The amendments are also intended to provide further protection to landlords. The provisions create a civil penalty scheme which the Government are committed to applying on a light-touch basis. Where a suspected contravention is discovered, the Secretary of State may issue a penalty notice, including where they are not immediately contactable. The landlord is then afforded a right to raise objections. Where these objections show that the landlord has a statutory excuse from a penalty, they will be notified in writing. No further consequences will arise if the objections show that the landlord has a statutory excuse.

The power to increase a penalty is important—it is a kind of parallel power—as it may not be immediately clear whether the landlord has been previously penalised in this way. The landlord may, where it is decided to maintain a penalty, appeal to the courts. That is the right order of events: rather than going immediately to appeal, adjudication can take place informally between the landlord and the Secretary of State.

12 Mar 2014 : Column 1799

It is proposed that where a penalty remains unpaid the Secretary of State should be able to pursue recovery through the courts if the penalty were due under a court order in exactly the same way as a civil penalty. In cases where an appeal has been heard by the courts, this avoids the landlord, the Secretary of State and the courts having to return to the same court to hear an application for judgment for an amount the court has already determined should be paid by the landlord.

Turning to Amendments 55A and 55B, to which my noble friend wanted me to pay attention, I remind the House that the proposed sanction is a civil penalty, an administrative scheme; it does not form part of a criminal investigation. Clause 23 places a responsibility on the landlord and/or agent to evidence that they have complied with the prescribed requirements and have maintained an excuse against a penalty where necessary. That does not mean to say that the Secretary of State is not required to establish that there has been a contravention of Clause 17 to justify the issue of a penalty notice, nor that the Secretary of State will not engage with the landlord or agent and give them the opportunity to establish an excuse before a penalty notice is issued. I can confirm that the intention is that landlords and agents will be invited to demonstrate their excuse before a penalty notice is issued. However, in cases where the landlord or agent refuses to co-operate with an investigation, the Government consider that this is a proportionate and practical approach. The landlord or agent can easily prove that they have undertaken the checks by producing copies of the relevant evidence, whereas it would be difficult for the Secretary of State to establish a negative and establish that the prescribed requirements were not complied with.

6 pm

Perhaps I may turn to Amendment 55Q, because it was also mentioned. The amendment would limit the ability of the Secretary of State to impose a proportionate penalty. It may not be immediately obvious, for instance, that a landlord who is served a penalty has been served a penalty in the past, and so falls to suffer the higher penalty. Because of the nature of these arrangements there are indeed higher penalties for repeat offenders. The objection process may identify information which suggests that the penalty should be raised as well as lowered, and the Secretary of State should be able to take this into account.

This group of amendments also relates to the checks required of landlords. Removing the need for further checks when a tenant’s immigration leave is to expire will fail to deter overstayers. Allowing landlords to avoid the further checks by reporting a contravention may tempt some landlords simply to take the easier route, regardless that the tenant may have extended their immigration leave, which is the reason why these documents need to be checked. This will not serve the policy objective well and has the potential to undermine the whole scheme.

I turn now to the regulations that will make it clear to landlords which documents are acceptable in establishing an excuse. My noble friend Lady Hamwee laid great store by this area, and I agree that it is an

12 Mar 2014 : Column 1800

important aspect. Allowing the use of any document that purports to be an immigration document risks opening the way for fraudsters; nor should there be a need for certified copies because that will lead to extra costs and potential delays. It is quite reasonable to expect tenants to produce original documents for checks. As regards non-EEA family members of EEA nationals, these family members will be able to show Home Office-issued residence permits or certificates of application as evidence of their right to rent. The noble Baroness asked what would happen when these documents are not available because they might be lodged with the Home Office with an outstanding application. The landlord’s checking service will be able to confirm in writing that the landlord may rent within 48 hours. That is a commitment which we have put into the legislation.

I hope that my noble friend will feel able to withdraw her amendment, and if I have failed to satisfy her on any points, I will write to her.

Baroness Smith of Basildon: I apologise because I now understand why the noble Lord is inching towards our pilot. However, I have asked him a question in the last two debates: has any assessment been undertaken of the impact of this part of the Bill on the availability of rooms to rent and properties to rent?

Lord Taylor of Holbeach: I cannot give the noble Baroness an absolute answer to that question. Of course one of the reasons why the rollout is important is that we need to check to see if there are any adverse implications in this policy.

Lord Avebury (LD): My Lords, can I ask the Minister a question about asylum seekers and persons appealing against a refusal of asylum who are occupying rooms in private houses? It has been said that there are quite a few people doing this, notwithstanding the fact that accommodation is normally provided for them under the Immigration and Asylum Act 1999. Can my noble friend elucidate what provisions are being made for documents to be produced by those who are occupying rooms in private houses because they are not covered by the provisions of Schedule 3, to which he has referred? They deal only with the accommodation that is provided to most asylum seekers under the 1999 Act when they cannot afford to pay for accommodation of their own. However, there is still an important residual group of people who find space in private houses. They will need documentary proof that they are allowed to live in those houses and thus ensure that landlords are not breaching the conditions by taking them in.

Lord Taylor of Holbeach: I think I have made it clear that for people who have asylum seeker status, where it is not safe for them to return and therefore they may be failed asylum seekers, the Home Office will provide the necessary documentation to show that they have a right to accommodation even though their status may well be that of failed asylum seekers.

The Lord Bishop of Newcastle: My Lords, perhaps I may also ask for some clarification. One of my concerns about this part of the Bill is that many landlords will simply not rent to anyone who seems to be foreign or who does not hold a British passport for fear of

12 Mar 2014 : Column 1801

getting it wrong and being fined. I am afraid that that will inadvertently result in further racial discrimination and provide a charter for those unscrupulous landlords who are racist.

In response to the consultation, the Government accepted that the new rules might provoke landlords to discriminate against people they perceive to be foreign rather than to conduct proper checks. They also recognised the risk that vulnerable people might be impacted. So, is the code of practice and the associated guidance which will make it clear that the checks do not allow landlords to act in a manner inconsistent with the UK’s equality legislation sufficient? It simply requires landlords to read the code and adhere to it without any redress at all if they do not. Moreover, it will be extremely difficult and costly for any potential tenant to bring a challenge of discrimination or victimisation against a private landlord. If people cannot rent relatively easily, they will be forced to seek accommodation in the more shadowy parts of the housing market. I wonder whether the Minister can tell me whether I am right or wrong about this.

Lord Taylor of Holbeach: My Lords, I do not want to sound complacent because I recognise that this is a cause of anxiety which has been expressed in meetings I have attended. It has also been expressed by other noble Lords in our earlier discussions about the Bill. I do not want to lay too great a store by the codes, but those codes exist, and I do not want to lay too great a store by racial discrimination legislation, which would clearly apply in such circumstances.

What I will do is to ask the right reverend Prelate to accept that this surely applies in connection with employment. I do not know whether the right reverend Prelate feels, as he looks at the nature of people who are engaged in work in this country, that there is widespread evidence of racial discrimination, but I would have thought not. I think it is to the great credit of this country that it is able to welcome people, and this is certainly not a Bill that is designed to make people unwelcome, as long as they have a right to come here and to remain here. That is the principle of this legislation, and I hope the right reverend Prelate will be reassured by that. It is not meant complacently but I believe that, at bottom, the analogy with employer provisions is a good one and leads me to suggest that the particular fear that the right reverend Prelate refers to is not the cause for concern that he thinks it is.

Baroness Hamwee: My Lords, this discussion has confirmed for me the complexity of the provisions, and therefore the advantages in having the sort of verifying body to which the noble Lord, Lord Best, referred in the previous group of amendments. We will come later in the Bill to the position of immigration advisers and tightening up arrangements there. It seems that, as well as rogue advisers, there must be many who are simply incompetent. One could almost say, “Who can blame them?”, but nevertheless I do blame them. Any arrangements which can make it simpler for those who are, as it were, at the coalface to operate will be very welcome. This debate has confirmed that in my mind. My noble friend Lord Avebury has been muttering in my ear about whether case law on

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employment restrictions applies here. That is another area where I dare say the Minister would say that it depends on the facts, but it is a good illustration of what we may be dealing with.

The Minister said that there was no need for a certified copy of a document, but I was suggesting—I hope—that it could be an option. The reference to the 48 hours to check reminds us all that, in this extraordinary letting market, the property will be gone in 48 hours. The Minister in the Commons talked about the increase in the penalty being based on “aggravating factors”. He said:

“If new information comes forward that demonstrates that, for example”—

I must concede that—

“the mistake was not innocent, but some sort of connivance was involved … it seems only right … that someone looking at the issue afresh should take that into account and reach a conclusion accordingly”.—[

Official Report

, Commons, Immigration Bill Committee, 7/11/13; col. 272.]

In my mind, that sort of connivance would be a new fact. I would be very happy to look at the language but I am concerned about the deterrent properties of this. I would hope that we might be able to pin that down a little more.

I will carefully read what the Minister said on this as it is a technical point. He referred to the detail of Schedule 3. My noble friend again questioned whether paragraph 8 of Schedule 3 covers the ground that we are concerned about. Going back again to the workability of these arrangements, I must of course read carefully what the Minister has had to say. I thank him for his answers and for what I think he said implicitly. These are detailed points which we might, if it is appropriate, look at again before Report so that we can make sure that anything we raise on Report is justified and not already covered. The Minister is nodding. I beg leave to withdraw the amendment.

Amendment 55A withdrawn.

Clause 16 agreed.

Amendments 55B to 55E not moved.

Clauses 17 and 18 agreed.

Amendments 55F to 55H not moved.

Clauses 19 and 20 agreed.

Amendments 55J and 55K not moved.

Clause 21 agreed.

Amendments 55L and 55M not moved.

Clause 22 agreed.

Amendments 55N and 55P not moved.

Clause 23 agreed.

Amendment 55Q not moved.

12 Mar 2014 : Column 1803

Clause 24 agreed.

Amendment 55R not moved.

Clause 25 agreed.

Amendment 55S not moved.

Clause 26 agreed.

Amendment 55T not moved.

Clause 27 agreed.

Amendments 56 to 56D not moved.

Clause 28 agreed.

Amendments 56E and 56F not moved.

Clause 29 agreed.

Amendment 56G not moved.

Clause 30 agreed.

Amendment 56H not moved.

Clause 31 agreed.

Amendments 56J to 56L not moved.

Clause 32 agreed.

6.15 pm

Clause 33: Immigration health charge

Amendment 57 not moved.

