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House of Lords

Monday, 10 March 2014.

2.30 pm

Prayers—read by the Lord Bishop of Coventry.

Railways: Line Resilience

Question

2.36 pm

Asked by Lord Berkeley

To ask Her Majesty’s Government what progress they have made in commissioning a study into alternative inland resilient rail routes to avoid the coastal route between Exeter and Newton Abbot.

The Minister of State, Department for Transport (Baroness Kramer) (LD): My Lords, the Government have commissioned Network Rail to undertake a study to identify options for providing a resilient rail route west of Exeter and rail access to the coastal communities in the Torbay area. We have also asked Network Rail to implement schemes already identified to resolve weather-related problems in the Thames valley and west of England. However, the immediate priority is to restore rail services on this route as soon as possible.

Lord Berkeley (Lab): I am grateful to the Minister for that Answer but, as we have had a lovely weekend and spring is clearly in the air, it is very easy for Ministers to forget about the disasters of the winter and to hope that they go away and that they will not have to spend the money. Will the Minister agree to come back to the House in a year’s time, just before the election, and say, “We have implemented all these long-term resilience measures that I mentioned, and a few more, and they are either finished or well on their way, and funded”?

Baroness Kramer: I always hesitate to say anything other than yes to the noble Lord, Lord Berkeley. As he will be well aware, we have a timetable for the long-term resilience project. We have completed the projects that were timetabled for 2013-14, such as the Whiteball tunnel, and others are timetabled for future years. However, the essence of what the noble Lord is talking about in terms of having a programme to make sure that we achieve resilience will be done over the next few months. The study that Network Rail is doing will lead to an interim report being published in July, which will result in a very important discussion in this House.

Lord Bradshaw (LD): Will my noble friend also take into account in her consideration the fact that, in finding an alternative route, the opportunity probably exists to cut 20 or 25 minutes off the journey time from Cornwall, which would be a massive improvement, akin to that achieved by HS2 between London and Birmingham? Perhaps she would have a look at that.

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Baroness Kramer: I hope that very shortly we will have the terms of reference for the Network Rail study, which it intends to carry out in close co-operation with local authorities and LEPs. Network Rail has made a request to me that people pass ideas on particular routes back to it directly. However, if any Peer wishes to do so through my office, I will make sure that that information is communicated so that the study is as thorough as it needs to be.

Lord Faulkner of Worcester (Lab): My Lords, the Minister’s initial Answer was very welcome and we look forward to seeing the outcome of those studies. Will she take this opportunity to congratulate Network Rail on bringing the line through Dawlish back into use significantly earlier than appeared to be likely? I understand that Network Rail had something like 100 people working seven days a week on the restoration of the line, and it is to come back into use on 4 April or even earlier. I declare an interest as a member of the First Great Western stakeholder board.

Baroness Kramer: I say to the noble Lord, Lord Faulkner, that that is probably the most delightful question I have ever received because it indeed gives me the opportunity to congratulate and thank Network Rail for its incredibly hard work both during the days of crisis and since. We expect the Dawlish line to be back in use no later than 4 April—well in time for Easter—and that took a very strenuous effort. While I am at the Dispatch Box, perhaps I may also thank: the travelling public, who handled this situation so well; the bus and coach companies, which provided an alternative to rail; the train operators themselves, which provided, for example, special ticketing arrangements whereby people did not lose out because they could not make advance bookings; Flybe, which doubled the number of its flights to Newquay; and probably others whom I have missed. There are many to thank and I appreciate this opportunity to do so.

Lord Dykes (LD): How long will it be before the completion of the new north Oxford to London line?

Baroness Kramer: I say to my noble friend Lord Dykes that I do not have the data in the foremost part of my mind. As he knows, the matter is very much under discussion and I will get back to him with whatever detail is available.

Lord Brooke of Alverthorpe (Lab): My Lords, among those for whom there is a residual problem are the poor, beleaguered commuters travelling from Hastings to London, who for weeks now have had disruption due to flooding and have been trying to secure refunds from the rail operative. What are the Government doing to bring those rail companies into line, ensure that people are given a full refund for the tremendous inconvenience that they are suffering, which goes on and on, and bring this to an end quickly?

Baroness Kramer: This is the Tonbridge to Hastings route, which was closed because of a landslip. My understanding is that the reopening is delayed due to

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ground movement. We very much hope that the line will open again shortly but if there are issues—and I understand from the noble Lord that there are—will he pass them to my department and we will make sure that that they are passed on to the appropriate institutions for proper answer?

Lord Jenkin of Roding (Con): I draw my noble friend’s attention to the excellent report produced by the Department of Energy and Climate Change on the severe weather over Christmas 2013. This indicates that a great deal can and has been done but one needs to know about it and find out what it all is. Would not a report of that kind, produced by my noble friend’s department, be extremely valuable?

Baroness Kramer: I assure your Lordships that there is constant monitoring, and a cross-departmental ministerial recovery group now meets weekly to discuss flooding issues. We take it in turns within my department to attend that meeting and make sure that the process is ongoing. It is also accurate to say that responsibilities have been divided up among a number of us to make sure that monitoring is effective; my responsibility will be as the ministerial representative for flood recovery for Gloucestershire and Worcestershire. Similarly, others have regional responsibilities and I will make sure that we report back as we get information through that process.

Lord Davies of Oldham (Lab): My Lords, the Minister knows that the floods have already cost something like £170 million. We are aware that the Prime Minister says that money is no object, and we will bear that in mind when the costings come through. However, how will Network Rail cope with the additional funding that will be necessary, either for the alternative line to which my noble friend Lord Bradshaw referred or for making the Dawlish line absolutely secure? Is the Minister being somewhat premature in praising Network Rail without convincing everyone that its funding will be adequate?

Baroness Kramer: Perhaps I can give the noble Lord some reassurance. Network Rail has estimated the cost of resilience projects—not recovery, which is handled separately—at £31 million. It is putting £5 million of its existing funding into the pot, and new money of £26 million is going towards that. If, when we get the interim report, we are starting to look at something much bigger—effectively, new construction—we will need to sit down and plan that properly.


Women: Board Membership

Question

2.45 pm

Asked by Baroness Seccombe

To ask Her Majesty’s Government what progress they are making towards their target of 25% of the membership of FTSE 100 company boards being women by 2015.

Baroness Northover (LD): My Lords, women now account for 20.4% of board members in FTSE 100 companies. That is the figure from January 2014,

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which is up from 12.5% in February 2011. Although the figures are going in the right direction, we need to keep up progress to reach the 25% target. We need 50 new female directors to be appointed to FTSE 100 companies in order to reach the 2015 target.

Baroness Seccombe (Con): My Lords, that is most encouraging news, but there is still a way to go to reach that 25%. Does my noble friend agree that independent and individual mentoring has helped to achieve this success? I am sure that we all know women who should have been appointed in the past but were always passed over.

Baroness Northover: I thank my noble friend for her encouraging comments. I am sure that mentoring has indeed helped, and I think that transparency and pressure have helped as well.

Baroness Thornton (Lab): My Lords, would the Minister care to tell the House how the Government are doing in increasing the number of women on public bodies? Those figures seem to be slightly more woeful than the ones for corporate bodies. Secondly, I am sure that the noble Baroness is aware that twice as many women as men leave the corporate sector once they reach mid-level management. Given that, does she agree that, alongside measures to increase the number of women at board level, we need to fix the leaks, as it were, in the talent pipeline and ensure that women are properly represented at every level of an organisation? How does she think this might be brought about?

Baroness Northover: We are aiming for women to account for 50% of new public appointments by 2015. They are currently averaging 45%, so we are moving in the right direction. The noble Baroness is quite right that we need to address this at every level. One of the beneficial things about the Davies approach to company boards is that it is also having an effect on the response of companies at other levels. This issue has to be addressed at every level.

Baroness Chalker of Wallasey (Con): Is my noble friend aware that the Institute of Directors and many other professional bodies could also contribute in this regard by mentoring some of their women members? They may not be as numerous even as 25%, but there are some excellent engineers, accountants and lawyers and so on who could, with assistance, be very good members of boards and, indeed, members of those professional organisations.

Baroness Northover: My noble friend is absolutely right. I do not think that there is a dearth of talent; it is a matter of making sure that those people end up on boards. There is a lot that we ourselves can do. As I did in the debate on International Women’s Day last Thursday, I should like to mention the two companies in the FTSE 100 that have not yet appointed women. Last year, there were five; significantly, two dropped out of the FTSE 100 and one of them—the one that I mentioned—has now appointed a woman. There are

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two left: Glencore Xstrata and Antofagasta. Perhaps I may point out that Glencore was speedy enough to seek help from the United Kingdom Government when it was trying to finalise a deal overseas. I quote from it:

“We seek to apply best practice, ensuring that our approach is up-to-date and relevant”.

Hmm. I come to Antofagasta, which is Chilean based. Tomorrow, Chile swears in as its new president Michelle Bachelet, the formidable former head of UN Women, so I think that we have a pincer movement here.

Baroness Howe of Idlicote (CB): My Lords, can the Minister tell us to what extent she and the Government believe that it is the yearly reports that are required on progress from each of the companies involved in this scheme that have had a major effect in getting the continuous stream of improvements, although I thoroughly agree with her that there is still a long way to go?

Baroness Northover: The noble Baroness is right that transparency and reporting are absolutely key. She will know that Charlotte Sweeney has just reported on the voluntary code among those who are recruiting for those positions. She notes that only 25% of those headhunting firms even mentioned this on their websites, so they themselves have a long way to go.

Lord Harris of Haringey (Lab): My Lords, can the Minister tell us how many of the FTSE 100 companies have women chief executives? What are the Government doing to improve the position?

Baroness Northover: The noble Lord puts his finger on a very important point. There are only four female chief executives in the FTSE 100 at the moment. It is indeed an area in which companies need to make a lot more progress.

Lord Smith of Clifton (LD): Does my noble friend agree with what I said last Thursday regarding gender balance in the Cabinet? The battle for gender equality will not be won on the playing fields of Eton or Westminster School.

Baroness Northover: What can I possibly say?

Lord Foulkes of Cumnock (Lab): My Lords, following up on that excellent question, can I commend the Minister for her excellent answers to all the questions today? Does that not show up that the two people who also need a pincer movement are Clegg and Cameron?

Baroness Northover: Again, I could not possibly comment.


Houses of Parliament: Education Centre

Question

2.52 pm

Asked by Lord Flight

To ask the Chairman of Committees what representations the House Committee made to the House of Commons Commission regarding the proposed education centre to be built in Victoria Tower Gardens; and whether any risk assessment has been carried out.

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Lord Flight (Con): My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest in that my wife is a Westminster councillor.

The Chairman of Committees (Lord Sewel): My Lords, the House Committee has informed the commission that the House of Lords will not contribute to the capital costs of the demountable education centre, estimated to be more than £6 million, on grounds of value for money. The House Committee has serious concerns about health and safety and has requested a risk assessment of the proposed access routes, which is expected to be conducted before the Easter Recess. We remain committed to the provision of an education service, as opposed to the specific building.

Lord Flight: My Lords, as well as the objections of the House Committee, the Royal Parks Board, which owns Victoria Tower Gardens, made strong objections to the House of Commons Commission but was overruled by the Secretary of State of the DCLG. The City of Westminster planning committee was divided 3:3 with very strong objections being made, but the chairman gave his casting vote in favour, contrary to convention. Local residents are objecting strongly as no notices of the planning proposal were posted in adjacent residential areas. Above all, Victoria Tower Gardens was created as an open space more than 100 years ago to give a setting to the House of Lords building. Surely it would be a grave mistake to build on nearly a quarter of it in a style that is not sympathetic to that of the Palace of Westminster. Has the House Committee any powers to enable this project to be reconsidered, or at least delayed?

The Chairman of Committees: My Lords, in this instance the House of Lords has no powers to ask the House of Commons to think again. However, we are concerned about the health and safety issues and access routes, and we requested a full study to be undertaken. Ultimately it is the Clerk of the Parliaments, as corporate officer, who is responsible for health and safety on the Lords part of the Parliamentary Estate and he will need to decide whether he feels that the proposed routes are safe.

Lord Kirkwood of Kirkhope (LD): Does not the Chairman of Committees agree that the work done by the education and outreach department is extremely important and deserves our support? Will he confirm to the House that the Information Committee has been actively advocating a facility of this kind for at least seven years? Is not the real risk that this institution will become increasingly irrelevant in future? Why? Because so little is understood about the excellent work that is done here.

The Chairman of Committees: I thank the noble Lord for his question because it enables me to underline the complete commitment of this House and the House Committee to the work of the Education Service. Many Peers take that upon themselves as active

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participants in the outreach programme going to schools. It is true that the original, if you like, en principe or in principle decision—there is a subtle difference between the two—was made in 2007. However, that was a different world.

Lord Campbell-Savours (Lab): My Lords, will the Chairman of Committees indicate to those carrying out the risk assessment that we do not want a fudge? We want a proper risk assessment which takes into account the fact that it is proposed that tens of thousands of children will be required to pass through to Black Rod’s Garden from Victoria Tower Gardens through what is effectively now a builder’s yard, and which will remain a builder’s yard throughout the restoration and renewal programme.

