opportunity for him to
consider the issue further on Report, or at least suggest how such
matters might be more properly addressed in the
future. I
remember my right hon. and learned Friend introducing a White Paper
some years ago, when he was at the Home Office. I think it was entitled
“Faster, Firmer, Fairer”. Many improvements have been
made to the immigration control system, some parts of which are faster,
but people can still exercise appeal rights and some will not be
returned for other reasons, such as the country of origin being deemed
unsafe and no safe third country being identified. Genuine issues
should not be treated or dismissed
lightly.
Mr.
Mike O'Brien: I begin by being clear that the Government
recognise and respect the fact that their duty is to ensure that the
provision of health care is fully compliant with human rights
principles. That is important, and we want to ensure that it is firmly
on the
record. There
are two distinct parts of the new clause, both of which seek exemption
from charging for NHS hospital care—an addition to the existing
category of refugees and an extension to those refugees and other human
rights applicants to include those whose applications have been
refused, generally referred to as failed asylum
seekers. On
the addition to the existing category of refugees, I should make it
clear that the definition in the regulations is intended to cover any
person seeking refuge or protection, whether under the 1951 UN
convention—in other words, an asylum seeker—or through
any other route, including the European convention on human rights. The
trigger, therefore, is not whether a person is designated an asylum
seeker, but whether they are deemed to be
seeking refuge—that is an important category. That means that, in
addition to asylum seekers, others may be
included. That
definition, in practice, already captures most human rights applicants.
As such, they are entitled to free health care while their claim is
being considered. A small number may seek leave under the articles of
the ECHR relating to family life or marriage. That is a separate
category, as they are not seeking refuge but are seeking entry in
relation to family life and marriage. We would not extend full rights
and benefits unless, or until, leave to remain was granted, as is the
case with any other foreign national who seeks to remain in the UK.
That exception is important, but for those seeking refuge the position
is clearer, although I am not saying that it is entirely
clear. The
existing regulation is therefore sufficiently broad to cover genuine
humanitarian needs and does not require amendment. However, the
Department is looking at the issue with care and wants to update its
guidance on charging. For the avoidance of doubt, we will certainly
ensure that the intended meaning of the definitions is made fully clear
when the guidance is
published. On
the proposal to extend free hospital care to failed asylum seekers, the
issue of whether they should receive free and unrestricted treatment
must take into account a range of complex health conditions, in
particular balancing migration strategy with the need to support human
rights and public health. Hon. Members will be aware that a review of
access to the NHS for foreign nationals is looking at that issue and
will report shortly. It would not be appropriate for me to prejudge the
outcome of that review. The issue is being looked at, and it is right
that it should
be. I
should set out some of the key rights that people have. I want to look
at the human rights of the people mentioned, many of whom are here
because of their circumstances. We are aware that failing an asylum
test does not mean that a person’s human rights are somehow
invalidated—that is not the
case. First,
any course of treatment that commenced before an asylum claim was
refused will continue free of charge until a clinician considers it
complete. Only new courses of treatment will incur a
charge. Secondly,
treatment in a hospital A and E, or any emergency treatment at a GP
surgery, is free of charge. Treatment for many infectious diseases and
sexually transmitted diseases—I will come back to HIV—is
also
free. Thirdly,
urgent hospital treatment must not be denied, delayed or restricted.
Hon. Members may be aware that a recent Court of Appeal judgment found
that the Department’s guidance on that was not entirely clear.
The Department has fully accepted the court’s judgment and
welcomed the opportunity to act further to ensure clarity on the rights
to treatment and their being
enforced. We
issued immediate interim guidance to the NHS to clarify matters related
to urgent treatment, which is what clinicians judge cannot wait until
the patient is likely to return home—whether or not some
treatment can genuinely wait and that not exacerbate a condition seems
to be the real issue. That urgent treatment should always go ahead even
if payment has not been received. If the patient genuinely has no funds
or resources, a hospital may decide not to ask for deposits or may
write
off any debt. We expect hospitals to act reasonably when asking for
payment or seeking to recover any
costs. We
have also committed to a full redrafting of the guidance on the urgency
of treatment—in the autumn, after assessing the impact of the
interim guidance. We want to see what the guidance we have issued so
far has done and then look at how it needs to be changed. We want to do
that in reasonably good time in the
autumn.
Sandra
Gidley: I am not sure whether the Minister is saying that
the guidance will be reviewed or that new, revised guidance will be
produced in the autumn. When does he expect new guidelines to be
produced?