Amendment 58

Moved by Lord Patel

58: Clause 33, page 27, line 24, leave out from “charge” to end of line 25

Lord Patel (CB): My Lords, after Monday’s debate, I do not think this should take very long. Amendment 58 relates to Clause 33, on immigration health charges, and specifically to subsection (3)(b), which says:

“An order under this section may in particular … specify the amount of any charge (and different amounts may be specified for different purposes)”.

My amendment would remove the words in brackets. As I understand it, we already have the defined charges of £150 for students and £200 for other immigrants.

In the debate we had on Monday, I asked the Minister:

“Once that levy has been paid, it will allow them”—

we were speaking about students—

“to access all health services. Is that quite clear?”.

The answer the Minister gave was:

“Yes, that is exactly right. They will have the same access to health services as is available to a permanent resident”.—[Official Report, 10/3/14; col. 1573.]

Later in our discussions I said:

“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”.

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In his reply, the Minister corrected me. He said:

“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”.

I accept that. But he went on to say:

“But yes, that is exactly right”.—[Official Report, 10/3/14; col. 1574.]

That is, there will be no further charges and all health services will be available to whoever has paid the levy or the health service charge—students or other immigrants.

In that case, I do not know why there is a need to have the words,

“and different amounts may be specified for different purposes”.

We need to know what these purposes are and whether there will be extra charges. If there are, what will they be for, and what will be the tariff? That is my amendment. I beg to move.

Lord Avebury: My Lords, when we discussed this previously, I, too, asked my noble friend the Minister about the relationship of this provision to Clause 33(4), which says that,

“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”.

I said that that implied that certain services provided by the health service were not going to be free of charge to these people. My noble friend tried to reassure me on this point but it is there in the Bill. It seems inconsistent with the repeated declarations that were made by my noble friend the Minister—which the noble Lord, Lord Patel, has just quoted—that once you have paid this levy, you are free to access all health services provided by the NHS. If that is the case, Clause 33(4) should be deleted from the Bill.

Lord Hope of Craighead (CB): My Lords, when we discussed Clause 33 previously, the Minister was subjected to a very large number of points. I suggested then—and beg leave to suggest again this evening—that somebody should go over the clause very carefully and look at all the bits in brackets, of which there are quite a lot, and the various subsections and so on, to try to trim it down and make sure that it contains what is really necessary and does not have the opportunities for obscurities and criticism that it presently contains.

It is quite a difficult clause and I understand very well why when one gives power to make an order one wants to give as much scope as one can to the Minister, but this clause goes rather too far by trying to hedge too many bets, and I suggest that it should be looked at very carefully.

Lord Leigh of Hurley (Con): My Lords, I attended some of the debate on Monday and heard my noble friend Lord Bourne refer to the £200—or £150 because he was talking about the student rate at about £3 a week—as being very reasonable and fair. As he said,

“it is the cost of a Sunday newspaper”.—[

Official Report

, 10/3/14; col. 1605.]

It seems sensible that there is some flexibility in this health charge.

The cost to the National Health Service for an individual between the ages of 15 and 44—presumably young enough to be in reasonably good health normally —is £700 a year. Of course, that rises for older people.

12 Mar 2014 : Column 1805

As your Lordships may be aware, Professor Meirion Thomas has written extensively about the abuse of health tourism. Because we are not in the Schengen visa system, people do not need compulsory health insurance to come to the UK and as a result he has identified many instances of abuse by healthy people and particularly by people who are not well and pregnant women coming to this country to get health treatment without any coverage of costs.

It is true that the National Health Service has charged such “health tourists” some £300 million but it is also true that it has managed to collect only 16% of the amount it has invoiced. Other countries, such as America, Canada and Australia, have much more severe restrictions on people coming in without health insurance and consequently we get more than our fair share. I would argue for flexibility in the health charge and clarification, as the noble Lord, Lord Patel, requested, of the parts of the health service to which it applies.

Lord Rosser (Lab): My Lords, I would hope that if the intention of the words that the amendment seeks to delete is as the noble Lord, Lord Leigh of Hurley, speculated, the Minister will stand up in response and say it loud and clear to get it on the record.

I did not intervene in the debate on Monday. I read Hansard subsequently and I, too, was left somewhat confused as to the Government’s position. So I looked at the Explanatory Notes, and they do not explain the significance or purpose of the words,

“and different amounts may be specified for different purposes”,

which rather seems to defeat the primary objective of a document headed “Explanatory Notes”. The notes refer only to what is in Clause 33(3)(f), which is a reference to a “reduction, waiver or refund”. I then looked at the Home Office factsheet on Clauses 33 and 34, which also remains silent on the intention of the words, except to say that those who have paid the surcharge will be able,

“to access free NHS care to the same extent as a permanent resident, subject to some exceptions for particularly expensive discretionary treatments”.

I then looked at the letter we all received from the noble Earl, Lord Howe, dated 6 March, in the hope that the Department of Health might be able to throw some light on this, but the letter provides no help on the purpose or intention behind these words, which this amendment seeks to delete—although obviously the amendment has been tabled with a view to getting an explanation from the Minister as to what this means.

I then looked at what the Minister said on Monday. I came to the conclusion that the Minister, too, was unable to tell us why these words are in Clause 33. He said on Monday that those who have paid the levy will be allowed the same access to all health services,

“as is available to a permanent resident”.—[

Official Report

, 10/3/14; col. 1573.]

As the noble Lord, Lord Avebury, pointed out, 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”.

12 Mar 2014 : Column 1806

The Minister also said on Monday that when the Bill was initially implemented, it was the Government’s,

“clear policy intention that there will be no further charges for treatments”.—[

Official Report

, 10/3/14; col. 1572.]

But the Minister accepted that this policy stance was not in the Bill. He said that the Government,

“will clarify the position on implementation”.—[

Official Report

, 10/3/14; col. 1575.]

Frankly, the Government should be clarifying what their Bill means today. Will the Minister now indicate what the words,

“and different amounts may be specified for different purposes”,

are actually intended to mean, and will he give some concrete examples? What different amounts and for what different purposes do the Government have in mind? Is Clause 33(3)(b) simply some sort of ghost paragraph that the Government think may come in handy at some time in the future for purposes about which they are currently unclear? Can the Government’s present position on why and at what stage these words in the Bill will be applied best be summed up as, “Don’t know where, don’t know when”?

I hope that the Minister can today give us clear reasons—which is what the noble Lord, Lord Patel, asked him to do—as to why these words are needed in the Bill and clear up the confusion that I think a number of Members of the Committee, both those who intervened in the debate on Monday and those who subsequently read Hansard, feel exists at present.

6.30 pm

Lord Taylor of Holbeach: My Lords, it is helpful that we have had this debate; I am pleased that the noble Lord, Lord Patel, has moved the amendment. As he said, it was originally designed to supplement his amendment relating to students. I think that we have got a good story to tell in connection with students. If I may, however, I shall deal with the particular amendment, Amendment 58.

The noble Lord is right that the provision is not immediately transparent; indeed, the noble Lord, Lord Rosser, has challenged me on this point, too. I understand that the intention of the noble Lord, Lord Patel, may have been in respect of the exclusion of certain expensive discretionary treatments from the free access afforded by having paid the surcharge—I think that that was his concern. I said on Monday, and I am happy to repeat today, that no such exclusions will apply when the surcharge is introduced, and none is planned for the future either. We intend that the payment of the surcharge will provide the same access to health services as is available to a permanent resident.

I turn to the penetrating critique from the noble Lord, Lord Rosser. Both he and the noble and learned Lord, Lord Hope, felt that a degree of ambiguity lay within the clause, so perhaps I may explain why Clause 33(3)(b) states that,

“different amounts may be specified for different purposes”.

The answer is that it allows regulations to specify different amounts of surcharge for different categories of migrants—currently, there are only two amounts: the £200 rate and the £150 rate—without which we would not be able to give the discount to students, which is one of the elements of the Bill. We need this

12 Mar 2014 : Column 1807

capacity to do so. We do not have it in mind that there will be other categories, but this is the way in which the discount for students is facilitated by the legislation. It does not refer to NHS charging in the legislation.

Perhaps I may refer to the comments made by my noble friend Lord Leigh of Hurley, because we have a very different health system here from that in the USA and in Australia which requires a different solution. Health insurance requirements would be expensive and compromise our own competitive position in the international market for students and for workers, which is not what we want the Bill to do. Most EU countries do not enforce the Schengen visa health insurance requirement at their borders. A student applying to Harvard in the USA, for example—my noble friend Lady Williams of Crosby referred to Harvard and its great pull as a centre of learning for overseas students—has to pay a fee of $958 per year to access basic health services. To access Harvard’s more comprehensive health insurance plan, which is comparable to what the £150 rate gives access to, would cost a further $2,190 per year. That gives some measure of what is involved. We have already committed to this discount for students—that is what this clause is about—in recognition of their contribution to the UK, reinforcing, I hope, arguments that I am trying to make at regular intervals in our debates. They will pay just £150 instead of £200, which is 1% of the cost of coming to study in the UK and exceptional value for money, as I am sure noble Lords will agree.

Why does the Bill allow surcharge payers to be charged for further treatments? So that noble Lords are clear, I should clarify that the Bill does not prevent the exclusion of certain expensive, discretionary treatments from the free access. However, we have made it clear that we intend that no such exclusions will apply when the surcharge is introduced. The Department of Health has been clear that it will consider these in future only in the event of exceptional and compelling specific justification for health purposes; and any changes would need to be put before Parliament in the form of revised NHS charging regulations. One might say that this is for treatments which may in future emerge where it is considered that the health service quite properly should charge not just migrants but members of the UK population.

My noble friend Lord Avebury asked whether there was a problem with the drafting of Clause 33(4). The drafting purpose of Clause 33(4) is to provide a clear link in the Bill to health treatment. Without it, the clause would give an unlimited power to charge for any purpose, which is the intention neither of the clause nor of that particular subsection of it. I note what noble Lords have said about the wording of the subsection. It has been carefully drafted, but if I can provide noble Lords with an explanation of line-by-line implications, I shall do my best to do so before we get to Report. Meanwhile, I hope that the noble Lord will withdraw his amendment.

Lord Avebury:Where the Bill uses the words,

“likely to be available free of charge”,

in Clause 33(4), it anticipates the possibility that the Minister mentions—that while we do not intend to

12 Mar 2014 : Column 1808

charge anybody at the outset of the operation of the Bill for services of particular cost, we have it in mind to do so in the future. That would apply to students and to short-term migrants as well.