The Chairman of Committees: The noble Lord makes a very strong point of which the House Committee is well aware. That is the reason why it has asked for a risk assessment to be carried out. I have utter confidence that it will be a thorough and robust risk assessment.

Baroness Boothroyd (CB): My Lords, would it not be appropriate for a well chosen delegation from this House to see the House of Commons Commission on this issue?

The Chairman of Committees: My Lords, we already have—and we failed.

Lord Elton (Con): My Lords, can the Minister broaden his Answer a little to take in the aesthetic content of this problem? Who has the dominant voice there? What is the role of English Heritage? How has it come to be accepted without further discussion in this House?

The Chairman of Committees: My Lords, it is fair to say that in planning issues, under which I include the aesthetic dimension, the key player is Westminster City Council. Having dealt with the internal decision-making of your Lordships’ House for some time, which is on occasion somewhat Byzantine, I do not wish to speculate on the internal decision-making of Westminster City Council.

Lord Hunt of Kings Heath (Lab): So, my Lords, it would appear that there is something to be said for health and safety. Will the Chairman of Committees convey to the Clerk of the Parliaments that this House will be right behind him when he comes to make that decision?

The Chairman of Committees: I think the noble Lord has already conveyed that.

Lord Foulkes of Cumnock (Lab): My Lords, was not an alternative site suggested at 1 Parliament Street? Why has that not been considered?

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The Chairman of Committees: That is absolutely true. The position of the House Committee was that in the relatively short term—and this demountable building will be in operation for, at the most, 10 years—it would be better for the permanent solution to be part of the restoration and renewal plans and that, in the mean time, it seemed to us that provision was capable of being made within the existing Parliamentary Estate, and particularly 1 Parliament Street, but that was not acceptable to the House of Commons.

Lord Forsyth of Drumlean (Con): My Lords, following up on the point made by the noble Lord, Lord Kirkwood, none of us is against people having access to this building and appreciating its aesthetic status, but is it not rather perverse to seek to damage that status in pursuit of the education which people are coming for?

The Chairman of Committees: Yes.


London Underground: Industrial Action

Question

2.59 pm

Asked by Lord Carrington of Fulham

To ask Her Majesty’s Government what assessment they have made of the impact on the economy of the industrial action on the London Underground in February.

The Minister of State, Department for Transport (Baroness Kramer) (LD): My Lords, the Government have not made such an assessment. Responsibility for London Underground, including industrial disputes, is a matter for the Mayor of London and Transport for London. The industrial action last month was regrettable and will undoubtedly have had a significant economic impact, but there is no straightforward or standard way of quantifying this.

Lord Carrington of Fulham (Con): I am grateful to my noble friend for that response. Does she agree that the major damage caused by the strike was not monetary, but in terms of the aggravation, frustration and inconvenience caused to the poor benighted citizens of London? This raises the question of whether it is not time to reconsider whether strikes in public sector monopolies should be made illegal, or at the very least whether trade unions should be required to get a vote of two-thirds of the workforce in favour of action before calling a strike.

Baroness Kramer: My Lords, I join in celebrating the heroism of Londoners in coping with such situations, which are very stressful and inconvenient. Last autumn, the Department for Business, Innovation and Skills announced a review of industrial disputes, and we hope to hear more detail on that shortly. At this moment in time the two sides in the London Underground issue are in negotiation and are due back at ACAS on 4 April. I think that this is a good time not to pour petrol on flames.

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Lord Bradshaw (LD): Will my noble friend take account of the fact that at many London terminus stations connecting with the Underground, there are huge queues of people and a lot of machines that work only slowly? For London Transport to say at this time, “We are going to close all the ticket offices”, sends out the wrong signal. London Transport needs to overhaul what is going on, at which point it will have a much better case to take to the trade unions.

Baroness Kramer: I am afraid that essentially I cannot agree with the noble Lord, Lord Bradshaw, on this one. Only 3% of journeys actually include going to a ticket office. The number of visits has fallen extremely sharply as people turn to buying online, using machines, taking advantage of systems like the Oyster card and, increasingly, using their bank cards. As he will know, the goal of London Underground is to change the role of those working with these ticketing issues by bringing them out from behind the glass of the ticket office and on to the platforms. They will be given a much wider range of responsibilities to help people, building on the kind of experience we had with the Games makers in the Olympics. They should be able to teach and train people to use the machines and provide support in a much more effective and flexible way. I would think that that has to be the future and a reasonable path to tread.

Lord Balfe (Con): Does my noble friend agree that we should think very carefully before we impose further restrictions on the freedom of trade union action? If one looks at the strike, one can see that it was not very successful at all. There are also fundamental matters of human rights involved in legislating in this area.

Baroness Kramer: Your Lordships are right to say that Transport for London, or London Underground, was able to run about 40% of its trains during the strike and that Londoners, although under stress, found different ways to get to work—as Londoners do. As I say, at this point in time the two parties are talking, and I hope very much that they are talking constructively. BIS is planning a review of the whole area of industrial disputes, and I think it is best if I do not add yet another set of views.

Lord Kinnock (Lab): Does the Minister accept that the consequences of strikes in public transport are invariably that people are deeply inconvenienced, demoralised and absolutely furious—with justification? However, would she advise those who are asking for bans on strikes in public transport to acknowledge the fact that in a free society, if workers in crucial services are denied by law the right to strike, their resentments and difficulties will then find expression in even more inconvenient ways? That is the reality of democracy.

Baroness Kramer: All Members of this House recognise that there is complexity around all of these issues. They need a great deal of thought and a great deal of debate.

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Lord Naseby (Con): Is my noble friend able to clarify the figure of 3% that she quoted? Does it not represent millions of journeys made on the Underground, and are not the majority of those made by tourists? Do we not want to be able to attract tourists?

Baroness Kramer: I do not have a breakdown of how the 3% is divided up although I assume that tourists are a significant part of that number. If tourists can turn to someone on the platform—someone who is clearly in a uniform, who is able to help them and who possibly has access to another language, where necessary, if that might make it easier—and ask that person about their journey and be directed, that could make London Underground very attractive to them. It is similar to what the Games makers did during the Olympics.

Lord Davies of Oldham (Lab): My Lords, does the Minister agree that it is incredibly impolitic to raise the issue of trade union rights at this time, when in fact the second potential industrial action of this dispute was called off? The dispute is now before ACAS; both sides are talking constructively and we hope for a successful outcome. If there is going to be political point-scoring, all of us can do that. After all, in 2010 the Mayor of London said:

“This Mayor takes his promises to Londoners extremely seriously. Every station that has a ticket office will continue to have one”.

Baroness Kramer: I believe that debate in this House and in this country as a democracy is always good, no matter the timing of it. I join your Lordships in hoping for a very successful outcome to these negotiations.

Lord Anderson of Swansea (Lab): My Lords, I invite the Minister to attend Paddington station in the early hours—say between 8 am and 10 am every morning—to see the long queues forming for the ticket office. She might revise her views if she did so. I hope that Transport for London might do the same and recognise that there is validity in the trade union case, at least in that respect.

Baroness Kramer: I have often been to Paddington station, and obviously there are additional issues for stations linked to the overground rail. Once again, this is a different way of providing a service, not a case of eliminating the service. It is important to consider how those systems can work effectively. It will ultimately be a decision for TfL.

Supply and Appropriation (Anticipation and Adjustments) Bill

Supply and Appropriation (Anticipation and Adjustments) Bill (Money Bill)

Second Reading (and remaining stages)

3.07 pm

Moved by Lord Newby

That the Bill be read a second time.

Bill read a second time. Committee negatived. Standing Order 46 having been dispensed with, the Bill was read a third time and passed.

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Immigration Bill

Immigration Bill

Committee (3rd Day)

3.08 pm

Relevant documents: 22nd Report from the Delegated Powers Committee, 8th and 12th Report from the Joint Committee on Human Rights, and 6th Report from the Constitution Committee.

Amendment 48

Moved by The Earl of Listowel

48: Before Clause 15, insert the following new Clause—

“Pregnancy exemption

Any—

(a) restriction on eligibility for services, or

(b) charge,

in this Part shall not apply to any person who is pregnant.”

The Earl of Listowel (CB): In moving Amendment 48, I will speak to Amendments 55, 63 and 65 and support my noble friend Lord Patel’s Amendment 60. I apologise for not having been able to take part at Second Reading. Perhaps it would be helpful to the Committee if I paused for a moment.

Baroness Anelay of St Johns (Con): My Lords, the noble Earl, Lord Listowel, is trying to introduce his amendment and I would ask that noble Lords leave quietly. That was quite a din. I also remind noble Lords that, when they leave, they should not walk in front of the speaker. It not only drowns him out, it means we cannot even see him.

The Earl of Listowel: I am most grateful for that intervention. Amendment 48 would exempt pregnant women from all charges and penalties associated with Part 3, particularly with regard to health charges and concerns for landlords about having tenants who might not be legal migrants. I want to take pregnant women out of this picture.

I recognise the difficulties that the Government face in terms of immigration. I grew up in Hampstead but I have lived and worked near Bermondsey, and I know that for the people of Bermondsey and other similar areas there can be more challenges due to immigration than in places such as Hampstead, around schooling and access to the health service but particularly around housing. There are real concerns and the shortage of housing can be a cause of social tension.

This, too, is a knotty political question, but if the Government and Opposition could come to some consensus about how to provide enough social housing and affordable housing for our people, many of these tensions might be far less acute than they are today. I know that is a great challenge but it relates to this issue and the concerns of our people about migration.

Perhaps it is helpful to think about how maternity has a certain sacred association. If one wanders around the Sainsbury Wing and looks at the earliest paintings there, one sees paintings from the 13th century of the Madonna and child, and nativity scenes. Respect for

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the mother and child during that very important period at the beginning of a family is at the heart of our Christian faith. It is not too surprising that France, Spain and Portugal—some of the Catholic countries—exempt pregnant women from any charges for accessing their health services. It points to the wisdom of the great faiths, as we increasingly realise how vital the very earliest months of a child’s life, from conception through the first two years of life, are to the successful later development of children.

Indeed, the right honourable Iain Duncan Smith did very important work concerning early intervention with families. Graham Allen MP, who worked with him in that endeavour, has set up the Early Intervention Foundation, which aims to raise awareness of the crucial period between conception and two years of age, and perhaps a little bit beyond that. Frank Field MP and Andrea Leadsom MP have set up the All-Party Parliamentary Group for Conception to Age Two—The First 1,001 Days, to really focus our minds on this crucial time in a child’s development. It takes several years for a child to grow into the physical stature of an adult but the brain is developing extremely rapidly in the first months of life and achieves its main development by age four. It is crucial to think carefully about how we treat mothers and their very young children.

I should have said something about newborns in my amendment. I talked only about pregnant women, but I hope that the Government will also think about mothers with newborn children within the first two years of life.

On several occasions I have had the privilege to speak to mothers in temporary accommodation through the Barnardo’s Families in Temporary Accommodation project. What came through particularly from their stories was the sense of isolation that they experienced and how difficult it was because of their temporary accommodation—they may be placed a long way from family or anybody of their ethnic group.

3.15 pm

My second amendment, Amendment 55, would exempt pregnant mothers so as to avoid a landlord fearing a penalty should they provide accommodation to a pregnant mother who is an illegal migrant. I spoke recently with a London landlord who has 180 tenants, 120 of whom are foreign. He is a spokesman for landlords and is well respected. He said to me, “Well, talking with my network, many of us will simply stop letting to people who speak with a foreign accent or who look foreign, just to be on the safe side”. My concern is that it will be harder for migrants to get access to accommodation. I think about the difficulties that mothers face when they are pushed into very poor accommodation. The more difficult one makes it to access accommodation, the more concern one might have that they will get the very poorest accommodation. I visited with a health visitor a few years back a mother in a house in multiple occupation in Walthamstow. This was a mother with a two to three month-old son. Her husband had abandoned her. She was from Africa. She had no neighbours or local community; she knew nobody. The only help to her was the local church. We visited for just 15 to

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20 minutes. This woman was so vulnerable, so isolated. The health visitor did a tremendous job, but I am concerned that if we are not sensitive to the vulnerability of such women and their children we may isolate them further, make their lives even more difficult and undermine to some degree the very important relationship that they form with their young child.

Amendment 65 is just another way to stop charging from the NHS to pregnant mothers. It is so important that mothers engage early with the health service—I am sure that my noble friend Lord Patel will put this case eloquently. I visited the Albany Midwives service in south London some time ago. It works with mothers from the very earliest stages of their pregnancy. It was outstanding in that there was one midwife to one mother. They developed a relationship with a mother; they provided the antenatal care; and there was a beeper, so that when the mother came to give birth they were there for her and would support her after the birth. This gave rise to much improved breastfeeding rates in mothers and lower levels of surgical intervention. That example just illustrates how important is that ongoing relationship with the health service from an early stage. The concern is that the charges that might arise for them would perhaps undermine that contact with the health service. If there is a perception among mothers that if they approach the health service for help they might be drawn into issues around their nationality and their status of stay here, they may be less prone to do so. Assurances from the Minister on that point would be welcome. I look forward to his response.