Mr.
Mike O'Brien: I am saying, in effect, both. We want to see
the impact of the interim guidance—how it deals with the
problems that have arisen, some of which were outlined by the hon. Lady
and others—but we also want to review how the guidance can be
further developed. A review of the guidance and a review of how the
interim guidance has operated—we want to ensure that we do both.
In that context we want to consult the key stakeholders to ensure that
the final guidance is clear, operable and compliant with the Court of
Appeal
judgment.
Mr.
Slaughter: I am pleased to hear what my right hon. and
learned Friend says about looking at such matters again, including
charging. He will consult with no doubt better qualified people, but
will he also consider meeting me and other hon. Members who are
interested in the
issue?
Mr.
Mike O'Brien: I shall be happy to meet my hon. Friend and
others to discuss the issue. Let me add that the Government are
committed to re-examining the case for exemption from charges for those
failed asylum seekers whom the UK Border Agency accepts have a
legitimate, temporary barrier to leaving the UK—of the sort he
identified—and who are given section 4 support. I confirm that
the review of access is actively considering
that. We
take the issue seriously in relation to not only human rights, but
people’s most basic rights and the principles of the NHS. I
assure the Committee that the Government want to deal effectively with
the issues of accessibility to health care for refugees, as shown by
our actions and commitments on the definition of
“refugees”, the urgent treatment guidelines and those
failed asylum seekers covered by the section 4
provision—legitimate temporary barrier to leaving the
UK. Given
those safeguards and commitments, the Government do not feel that a
more explicit and extensive exemption from charging is appropriate now.
We want to see what the impact of the interim guidance is. We want to
have a look at the issue in the round and we do not deny that there are
related issues. There is no Government denial that the issue is
sensitive and needs to be resolved with a degree of care and concern
for people who may well be vulnerable. On that basis, I hope the hon.
Member for Romsey will not press her new clause to a
Division.
Sandra
Gidley: I am inclined not to press the new clause to a
vote. I do not think that I would receive support from Conservative
Members. Interestingly, I might receive some support from Labour
Members, but I shall not push it at this
stage.
Mr.
Stephen O'Brien: That is not because of the issues that
lie at the heart of this. I hope I made that clear. Indeed, it needed
to be made clear to the hon. Member for Bedford, who cast completely
unfounded aspersions about the motives of Conservative Members.
[Interruption.] Completely unfounded, and he should withdraw the
remark. It
is important to recognise that there is a real issue here, because what
is contained in the new clause is a very large spending commitment,
which at the moment is not costed, making things very difficult for
anyone looking at the deployment of resources either in the NHS or in
any other Government budget. A much better cost assessment would be
needed in order to proceed to support what lies at the heart of the
issue—the substance—on which the hon. Lady made some very
fair points. However, without costings, the measure presents
difficulties, of which I dare say she might be aware, for her own
party’s economic
policy.
Sandra
Gidley: I thank the hon. Gentleman for that clarification.
I can assure him that my hon. Friend the Member for Twickenham (Dr.
Cable) would have my guts for garters if I proposed an unlimited
spending commitment. However, neither of us knows the truth of the
matter at this stage and I accept that the hon. Gentleman supports the
sentiment behind the new
clause. I
am reassured that there is an active review of section 4 payments,
because it struck me that this area is particularly unclear. I retain
some concern over the public health aspects, but there seems to be
quite a lot of work going on. At this stage, therefore, I think it
better to withdraw new clause and to review what is happening, prior to
consideration on
Report. Something
may be produced at that time, but it would be helpful if the Minister
wrote to me on any other points of clarification, because significant
numbers of people working in the health service find the guidelines
difficult to work under. They are not exactly clear and the sooner we
have clarification on this matter, the better it will be for the people
who are suffering as a result of the policy. It will also be better for
managers and clinicians, who are sometimes caught, having to make
difficult decisions. We need greater clarity. I beg to ask leave to
withdraw the
motion. Clause,
by leave,
withdrawn.
New
Clause
9Accessible
information ‘(1) This section
applies to information provided by the National Health Service to
patients or members of the
public. (2) Information to
which this section applies shall be made available in a manner which is
accessible to people with
disabilities. (3) Each NHS
trust shall publish annually, as part of their reporting on their
Disability Equality Duty obligations, details of the number of
documents they have provided to disabled people in formats other than
standard print.’.—(Sandra
Gidley.) Brought
up, and read the First
time. 3.15
pm
Sandra
Gidley: I beg to move, that the clause be read a Second
time.