Lord Taylor of Holbeach: I think that I made it clear that the wording is designed to enable the health service, if it feels that particular treatments should be charged for, to do so. There is no intention to do so at present, but it is important that the Bill makes it clear that this is a facility which the health service wishes to reserve for itself. I think that it is quite proper for it to do so, but there is no intention on the introduction of the health charge for there to be any additional fees for additional treatments.

Baroness Tonge (Ind LD): My Lords, will the Minister clarify two things? I apologise if I appear to be Baroness Dim on these two points. The first is: will people who do not want to pay the health charge be refused permission to come into this country? I want to make that clear and have it in Hansard. Secondly, I am still not clear about the phrase that the Minister used a while ago, “different categories of charging”. I am still not clear about what will happen

Lord Taylor of Holbeach: There are two different categories of charge currently: that for students and that for everyone else. I just wanted to make that clear. The wording is general, but those are the two categories that the Bill is intended to introduce. On the question of whether paying the surcharge is mandatory, yes, it is for overseas applicants.

Lord Willis of Knaresborough (LD): Will the Minister confirm that the real purpose of the clause and those words is to open the gates so that at some time in future, UK residents could be charged for services?

Lord Taylor of Holbeach: No, that is not the case, but they may be, as they currently are, charged for particular treatments. There are some medical treatments available in this country which are not available under the National Health Service. That would remain the case. That is not the purpose of that particular phraseology. As I have explained, it is to provide for the charging of different categories of migrants—students and others. That is the purpose of the wording. The National Health Service has always said that it will provide health treatment free at the point of use. The purpose of the charge is to put applicants on the same basis as every other resident of this country, so the anxiety that my noble friend expresses is ill founded. This is not the vehicle for introducing mass charging for treatment under the National Health Service. That is not the purpose of the clause and it will not be possible to achieve it through this legislation.

Lord Hope of Craighead (CB): My Lords, I listened with great interest to that exchange. If the noble Lord is prepared to follow my suggestion and look at the wording, there is a bit of a mismatch between what one finds in Clause 33(1)(b), which mentions,

“any description of such persons”,

and the phrase,

“different amounts may be specified for different purposes”,

12 Mar 2014 : Column 1809

in subsection (3)(b). I could understand the linkage if one were talking about different charges for different categories of persons, but it is the breadth of the word “purposes” in subsection (3)(b) which causes difficulty. Looking to the future use of the clause when it becomes a section, it would really be helpful if it were a little more precise.

Lord Taylor of Holbeach: I thank the noble and learned Lord for that advice—free legal advice to the Government is considered to be very valuable. I hope that I have been able to explain what the legislation is intended to do and have reassured noble Lords on that point. Beyond that, I can commit to go back to look at the wording of the clause to see whether the intention could be made more explicit. That I will seek to do.

Baroness Barker (LD): Perhaps I may help the noble Lord. Noble Lords understand that there are now NHS treatments and services for which charges are made and that people who are resident in this country pay those charges, as do visitors. What is perplexing about the clause is, given that that is the case, what is the Government’s intention? Is it to reach a point in future where different categories of people have to pay for identical services? If the Minister could write to noble Lords and give us some examples of what scenario the Department of Health envisages under the legislation, that would be extremely helpful.

6.45 pm

Lord Taylor of Holbeach: There is nothing sinister here. This is not a Machiavellian move by the Government. It is to bring in a differential between the charge for students and the charge for ordinary migrants, which I am sure that noble Lords applaud. That is the objective. I reassure my noble friend that I will take her advice and write to Noble Lords on this point. I was here for Third Reading of the Pensions Bill, when mention was made of the weight of paper with which noble Lords have been bombarded concerning that Bill. I fear that we may be getting into the same situation here, but I hope that noble Lords will understand that, in technical matters such as this, it is often easier to put things in writing, because I can be more explicit.

Lord Patel: My Lords, I thank all noble Lords who have spoken. I have a few points to make. First, the Minister said that the subsections of Clause 33 were very carefully drafted. Listening to the debate, I think that there will be a collective opinion in the House today that that is not the case. I am pleased that the Minister said that he will look at the provisions to see whether the purpose for which they have been written can be clarified. I look forward to new amendments.

I am much clearer now about three things. First, once the health charge, or the levy, is paid, currently, for all those who pay the levy, health services will be available to them free of charge, just the same as permanent citizens of this country. That bit is clear. The second thing clarified by the Minister—I thank him for doing that—is that the words,

“and different amounts may be specified for different purposes”,

12 Mar 2014 : Column 1810

do not refer to health service charges but to categories of immigrants or students who we allow to come to this country.

The third purpose is what the noble Lord, Lord Avebury, referred to in subsection (4), which does refer to health charges that might be brought in subsequently. In answer to the question of the noble Lord, Lord Willis, the Minister was quite clear that they do not apply to residents of this country and that the Government had no intention of using this as a backdoor way to bring in charges in the NHS for citizens of this country. The subsection refers to extra charges that the Government may introduce through legislation which will be brought to Parliament in the first instance. I hope that I am clear in what I understand and that that is what the Minister said.

On that basis, until we see the redrafted clauses, I beg leave to withdraw the amendment.

Amendment 58 withdrawn.

Amendments 59 and to 60 not moved.

Amendment 60A had been withdrawn from the Marshalled List.

Amendment 61

Moved by Lord Rosser

61: Clause 33, page 27, line 36, at end insert—

“(4A) The Secretary of State will, within 12 months of the passing of this Act, lay before the House a report on the sums collected under this section and the expenditure thereof.”

Lord Rosser: This amendment also relates to Clause 33. The only comment I make to start with is that if all the verbiage in Clause 33 does is give the power to charge one rate to students and another to everybody else, it seems unbelievable that it cannot be made simpler and more explicit. I hope that the Minister will bear that in mind when he reflects on the debate that took place on the previous amendment.

Clause 33 provides the Secretary of State with a power by order to require certain migrants to pay an immigration health charge. It relates only to people who are seeking immigration permission; it does not relate beyond that. The charge would be paid by someone who was applying for leave to enter or to remain in the UK or for entry clearance. The amount, the method of payment and the consequences of non-payment will be set out in secondary legislation although, as has been said on a number of occasions, we understand from the Government that the amount of the charge will be £200 a year and £150 for students and that paying the charge will be a precondition of entry.

We agree with the principle of the charge. It is right in our view to require migrants who are here for a limited period to make a contribution to the NHS. We also agree that the test of ordinary residence is fairly generous. At the moment it is satisfied by many new and temporary migrants almost immediately and covers many people, including newly arrived family members.

12 Mar 2014 : Column 1811

We have tabled only one amendment to this clause, Amendment 61, which requires the Government to provide information to Parliament on the sums collected under Clause 33. Obviously, in large part the amendment is to find out a little more about the Government’s intentions on this score. The amendment asks for a review of the sums that are to be collected and how they are to be disbursed. The Bill states that the money will be paid into the Consolidated Fund or be applied in such other way as the order may specify. At Second Reading, in response to a question from my noble friend Lady Smith of Basildon, the Minister said that,

“on 20 January the Chief Secretary to the Treasury confirmed to departments and the devolved Administrations that the money that is collected by these charges … will go directly to health services”.—[

Official Report

, 10/2/14; col. 524.]

Where will this be set out, and where is the guarantee of it?

There are further questions. Will hospitals that treat a high proportion of foreign nationals get an appropriate or proportionate share of it and how will the money be shared with the devolved Administrations? What is the definition of the words “health services”? Could the money go to the private healthcare sector, for example? If the money is to go to health services, why not say so in the Bill and end any doubts on that score? Will the money from the charge be in addition to the money that the Government provide for the NHS or for health services, or will it be used to reduce the amount that the Government would otherwise have provided? In other words, is it extra money or is it simply going to be used to reduce the amount that the Government themselves provide? Some response to that point would be very helpful.

I want to ask about the implementation of the provisions, because in the consultation document the Government indicated that the migrants’ biometric residency permit would be endorsed to show that they were entitled to NHS treatment without further charge. How will hospitals and doctors be made aware of that? I ask that in the context—I understand that I may well be wrong, and I am sure that if I am I will be corrected—that the Department of Health will publish a full implementation plan—indeed I may be told that it has already done so—which will include plans to develop a new NHS registration process for the identifying and recording of patients’ chargeable status. If that has not already been produced, will the Minister confirm when it might be available? We also want to ensure that there is no disincentive for people who bring benefits to this country. One category is students. How will that charge be kept under review to ensure that it does not act as a disincentive for people who we would wish to come here to do so?

In probing what the Government’s intentions are and how they see this operating, I want to ask about transitional arrangements. The Minister has confirmed to us in a letter that affected migrants who are already in the United Kingdom at the time when the policy is implemented will not be liable to pay a surcharge and will not be charged for healthcare for the remainder of their leave if they were previously exempt from NHS charges. However, once their leave expires, the migrant will be required to pay the surcharge as part of any

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further immigration application unless they are applying for IDR. Will the Minister confirm where this will be set out in the legislation and how people will be made aware of it? In that scenario, how will a GP know whether someone who should pay the charge is covered if for that patient the charge becomes payable only when they apply for an extension of leave to remain? If a GP refers to hospital a patient who should have paid the charge, will the hospital also have to check that that patient has paid—a double check—or can the hospital accept that the GP making the reference will have done a check and rely on that?

The Minister said on Monday, in a discussion on the issue of the charge, that there would be no transitional arrangements. I ask him not to confirm that there will be no transitional arrangements, because that is clearly in black and white in Hansard, but to confirm that that also means that there will be no transitional costs relating to the bringing in of this payment. It would be helpful to have clarification on that.

I have raised a number of questions: what the Government’s intention are; how this will operate; where the money will be going; whether it will be used to reduce the amount that the Government provide to the health service or whether it will be additional money; what the definition is of “health services”; and whether the money could go to the private sector. I have also raised queries about the position of GPs and the checks that they have to make, and in particular whether there is a double check if they refer someone to a hospital or whether the hospital can take it that the GP will have done the checks and that is the end of the matter. I beg to move.

Baroness Barker: My Lords, I shall speak to my Amendment 66F in this group. Following the consultation in 2013, the Department of Health said that,

“while there is a great deal of speculation about the numbers of visitors and short-term migrants using the NHS, robust data are very limited”.