Baroness Smith of Basildon (Lab): My amendment is the second in this group and is the only one that deals with domestic violence. I thought that it would be helpful to include the amendment in this group rather than have a separate debate on domestic violence.

I want first to turn to the housing provisions, which require landlords to check the immigration status of those to whom they let. I said at Second Reading that we have serious concerns about these measures and we have tabled a number of amendments to the relevant part of the Bill. I shall not go into detail here because it is a separate debate for, one hopes, later today.

I want to put on record our concern about the workability and what I will refer to—I hope that this is accurate—as the unintended consequences of the provisions. The Government should be aware of the impact of the proposals on vulnerable persons, such as pregnant women and many others, as the noble Earl, Lord Listowel, highlighted. The amendments in this group highlight the concerns about those issues.

Not everybody in life is well organised, not everybody has all their documentation up to date and not all landlords will be able to fulfil—or, perhaps, even understand—all their obligations under the Bill. People can make mistakes. I think that I am a well organised person, but can I say that I have never forgotten to pay a bill or never missed my MoT date? Of course I cannot; we all make mistakes.

We learnt that when the former Immigration Minister, Mr Mark Harper, had to resign. Even with all his good intentions and integrity, wanting to obey the law

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and trying to do so, he still made a mistake. There are great concerns about those whose lifestyles may be a bit more chaotic, or those who are here legally but do not have the right kind of documentation. That could include pregnant women and victims of domestic violence. They might end up being refused accommodation as a result of these measures because landlords do not want to take the risk of making a mistake. The danger is that that could result in them falling into the hands of rogue landlords or becoming homeless.

I hope that the Minister can be clear on whether those issues were considered when discussions were held on including the provisions in the Bill. If they were considered and the Government are aware of all those consequences for vulnerable groups, how will they address them—in particular, under this group of amendments, pregnant women and victims of domestic violence?

Most of the amendments referred to the health charges. There is a lot of confusion about the measures in the Bill and other measures announced by the Government. They must recognise that they must take responsibility for any confusion. The Government’s rhetoric and the sweeping statements that we have heard about what they call health tourism add nothing to the seriousness and quality of the debate. Again, I do not want to go into the wider issues—we will have a wider debate on health charges later, and I will raise the bulk of the questions and concerns that we have then—but I want to ask a few questions on specific issues raised by this group of amendments.

I want to be clear from the outset that we agree with the principle of a one-off health surcharge. It is not unreasonable that those who use the NHS contribute to it. My understanding is that all those who have paid the charge would then have full access to the NHS, but the Government’s consultation document then excludes a few treatments. That is not in the Bill, but it starts to cause confusion. In particular, the consultation document states:

“It may be appropriate to build in a very limited set of excluded treatments for which specific charging should still apply. These might include any or all of the following”.

One of those in the list is services for pre-existing pregnancies. As I said, that is not in the Bill, and that is why I want some clarification. As I read it, that seems to mean that women who have paid the visa charge and come to the UK already pregnant—presumably at whatever stage of pregnancy, whether they know about it or not—will nevertheless have to pay for treatment related to their pregnancy. Is that all treatment or some treatment? We just do not know, and the Bill does not provide any clarity on that. I wonder whether when those women get their visas they get a pregnancy testing kit at the same time to check whether they are pregnant.

A number of groups are to be exempt from paying the health surcharge on humanitarian grounds. We totally support that; it is absolutely right. The Department of Health said that that would include refugees, asylum seekers and victims of human trafficking—presumably, whether or not they are pregnant. I know that victims of trafficking will now be debated in a separate group, but I want to press the Minister on how this will work

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in practice, as there will be cases when they will present to the authorities only when they are pregnant. Trafficked women will not, by definition, have paid the charge. The UK Human Trafficking Centre suggested in its 2012 baseline survey that more than half of all trafficked victims were not referred to the relevant authorities for assessment, so how will we know who they are?

Specifically on domestic violence, what will happen to women who are trying to escape a violent relationship and who, in fleeing the home, are left without any evidence of their entitlement and no information on their immigration status? They may be UK citizens or have indefinite leave to remain but do not have the documentation. They have fled their home because of violence and to protect themselves and their children. Women who flee a violent partner often do so at the time of the most extreme circumstances that they can face. They will not have time to pack up their belongings, hunt for their passport, pack it into their bag, fold up their documents and bring those out with them. They are going to flee the home to protect themselves and their children so when they present for housing they will, if they are fortunate, be placed in a hostel or refuge. If I am correct, the Government are quite rightly exempting that. However, others will just run and, having run, will try to find suitable accommodation.

With the financial difficulties being faced by women’s aid groups across the country—I declare an interest in that I am patron of Basildon Women’s Aid—supply cannot always meet demand. What do the Government expect these women to do? How will they find accommodation? Will a sympathetic landlord be forced to turn them away if they do not have their documents and, if they are pregnant, where are they going to give birth if they have been turned away by a landlord? Where will their home be? A number of questions are being asked today, and I think that there will be many more from other noble Lords who have amendments in this group, about the implications of Clauses 33 and 34 for pregnant women and victims of domestic violence.

I have spoken to the Minister about this already, so he is aware of my concerns. However, we need far greater clarity about what is in the scope of the Bill and what has been just government rhetoric or other issues which the Government pretend they will take later. What is going to happen and how will it work in practice? I would find it quite helpful if the Minister could help me understand the position of someone who is here legally but who has not paid the visa surcharge—because they are here at present and that surcharge has not come in—and does not have permanent or indefinite leave to remain. What is their position regarding healthcare? I am assuming that transitional arrangements will make provision for that but I am not clear on how that will work in practice. If the Minister can shed any light on that, it would be extremely helpful.

Baroness Cumberlege (Con): My Lords, I have two amendments in this group—Amendments 59 and 63. I declare my interests, which are in the Lords’ register.

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We received a very interesting letter from my noble friend Lord Howe over the weekend. His letter explains that Clauses 33 and 34 are designed to break, or perhaps put a stop to, the activity of health tourism. It is absolutely right that we should do that. Having read his letter, I understand that estimates suggest that between £70 million and £300 million of costs—it seems to be rather a large gap—are attributed to people who deliberately travel to England to get free healthcare because their treatments are so expensive in their country of origin. In no way should we entertain health tourism; it should be detected and the individuals suitably charged. The NHS, as we know, is enormously generous and supported by us all through our taxes. The whole purpose is that we should contribute, through our taxes, to the well-being of our own country’s health.

I have had a long-time interest in maternity services. As the noble Earl, Lord Listowel, indicated in introducing his proposed new pregnancy and maternity clause, there really are few things more important to a woman than bringing a new life into the world. It is a journey of dramatic physical, psychological and social change; of becoming a mother, of redefining family relationships and in taking on the long-term responsibility of caring for and cherishing a newborn child. If the needs of child-bearing women and their babies are ignored, then not only are the physical, social and psychological long-term effects damaging to those concerned but the economic implications for the country are considerable.

3.30 pm

As I understand it, the present rules charge women for maternity care if they are not “ordinarily resident”—that is, if they do not have permission to live here permanently. However, they can gain the status of being ordinarily resident immediately or shortly after they enter the country. Women whose status attracts a charge receive an invoice for their care, often early in their pregnancy. If they are unable to pay, though, they should not be refused care. The reason for that is that maternity care is classed as “immediately necessary treatment”, which means that it should not be refused or delayed for any reason. This is because we know that the consequences of delay in extreme circumstances can mean the loss of life or serious damage to the mother, the child or both.

If a woman does not pay, the Home Office may be notified and choose to deny subsequent immigration applications until the debt is paid. While the rules state that women should not be refused care if they are unable to pay, there is evidence of women who are wrongly refused care. There is evidence of women deterred from seeking care because of the charges and the impact of such a debt on subsequent immigration applications. These rules are very poorly understood by migrant women and are very poorly implemented by the NHS. The government research suggests that as many as 30% of the people assessed by NHS trusts are incorrectly classified, resulting in charges being imposed on people entitled to services free of charge.

The research that has been undertaken by both the BMA and Maternity Action highlights the confusion among staff not knowing who is to pay and who

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should receive care free at the point of use. Secondary legislation under Clause 33 of the Bill will not solve this problem, as I see it; instead, it could make the situation a lot worse. The clause enables the Secretary of State to introduce a migrant levy as part of applying for a visa, as the noble Earl, Lord Listowel, has said. It will significantly increase the number of migrants who are subject to charging, and it will expand the NHS services that attract a charge.

My concern is that, if charges are introduced, they will create a risk that women will not attend antenatal care or will be denied access to services because of their inability to pay. This could prevent midwives from identifying and treating health conditions early in pregnancy, leading in turn to significantly worse health outcomes for these vulnerable women.

As with every piece of legislation, we must try the “What if?” tests. What if a woman finds herself pregnant after her relationship has broken down? If she was dependent on her husband or partner for her immigration status, is she to be charged for maternity care, GP care, prescriptions and dental care? What if a woman whose asylum claim was refused, and is destitute and living on the streets, becomes pregnant as the result of a sexual assault? Is she to be charged for maternity care, GP care, prescriptions and dental care? What if a woman who is married to a British man and has submitted an immigration application to the Home Office becomes pregnant and gives birth while the application is being assessed? Is she to be charged for maternity care, GP care, prescriptions and dental care? Nationally, 20% of all maternal deaths are to women who started their care late in pregnancy, estimated as after 22 weeks, who have missed more than four antenatal visits or who have had no antenatal care at all.

My Amendment 63—I thank other noble Lords who have put their names to it—addresses the needs of migrant women, who have significantly worse maternal health than the rest of the population and have sicker babies. NICE recognises this. NICE guidance identifies migrants, refugees and asylum seekers as a distinct risk group. It recommends that additional measures to promote their early involvement in maternity care should be followed. Screening during antenatal care enables midwives to identify and treat diseases such as HIV and hepatitis. These diseases can be passed on to the baby. Rubella and syphilis can cause serious abnormalities in the baby. The risks associated with FGM can be averted when it comes to labour and the birth of the baby. Lastly, conditions that might lead to early labour can be assessed, for example, blood pressure, urine infections and multiple pregnancies.

Even under the present system, we have cases of women who have been deterred from seeking care. I want to mention just one. A woman who had experienced problems with her first baby was found to have high blood pressure during her second pregnancy. Her doctor wanted her to be admitted to hospital, but she refused because she was fearful of being charged for maternity services. This woman had been charged for NHS care for her first baby. She attended an appointment with a midwife during her second pregnancy, but refused to go to hospital despite strong recommendations from

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the midwife and the doctor. By the end of her pregnancy, she was very ill, and when she gave birth, her baby was very unwell. The woman’s kidneys failed. She was admitted to the intensive care unit and now requires long-term dialysis. The ongoing poor health of the woman and her baby could have been prevented had she received the care that she needed earlier in her pregnancy.

The final costs of deterring women from attending antenatal care can be considerable. The simple process of identifying and treating a common complaint in a pregnant woman, such as a urinary tract infection, can prevent a woman developing an inflection of the kidneys, which can result in a premature birth. The cost of delivering standard care, including treatment of a urinary tract infection is £2,600. The cost of providing care to a woman with kidney failure and her premature baby is £59,000. Diagnosis and treatment of HIV during pregnancy can reduce the risk of HIV transmission to the baby to a negligible level. The cost of providing maternity care and HIV treatment is between £15,000 and £24,000, depending on the treatment, but the lifetime cost of care for a baby born with HIV infection is at least £280,000.

I can understand the wish of the Government to simplify the present system, but they must ensure that the proposed changes will not deter some pregnant women from seeking and accessing maternity care. It is important that these clauses do not have a negative impact on the health of these women and their babies and perversely lead to a need for more medical care at greater cost.

My Amendment 63 is carefully drawn. It identifies women who should not pay charges but does not restrict the Secretary of State adding to the categories, should he wish. It also gives him flexibility through guidance, and it gives discretion to providers of services in identifying whether there are reasonable grounds about whether charges should apply in certain circumstances. My concern is that, in trying to deter pregnant women from health tourism, the ultimate result will be that we will be left with a higher bill to pay nationally and will cause considerable misery on the way. I look forward to my noble friend’s reply.

Lord Patel (CB): My Lords, I shall speak to Amendment 59, which stands in the name of the noble Baroness, Lady Cumberlege, and to Amendment 60, which stands in my name. I have added my name to Amendment 59. I also strongly support Amendment 63, which stands in the name of the noble Baroness, Lady Cumberlege, and other noble Lords. I would have added my name to it, but another Lord Patel—the noble Lord, Lord Patel of Bradford—beat me to it. I think the priorities were wrong there, but never mind. It just shows that Amendment 63 has wide, cross-party support in the House.