The Committee
will be relieved to know that this will be a somewhat shorter
explanation. Earlier in Committee, I raised concerns about the
accessibility of the NHS constitution in formats for people with
different disabilities, and was not entirely reassured that this was
covered under the Disabilities Discrimination Act 2005. We have had
that Act for some time, and the figures I produced previously showed
that a lot of people—particularly partially sighted
people—are not receiving information in a useable and useful
form. The
Government have talked a great deal about the importance of
information: we have the NHS Choices website and NHS Direct. They have
been very committed to providing the public at large with information,
and I welcome that. However, people working in government and in trusts
have a duty to ensure that as many people as possible can access that.
Therefore, this clause asks that trusts should publish, as part of
their reporting on their disability equality duty obligations, details
of the number of documents they have provided to disabled people in
formats other than standard print. Again, it is all very well having
the legislation, but if it does not require people actively to do
something which can be monitored, it is very often forgotten or, worse
still, ignored. With that, I withdraw my remarks to a
close—sorry, draw my remarks to a
close. Mr.
Stephen O'Brien: I was just trying to work out what
withdrawing the remarks meant, and whether I was going to have an
opportunity to stand up and support the spirit of the new clause. I
would, however, have preferred subsection (2) to say “patients
or members of the public with
disabilities”. Subsection
(2) seems valid; subsection (3) is more bureaucratic, which I think the
hon. Lady accepts, and I am not sure whether accountability could not
be exercised in other, somewhat less bureaucratic, ways. Without costs
being properly identified and attached to this, it would be difficult
to gain the Opposition’s support, but at the same time I welcome
the spirit in which it has been presented and
moved. Mr.
Mike O'Brien: The hon. Member for Romsey
shares common ground with us in wanting to ensure that people who need
access to this sort of information get access to it. The only
difference between her view and mine is that I think that the
legislation is covered, in the sense that provisions are in place to
enable access to such facilities. We would do no good in putting on the
statute book something that is already there, merely because the
provisions have not yet had the impact that she and I want.
Repetition
does nothing. We need to ensure that existing legislation is used
effectively. Governments and the House can put on the statute book
provisions enabling those with disabilities to get the access and
information that they need, but those powers need to be used and
enforced. Sometimes that requires individuals taking cases; more often,
it requires authorities and organisations to comply better.
I have no
problem sharing the hon. Lady’s ideas, but we already have the
Disability Discrimination Act 2005, which came into force in December
2006 and is working its way into place. It placed a new statutory duty,
the disability equality duty, on public bodies to promote
greater equality of opportunity for disabled people and required public
bodies to make reasonable adjustments to meet the needs of people with
disabilities. At the time, the Department of Health published
“Creating a disability equality scheme: a practical guide for
the NHS”, which included sections on monitoring within such a
scheme. Further to that, in June 2009, the Government published the
revised single equality scheme setting out how we intend to meet our
duties under equality legislation, including the DDA. I will be happy
to circulate those documents to the Committee so that members can be
satisfied about the
policy. As
for implementation, the Government are aware that the NHS can
demonstrate examples of good practice, but we certainly acknowledge, as
the hon. Lady observed, that there is still some way to go in order for
equality to be mainstreamed and sustained. In other words, there is
still a lot of work to be done. To address those practical issues, the
Government put in place a number of initiatives, often working in
partnership with the NHS and other key stakeholders. Of central
importance will be the new equality and diversity council, which aims
to improve the NHS’s equality performance for both patients and
staff. Furthermore, as part of the pacesetters initiative, the
Department of Health is working with six strategic health authorities
and 34 trusts to trial different approaches to deep-seated
inequalities, including those arising from disability. Evidenced good
practice will then be disseminated widely in the NHS.
Last year,
the Department, with support from the Equality and Human Rights
Commission, trialled legal compliance workshops. A model workshop is
now available for strategic health authorities to use, and NHS South
West has already used the model to run its own regional event. As
subsection (3) of the proposed new clause highlights, good equality
data are needed so that the NHS can better draft and understand its
equality schemes, plan, commission and monitor service delivery and
plan and monitor work force developments. In November, a new equality
monitoring guide covering all equality strands, including disability,
will be issued. The guide will confirm the codes that the NHS should
use when monitoring for equality and give good practice examples of
equality data collection and use.
In other
words, we have the law, and I do not think that we need to repeat it.
What we need to do now is to find better ways of ensuring that it
happens in practice for those affected and those with disabilities.
That needs to be the objective.
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