That is the point that I wish to address. I have no problem with the Government’s intention to introduce a health levy, and I have no problem with them seeking to have different rates for different groups of people. However, I want to be sure that when this House makes a major change to a fundamental policy that we have held in this country for over 60 years, that it does so on the basis of sound evidence.

Back in 2006, noble Lords will remember that proposals of this kind came before this House from the then Labour Government but then disappeared, principally because someone went back to the department and worked out that the cost of implementing the proposals far outweighed any benefit. It is simply good business practice to have done a cost-benefit analysis of a major change before one implements it. The Government are wedded to doing this—fair enough, and I have no doubt that they will go ahead—but it is only right that if they go ahead they should do so on the basis that its implementation will be thoroughly analysed, so that we do not find ourselves back here in five years’ time responding yet again to an agenda that has been set by various media organisations and political groupings on the basis of nothing more than speculation.

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7 pm

When we talk about this issue, we always find the Government talking about the work of overseas visitors officers and so on and claiming that there is a degree of undercharging and that the NHS budget would be helped substantially if we had a scheme such as this in place. People who work with minorities and vulnerable groups in our society have quite legitimate fears about the potential cost not just in terms of public health but of acute care if migrants and so on are deterred from seeking NHS services at an early stage. Neither side has any real, strong evidence base. This amendment seeks to build the evidence base so that we know the full cost, not just in financial terms but in terms of public health.

This amendment requires the Government to appoint an independent person to carry out a review. The amendment states that the review should cover a period of two years. Actually, I would prefer it to be three years. I do not believe that the review period of one year suggested by the noble Baroness, Lady Smith of Basildon, is long enough because it may be that there is something unusual. If this proposal had been put forward a few years ago, and we then proceeded to have a swine flu epidemic, it would have thrown the data completely. I would like to see three years’ comparative data.

The data should not be on just the simple, straight transactional costs of collecting the fee. They should be robust about the impact on public health and on the use of expensive acute services by people who have not gone to primary healthcare services because of the deterrent effect of the changes proposed in the Bill.

Baroness Meacher (CB): My Lords, Amendment 66 requires information outlining details of health charges for health services applicable to the individual to be given at the point of an application for immigration permission or upon request. One of the biggest worries about the health service clauses in Part 3 is that they could create confusion and wrongly discourage some migrants from accessing free healthcare to which they are entitled. According to the Catholic Bishops’ Conference of England and Wales, for whose briefing I am most grateful, there is already a notable lack of understanding about how the charges for health services will work among both individuals and healthcare professionals. Even more worrying, there has also been inconsistency in how charges are implemented.

Most welcome is the exemption from charging for the treatment of diseases which present a public health risk. However, public confusion could result in delays in people presenting themselves and therefore in diagnosis. Already in 2012, 47% of adults newly diagnosed with HIV were diagnosed late. I am not sure what percentage of those late diagnoses would be attributable in any way to confusion. Overall, 81% of AIDS-related deaths in England and Wales in 2012 were attributable to late diagnosis. There is an issue about timing.

Equally, unless people are made aware of their entitlement to health treatment right at the start of their application for immigration permission or when they request it, they are likely never to sort this out or to become clear about the services to which they are entitled. From the taxpayers’ point of view, it is crucial

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that those entitled to free GP consultations are aware of it. The risk is that fear of being charged for a visit to the GP may result in people not doing that and later needing an A&E appointment. The cost differential between these two options is £90 per patient and could over time add up to quite a bit for the taxpayer, quite apart from the detriment to the patient.

Does the Minister agree that readily available information accompanying any changes to the healthcare charging system or to the collection of charges—I understand that is going to be much tougher in future—is essential to prevent public health risks and unnecessary costs to the Exchequer? I hope the Minister will inform the House what assessment the Government have made about the current level of public understanding about healthcare charges and exemptions for specific groups and what steps they have taken or will be taking to improve awareness among healthcare professionals and members of the public.

Baroness Lister of Burtersett: Following what the noble Baroness, Lady Barker, said about the importance of the evidence base, I take us back to our debate on Monday. In that debate, a number of noble Lords questioned the evidence base for the claim that there is a problem of so-called health tourism in this country. They asked the Minister what the evidence base was for that claim and questioned the Department of Health’s report on it. The Minister had an awful lot of points to make in his summing up speech and, after about 30 minutes, he quite understandably thought that he had had enough and probably everyone else had, too. Although he has already helpfully circulated a letter following our first day, I could not see anything in it that responded to the concerns raised on all sides of the House. I use this opportunity to invite the Minister to respond on that this evening.

Lord Leigh of Hurley: Perhaps I should declare an interest as a chartered accountant. As such, I looked at Amendment 66F with care. I agree that it is important to have a proper review, analysis and evidence of real costs, but the trouble with the proposed new clause is that it asks for a calculation of the total charges paid, among other things, but it does not look for an assessment of the cost against those charges. For the proposed new clause to be meaningful and for the assessment of the health charge to be made, one would have to look at the costs incurred by the National Health Service for the £200 or £150.

Baroness Barker: As someone who is not a chartered accountant, I thank the noble Lord for the free advice. If I were to redraft the clause, I would include that in it.

Lord Taylor of Holbeach: My Lords, I welcome the general support offered by the noble Lord, Lord Rosser, for the surcharge. Indeed, I felt that there was support around the House for the surcharge in principle; it is just on implementation and the practicalities that the Government are quite properly being challenged.

The Home Office, which is responsible for administering the health charge, but not for spending the money, will be open and transparent about the operation of the

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surcharge. As my noble friend Lord Howe set out in his letter to all noble Lords last week—I hope it helped; it was designed to try to put these changes to the law in the context of wider health service reforms—the surcharge income will be allocated directly to the National Health Service across the UK. Allocation will be in accordance with the Barnett formula.

The dear and much-loved noble Lord is not in his place, but much as he seeks to see the end of his legacy in establishing the formula, it is still widely used in government and it seems the most appropriate way of ensuring that the money goes to the NHS. It will go to the NHS—the National Health Service—not to any other agency offering healthcare in this country. How the NHS spends it is for the Department of Health, of course, and the devolved Health Ministers, because health services are a devolved matter. The allocation of the money will be made by affirmative order, so we will have control here in Parliament of how this is finally resolved.

I note what my noble friend Lady Barker said in speaking to her amendment. While the Home Office already has a well established procedure through which it is accountable to Parliament, I appreciate that this House would benefit from the means to scrutinise the impact of the surcharge. I am therefore prepared to make a Statement to this House to provide information about the Home Office’s administration of the surcharge within 12 months of it going live. I hope that that will give some assurance to noble Lords on how the surcharge is working.

It may include details such as the number of migrants who pay the surcharge and the total amount of surcharge collected and directed to the National Health Service. I believe that this sort of transparency is important, and the Statement will provide proper transparency and provide the House with the necessary flexibility in scrutinising the surcharge scheme. Furthermore, any future changes to the core operating principles of the surcharge, including the amount to be paid, will have to be agreed by both Houses under an affirmative resolution procedure.

On Amendment 66, tabled by the noble Baroness, Lady Meacher, we intend to do our utmost to ensure that visa applicants understand the purpose of the surcharge and how it might apply to them. We will make the information available to individuals, including through our website and visa application centres. Indeed, the visa application form is where most people encounter this surcharge because it is directed only at those applying for a visa for a stay of six months or more. The form itself will explain it.

My noble friend Lord Attlee has pointed out in conversation that universities themselves might like to promote the student surcharge as being a very competitive offer at £150; it certainly is a bargain in global terms. However, it would be most unfair to ask migrants to pay a surcharge that they know nothing about. Both the reasons it is being charged and what it gives migrants access to are very important.

The noble Lord, Lord Rosser, asked when the Department of Health will publish its detailed implementation plan for patient registration and

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identification. If I say “shortly”, he will know that that word is used regularly enough. We do not have an exact date, but it will be shortly. He also asked how the transitional provisions would be set out and how a hospital will know if a person is a transitional case. This will be done in the order implementing the surcharge. We will use the patient registration system to flag people who have paid the surcharge. We will consider doing so also for those who benefit from the transitional arrangements. The simple production of a visa or biometric residence permit—BRP—that is current and valid will give evidence of free entitlement to the NHS, and transitional cases will be identifiable because their entry clearance or BRP will be dated before the commencement of the surcharge scheme, which will be known.

My noble friend Lady Barker asked about the costs of implementing the health charge and whether we have done a cost-benefit analysis. We have indeed. The Home Office has produced a full impact assessment on the Bill. It is available on the Immigration Bill page of the website.

The noble Baroness, Lady Meacher, asked about treatments for infectious conditions, such as HIV and TB, for example. They are free, and will remain so. It was this Government who abolished the NHS treatment charges for HIV.

I hope that I have answered most of the points. I will go through the record and see whether there are aspects that I have not addressed. The noble Baroness, Lady Lister, is looking particularly questioning. Can she remind me of what I have missed?

7.15 pm

Baroness Lister of Burtersett: Given that the Minister was able to slip out of answering this point on Monday—it did not seem fair to push him on it after he had covered so many points—perhaps I might remind him about the evidence base for health tourism. I have a snippet of information that one piece of research that the Department of Health is relying on is that, out of nearly 1,000 migrants screened by overseas visitors officers in more than 15 trusts during August 2013, only four individuals—0.4% of the sample—were identified as “health tourists”. Even if the Minister cannot now tell us what the evidence is for this claim of health tourism, I would be grateful if he could commit to write specifically on this issue, given that it kind of got left out of his last letter.

Lord Avebury: My Lords, when the noble Lord is replying on that point, will he deal with story of the 300 maternity patients who were alleged to have been treated at St Thomas’s hospital? When we last discussed this, the allegation was found to have been apocryphal. I would be grateful if the Minister would repudiate it.

Lord Taylor of Holbeach: I would not wish to get involved in hearsay or gossip or, indeed, the suggestion that some of this stuff is just newspaper chat. I will get back to the noble Baroness, Lady Lister, with a reasoned reply explaining the Government’s analysis of the situation. However, the purpose of this measure is not to do with health tourism at all; it is to do with

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providing a charge whereby people who stay here for more than six months make a contribution to the NHS. It will make it more difficult for people who are not entitled to access healthcare to do so, but that is a secondary purpose.

Baroness Meacher: Perhaps I might ask for clarification on one point. The Minister skated rather quickly over that fact that “it” will be explained on the visa application form. I wonder what “it” refers to. Will it spell out clearly that all health services freely available to permanent residents will also be available to the applicant as somebody who has paid the surcharge?