I declare my interests. I am on the specialist register of the General Medical Council as an obstetrician. I also hold the position of professor of obstetrics at the University of Dundee. The noble Baroness, Lady Cumberlege, gave a long list of reasons why pregnant women should be seen early in pregnancy, and I could add another 500 or more, but I do not want to recite a

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textbook of obstetrics and antenatal care. It is important that every pregnant woman is seen as early as possible during pregnancy if we are to prevent problems occurring later in pregnancy for her and her child’s well-being. It is important that she is seen early so that problems that are occurring are identified early and can be treated early to prevent serious complications developing later. As the noble Baroness, Lady Cumberlege, said, in maternal mortality reports, it is the women who are seen late in pregnancy who develop the most complications and even die. Hence anything we do that will prohibit or prevent women from being seen early in their pregnancy will be wrong.

As for health tourism, the visitors are not part of this levy or these charges. It is likely that the so-called childbirth tourism occurring here, often referred to by some hospitals as the “Lagos shuttle”, is about visitors and not those seeking to enter this country on different visas. I therefore hope that the Minister will look again at why pregnant women are included in the levy and charges.

My Amendment 60 includes not only persons who are pregnant but also children. To clarify, I included children under 18 because, currently, children under 18 in this country are exempt from NHS charges. Of course, I realise that, in terms of risk, children under five years old are different from children aged five to 12 or, for that matter, 12 to 18. As no other noble Lord is likely to speak about children, although the noble Earl, Lord Listowel, referred to them briefly, I intend to speak at length only to demonstrate how important children are and what harm the levy, or imposing charges on children, could possibly do.

My amendment would exempt children from the migrant health levy when they apply or are included as dependants in an application for leave to enter or remain. The levy is to apply generally to visa applicants who are students, workers or families, but not visitors. Currently, it is intended that payment of the levy will provide the applicant with free access to all NHS services for the duration of his or her visa. As the noble Baroness, Lady Smith, said, we need clarification about whether the levy means that they will get all NHS services free of charge. There is a lot of confusion about that. For instance, Clause 33(4) makes it clear that there is no guarantee that restrictions on access to particular services will not be introduced. Clause 33(3)(e) includes a power for the Secretary of State to make exemptions from the levy. However, it is not clear in the Bill what the consequence of such an exemption would be. Without more, it appears that a charge would be made where a child exempted from the levy needed to access NHS services, save for any services which regulations may exempt from charging.

As to which services charges will apply, the intention is that this will include primary and secondary care services, including accident and emergency services. GP consultations will be free, although it is unclear whether any treatment that may be delivered by or via the GP will be free. Treatment for specified communicable diseases and sexually transmitted infections will be available. It is yet to be decided whether any, or how many, mental health services will remain free. There is a great deal of doubt.

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The Department of Health response to last year’s consultation on migrants’ access to NHS services recorded,

“widespread support for exempting all children, not just those in local authority care, from charging”.

However, the Government then concluded:

“We do not intend to establish an exemption for children as we believe this poses a significant risk of abuse by visitors seeking treatment for children … Vulnerable children, such as victims of trafficking, those seeking asylum, and migrant children in local authority care currently receive free healthcare and will continue to do so. We will listen to arguments about how best to cover other vulnerable children who might otherwise be denied treatment”.

Can we know what this group of “other vulnerable children” will be? To me, all children of a certain age are vulnerable.

3.45 pm

Therefore there are several problems with the Government’s position. First, the suggestion that exempting children would encourage migration to the UK is mere speculation. Research has found no correlation between accessibility of healthcare to migrants and migration patterns. That some people may abuse that is different, but it does not encourage migration. Secondly, not all children falling within the groups specified as vulnerable are in practice recognised as within those groups. As the Department of Health response acknowledges, victims of human trafficking are exempted from charges only if they have been formally recognised as victims or potential victims, and most do not engage with the formal recognition system. If they do not do so, they are not recognised. Child asylum seekers may also be excluded by reason of disputes as to their age.

Thirdly, the Government’s position fails to have any regard to the effect of greatly extending charges to cover primary care and accident and emergency treatment. While children are not generally exempted from NHS charges now, the consequences of this are less harmful because primary care and accident and emergency treatment are currently provided free. Fourthly, the Government’s position seeks to draw a generally inappropriate distinction between children who are vulnerable and those who are not. While some children face greater risks to their health and well-being than others, all children are vulnerable to such risks by reason of their physical and mental immaturity and their dependency on parents or guardians. That is why we look after our children—because they are vulnerable.

If the Government proceed with their current proposals, children face being effectively excluded from basic primary care and accident and emergency treatment if they or their parent or guardian are deterred because they cannot afford to pay a charge, are worried about the consequences—including immigration consequences—of incurring a debt they cannot afford, or are simply afraid that if they seek healthcare, the Home Office will be informed. Clinical experience shows that individuals and families are already deterred from accessing health treatment they need. The Royal College of General Practitioners said that,

“we are concerned that limiting access to primary care would impact detrimentally on immunisation rates”.

At Second Reading, the noble Lord, Lord Taylor of Holbeach, offered the reassurance that,

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“claims that we intend to turn GPs into immigration officers are untrue”.—[

Official Report

, 10/2/14; col. 419.]

However, can he comment on the plans expressed by the Home Office Permanent Secretary to extend the Home Office “radar”, as he puts it, into the NHS? The Minister has sought to portray the Bill as making little difference to the accessibility of healthcare. That picture is profoundly flawed. The Bill significantly extends, by Clause 34, those migrants who may be charged for healthcare. The healthcare services for which this wider group of migrants may be charged are also to be greatly extended. To implement this, and the migrant levy in Clause 33, the Department of Health and the Home Office are working on a registration system to be applied throughout the health system. I refer noble Lords to page 18 of the Department of Health’s Visitor and Migrant NHS Cost Recovery Programme: Sustaining Services, Ensuring Fairness in the NHS. Will the Minister comment on whether they are working on such a system and what its purpose is?

The proposals can lead only to an increased public health risk—and I have no doubt that we will deal with that at a later stage. Children’s health and well-being will be put at greater risk if a parent or family member is not treated for an infectious disease. The people who will be most at risk are the children. The Department of Health accepts the responsibility to provide healthcare to anybody who needs it, but the proposals in the Bill will play against that. The children’s future will also be put at risk if their mothers do not receive any or timely antenatal care. A physically or mentally ill parent may be unable properly to care for his or her child, with health and other safeguarding consequences. Indeed, when children are not attending healthcare services, the risks that safeguarding concerns are missed will be increased. Hence, the Bill runs counter to the Home Secretary’s duty to safeguard and promote the welfare of children. Nor is it consistent with the UK’s general duty that,

“in all actions concerning children, the best interests of the child shall be a primary consideration”.

That is a reference to the 1989 UN Convention on the Rights of the Child. How do the Government feel that they will fulfil this by introducing the proposals in the Bill?

Imposing the health levy and other NHS charges on children and pregnant women for preventive, acute and emergency care will not fulfil the Government’s legal, moral or ethical responsibility for providing care for children, particularly emergency care. They will fail in their commitments to the UN convention. If we do not care for those vulnerable children, particularly the very young, and pregnant mothers, who do we care for? Is it only those who can afford to pay?

Baroness Barker (LD): Clause 33 enables the Government to introduce a health levy. The noble Baroness, Lady Smith, said that her Benches support it in principle; on our Benches, we support it as the least worst of a number of options, none of which we particularly favour. We think that a health levy is preferable to requiring people who come to this country to take out forms of private health insurance that do not meet their needs and are considerably more expensive. However, having said that a health levy may be one

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way of generating income for the NHS that we can support, like other Peers we have considerable reservations about what the effect will be in practice—and, in particular, what the deterrent effect will be on people who require health services. We will go on in later groups of amendments to discuss that in greater detail, but in this group noble Lords have focused first and foremost, perhaps not surprisingly, on pregnant women and children.

The noble Earl, Lord Listowel, in his introduction was almost biblical in his references to our consideration for expectant mothers and children. I am not as spiritual as he is—I am much more practical. I would say that one of the haunting images of last year was that of the asylum seeker who drowned in the boat off Lampedusa in southern Italy, who was found to be giving birth at the time. When I listen to people talking about maternity and health tourism, time and again I go back to that woman and what must have been going through her mind, and what her life must have been like, to be pregnant and in that position. That is just my disposition towards our general discussion.

The noble Baroness, Lady Cumberlege, introduced her amendment in her characteristically thoughtful and well researched way. She, too, referred to the letter of the noble Earl, Lord Howe, of 6 March, in which he explained the thinking behind this Bill from the point of view of the Department of Health. I, too, wanted to focus noble Lords’ attention on the statement that he made. He said that there was “widespread evidence” and,

“a cost of between £70 million and £300 million from people who deliberately travel to England to get free NHS treatment—so-called ‘health tourists’”,

of which those seeking maternity treatment were most prominent. There is some difference between £70 million and £300 million. My first question to the Minister is: can he explain the range? Even if he can, £300 million in terms of the overall NHS budget is minuscule. Consequently, when we are doing our job in this House as we should, which is to consider not just the immediate cost but the overall impact of a charge, we have to do it in recognition of that fact.

I should like the Minister to explain exactly how the Department of Health arrived at that estimate, particularly as the small charity, Médecins du Monde—Doctors of the World—conducted research across the European Union and discovered that there is no higher rate of migration to this country under our current system of charges than to places such as Germany. I simply repeat, as I did at Second Reading, that I have no problem with our making a fundamental change to our health policy provided that we do so on the basis of proper evidence and not the cynical opinion of newspapers.

Amendment 64A in this group stands in my name. Other amendments in the group, which I support, refer to pregnant women. Mine refers to women who are pregnant or require postnatal treatment. We afford postnatal services to those who are ordinarily resident. We do so routinely for women who do not have problems, who also have access to health visitors to ensure that they and their children are functioning well in the first few weeks of the children’s lives. We

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afford these services to women who have problems which may not be very significant but which we know are important in the development of their children—for example, women who are having trouble breastfeeding or women who are suffering from postnatal depression. We also extend treatment to women who have suffered traumatic deliveries and need surgery following deliveries that have not gone well. That is what we do for our own people because it is the right and decent thing to do. I should like to think that in future, no matter who a woman is or what her financial status is, she, too, will be afforded such treatment.

Finally, I thoroughly support the amendment of the noble Lord, Lord Patel, which mentions children. I pay my taxes to live in a country where the first question that a doctor asks concerns what is wrong with a child and what treatment they need, not who their parents are. Our wish is to retain that as far as we possibly can.

Baroness Lister of Burtersett (Lab): My Lords, I support the amendment on domestic violence in the name of my noble friend Lady Smith of Basildon. She has made the case for it, so I will not repeat that, other than to point out that this amendment is totally consistent with the Government’s own action plan on domestic violence and builds on the destitute domestic violence concession. It is a very modest amendment, which would simply guarantee a period of safety, with access to services and benefits, after the breakdown of a relationship because of domestic violence. I hope I am not being naive when I say that I am confident that the Government will support this amendment, given that it is so consistent with their own policy.

I also support Amendment 60, in the name of the noble Lord, Lord Patel. I am very glad that he introduced an amendment on children to remind us of the potential effects on children of some of these changes. I draw noble Lords’ attention to what the Joint Committee on Human Rights, of which I am a member, had to say on this matter. It referred to the concerns that,

“arise about the possible impact on children of the provisions in the Bill which extend charging for NHS services … Extending charging to migrants not previously charged for accessing health services, and extending the range of services for which charges apply, are likely to have a deterrent effect on accessing health care, which in turn is likely to have a particularly detrimental effect on the children of such migrants”.

I will not go into the full detail but our recommendation was that to meet these concerns,

“about the impact of extended charging for health services on children’s health, we recommend that new guidance be issued specifically on the s.11 Children Act duty”,

which applies to the NHS,

“explaining to front-line decision-makers in the health sector exactly how that duty applies in the context of extended charging for NHS services”.

I should therefore be grateful if the Minister would say what the Government’s response is to that.

4 pm

I want to go on to talk about a number of amendments that relate to pregnant women. I will not make the health case because it has already been made so well

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by people who are much better placed than I am to make it. I want to reflect on some of the comments made by Ministers in response to concerns raised at Second Reading. In his letter, the noble Earl, Lord Howe—the noble Baroness, Lady Barker, referred to this issue—singled out,

“those seeking maternity treatment as the most prominent among so-called health tourists”.

I am glad that he used the words “so-called” in front of “health tourists”, because it is a horrible term. He talked of “widespread evidence”. Like the noble Baroness, I should be grateful if the noble Lord could clarify what that evidence is. My understanding is that no primary research has been undertaken. If he was referring to the Department of Health’s research, noble Lords should bear with me while I quote from the report of the Joint Committee on Human Rights, which noted:

“Given the very wide range of the estimates it has produced”—

the noble Baronesses, Lady Barker and Lady Cumberlege, referred to these “very wide” estimates—

“we caution against ascribing too much weight to the Department of Health’s research when assessing whether the Government has demonstrated an objective and reasonable justification for the differential treatment to which the health charging provisions in the Bill give rise”.

The letter therefore seems to ascribe too much weight to not very firmly based evidence—it is not research, as such.