My second question concerns people with infectious diseases who may not have paid the surcharge but who will be entitled to free treatment for an infectious disease. What sort of action will the Government take to inform them of their entitlements?

Lord Taylor of Holbeach: The latter point is more difficult to answer positively; it is something which my noble friend Lord Howe would be in a position to reply to with authority. On the first point, I think that the wording which the noble Baroness suggested is particularly good. It sums up the policy as I have tried to describe it to the Committee.

Baroness Barker: My Lords, I thank the Minister for his response, which was far more helpful than I had expected. Perhaps I may press him a little further and ask whether he would be prepared to make not just a one-off Statement to the House about the introduction but perhaps to do so annually, or more than once, so that we can have comparative data in different years. That would give us a slightly more robust evidence base than we would have by having just a one-off Statement in the year after a measure has been brought in. A fair amount of information and attention would, presumably, attend its introduction.

Lord Taylor of Holbeach: I start from the position that an informed House is better able to make decisions and judgments on issues. Having said that, I am not sure that I could commit to making a periodic Statement on this issue, although I know that the Home Office will always respond to questions that might seek updated information of this type, and indeed there are other ways in which this House has the capacity to bring the Government to account on policy. At least by promising this Statement I am giving an indication that we are confident that this particular measure will be a success and raise money for the National Health Service, which will be to the advantage of the taxpayers of this country and a bargain for migrants to this country. I hope that my noble friend is reassured by that point.

Baroness Hamwee: My Lords, I am sure that my noble friend is reassured. However, I think that the Committee would also be glad to know—I do not expect the Minister to pin down the detail tonight—the range of issues that will be covered by a Statement. That addresses my noble friend’s point about the data which will be collected. We were quite rightly reminded about the costs of the services, which have not been included in our list. I am sure that there are other

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points as well. It is the detail that is important and that noble Lords will be interested to know. Perhaps I may leave that with the Minister as something to think about after this stage.

Baroness Williams of Crosby: If my long-suffering noble friend will be kind enough to bear with me for one minute, perhaps I may raise one further point which follows what the noble Baroness, Lady Meacher, said. I think that the Minister said in his response that it was already the case that no charges would be made under the NHS for treating infectious diseases such as AIDS and tuberculosis, and that that would still be true for those who are not permanent residents. I believe that I understood that correctly. It is therefore strange that I have had briefings, particularly from the National AIDS Trust and from bodies concerned with drug-resistant TB, asking that it should be made quite clear that there would be no charges for treatment in the cases of these wildly infectious and very frightening diseases. There is, therefore, something of a conflict of understanding which the proposal of the noble Baroness, Lady Meacher, might go some way towards meeting. However, it is troubling when a professional foundation says something quite different from what I understand we have been discussing and have been told here in this Chamber.

Lord Rosser: I, too, thank the Minister for his response. I am in much the same position as the noble Baroness, Lady Barker, in the sense that it went rather further than I thought it would go, so I genuinely thank the Minister for what he had to say in his reply. I am also sure that the Minister might wish to reflect on the number of points that have been made after he sat down. Bearing in mind that he has said that he will send a letter to pick up any points he has not covered, perhaps he will reflect further on some of the points that have been raised in the past few minutes.

I do not expect the Minister to respond to the questions now because he has said that he will write a letter. He has certainly not responded to some of the issues that I raised but I accept that he will do so in the letter. One of those issues, of course, is why it does not say in the Bill that the money will go to the NHS—why not put that in there? We are not proposing, are we, that the National Health Service will be disappearing within the next few years, so it is not the usual argument that you do not want to put this in the Bill because it might not be there for very long? Or at least I hope that that is not the point. I have not received a specific response yet, but I know that I will when the Minister sends the letter about whether this will be additional money to the National Health Service or whether it will simply be used to reduce the amount that the Government provide.

Lord Taylor of Holbeach: It will be an additional sum.

Lord Rosser: I also asked about whether there would be any transitional costs as opposed to transitional arrangements. I take it that the Minister will respond to that question, too.

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The Minister will be aware that doctors and other parts of the health service have expressed a view that the kind of checks they will have to make will be an administrative burden. I asked a couple of questions about whether a hospital, if a patient has been referred to it by a doctor, can assume that the doctor has done the check and not have to do a double-check, and how a GP can know whether a patient who is already in the country, and therefore not covered by these new arrangements, requires a renewed application to remain here. I am sure that that will be picked up in the Minister’s reply.

My general point—bearing in mind that some doctors have expressed a concern about what they feel will be an administrative burden, and that the Minister has said that a Statement will be made to Parliament—is whether the Statement will also cover whether the arrangements have imposed an administrative burden on doctors. As some doctors have raised the issue, this would be one way of getting an analysis of it and discovering whether there is any substance to it, or whether their fears have not been realised. Perhaps the Minister can also comment on that point when he sends the letter. Once again I thank the Minister for his reply, and I beg leave to withdraw the amendment.

Amendment 61 withdrawn.

Clause 33 agreed.

House resumed. Committee to begin again not before 8.27 pm.

Bletchley Park

Question for Short Debate

7.28 pm

Asked by Baroness Trumpington

To ask Her Majesty’s Government what plans they have for the future of Bletchley Park.

Earl Attlee (Con): My Lords, timings for the QSD are quite tight. I remind noble Lords that when the indicator shows “4”, noble Lords are in their fifth minute and therefore out of time.

Baroness Trumpington (Con): My Lords, I am very grateful for the opportunity this short debate presents to recall the significance that Bletchley Park represents to our history. This debate allows me to provide some background and context to the restoration that is being contemplated as a result of the £8 million financing that it has received. I hope that those involved will avoid creating a Disney theme park experience for the visitor—the Hollywood films that have been made to date bear little resemblance to the Bletchley that I recall. I still find it difficult to discuss this subject in public. After all, the Bletchley that I knew was a highly secret place and for many years we were forbidden from mentioning it.

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I am especially pleased to see that the noble Viscount, Lord Astor, will be speaking. His mother Sarah was my colleague and a great friend. Three weeks ago I was called to a small table in the tea tent of the Peers’ Dining Room where a host Peer and his wife had as their guest 96 year-old Pamela Rose. Pam worked and I typed through those wartime days and nights. We were employed by the Foreign Office, never in uniform, and we did not look after Colossus, as did the Wrens pictured so recently in the Times.

Let me try, very briefly, to describe my recollection of the Bletchley Park that I knew. I spent my time working in Hut 4, followed by Block B. We were never allowed to visit other offices. I am delighted that the original Hut 4 remains. In 1941, it was the centre of U-boat warfare research before Colossus; nowadays, Hut 4 is a bar. I never went into the mansion, which was known to me and my colleagues as “The Other Side”. The present day invaluable post office did not exist, and at the back of the mansion lay paddocks belonging to Captain Ingram’s stud farm. Nowadays, those paddocks are covered by huge housing estates, and only someone as old as me and as keen on racing as I am would know of their past. The pond, now a rather grand lake, stood alone, and a nearby path is bordered by American shrubs, to which we all contributed in order to commemorate American involvement with Bletchley, which was an important part of the latter part of the war.

Food was actually a bit of a problem. Outside the main gate was a short road. On one side lay strictly private houses and on the other side a very large shed housed our only canteen. At the end of the building was a raised stage from which Bletchley Park choirs sang and theatrical productions took place. It is a pity that the shed was not preserved for visitors’ use in peacetime, although I am glad that the disgusting food is not available. I hope that some of the new money can be set aside to provide first-class meals, snacks and maybe facilities for banquets—and I consider this to be very important.

The recent debates in this house about Alan Turing have highlighted some of the work done at Bletchley. It strikes me that I am probably seriously out of date; I should therefore be wise to seek the help of the many voluntary guides who I know do such an admirable job. In the mean time, I hope that it does not sound cheeky for me to wish that funny old place a magnificent future.

7.35 pm

Baroness Andrews (Lab): My Lords, it is an extraordinary privilege to speak in this debate and to follow the noble Baroness, Lady Trumpington. I think that she has shared with us this evening more memories than she has allowed herself to speak of at other times, because she has kept the oath of silence magnificently over the years. In fact, she has been more concerned to recognise the efforts of others, notably Alan Turing, than she has been to promote her own contribution at Bletchley. It is with great humility that we all take part in this debate to follow what she has said.

I would like to quote something from one of her colleagues, the noble Lord, Lord Briggs, who when he wrote of his own memories in 2003 wrote about Jean’s

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contribution. I am using the noble Lord’s term, “Jean”, because she is such a noble friend to all of us. The noble Lord, Lord Briggs, said essentially that, when she spoke at the opening of the visitors’ information centre at Bletchley in 2003, she took a long-term view. Jean, he said, was exactly the right person to present it in 21st-century Bletchley Park. She always takes a long-term view and she has taken it again this evening by sharing those memories and sharing her optimism and hopes for the future of Bletchley, in which she has played such an extraordinary role.

It is very difficult to underestimate the importance of Bletchley and its scientific and technological heritage, as well as its wartime role. There were 9,000 people on that site, and they all kept silence for such a very long time. Code-breaking is what it is known for, but the work of those brilliant men and women did not just shorten the war and save countless lives; Bletchley Park proved to be to the information age what Ironbridge was to the industrial age 300 years ago. For many years, the site itself was silent and deteriorating under the long shadow of wartime secrecy, but gradually history, memories and voices have emerged. However, as with so much of our heritage, it was terrifyingly touch and go 20 years ago that anything would be saved or celebrated at all. It is extraordinary to think that in 1991 the site was almost turned into a housing development. In 1993, the mansion was not even listed, because it was not thought to be of sufficient special interest.

It was not until 2004 that English Heritage began the detailed archaeological research that showed, for example, how the secrecy of the operation was maintained by the physical separation of the huts and how, as the huge volume of the signal traffic increased, those huts became permanent. As recently as 2006, they were in a very fragile condition, and I am pleased to say that English Heritage jumped in, as it often does, with emergency funding to enable the bigger funders to come and provide that £8 million of public and private help. The master plan set out last year by the trust will produce, I think, a very important and productive future for the trust. We know that there are now 15 listed buildings on that site. Block C is a visitor interpretation centre, and the huts that housed the code-breakers and bombes will be restored—all because of Bletchley Park Trust 20 years ago and the volunteers and veterans.

As the noble Baroness said, we know more through documentaries and films. The visitor numbers have trebled in the past six years, and what is encouraging is that it is recognised as a world site. A world-class learning and interpretation centre must now be provided, which tells the complex and often personal stories of the genius of individuals but also of the culture of Bletchley, and the creativity and tensions not just of the mathematicians but of the historians, poets and musicians who also played such an important role. I hope that that will include the noble Baroness putting her own memoirs into that living archive so that more people learn of her contribution to this extraordinary story.

7.39 pm

Lord Addington (LD): My Lords, when I saw this subject on the Order Paper and noted that my noble friend would lead the discussion on it, I could not resist getting involved given that she knows so much

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about this important matter. Indeed, my noble friend hinted that the whole story may not have come out yet and it is still exciting and changing. Therefore, we should have a good, long, hard look at what was at Bletchley Park, and what it meant.

Bletchley Park is also exciting because it is not just a part of a war; it was effectively the start of the computer age in which we now live as Colossus was there. I wish to deal first with an issue that has been in the press—namely, the two organisations, both of which are in receipt of public money, which are not co-operating. I suggest that it might be the role of Parliament to bang their heads together until they either scream or agree to co-operate as the two of them are interlinked. The issues surrounding the construction of the fence and where tour groups can visit can surely be resolved given the importance of this site. Pressure should be put on the two organisations concerned to operate in a more seemly fashion. There is no reason why this cannot be done. I do not know the ins and outs of the argument, who said what or know about the egos involved—I am sure egos are involved on both sides—but surely differences can be resolved. Those who look after the Colossus, the National Museum of Computing and the Bletchley Park Trust must come together and look after the whole site as all its parts are interlinked.

Looking at the history of computing, effectively modern computing started at Bletchley Park—at least, that is my interpretation of it. I speak diffidently given who will speak later in the debate. The work done at Bletchley Park led to the development of the modern computer, which is changing our lives on a daily basis, and affects just about everything we do. Therefore, this issue is not just about the past but constitutes a link to something which dominates our lives today. The fact that computing started at Bletchley is an enormously important lesson for us to learn in terms of understanding that good things can come out of conflict—that is, if we agree that the modern computing age is a good thing. It is possibly not an unmixed blessing but it has changed the way we live.

I would like to give noble Lords a small example of what computing has achieved in the minute or so I have left to speak. I cannot write properly without using a voice-operated computer because of my dyslexia. Literally millions of people in this country are assisted to communicate by computers. I declare an interest as chairman of a firm that provides assistance to people in this country and many parts of the world, including deaf people, those with dyslexia and blind people, by means of text-to-voice and voice-to-text machines and screen images. This work all started at Bletchley Park.

We are in danger of losing the link between the past and the present embodied in Bletchley Park. The work that was done there affects us to this day in virtually every aspect of our lives.

7.43 pm

Lord Higgins (Con): My Lords, I congratulate my noble friend on obtaining the debate and, of course, on her speech. One is constantly astonished by the noble Baroness. Even two nights ago, I happened to turn on the television and see a recorded version of

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“Have I Got News For You?” in which the noble Baroness appeared. I have never seen the regular panel so intimidated as they were on that occasion.

The noble Baroness has a very close and long association with Bletchley Park. Curiously, I discovered that I, too, have links, albeit rather remote ones, with Bletchley Park, although I was quite unaware of it at the time. I did my national service in 1947-48 in the air force. It was a pretty miserable time as there was no prospect of promotion or learning to fly; one was just there to make up the numbers while others were demobbed. I may have spent much of my time training for the 1948 Olympics, but I was also trained ostensibly as what was known as an “instrument basher”, where one had the responsibility of looking after aircraft instruments and so on. I did not think much of the training and I took the precaution of never going up in an aircraft which had an altimeter that I had calibrated. I was later posted to somewhere in the south of England which was responsible for testing and repairing type X machines, which were the British equivalent of the German Enigma. If there is one theme in my remarks this evening, it is that I think the type X machine has been grossly misrepresented compared with the Enigma machine. After all, the Enigma codes were broken, which was never true of the type X machine used by the British.

Reading through some of the books that have recently been published, it has become clear to me that it was not just a question of decoding the Enigma ciphers; you also had to decipher them in a form which was readable. To do that, you had to put it into a similar machine. We clearly did not have very many Enigmas, so the type X machine must have been used. I believe that that was the case. Therefore, the type X machine played a major role in the success of the whole code operation and its effect on the outcome of World War 2.

As noble Lords have pointed out, the work which was done at Bletchley was of great importance. I fear that, increasingly, we are tending to concentrate on World War 1 rather than World War 2. Perhaps this is just because it is the anniversary of World War 1. It is very strange how World War 1 seems to have captured young people’s imagination more than World War 2. However, young people may be inspired by Bletchley as the place where modern computing began, and where they can discover what it was all about, which is important.

Just before I was demobbed, I was told that the type X machines were going to be destroyed. I gather that that did not take place, but I believe that Churchill had the big machines destroyed. That was a shame, but it is good that the exhibition has those machines on display. That is as astonishing as the extraordinary decoding work that was done at Bletchley Park in the war, including by my noble friend.

7.48 pm

Lord Stirrup (CB): My Lords, it is a great pleasure to follow the noble Lord, Lord Higgins, although I must conclude, with some relief, that during my career I clearly never encountered any of his altimeters.

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I, too, welcome this debate and add my thanks to the noble Baroness, Lady Trumpington, for securing it. I should also like to express my admiration for her sterling efforts in support of the work to secure a pardon for Alan Turing. A few years ago, I had the privilege of opening the Turing building at Qinetiq’s facility in Malvern. The increasing official recognition of the debt that we in this country owe to Alan Turing is very much to be welcomed. We cannot, alas, reverse his personal tragedy, but we can at least ensure that he and his work are remembered and honoured. And, of course, some of the most important strands of that work were carried out at Bletchley Park.

This year sees the 70th anniversary of Operation Overlord, the allied landings in Normandy. Bletchley Park played a defining role in that operation, as it did in so many others during the course of the Second World War. The intelligence produced by Bletchley Park undoubtedly shortened the war and saved countless lives. This success depended upon the talents and dedication of many people, and, above all, upon their unyielding secrecy. It is worth remembering that, while transparency is often a good thing, it can occasionally be destructive. One whisper of the successes at Bletchley Park would undoubtedly have led the Germans to eliminate the poor operational procedures on which the code-breakers depended. The history of that time underscores forcefully the old adage that secret intelligence needs, above all, to be secret.

We in this country need a considered debate on the balance that we should seek to strike between the sometimes competing needs of security, liberty and privacy. In such a debate, the story of Bletchley Park has important lessons to teach us.

Bletchley Park is relevant to our consideration of the future as well as to our remembrance of the past. It reminds us of a debt that we owe, but also of the need to make hard choices. It is an important part of our national heritage, but it should also help to stimulate an important discussion about our future society.

We should be very grateful to the Bletchley Park Trust, which over the past 22 years has transformed the site from a derelict wasteland to a thriving memorial. Visitor numbers have indeed increased threefold since 2007, but continue to rise steeply. Many of the historic buildings have been restored, and in June the carefully rescued code-breaking huts will be formally unveiled, along with a new visitors’ centre. Of the some 250 staff at Bletchley Park, 174 are volunteers, including all the 46 tour guides. The work of that team has been and will continue to be crucial to the preservation and development of Bletchley Park, and we can only admire and praise its commitment.

There has been some controversy in the media recently surrounding the relative positions of the Bletchley Park Trust and the National Museum of Computing, a valuable independent enterprise that occupies part of the site. Needless to say, the coverage has aimed to maximise the controversy rather than to reflect in a balanced way the issues involved. I am sure that the leadership of both enterprises is mature and experienced enough to work out an appropriate modus vivendi.

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I would just say this: for most of the past 22 years, Bletchley Park has been in survival mode. Only now—only today—after the sustained efforts of the trust, its staff and its supporters is it able to think with confidence about the future. As visitor numbers grow, so the quality of the Bletchley Park experience needs to develop to meet that demand. That means continued change. Change is never easy and often controversial, but standing still is not an option. Bletchley Park is simply too important both to our heritage and to our future in this information age. The trust recognises that, I know. We should be grateful to it for bringing Bletchley Park to its present successful state, but should also support it in its endeavours to fit it for the challenges ahead.

7.52 pm

Viscount Astor (Con): My Lords, Bletchley Park is a crucial part of our history. Its role in cracking the German codes gave us a unique advantage in the Second World War. Winston Churchill told King George:

“It was thanks to Ultra that we won the war”.

The name, of course, arose because the intelligence that was obtained was considered more important than that already designated by the highest British security classification, “most secret”, so it became “ultra secret”. Much of the German cipher traffic was encrypted on the Enigma machine. Used properly that machine would have been virtually unbreakable, but in practice shortcomings in its operation allowed it to be broken.

As my noble friend said, my mother was also in Hut 4, the naval section, from 1941 to 1944, when she moved to the Admiralty in London to be the liaison officer between Bletchley and the Admiralty. She and my noble friend became great friends, and their friendship lasted all my mother’s life. Just before she died last year, I asked my mother what two things she remembered and was most proud of in her time at Bletchley. She said that she was most proud of being part of the team which was able to find where the U-boats were waiting to sink Allied convoys, and being able to alert the Admiralty. The second thing was what she really remembered—it was, one afternoon, putting her friend Jean in a large laundry basket on wheels, which was normally used to move “most secret” files, and launching it down a long corridor. It gathered considerable momentum, and Jean and the basket disappeared through the double doors down the next corridor, before finally crashing to a halt in the men’s lavatories. I do not think that noble Lords require an Enigma machine to work out who Jean was. A serious reprimand was administered to both of them, and their watches were changed so that they were distributed among what were called more sober colleagues.

Over the last few years Bletchley Park, managed by its trust, has been transformed with a new visitor centre, and receives more than 150,000 visitors a year. There is more to do as interest grows in the extraordinary work and achievements of its code-breakers. I thank my noble friend for initiating this debate and giving us all the opportunity to thank her and all those who served at Bletchley for their extraordinary wartime work.

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7.55 pm

Lord Sharkey (LD): My Lords, I congratulate the noble Baroness on securing the debate, and that is not just the usual formula. It is clear that the situation at Bletchley Park needs some attention. I was rather dismayed when I looked through the Library briefing for this debate. Bletchley Park is much too important to allow the current problems to continue. As many speakers have said, two important things happened there: the cracking of the Nazi Enigma code, and the beginning of computing and of computer science. Both deserve a proper, civilised and shared commemoration. It is entirely appropriate that we should have a museum of code-breaking and a museum of computing on the site. What is entirely inappropriate is that the two museums should be on such very bad terms.