The Minister, the noble Lord, Lord Taylor, in his helpful response to issues raised at Second Reading, reassured us in his usual soothing way that, following representations from Maternity Action and the Royal College of Midwives about the harmful effects on pregnant women among illegal migrants, short-term visitors, failed asylum seekers and visa overstayers, the proposals in the Bill did not apply to them. However, Clause 34 extends the reach of NHS charging provisions to migrants not currently covered. Will the proposals not therefore increase the likelihood of a pregnant woman falling into this category, and is it possible to consider the Bill separately from the parallel healthcare changes being proposed?

If we really are all barking up the wrong tree with our concerns about pregnant women, I hope that the Minister can give us a firm assurance that not one pregnant woman who would not be charged under the current rules will not be charged as a result of the Bill and the related health changes. If he cannot give that assurance, I hope that noble Lords will support this range of amendments that exempt pregnant women.

Finally, the claim at the end of the noble Earl’s letter that, taken together, the changes will,

“maintain safeguards to ensure necessary treatment is not denied”,

ignores the extent to which necessary treatment is already being denied. That point was ably and well made by the noble Baroness, Lady Cumberlege. The letter denies the extent to which pregnant women are deterred from accessing services, even though they would not be charged until afterwards, for fear of the implications of being charged, reported or whatever, or for fear of misapplication of the rules. A report of

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the Joint Committee on Human Rights, going back to long before I even joined your Lordships’ House, referred to the evidence on this. It said:

“The arrangements for levying charges on pregnant and nursing mothers lead in many cases to the denial of antenatal care to vulnerable women. This is inconsistent with the principles of common humanity and with the UK’s obligations under ECHR Articles 2, 3 and 8 ECHR. We recommend that the Government suspend all charges for antenatal, maternity and peri-natal care. We recommend that all maternity care should be free to those who have claimed asylum, including those whose claim has failed, until voluntary departure or removal from the UK”.

That recommendation was never accepted. That was a few years ago but my understanding from Maternity Action and the Royal College of Midwives is that pregnant women are still deterred and the rules are still misapplied. The Bill is taking us in the diametrically opposite direction to that recommended by the Joint Committee on Human Rights back in 2006-07.

I also look forward to what the Minister has to say in response. I hope that he can genuinely reassure us this time, because I was not reassured by his response when these issues were raised in at Second Reading.

Baroness Tonge (Ind LD): My Lords, I support all these amendments—in particular, Amendment 63, to which I have added my name. Unfortunately, due to circumstances, I was not able to be present at Second Reading, but I support these amendments because I worked in the health service for more than 30 years, particularly in women’s health services, implementing, supplying and managing those services. My late husband worked in the health service for more than 40 years.

The first point that I would like to make from that experience and that of many colleagues with whom I am still in touch concerns health tourism. It really is most extraordinary that this term is bandied around to scare people that the health service is being misused by countless numbers of people who really should not be here. It is the same old thing that appeals to Daily Mail readers: these people should not be here and they must not access our facilities. Yet, in all that time neither I nor my husband ever came across health tourism and nor have I ever heard colleagues talk about it. I reinforce what the noble Baronesses, Lady Barker and Lady Lister, said: the letter from the noble Earl, Lord Howe, was extremely woolly in that department. I think that the so-called evidence for this is really just anecdotal.

Perhaps I may say a few words about the noble Earl, Lord Howe. He writes a wonderful letter and he is the most emollient man. I think that if I were on my deathbed and the noble Earl appeared, I would rise and feel well again. He has that ability. He is in the wrong profession—he really should be out there tending the sick because he makes us feel happy and cured. However, being a cynic, I do not believe all that he says, and I hope that sometimes he does not believe it either.

So let us sit back and think really hard about whether health tourism exists. In any case, if, through some medical sleuth, we identified that there were health tourists, would the problem be large enough to make a difference? Would it really bring in that much more money to the health service?

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In passing, my late husband was at St Thomas’s Hospital, which is alleged to have experienced the “Lagos shuttle” in relation to maternity care. St Thomas’s and the Royal College of Midwives have denied this, so I question whether this should be used in any way as evidence for charging pregnant women if they want to come to this country as migrants.

My second general point is that one of the reasons why I support Amendment 63 is because it points out awfully well how terribly difficult it will be to make any of the charges. How will that be done? I have been out of the health service for quite a while and I wonder who will implement this? If a pregnant woman says, “I’m pregnant and need antenatal care”, presumably a layer of bureaucrats will have checked her bit of paper. However, what if she does not have a bit of paper, forgot to get it, has lost it or does not speak English? She may have high blood pressure or be carrying twins—we will not go into all the medical obstetric possibilities that the noble Lord, Lord Patel, mentioned. If so, will we really deny the woman care? Doctors and nurses go into their profession because, I hope, they possess a certain amount of compassion, and want to help people. We have to ask patients myriad questions before we even start asking medical questions about their health. Are we to add another layer of questioning? How will we have time to do it? We do not have enough doctors and nurses. They are all overworked, so how will we implement this? Again, will it be financially worth it to create all that distress and bureaucracy?

I know that I have made general points but I say finally that I want to support all noble Lords who have pointed out that if we fail to give proper antenatal care to a pregnant woman we are failing her and her future health, and we are failing the baby or babies she is carrying and their future health. That is not only a double human tragedy but it is denying them their human rights. It is also setting up far more work and expense for the health service in the future if it is not dealt with properly. I beg the Minister to reflect on this between now and Report and to withdraw this awful provision.

Baroness Masham of Ilton (CB): My Lords, this list of important amendments deals with the health of some very vulnerable people. I have put my name to Amendment 65, but several deal with exemption of payment for pregnant women if they are unable to pay. I do not know which of the amendments is most appropriate but I hope that the Minister will accept the spirit behind the amendments and bring forward an acceptable amendment on Report.

Charges at the point of care create risks that women will not attend care, will attend late in their pregnancy or will be denied access to care because of inability to pay. This can prevent midwives identifying and treating health conditions early in pregnancy which, in turn, can lead to significantly worse health outcomes for vulnerable, migrant women. NICE has acknowledged this and recommended that care providers take additional measures to promote early engagement with maternity services. FGM reversal is best undertaken prior to 20 weeks of pregnancy. Charges at this point of care can result in higher costs later to the NHS. Pregnant

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women who are HIV positive need treatment so that their babies are born free of HIV. They should not be put off seeking care. Delayed or no antenatal care can lead to complex interventions at a later date. For example, identifying and treating urinary tract infections during standard antenatal care prevents a woman developing a kidney infection that can result in premature birth which can be very expensive to the NHS. I hope that the Minister will do his very best to agree to some of our points.

4.15 pm

Lord Harries of Pentregarth (CB): My Lords, I have listened carefully to the debate and support the general thrust of all the amendments. However, like the noble Baroness, Lady Masham, I am not clear which of the amendments particularly meets the bill. I hope the Government will indicate not only whether they are receptive to the general thrust but which amendments are particularly inadequate. I hope the Minister will address the question posed by the noble Baroness, Lady Tonge, of what exactly is meant by the phrase “health tourism”. What is the evidence that it exists?

Baroness Finlay of Llandaff (CB): My Lords, this has been an important debate and I declare all my health interests. In speaking briefly, I will not reiterate the points made by the noble Baroness, Lady Cumberlege, and my noble friend Lord Patel but they are incredibly important.

When the Minister comes to reply, perhaps he will give the figures in respect of the actual cost of antenatal care versus the actual cost of complications. Let us not forget that a massive haemorrhage in labour or a massive problem with obstructive labour will cost a great deal of money in emergency treatment when, if they had been picked up much earlier with a simple ultrasound examination, the problems could have been avoided. Will the Minister give the costs and the research evidence behind the reason for the Government not exempting pregnancy and children? Will he say what discussions the Government have had with the royal medical colleges and the Royal College of Midwives, in particular, over the background to this measure and its implementation? For doctors, nurses and midwives trying to implement it on the ground it will be a nightmare.

What do the Government intend to do to monitor the effects of the measure—in other words, how will they audit it—when and if they proceed to implement the Bill as it is currently drafted? Will that audit include a cost of the complications that would have been avoided in the event that pregnant women had had appropriate antenatal care?

There is a great deal of evidence behind this. From all the amendments that have been tabled today it seems evident that a consolidated and focused amendment will be brought back on Report. Like others who have spoken, I believe it would be most sensible for the Government to listen today and take the evidence on board, rather than push the House to determine its view.

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Lord Avebury (LD): My Lords, I should like to add a few words to what my noble friend Lady Barker has already said about Amendment 64A which, unlike some of the other amendments in the group, covers postnatal as well as prenatal treatment.

We had a meeting with representatives of the Royal College of Midwives, as mentioned by the noble Baroness, and Maternity Action on 27 January and we have taken note of the strong arguments for exempting these patients from charging, as I hope the Minister will have done by the end of this debate. As has been said repeatedly, there is no official estimate of the net cost to the NHS of non-EEA short-term migrants needing maternity treatment once those exempt from charging are removed from the equation. Neither in the Government’s briefing nor in any other source have I been able to find a reliable estimate of the volume of alleged maternity tourism. However, as has been said, anecdotal evidence exists, of which the Minister’s letter is an example.

This all seems to have arisen from an assertion by Sky News that 300 women had been stopped at Gatwick but then had to be admitted because they were assessed as being more than 36 weeks pregnant and therefore unable to travel back to their countries of origin. This information was said to have come from a government report, but no title or reference was given. The noble Baroness, Lady Cumberlege, quoted the letter from the noble Earl, Lord Howe, giving a wide range of estimates of the volume of health tourism generally but not maternity tourism in particular. All it had to say on that subject was that maternity tourism formed a large proportion of the total value of health tourism. Surely the answer to that problem is for the Government to stipulate that airlines flying pregnant women to UK destinations should be required to obtain certificates of the length of pregnancy from doctors they can trust, and for carriers that bring women who are more than 36 weeks pregnant to the UK to be subject to fines. That should not be too difficult because the alleged maternity tourists are said to come from a limited number of destinations. When my noble friend the Minister comes to reply, I would like him to make some comments about that idea.

At the other end of the spectrum from the Sky News report was an article about a woman whose case was reported in the Guardian. She had been living in the UK as the wife of a British citizen for seven years, but for some reason not explained in the article had evidently not obtained indefinite leave to remain. Having paid Lewisham Hospital £5,000 for maternity services in regard to care during and after her first child’s birth, she was terrified of going near the NHS and was expecting to give birth without medical supervision because she and her husband were still paying off the bill for the first child.

My noble friend Lady Tonge asked about the denial of treatment for women who present themselves as maternity patients but cannot satisfy the health authorities that they are legitimately entitled to those services. Surely the answer to that must be that the delivery of the services should come first and the ascertainment of the woman’s right to treatment dealt with afterwards. I cannot imagine that any clinician would say that they

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would not provide maternity services for a woman in the early stages of pregnancy, and that may be the answer to those who say that complications arising from a variety of serious causes might result from the failure to treat those who are in the early stages of pregnancy. I hope that I am right in saying that this will not happen because of the first duty of clinicians, mentioned by the noble Baroness, Lady Lister, to treat patients who come before them.

Baroness Tonge: Will the noble Lord give way? I appreciate his point, but if someone gives a patient the benefit of the doubt for antenatal care and it then turns out that they do not have an entitlement to treatment, do they then say that the patient is not going to get any more antenatal care?

Lord Avebury: My Lords, it has been the case in the past that people who receive services to which they were not entitled incur a debt. I believe that something like two-thirds of the charges levied on these people lie on the table because they cannot be recovered.

Baroness Tonge: As I am sure my noble friend is aware, pregnancy goes on for nine months. It is not a short intervention which is treated and the patient then goes away; it is an ongoing thing that includes postnatal care and goes on for a long time, as the noble Baroness, Lady Barker, pointed out. This is a long-term treatment and it is important that it should be so. Perish the thought that treatment is cut off mid way.

Lord Avebury: No, what I was saying is that I hope that the treatment would be given irrespective of the woman’s entitlement while checks are being made to see whether she is a valid patient of the NHS or is someone who should incur the charges. However, if the charges do fall on the woman, I hope that they will simply lie on the table, as obviously a substantial proportion of the costs of treatment of migrants has done in the past. From the official figures given by the Department of Health, I think it was two-thirds of the charges incurred—not just by pregnant women but by persons who were not entitled to treatment presenting themselves to the NHS. In no case that I have heard of were patients denied treatment, but the charges piled up and the debt was left there on the table. I do not know what the mechanisms for recovery will be under this system, and perhaps the Minister will deal with that point in his reply.

I assume, and want confirmation, that no woman would ever be denied treatment, but if it was ascertained subsequently that she was not entitled to it, the debt would be recorded somewhere. Whatever steps the NHS might take to recover it would be fair enough, but if it could not be recovered, like so many other debts which have been incurred by migrants generally in the past, would it be written off to the NHS? I would like reassurance from the Minister on that point.