I will not rehearse again the various charges and countercharges levelled by each museum against the other. I will not comment on the obviously dysfunctional management that allows the situation to continue. However, I will say that any organisation which loses the person who saved it is obviously doing something wrong. That person is Dr Sue Black, who is largely responsible for saving Bletchley from dereliction in the first place. She was instrumental in obtaining the funding needed to secure Bletchley Park’s future, yet has resigned from the board of the Bletchley Park Trust in protest against its failure to sort out the long-running dispute with the National Museum of Computing. Dr Black even suggested that the gender balance on the boards could be preventing a solution; she did not mean that there were too many women on the boards.

It is clear that the relationship between the Bletchley Park Trust and the National Museum of Computing has broken down. It is clear that some kind of intervention is needed. Common sense needs to be restored. The commentator Gareth Halfacree, in his blog of 29 January, made an extensive analysis of the situation and several common-sense recommendations. He recommended: that there continue to be knowledgeable and expert volunteer guides alongside the modern audio guides; that there be a review of the joint ticketing arrangements, which is eminently sensible; and that the trust look again at the way in which it communicates its goals and plans to its employees. He did not recommend the removal of the fence, but that was because it had not been built when he wrote the review.

None of those recommendations seems difficult. In fact, they all have a common-sense and conciliatory air. However, to put them into place and even to begin to discuss them, firm leadership is required. Bletchley Park and its history are too important to allow a rather shameful quarrel to continue there. Intervention is needed, and I hope that the Government will think creatively about how they can, if at all, help to resolve the situation. But there is another kind of intervention available. When the campaign to pardon Alan Turing seemed to be stalled the noble Baroness, Lady Trumpington, wrote to the Prime Minister. Two months later, Turing was pardoned. Perhaps it is time for her to take up her pen again.

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7.59 pm

Baroness Lane-Fox of Soho (CB): My Lords, as a novice Baroness and a woman who has worked in technology her whole career, an invitation to tea from the noble Baroness, Lady Trumpington, in the first few weeks in your Lordships’ House was indeed a highlight. Hearing her this evening, I defy anyone of my generation not to be inspired by her example. I am not an expert on the situation at Bletchley, but I would like to suggest three ideas which I hope illustrate why it still has wide-ranging significance and must be preserved.

First, today is the 25th anniversary of the invention of the world wide web. It was probably about this time of the day when Sir Tim Berners-Lee gave to his boss the piece of paper on which he had written down his invention, and on which his boss famously wrote “vague but interesting”, and handed it back.

Like the millions of lives that were saved due to the direct work at Bletchley, the web has transformed millions of lives, and both are achievements that this country should be immensely proud of and grateful for. I believe that both Bletchley and the invention of the web could be used more widely as examples of British creativity and possibility. I am not convinced that many people in our country are aware of the history of either.

Yesterday I had the opportunity to spend time in the Science Museum with the computer on which Tim wrote the first code for the web. It has come on loan from CERN, and I felt a bit giddy next to it. We were in a room full of computational history, including Charles Babbage’s analytical engine, the first Lyons tea factory LEO computer and ERNIE—the random number generator that ran the premium bonds. What struck me was how many women were part of the stories of all these computers—from Ada Lovelace to the women working on ERNIE and at Lyons.

Starting with Bletchley and on through the 1950s and 1960s women worked in computing and fuelled the burgeoning computer industry. The unbelievable Dame Stephanie Shirley employed only women in her company, all working remotely at home and on complex problems, from the black box on Concorde to the Polaris submarine. Half the people working at Bletchley were women, yet we are now facing stagnation in the numbers of women in the tech sector. How can Bletchley be more widely used to help reverse this trend? The numbers are depressing.

Finally, I should like to mention coding itself. From September this year, every child at primary school will be taught to code. This is a visionary policy and the Government should be congratulated. We will lead the G8. A number of organisations have been encouraging coding for many years, especially among children—including Young Rewired State, Decoded, Free:Formers, Code Club and #techmums, started by Dr Sue Black. The curriculum shift has also raised the profile of coding, with Hour of Code and Year of Code being particular examples, and demonstrates the power of this incredible language. Yet, there remain a number of challenges in training teachers and it would be sad if this incredible opportunity was not given the best chance of success.

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I look at Bletchley and think what an immense shame it would be if it did not continue to be a national treasure. What a tribute it would be to the brave people who worked there in secret for so long if we used it to celebrate more noisily our technology inventions, to encourage more gender equality in the sector and, finally, to inspire a whole new generation of coders.

8.03 pm

Lord Cormack (Con): My Lords, it is a great privilege to follow one of our most remarkable new Members of your Lordships’ House. She has today become the chancellor of the Open University and we should all congratulate her on that.

It is a real privilege to speak in a debate introduced by my noble friend Lady Trumpington. She is a national treasure. If we had, as the Japanese have, national treasures as human beings, she would be right at the top of the list. She embodies so many of those qualities that made our country great. She is determined, never takes no for an answer, has a wonderful good humour but, above all, has a passionate love of her country.

I remember taking my noble friend to Bletchley. A few years ago, she will remember, I was asked to take there a group from the All-Party Parliamentary Arts and Heritage Group. We had a bus load of Members of this House and of another place and went to see the manor and the huts. The company included not only my noble friend Lady Trumpington but the son of Viscount Montgomery of Alamein and Countess Mountbatten of Burma. It was a real historic day. Of all the buildings that the all-party group has visited over the years, every one is more distinguished architecturally than the house at Bletchley. We saw huts that would never enter the heritage league but we came away united in the realisation that we had seen something of imperishable worth that was truly part of our national heritage, because the work that was done there helped to preserve our national heritage of freedom and democracy at a dark time. I very much hope that young people going there will realise just what was done by a number of extraordinary people, led by Alan Turing but including my noble friend—our noble friend—Lady Trumpington and so many others, such as the mother of my noble friend Lord Astor.

It would be very bad indeed if we allowed any disputes between individuals to confound the preservation of Bletchley Park. I have the honour to be a patron of the trust and hope that the patrons together might help to bridge any gaps that may exist. Of course it is vital to have a computing museum. As my noble friend Lord Sharkey said, it is nonsense to have disputes between two essentially worthwhile organisations confounding the realisation of both. If there is one thing that I hope the Minister will be able to say when he replies, it is that the Government are utterly determined to ensure that this part of our history, symbolised by a rather indifferent Victorian manor house and a number of huts, is preserved for future generations. These huts are every bit as important as—indeed, in many ways more important than—Captain Scott’s huts in the Antarctic, which should also be maintained. I hope that we will have a positive response from my noble friend to the debate, which was so brilliantly initiated by our noble friend Lady Trumpington.

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8.07 pm

Lord Stevenson of Balmacara (Lab): My Lords, I thank all those who have spoken in this debate, particularly the noble Baroness, Lady Trumpington, for arranging for us to debate these issues.

I notice that most noble Lords have a small memory of working with, or a story about, the noble Baroness. I should like to mention a small event. She may not recall it but she was briefly a Films Minister in the Conservative Administration when I was director of the British Film Institute. She is nodding, so I have stirred that memory. She may not remember that one of her duties, which I do not think she volunteered for but she accepted with great grace, was to open the London Film Festival. It was not a happy hunting ground for Conservative politicians, certainly not before she arrived. I was terrified because there were some 2,000 film fans there who were eager to bay for the blood of those who, they felt, were cheating them of their right to watch films for free in perpetuity and at the public’s expense—I exaggerate slightly to make the point, but noble Lords will get the feeling.

When the noble Baroness arrived, she made it clear that she was not entirely happy to stand around waiting and wanted to get on with it. We went on stage at the Odeon Leicester Square, which holds some 2,000 people. We arrived slightly early, so the organ was still playing and we had to wait around while it disappeared slowly down. The organist disappeared in a mysterious way that I never quite understood. She then wowed the audience with a completely unconvincing narrative about how supportive the Conservative Party was of film at that time. However, the members of the audience were all so terrified and impressed by her that we went off without a single hoot of derision. There were cheers, it was a triumph and I had a wonderful festival. Thank you very much for that memory. That is the sort of person who we are talking about. When she says that she wants the Government to reveal their plans for Bletchley Park, I am sure that the Minister is quivering in his shoes and will come up with some wonderful new announcements, even as we speak.

As the noble Baroness said, it is inevitable that the place that was built and operated in deepest secrecy should have retained that aura, and a lot of the contributions today have been about why it is difficult to understand more of what went on there and to understand better the role it played. I think that we owe it to the noble Baroness, Lady Trumpington, and all the others, including of course Alan Turing, to tell their story accurately and within the wider narrative of how Britain organised and won this aspect of the war.

Somebody said that until recently Bletchley was in survival mode. It is absolutely right that, when the works are completed, we should have a Bletchley that is fit for the 21st century and beyond, marking all the important things that we have heard about this evening. When the Minister comes to respond, it would be very good if he could explain exactly where we are in that process. We know the opening date, but I am looking through the good collection of material provided by the Library and I find it hard to work out who has made the contributions that have allowed this to happen. There is talk of the Heritage Lottery Fund and a sum

12 Mar 2014 : Column 1830

of about £8 million; there is the separate sum of about £330,000, mentioned by my noble friend Lady Andrews, for the restoration of the house; there are Google and McAfee; there is a donation from an individual, Maureen Jones, who I think worked there and left some money in her will; and there is money from the Foreign Office. Is this an independent trust which is gaining money on its own, or is it in fact part of the Government’s contribution and does it fit within the DCMS? It would be helpful to be clear about that.

We would like some information, if it is possible to get it, on what is happening in the dispute between what seem to be two very important national activities: the National Museum of Computing and the Bletchley Park Trust. As we have all said, this needs to be sorted out. Also, when the Minister comes to speak, perhaps he could say on what lines we should be thinking with regard to this site going forward. If we can get it fit for the 21st century, we have to think about how to take it forward.