Undocumented migrants such as overstayers and failed asylum seekers, of whom there are estimated to be half a million, are unlikely to be able to pay for maternity or indeed any other medical services. If such

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people work, they are on or below the minimum wage and are now likely to become unemployed with the tightening up of checks by employers on their right to work. Health authorities may invoice patients from this group, but can the Minister say what proportion of the debt is recovered and whether there is anything in this clause, or indeed in the Bill as a whole, that will make it easier to collect the money? Will they be able to transfer the debts at a discount to a debt collector, and will they be any better off than they would have been in the past before this clause was enacted?

The Earl of Listowel: My Lords, in listening to my noble friend Lord Patel’s concerns, which I share very strongly, about children and the charging of children, it occurred to me that there might also be an issue about the immunisation of children. If significant numbers of children do not get immunised, that might pose a threat. I would appreciate the Minister addressing that question in his reply.

The Parliamentary Under-Secretary of State, Home Office (Lord Taylor of Holbeach) (Con): My Lords, this has been a very full discussion about all aspects of healthcare and healthcare charging, some of which lie within the provisions of the Bill and some of which lie way beyond it and are actually part of the Department of Health’s consultation. I guess there are two ways of dealing with this debate: I can give either the short answer or the long answer. I have chosen to give the long answer—I hope that noble Lords will indulge me—in the hope that I will be able to disabuse them of some of their anxieties and reassure them. I am very mindful of the kind words from the noble Baroness, Lady Lister, but I am also slightly anxious as a result of the description of my noble friend Lord Howe. I am equally concerned to try to be as upfront as I can be about what the Bill provides for and to reinforce my noble friend’s letter, which noble Lords will have received, which seeks to place measures in this Bill in the context of wider health service charging.

Perhaps it would be helpful to provide a brief reminder of the intentions behind Clauses 33 and 34. I will refer to my noble friend Lord Howe’s letter because it sets out the context for these provisions, which is the Department of Health’s wider programme of work on migrant access and financial contributions to the NHS. Likewise, I want to reassure noble Lords that, first and foremost, the NHS is, and will remain, free at the point of delivery for permanent residents. But it is a national service, not an international health service. We believe that migrants should have a form of access to the NHS that is commensurate with their immigration status. That is our policy position.

4.30 pm

As my noble friend Lord Avebury said, we have perhaps one of the most generous health services in the world. Temporary migrants with leave of more than six months currently qualify for free care almost immediately after their arrival in the UK. In effect, this means that only tourists and illegal immigrants are generally chargeable for healthcare in the UK. I ask noble Lords to bear that in mind when we come to discuss the detail of the amendments.

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Temporary, non-EEA migrants will be required to pay an immigration health surcharge. Our policy is that this will provide them with generally the same free NHS access as permanent residents. This will cover treatments including maternity services. I remind noble Lords that this is not a charge to be paid when they go to the doctor or to hospital; this charge is paid on application for a visa to come to this country. It is a charge that is part of the package and is designed to give those people—who, I agree, could be vulnerable—the same status as citizens and permanent residents of this country.

As my noble friend Lord Howe set out in his letter, in itself the Bill will not make any changes to NHS structures or remove the ability of the Department of Health or devolved health ministries—we must remember that while immigration is UK-wide, the administration of healthcare is devolved—to exempt certain groups or treatments from overseas visitor charging on health grounds. Short-term visitors—those here for less than six months; that is, people who are not provided for in this Bill—and illegal immigrants will continue to be liable to NHS charging, as they are now. There is no change proposed by the Bill.

Decisions on what services should and should not be exempt from this charging regime are set out in the NHS charging regulations, which are laid before Parliament, where matters such as those raised by many noble Lords today could be discussed. The regulations are a matter for the Department of Health and the devolved Administrations for health purposes and not part and parcel of immigration legislation.

Baroness Masham of Ilton: Does the Minister agree that they should be working together in maternity cases? It is health but it is immigration as well.

Lord Taylor of Holbeach: I hope that I will be able to go on and talk about these matters when I address the specific amendments. I hope that when I have concluded my remarks, the noble Baroness will feel that I have indeed satisfied her in that respect. I understand the vulnerability of pregnant women and the care that is needed to ensure that both mother and child have healthy prospects.

The health surcharge is designed to ensure that legal migrants make a fair contribution to the NHS, commensurate with their immigration status. We intend for it to be applied fairly and without unintended consequences. As I have just said to the noble Baroness, Lady Masham, pregnant women should not be adversely affected—I listened with great care to the noble Earl, Lord Listowel, and to subsequent speeches on this subject. However, it is important to consider the safeguards already provided in the Bill.

In respect of the provisions relating to landlords, there are exclusions from the restrictions in accessing accommodation at Schedule 3 to the Bill to protect the vulnerable. Local or housing authorities providing accommodation in discharging a statutory duty—for example, under national assistance or children’s legislation—are not subject to these restrictions.

Asylum seekers and failed asylum seekers who face recognised barriers to return will be authorised to rent

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property by the Home Office, and the department will continue to support destitute applicants. Accommodation for vulnerable individuals, such as hostels for the homeless and refuges for victims of violence, will also be exempt from the checking requirements—I mention these because the noble Baroness, Lady Smith, rightly expressed concern about the vulnerable and I shall address her amendments later.

We need to consider the checks that would be required by some of the amendments. These would be intrusive; indeed, it would be objectionable to ask all temporary female migrants of childbearing age if they were pregnant and to verify that information. How could the Home Office or a service provider establish that an individual was indeed pregnant rather than merely seeking to circumvent the rules? Rather than a simple check of documentation, which is what the Bill provides for, inquiries would need to be directed to the individual’s health provider. We must also consider the unintended distress that such a practice could cause. What if a woman was reluctant to reveal a pregnancy? What if she suffered a miscarriage while her visa or other applications were being considered? She would no longer be exempt; she would need to tell us of her loss at a time of great distress. The more one looks into the detail of this and the practical application of the policy, the more the intrusive nature of these amendments becomes clear.

Some of the amendments would allow pregnant women who were illegal migrants to rent accommodation, open bank accounts and hold driving licences. As such, they would help them establish a life in the UK. However, they would also create a dangerous loophole through which illegal migrant women might be encouraged or pressurised into becoming pregnant so that they could rent accommodation or open a bank account for themselves or their family members. We surely cannot introduce legislation that places women at risk of such exploitation.

Before turning to the particular amendments, I shall address some of the questions that have been asked. The noble Baroness, Lady Smith, asked me about the health consultation. The Bill provides that certain expensive treatments could be charged for, even though persons have paid the surcharge—it is important to have flexibility in the legislation—but when the Act is initially implemented it is our clear policy intention that there will be no further charges for treatments where people have paid the surcharge. They will be treated as if they are permanent residents. The Bill’s provisions are therefore wider than the application of the legislation

The noble Baroness also asked me about the transitional arrangements. There are no transitional arrangements to the extent that anybody who is already here under existing immigration laws permitting them a period of stay greater than six months will not to have to pay the surcharge. The payment will be required only of people who are making a new application or new applicants. It should be noted that if somebody is extending their leave by making a fresh application the surcharge will become due. There is no question of trying to recover the surcharge from people who already have a right to be in this country for more than six months.

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Baroness Smith of Basildon: I apologise for interrupting the Minister, and I am grateful for his response to my queries. I am still slightly confused on the issue of pregnant women. I think that he said that the Bill allows for such charges but there is no intention to make them. If I have that wrong, perhaps he could clarify it for me. The only reason it has been flagged up is that the public health consultation mentioned additional charges. I want to be absolutely clear that if a woman has paid the surcharge, there is no additional charge to be made. I may have misunderstood, but what he said seems slightly contradictory.

The other point is on transitional arrangements. If someone is already here legally, my question is about the practicality and workability of the measures. How will we be able to distinguish between someone who has paid the surcharge but is here illegally and someone who is here legally but has not paid the surcharge?

Lord Patel: If the Minister will allow me, before he answers the noble Baroness, can I make something clear? We keep confusing surcharge with levy. Let us talk about the levy that will be imposed on people coming here who are not visitors. Once that levy has been paid, it will allow them to access all health services. Is that quite clear?

Lord Taylor of Holbeach: Yes, that is exactly right. They will have the same access to health services as is available to a permanent resident. That is the whole purpose. It is administratively a tidy arrangement; it is straightforward and easy to police; and people will be paying it at the same time as they apply for their visa. Their visa application will show that they have those rights, so if anyone seeks to charge such a person, they will not be chargeable because they will have a clear right to free healthcare, just as the noble Lord and I would.

It is really important to emphasise that point, because the whole point of having the levy, the charge or whatever we call it, is to provide a contribution from people who stay here and may impose some cost on the health service but to avoid asking them for payments for services provided or to take out an insurance policy before they come here to cover any chance that there will be health costs. It will be an asset to the health service in the sense that it will provide money to support the health service. It also regularises the position of the individuals involved. I hope that that satisfies the noble Lord.

Lord Patel: It does, but I wonder whether this is new policy thinking, because much in the Bill, particularly in this part, implies that the Government want to be able to impose charges for other things.

Lord Taylor of Holbeach: I do not think so. I think that the Bill’s provisions are purely about health service charging for those who come here for a fixed term of six months or more and who are not here as visitors. It clearly differentiates between those who are here legally and with proper documentation and those who are illegal, so it will make it more difficult for those people who are here illegally to avoid the implication of their illegal presence here in the United Kingdom. We should

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remember that most people who are here illegally are overstayers; they are not people who have come in but people who should have gone home. That is one thrust behind the legislation.

Baroness Williams of Crosby (LD): May I press the Minister just one step further, since this is quite a complex area? I think I am right that, at present, students count as being ordinarily resident as distinct from permanently resident. In future, because the ordinarily resident concept will broadly disappear, they will be regarded as permanent residents only if they put in the time to become, eventually, citizens in that sense. Many students, particularly those who are post-doctorate, continue to work in some area associated with what they are doing. For example, many post-docs work on research and are paid for it. If those students then pay taxes and national insurance on those earnings which they receive, but which are often well below what the market rate would be for their level of qualifications, am I right in thinking that they would not have access to free health treatment unless they had paid the surcharge at the moment when they got the visa?

4.45 pm

Lord Taylor of Holbeach: They will have access currently, as the noble Baroness will understand. When they make an application to come here from now on, they will have to pay the health surcharge on top of the visa that they are currently applying for. I hope that I have made that clear. At the same time, it has been suggested from the Box that I ought to make it absolutely clear that the surcharge will be paid when a person applies for a visa and for leave to remain when they are in the UK and extending their leave. I think that was what I said, but the Box obviously thought that it is such an important point that everyone should understand that.

Lord Patel: My Lords, what the Minister said in response to my question is clearly recorded, so we can all read it. As I understood it, I thought he said that once the health surcharge—let us say it is £200—is paid, for the duration of their legitimate stay in this country all health services will be available to them.

Lord Taylor of Holbeach: It is a per annum charge, so if they are here for three years and are not a student it will be three times £200. But yes, that is exactly right.

Baroness Williams of Crosby: On this point, I am sorry that we are pursuing the Minister, but can I take this one step further? I was talking specifically about a post-doctoral graduate who might be earning some relatively small sum while he was a post-doctoral graduate. I take it that he would therefore not be exempt from the surcharge as well even though he would be paying both national insurance and taxation, if he was about the taxation threshold, and had paid the surcharge already. That is where the sense of some unfairness in the system arises rather strongly.

Lord Taylor of Holbeach: I suppose that at any boundary point, there are bound to be these sorts of situations occurring. The post-doctoral leave to remain would be in addition, perhaps, to a university degree.

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There would be an additional application, so indeed it would be allowable because they would not be permanently resident here in the UK. That is a correct analysis of the situation and the noble Baroness, Lady Williams, is absolutely right in pointing that out.

Lord Avebury: My Lords, I hesitate to add to the interruptions that the Minister has already suffered, but I think I can understand what the noble Lord, Lord Patel, was getting at. Clause 33(4) states:

“In specifying the amount of a charge under subsection (3)(b) the Secretary of State must … have regard to the range of health services that are likely to be available free of charge to persons who have been given immigration permission”.

That implies that not all health services will be available to that person, but the noble Lord has insisted that such persons will be treated on the same basis as a native of this country in accessing the health service. Why do we need subsection (4), which implies that there are other services which the health service provides that are not covered by the surcharge?

Lord Taylor of Holbeach: I thought that I had made that clear in answer to an earlier question, and I am just trying to find my notes on that matter. When the Bill is initially implemented, it is our clear policy intention that there will be no further charges for treatment. The provision in the Bill is there for this particular period, but we will clarify the position on implementation. The policy position is that there will be no further charge. That is not on the face of the Bill, as the noble Lord, Lord Patel, rightly points out, but I am giving him the policy position from the Dispatch Box. I hope that that reassures him and my noble friend on that point.

Baroness Tonge: Would the Minister be patient one more time? I thank him very much for giving way. Unless the granting of a visa is made dependent on paying the health surcharge, will poor migrants—let us assume that a lot of people wanting to come to this country are coming for a better life and are very strapped for cash—not waive the health charge, or whatever we like to call it, and assume that because they are healthy when they apply for their visa they will never need medical treatment? Is there not a danger that we are forcing people into a situation where they will not be able to receive any medical treatment at all because they will be too poor?

Lord Taylor of Holbeach: I have to say that we are not looking to put people in that situation. Indeed, one would hope—this is the reason for the provision—that if people are here for a period of time, they have got cover for their healthcare. That is the whole point of the charge in the first place. If people come as temporary visitors then that is a slightly different position, but they make that choice. They make the choice to come here, and they carry the responsibility to do so.

Perhaps I may turn to some of the amendments. It is good that we have had this chance to talk about the principles behind the charging and I hope that it has clarified the position to some degree. However, there are points here that I think I need to clear up. The first

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is that the restrictions to services set out in Part 3 are designed to protect our services from illegal immigrants—people who are remaining here outside the law. Many of these provisions will have no impact at all on pregnant women who are in the UK lawfully. The Government are committed to ensuring that the new restrictions and charges in Part 3 are appropriately targeted and do not impose a disproportionate burden on either service providers or migrants.

I should like to address some other points regarding Amendments 59, 60, 63, 64A and 65, which seek to exempt pregnant women from the health surcharge or the NHS treatment charges. I fear that there has been a misunderstanding about the purpose of the surcharge and the manner in which it will operate. As I say, the surcharge will be paid by legal, temporary migrants who come to the UK for more than six months. Our policy intention is that those who pay the surcharge, including pregnant women, will not be subject to most other NHS treatment charges. That will include both antenatal and postnatal care. They will be charged only for services that a UK resident might also be expected to pay for.

Amendment 60 also seeks to exempt children under the age of 18 from the surcharge. This would undermine the general principle that temporary migrants should contribute to the NHS, commensurate with their immigration status. Children are as likely to need NHS care as anyone else. It is therefore reasonable to expect parents—and it would be parents—to make this contribution on behalf of their child.

We have seen the headlines about health tourism. I am afraid that Amendments 63 and 65 would exacerbate the problem of maternity tourism. They would allow any pregnant woman to use the NHS free of charge. The NHS is not equipped to supply free maternity services for the rest of the world, and I do not think that that is an unreasonable thing for a government Minister to say.

Baroness Cumberlege: Amendment 63, which I tabled, proposes four new subsections. Proposed new subsection (1A) states:

“Notwithstanding subsection (1), any pregnant woman shall be treated as ordinarily resident”,

and proposed new subsection (1B) states:

“However, subsection (1A) shall not apply where there is evidence the woman has entered the UK for the purpose of obtaining healthcare”.

I think that is quite clear. I am saying that people who apply here simply for the purpose of obtaining healthcare should normally have to pay. Perhaps the Minister will clarify that. I am still very concerned about the three examples I gave. Will he address them? The first is a woman who came in with her husband and the relationship has broken down. Is she now exempt from these charges? The second example is a woman who is destitute and living on the streets. If she becomes pregnant as a result of a sexual assault, is she exempt? The third is a woman who is married to a British man and has submitted an immigration application to the Home Office who becomes pregnant and gives birth while the application is being assessed. Is she to be charged? It is not just maternity services; it is the other services being introduced in this Bill, such as prescriptions, dental care and A&E.

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Lord Taylor of Holbeach: My noble friend is very prescient because I was just about to turn to Amendment 63. It is exceptionally difficult to prove that a migrant had a prior intention to use the NHS. Pregnant migrants would simply say that they fully intended to return home for the birth of their child. It would be difficult, if not impossible, for us to prove otherwise if they were a temporary migrant. This amendment would require GPs and hospital staff to act as immigration officers, and that is exactly what we are trying to avoid in setting this charge.

I have an answer here for my noble friend on victims of sexual assault. I have been speaking for 30 minutes, which is way beyond the conventions of the House, in answering these amendments. I am quite prepared to go on if noble Lords are prepared to do so. Other noble Lords are waiting to hear the Statement, and I have to crave their indulgence. If I skip any points, I will try to sweep them up by writing to all noble Lords who have spoken on this group of amendments, but there are an awful lot of points. I am literally but halfway through my speaking notes.

My noble friend asked about the operation of NHS charging regulations. Urgent treatment will always be provided no matter what the circumstances, and the Department of Health will still have the power to exempt treatments from charges. It is considering what exemptions for vulnerable groups are appropriate as part of its reform programme; there is no provision in the Bill.

My noble friend also asked whether women who have outstanding NHS debts will receive care. Women who pay the surcharge will not incur NHS debts. Where illegal immigrants or visitors incur debts, they will still receive treatment where it is immediately necessary or urgent. Their NHS debt for this treatment exceeding £1,000 will be taken into account by the Home Office when determining future immigration applications.

I reassure my noble friend Lady Tonge and the noble Baroness, Lady Finlay, that pregnant women in need of NHS care will receive it. Our intention is that surcharge payers will receive this care free of charge, at a fraction of the real cost of maternity services. Those who do not pay the surcharge, such as tourists and illegal migrants, who might otherwise be charged for maternity care, are also protected. Guidance to the NHS is explicit that, in order to protect the lives of both mother and unborn child, all maternity care, including routine antenatal care, must be provided to all women without delay caused by charging issues. I hope that I have made that clear in all the answers that I have given: the health of mother and child is paramount, regardless of the charging regime or the status of the mother.

5 pm

I want to address the point that the noble Baroness, Lady Smith, made about victims of domestic violence. The Government are quite clear that domestic violence is a terrible thing and are committed to combating it in all its forms. If an individual is the victim of domestic violence, they have full protection of the criminal and civil law and of the law enforcement

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agencies, regardless of their immigration status. That is not in question. But that is not to say that all victims of domestic violence should expect that they can stay here in the UK. There is provision in the Immigration Rules to grant indefinite leave to remain to victims of domestic violence who are here as the partners of someone who is a British citizen or settled in the UK, or a Foreign or Commonwealth member of Her Majesty’s forces who would be able to become settled were it not for service in those forces.

The noble Earl, Lord Listowel, also asked about access to vulnerable people. On child immunisations, the Government are committed to protecting public health as a priority. The Department of Health has confirmed that existing exemptions from NHS overseas visitor charges will remain for treatment of specific infectious diseases; that includes HIV, for example. The Department of Health is considering which groups and treatments should be exempt from NHS overseas visitor charging as part of its wider reform programmes, and we will look at child immunisation in that way.

Baroness Smith of Basildon: I am sorry to intervene on the noble Lord; I know that noble Lords are anxious to get on to the next debate. The answer the Minister gave me was not the answer to the question that I asked. I asked about those who have leave to remain in this country and are here legally—they could be UK citizens—but, having fled the domestic home where they have been subjected to violence, do not have the documents to show to a landlord and so cannot prove their status. How does the noble Lord intend for that matter to be dealt with, given the problems that it will cause to women fleeing domestic violence?

Lord Taylor of Holbeach: My Lords, I remember that the noble Baroness painted this scenario and I understood it well enough; I am sorry if I missed that point in picking up another. There are exceptions for refuge accommodation and local authority-provided housing. After all, a broad range of individuals are in this situation. Social services will be able to help them with long-term housing needs and asylum seekers will also be authorised to rent. If I have not satisfied the noble Baroness, I do not want to mislead her or the House by giving her an off-the-cuff response which is beyond my brief at the minute. I will write to her, and copy in everyone, on this matter.

I am looking through these notes, and see that I have satisfied a number of questions—such as those raised by the noble Lord, Lord Patel, on children—in the way in which I have answered the broader matters. However, I recognise, too, that I may not have covered all the points made by noble Lords, but I am very mindful of the time. If noble Lords will forgive me, I will ask the noble Earl, Lord Listowel, to withdraw his amendment. I thank all noble Lords who have contributed to the debate, which is by way of a warm-up, I suspect, for further adventures in these fields with the amendments that are yet to come.

The Earl of Listowel: My Lords, I thank the Minister for choosing to give the lengthy reply rather than the short one. This is clearly a matter of great concern to

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many of us, so I am most grateful to him for taking the time to answer our points as carefully as he could. I beg leave to withdraw the amendment.

Amendment 48 withdrawn.

House resumed.


European Council

Statement

5.05 pm

The Chancellor of the Duchy of Lancaster (Lord Hill of Oareford) (Con): My Lords, with the leave of the House I will now repeat a Statement made by my right honourable friend the Prime Minister in another place. The Statement is as follows.

“With permission, Mr Speaker, I would like to make a Statement on last week’s emergency European Council.

What has happened to the Ukraine is completely indefensible. Its territorial integrity has been violated, and the aspirations of its people to chart their own future are being frustrated. This European Council sent a clear and united message to Russia that its actions are a flagrant breach of international law and will incur consequences.

We agreed on a three-phased approach to stand up to this aggression and uphold international law: first, some immediate steps to respond to what Russia has done; second, urgent work on a set of measures that will follow if Russia refuses to enter dialogue with the Ukrainian Government; and third, that there should be a set of further, far-reaching consequences should Russia take further steps to destabilise the situation in Ukraine.

Let me say a word on each of these steps. First, as a response to what Russia has already done, we agreed on some immediate steps. We have suspended preparations for the G8 in Sochi indefinitely. As I told the House last week, my view is that it would be completely wrong for a G8 summit to go ahead at all under current circumstances.

We decided to stop work on a comprehensive new agreement on relations between Russia and the European Union, and we immediately suspended the talks that were under way on a more liberal visa regime in the Schengen area—the thing that Russian Ministers and business delegations have pushed for more than anything else.

Here in Britain, I have ordered an urgent review of all government business with Russia. We have already announced that no Ministers or members of the Royal Family will visit the Sochi Paralympics. Many other planned ministerial-level contacts will be cancelled in current circumstances.

All bilateral military co-operation is under review, with the presumption that we will suspend it, except for work carried out to fulfil international treaty obligations, such as European arms control inspections. I have ordered a review of licences for arms exports to Russia. It is hard to see how anything that could be used in Ukraine could be justified. However, as with other measures, it is best if possible to take these decisions in concert with our European allies.

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There has been intense work to persuade Russia to come to the negotiating table with the Government of Ukraine and to discuss its stated concerns face to face. The idea of such a contact group that included other countries and organisations was one I first proposed to the Polish Prime Minister back in January.

The Council agreed that it was essential for such talks to start within the next few days and for them to deliver progress quickly. We also agreed that if Russia did not co-operate there would need to be further measures—the so-called second phase—which would need to start rapidly. So at my instigation, the Council tasked the European Commission to begin work on additional measures which could be taken against Russia if these talks do not get going or do not start producing results. Those will include asset freezes and travel bans.

We are working closely with our American, European and other international partners to prepare a list of names, and these sanctions, plus the measures already agreed against Yanukovych and his circle, will be the focus of a meeting here in London tomorrow with key international partners.

There is an urgent need to de-escalate tension in the Crimea. We are all clear that any referendum vote in Crimea this week will be illegal, illegitimate and will not be recognised by the international community. I have to say, in addition, that any campaign would be completely impractical as well as illegal. There is no proper register, no proper campaign, and the territory is covered in troops. It is completely impossible for a proper referendum campaign to be carried out. As I discussed with Chancellor Merkel last night in Hanover, Russia can choose the path of de-escalation by signalling that it understands that the outcome cannot be acted on as legitimate. Chancellor Merkel and I were clear that any attempt by Russia to legitimise an illegal referendum would require us to respond by ratcheting up the pressure further.

Thirdly, and most significantly, we agreed that it was essential to stop Russia taking further unacceptable steps in Ukraine. The Council agreed that, if further steps are taken by Russia to destabilise the Ukraine, there will be additional and far-reaching consequences for the relationship between the Russian Federation on the one hand and the European Union and its member states on the other. The Council conclusions state that these consequences would,

‘include a broad range of economic areas’.

Britain played a leading role in helping to reach this agreement, including through a meeting that I convened with fellow leaders from France, Germany, Italy and Poland on the morning of the Council. Such sanctions would have consequences for many EU member states, including Britain. However, as I argued at the meeting, the costs of not standing up to aggression are far greater. Britain’s own security and prosperity would be at risk if we allow a situation where countries can just flout international rules without incurring consequences.

Finally, we decided to send a political message of support to the Ukrainian Government and people. The Ukrainian Prime Minister spoke at the European Council with great power and force. The Ukrainian people want the freedom to be able to choose their

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own future and strengthen their ties with Europe, and they want a future free from the awful corruption that they have endured for far too long. At the request of the Ukrainian Prime Minister, we agreed to bring forward the signing of the political part of the EU’s Association Agreement with the Ukraine, and to help Ukraine tackle corruption.

The EU has now frozen the assets of 18 people linked to the former regime, and Britain has deployed a team to Kiev from our National Crime Agency to help the new Ukrainian Government go after ill gotten funds and return them to the Ukrainian people. It is vital that Ukraine proceeds towards free and fair elections, which enable all Ukrainians, including Russian speakers and minorities, to choose their leaders freely. Britain is now providing substantial and immediate technical assistance to Ukraine to support elections and assist with reforms on public financial management, debt management and energy pricing. Ukraine also needs support to stabilise and repair its economy. The EU agreed unilaterally to lower trade tariffs and to work with the International Monetary Fund on a package of financial assistance to the Ukrainian Government.

As I agreed with President Obama during our call this weekend, there is still an opportunity for Russia to resolve this situation diplomatically. It should engage in direct talks with the Ukrainians; return Russian troops to their bases in Crimea; withdraw its support for this illegal and unconstitutional referendum in Crimea; and work with the rest of the international community to support free and fair elections in Ukraine in May. No one should be interested in a tug of war. Ukraine should be able to choose its own future and act as a bridge between Russia and Europe.

Britain’s own future depends on a world where countries obey the rules. In Europe, we have spent the past 70 years working to keep the peace, and we know from history that turning a blind eye when nations are trampled over stores up greater problems for the longer term. We must stand up to aggression, uphold international law, and support the Ukrainian Government and the Ukrainian people, who want the freedom to choose their own future. That is right for Ukraine, right for Europe, and right for Britain”.

My Lords, I commend the Statement to the House.

5.14 pm

Lord Hunt of Kings Heath (Lab): My Lords, I thank the noble Lord the Leader of the House for repeating the Statement made by the Prime Minister in the other place. I join him in expressing deep concern about the situation in Ukraine. Since this matter was discussed last week, we have seen an illegal referendum announced in the Crimea, OSCE observers prevented from crossing into the region by Russian forces for four days running and, yesterday, violence on the streets against anti-Russia demonstrators.

We support the twin-track approach of encouraging dialogue and, at the same time, maximising pressure on the Russian Government. However, no one looking at the unfolding situation on the ground would conclude that this is yet having the desired effect. It is on that basis that we should examine the discussions taking

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place, the outcome of the EU summit and the steps that should be taken in the days ahead. Of course, getting agreement among the EU 28 is always difficult, particularly when a number of member states are vulnerable to Russian action on issues such as energy. However, as we agreed last week, this is a test of EU resolve and of its commitment to uphold the rule of law, democracy and human rights—values that it prides itself upon as an institution.

I would like to ask the noble Lord the Leader of the House about the Prime Minister’s talks with the German Chancellor. I welcome the proposal for a contact group involving President Putin and the Ukrainian Government. Does the noble Lord agree with me that Russian co-operation in the establishment of this group is an absolutely necessary, though not sufficient, signal of its willingness to resolve the crisis by diplomatic means? I welcome the things that were agreed at the EU summit. These include the unity of the EU in condemning Russia’s actions and the decision to provide support and encouragement to the Ukrainian Government, including €11 billion of aid.

The Prime Minister also made reference to the suspension of both visa talks and a new agreement on EU-Russia relations. These are welcome although they had already been announced on 3 March before the further developments had taken place that I referred to at the start of my remarks. Does the noble Lord therefore accept that the evidence from recent days suggests that these measures alone will be insufficient to get Russia to change course and that further action will therefore be required?

Turning to what more needs to be done, I welcome the European Council’s decision to look at further measures, although the agreed language is weaker than we would have wished in that the communiqué merely committed to “take forward preparatory work”. I welcome what the noble Lord said about asset freezes and travel bans. Will he confirm that there will be a timeframe of days, not weeks, for their implementation, particularly given that the United States is already committed to action on this?

On the EU-Russia summit, unless there is an immediate change of course by the Russian Government, surely at the very least it makes sense to suspend preparations, as has already been done for the G8 summit. Beyond this, we welcome the Prime Minister’s Statement that we need actively to look at other measures. I urge the Government in the days ahead to build support for further measures among our European and other allies to prepare for the eventuality that they may be required. Specifically, if Russia does not change course, will the noble Lord confirm that the Government will consider working with the G7 to suspend Russia from the G8, something that the Prime Minister specifically called for at the start of the crisis in Georgia?

Following the announcement that the UK Government are reviewing every outstanding arms export licence to Russia, will the noble Lord confirm the timescale for the conclusions on this issue? Will he say what scope he believes there is to get an EU-wide agreement on the issue of arms exports? Will he confirm not only that the Government are open to wider economic and trade sanctions but what the circumstances are in which he thinks they would be required? Will he

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specifically confirm whether he would regard it as an appropriate response to Russia using the referendum to tighten its grip on the Crimea? This would clearly represent a major step and should not be done without consideration of consequences, but does he accept that it may be necessary if we do not see the change of course that is needed from Russia?

Let me say in conclusion that we should continue to use all possible channels to facilitate dialogue, encourage the Ukrainian Government to be as broad-based as possible and recognise the constraints on the Prime Minister in seeking to reach EU-wide agreement. However, we urge the Government, particularly as we approach the referendum in Crimea, to apply maximum influence on our allies so that, in turn, maximum pressure can be applied on the Russian Government. Hesitancy or weakness on the part of the EU about its response will send the wrong message. The UK has a vital responsibility in making sure that that does not happen and that, instead, the EU and the US stand together in clear and united resolve. The Opposition will provide the Prime Minister with all the necessary support as he seeks to achieve this.

5.20 pm

Lord Hill of Oareford: My Lords, I am grateful for the comments of support from the noble Lord, Lord Hunt of Kings Heath, and I agree with his concluding remarks about the responsibility that the British Government have—in particular the Prime Minister—in trying to pursue the twin-track approach in the way that the noble Lord described by working with both the United States and our partners in the European Union. I believe that the Prime Minister has been doing that assiduously in recent days.

I agree very much with the remarks that the noble Lord made at the beginning of his response about the importance of the contact group. It is, I suppose, our overriding aim at the moment to try to get that work taken forward and to apply pressure on the Russians to become involved in that process, because ultimately getting them and the Ukrainians to talk directly together is the most sensible way forward.

The noble Lord was concerned about whether the measures already announced were insufficient and he asked whether further action would be required if the Russians continue to behave in the way in which they have behaved in recent days. The honest answer to that is that the steps that Britain, the EU, the United States and others take will depend on the response that Russia gives. We are trying to be clear, consistent and predictable in setting out our position on that and on what would happen if Russia took further steps to destabilise Ukraine. That is what lies behind the idea of having a three-step, phased approach.

So far as travel bans and the freezing of assets are concerned, whether we move to that stage will depend on whether Russia agrees to the setting up of the contact group that we discussed. If Russia does not accept that, the Prime Minister has made it clear that travel bans and asset freezes would follow. He has also been clear that that should be able to happen within days rather than weeks, as the noble Lord asked me.

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As to whether it would make sense to suspend preparations for the EU-Russia summit as well as for the G8, it is the Government’s view that it would make sense for those measures to be considered in tandem and that the summit should not go ahead under the current circumstances. In response to the noble Lord’s question, we would look at all our options. As to whether we should suspend Russia from the G8, if progress is not made in setting up the contact group a step that could be taken would be to bring forward the revival of the G7, which would send a very clear message to the Russians. However, it would be better if things did not come to that and if we could resolve the issue through diplomatic means.

So far as the arms licences and the timescale are concerned, the Government are keen to review that issue across the EU to create the greatest amount of common ground that we can. So far as Britain is concerned, as the Statement made clear, the Prime Minister has already given instructions that a review of arms licences between Britain and Russia should be carried out immediately.

I can confirm that broader economic and trade sanctions are being considered. If the referendum in Crimea is approved and endorsed by Russia, the Government’s position on it is extremely clear: we cannot accept the referendum as legitimate. We think that it would be essentially farcical. There is no electoral register, there is no ability for people living within Crimea to travel from one side of the region to another and it would be impossible to have a proper campaign in the time available. If, despite that, Russia were to respond to the referendum and claim that it was legitimate, then the kind of broader trade and economic sanctions to which the noble Lord referred would certainly be considered.

5.25 pm

Baroness Falkner of Margravine (LD): My Lords, I, too, join in thanking the Leader of the House for that rather cautious Statement, but perhaps caution is the order of the day at the moment. I would like to press him on two matters. One is the composition of the contact group. We heard last week of the formation of the group and, indeed, in today’s Statement we are told that the Prime Minister was considering this back in January. Would the contact group be an EU initiative comprising just EU countries or would it be a wider group of countries that are slightly more disinterested and possibly therefore have more leverage with Russia? The noble Lord will be aware that when I asked my Question about Ukraine on 27 February when the Russian action was just beginning, I asked whether the good offices of the United Nations Secretary-General would be employed. I urge the Leader of the House to take that message back. However, it may well be more significant to have a contact group that comprises the wider international community rather than just the EU countries that he has mentioned. Can he tell us his thinking in this regard?

My other point concerns the 21 February transition. It may well be worth considering now what measures from that transitional agreement might be applicable. Regarding the elections to be held on 25 May, it would

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seem legitimate to reflect that at this time, when intense diplomacy is required and when any miscalculation on the part of any country could result in an upping of the stakes, we should consider urging the Ukrainian Government to go for talks through a contact group or to have direct talks with Russia, rather than rushing to elections on 25 May, perhaps sticking to the agreement of 21 February to have elections a little later and, when those elections come, to offer protection for all minorities. I look forward to hearing my noble friend’s response.

Lord Hill of Oareford: I understand the points made by my noble friend about the composition of the contact group. When my right honourable friend the Prime Minister talked to President Putin yesterday, he made the point that the precise format and composition of those talks is slightly less important than getting them going. I am not able to give a precise answer as to who the participants might be because that would clearly be part of any negotiation and discussion that would need to take place. However, the points made by my noble friend will clearly be taken on board and listened to by the Foreign Office as we go forward, as will her other point about the transitional agreement and so on. At the moment, all these areas are in a state of flux, so I am clearly not able to answer with the kind of precision that my noble friend or others might request. However, at the moment our priority is certainly to seek to bring about a de-escalation. The best way of doing that, whatever its precise form, is to find a way of the Russians and Ukrainians talking directly to each other.

Lord Grocott (Lab): My Lords, of course it is right that the Government should say that we cannot have constitutional change, and certainly not territorial change in the boundaries of any country, under duress or the threat of force. However, I would like some clarification on the Government’s position in respect of a referendum in Crimea. Again, the Government are quite right to say that the logistics of any referendum make it impossible or unrealistic for it to take place within a week or so. However, if it becomes the settled view of the people of Crimea or indeed any other country that the present constitutional arrangements are not to their liking, then surely it cannot be the Government’s permanent position that we will, as a matter of principle, say that we will reject that in all circumstances and at any cost.

Lord Hill of Oareford: Whatever form a referendum might take, it needs to be consistent with what is set out in the constitution of Ukraine itself. The simple point about the proposals for the referendum in Crimea is that it is utterly inconsistent with the Ukrainian constitution, which should control it—apart from some of the other practical points to which the noble Lord has already referred, including that when OSCE monitors and others have turned up to try to see the situation, they have been turned back at gunpoint.

Lord Howell of Guildford (Con): Has my noble friend noted some of the commentaries, particularly in the United States, where people still seem to think that we are fighting the Cold War? Will he join others in seeking to explain that the approach by our right

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honourable friends and our fellow European Governments in looking at the economics of the situation are a much more subtle and effective way of bringing pressure to bear on Moscow and Russia? Does he recall that the Russian economy really floats and survives on a sea of revenue from gas and oil? It may be a supplier, but suppliers need customers. This is the language in which we should bring to bear our efforts to improve Russia’s behaviour and make it more sensible in dealing with a very complex and difficult issue in the Crimea and in Ukraine.

Lord Hill of Oareford: My noble friend makes, as one would expect, a number of extremely pertinent and wise remarks which underline the fact that the importance of financial and trade sanctions should not be underestimated. There are those who seem to suggest that this is some kind of empty threat, but as my noble friend has illustrated forcefully, it is not an empty threat at all. That is why those options are all being considered. At the European Council meeting the member countries made it clear that those options would be considered if we needed to turn to them.

Lord Lea of Crondall (Lab): On the question of elections, is it not the case that if a country is divided very much on communal lines and identities itself in terms of nationalism, religion or, indeed, history and geography, as it does, elections which have been taking place under the present constitution—whether it is Tymoshenko or Yanukovych, whereby a result of 51% to 49% means winner takes all—do not work? I know enough about Ukraine to know that this has been coming for some time, because it does not work. Not only does it not solve problems, it exacerbates them. The United Kingdom has experience of something analogous, and I am talking about Northern Ireland. We all know that there are no easy answers but we found that instead of just having elections at 51% to 49%, along with Dublin—which is the equivalent of Moscow in this analogy—we brought people along, step by step, to power sharing. I do not know whether I can ascertain from the Leader of the House whether our experience here would be rather useful in discussions with our colleagues, and indeed with the people, in Ukraine. Can he say whether that experience has been brought to bear, and if not, would it be useful to do so?

Lord Hill of Oareford: The focus of the discussions last week was on prior questions about the need to set up a contact group, the legitimacy of the referendum, the steps that the EU would take and all the rest of it, rather than the minutiae—it is not minutiae, it is an important point—of how Ukraine would organise its own electoral system. I take the noble Lord’s point about some of our own experience, but I do not think that it is our task to try to prescribe how Ukraine carries out its own elections. The most important thing at the moment is that its constitution should be respected and its people should be able to make a decision themselves about the kind of future they want.