I was very struck by the contributions from the noble and gallant Lord, Lord Stirrup, and the noble Baroness, Lady Lane-Fox, about using the 25th anniversary of the world wide web and some of the suggestions surrounding that, such as having a Magna Carta for the web. The Government might get behind that and think harder about the balance between liberty and security. They might use this site and the relaunching of Bletchley as an opportunity to reaffirm their commitment to, and support for, the way that the web is developing. If, within that, we could get a British creativity centre located there that exemplified the best of British creativity—which is often talked about but rarely analysed and looked at—and particularly pick up the point about the need to have a better gender balance in that, then I think we would achieve something really worth while and something worthy of the efforts made by those who worked there in the 1940s.

8.12 pm

Lord Gardiner of Kimble (Con): My Lords, I, too, wish to say that it is an enormous privilege to speak in my noble friend’s debate. She brings to it an exceptional personal knowledge of Bletchley Park in its operational days. What we owe to the men and women like her is impossible to express adequately. Their importance to the history of our nation and, in turn, the free world should never be forgotten.

Why and how did this place and the truly extraordinary people who worked there become so crucial to the successful outcome of the Second World War, and therefore why is it so important that its future should be secured? Bletchley Park, until fairly recently, was probably Britain’s best-kept secret, a point to which my noble friend Lady Trumpington referred. Indeed, the secrecy surrounding all the activities carried out there was vital to our national security and ultimate victory, as the noble and gallant Lord, Lord Stirrup, and the noble Lord, Lord Stevenson, emphasised.

During the war it became the centre of code-breaking and intelligence activity. As has been said, it was at Bletchley that the Enigma codes were broken—an event which turned the course of the Battle of the Atlantic in our favour, as the mother of my noble

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friend Lord Astor knew at first hand—and later the Lorenz codes, with crucial implications for the D-day preparations. It has been estimated that the duration of the war was reduced by two years thanks to the work undertaken in secret at Bletchley.

Some of those who worked at Bletchley are now as famous as the site itself: Alan Turing, Gordon Welchman and Dilly Knox come to mind. Your Lordships have recently played a pivotal role in ensuring that due recognition is given to the supreme contribution that Alan Turing made and which the Government acknowledge. The noble and gallant Lord, Lord Stirrup, and my noble friend Lord Sharkey were particularly crucial in this matter.

The code-breaking activity at Bletchley developed into an operation on an industrial scale. I believe that up to 10,000 people were employed there at the height of the war. In October 1941, after receiving a letter from some of the senior code-breakers decrying the lack of resources being afforded them, Winston Churchill directed:

“Action this day! Make sure they have all they want on extreme priority and report to me that this has been done”.

Machines were developed to deal with the huge amount of data, including the Bombe, an electromechanical device which helped to reduce the potential number of codes. It was at Bletchley that Tommy Flowers built the Colossus, now recognised as the world’s first electronic computer. So Bletchley is also recognised as being of international significance due to its place at the beginning of the age of the computer. The noble Baroness, Lady Lane-Fox, highlighted this point, as did my noble friend Lord Addington and the noble Baroness, Lady Andrews. At the end of the war, the remarkable expertise that had been developed at Bletchley Park was taken forward by a number of the wartime Government Code and Cypher School staff in a new organisation known today as GCHQ.

In 1987, after 50 years of association with British intelligence, Bletchley Park was finally decommissioned. In 1991, many of the organisations that had occupied post-war Bletchley Park had moved out. The site became partially derelict and was being proposed for housing and a supermarket development. A campaign was launched to save the site. Inspired by veterans and others, the Bletchley Park Trust was formed and took ownership of the site on a 250-year lease.

Bletchley Park museum opened in 1993, and since then the trust has been working to restore the site. My noble friend Lord Cormack spoke of the beginning of this journey and the impression that it made on parliamentarians when they visited the site in those early days. In 2007, the Codes and Ciphers Heritage Trust began to establish the National Museum of Computing, which includes a working reconstruction of a Colossus computer, along with many important examples of British computing machinery.

A number of your Lordships have raised concerns about the reports of discord between the Bletchley Park Trust and the National Museum of Computing. I acknowledge the work of both these organisations and I very much hope, as I know do your Lordships, that they will look to collaborative solutions to their

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differences. Indeed, we look to both museums to tell the incredible story of Bletchley in the most innovative but accurate way that will enable Bletchley to be in the nation’s consciousness for many generations to come. Since opening, the Bletchley Park museum has seen a consistent growth in its visitor numbers: 40,000 people passed through the gates of Bletchley Park in 2006, with that number swelling to 150,000 in 2012. Indeed, there are ambitious projections for the next three to five years. The figures that I have seen for this year compared with last year are very remarkable indeed. It is obviously a place that is becoming very strong in people’s consciousness, which is so important.

This is a testament to the relevance and importance of the work of Bletchley in this country’s history. So many people of all ages and backgrounds want to come and understand how this site contributed to the world in which we live now. The noble Baroness, Lady Andrews, was absolutely right to mention education and interpretation. We have to inspire the next generation to understand what this was all about. The education and interpretation part will be a very important feature of what will happen at Bletchley.

Of course, this increased demand has meant that the Bletchley site has had to upgrade to reflect this continuing interest. The noble Lord, Lord Stevenson, rightly asked some questions about the status of the independent Bletchley Park Trust. In September 2011, the trust secured a grant of just under £5 million from the Heritage Lottery Fund towards the £8 million restoration of Bletchley Park phase 1 project. The noble Lord was absolutely right to acknowledge that there were other contributors to that £8 million which again has been hugely appreciated and is absolutely vital for the fulfilment of that first phase.

In this first phase of regeneration the once derelict Block C will become a vibrant visitors’ centre. The code-breaking Huts 3 and 6 have been restored to their original condition and the restored bomb Huts 11 and 11A will present exciting new displays. So, by the middle of this year, the huts will be ready for visitors to experience what life as a code-breaker was like. I thought that my noble friend Lord Higgins gave a fascinating and personal insight into what that could mean.

Remarkable work has been done and progress made over the past 20 years. We have mentioned discord, but it is important in all these things to get the balance right and record and celebrate the remarkable achievements. The strategic vision for Bletchley Park is to restore and put to productive use all the remaining buildings. Everyone I have spoken to who has visited—I have to say that I have asked quite a number of people how they would describe it—almost without exception has come up with the words, “This is such an inspiring place”. Our task is to ensure that that remains.

My noble friend Lady Trumpington and the noble and gallant Lord, Lord Stirrup, referred to volunteers. I say specifically that volunteers, as in so much of our nation’s life, have been at the heart of Bletchley’s regeneration and I take this opportunity to pay tribute to their work. It is through the dedication, knowledge and enthusiasm that they devote to Bletchley that has helped to bring it to life again. It is very clear from the

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rise in visitor numbers and the growing recognition of what we owe to the men and women of Bletchley Park that there is ever-increasing interest. It is clear that it is somewhere where families and children go, and it is very important that all of it is understood. These men and women who worked there gave of their best. Indeed, we are rightly very proud of my noble friend. It is for our generation and those who follow to ensure that this site of exceptional, historic and national importance is secure.

8.22 pm

Sitting suspended.

Immigration Bill

Committee (4th Day) (Continued)

8.27 pm

Amendment 62

Moved by Baroness Meacher

62: After Clause 33, insert the following new Clause—

“Domestic abuse and female genital mutilation

No charge may be imposed for health services—

(a) relating to injuries sustained as a result of domestic abuse as defined in Home Office Circular 003/2013 “New government domestic violence and abuse definition”, or

(b) relating to injuries sustained as a result of female genital mutilation as defined in the Female Genital Mutilation Act 2003.”

Baroness Meacher (CB): In moving Amendment 62, I shall speak also to Amendment 62A. The purpose of Amendment 62 is to ensure that treatment for any injury resulting from domestic abuse or female genital mutilation is exempted from NHS charges even if the victim does not have permanent leave to remain, or indeed if her immigration status is not clear. I should explain at the outset that these are probing amendments and I understand from the Minister that these matters will be dealt with by the Department of Health in regulations. Having said that, this amendment provides an opportunity for this House to try to influence those regulations. I think that I am right that there will be no further opportunity to do that.

Clause 34 defines for the first time the term “ordinarily resident”. If the person is not ordinarily resident they may be charged for health treatment. If they have paid the surcharge they should be covered for health services but many other people are already living in this country—I understand in the realm of about half a million—who have not paid the surcharge and are eligible for NHS charges. Further, Clause 34 brings ordinary residents into line with permanent residents. That means that instead of being here with a visa for a settled purpose such as a job, a university course or to reunite with a spouse for a minimum of one year, an immigrant will need to be here for a minimum of five years in most cases before they are fully covered for healthcare. This is why Amendment 62 is important and relevant to health charges, as I understand it.

In his letter of 12 March, the noble Lord, Lord Taylor, said that short-term visitors and those without lawful immigration status will,

“continue to be liable to pay overseas visitor charges for secondary care treatment under NHS regulations”.

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This is similar to the letter from the Minister for health quality, who said that,

“illegal non-EEA migrants and short-term visitors (under 6 months) will continue to be liable to NHS treatment charges as they are now”.

I am told that this is not precisely the case, as the National AIDS Trust’s excellent briefing points out. In fact, the Government plan to introduce new charges for primary care, apart from GP and nurse consultations, and for A&E services for this group and for any migrant who cannot show that they have paid the levy. The need to assess patient entitlement in primary care or A&E would be an unhelpful distraction in an emergency situation. This might be done after someone receives treatment—but that, too, is an alarming position for someone who may have little or no money.

In his subsequent note and his latest briefing, the Minister gave assurances about a number of vulnerable groups who will not be subject to the surcharge or charges for treatment under the NHS charging regulations. There is no mention of the victims of domestic violence or FGM in relation to either. Do the Minister and his colleague, the Minister for Health, intend to exclude these two groups from the surcharge and, in the case of those already here without permanent residence, from NHS charges? If not, it is a matter of great concern that the moral and humanitarian case previously accepted concerning these groups appears to have been set aside.

As to the practical difficulties in determining who the exemptions for domestic abuse and FGM would apply to, I understand that medical checks would be needed if these groups are to be exempt from the surcharge. I appreciate that could be problematic in the circumstances, but in the case of NHS charges for failed asylum seekers, irregular or undocumented migrants, short-term visitors and others without permanent residence, does the Minister not agree that if a patient in any of these groups has been domestically abused or damaged by FGM, they should not be charged for treatment? It would be helpful to have clarification on this point on the Floor of the House, if the Minister is able to give it, albeit that such provisions would ultimately be made in Department of Health regulations.

If irregular migrants and refused asylum seekers who would not have paid the surcharge cannot access primary care services, apart from GP and nurse consultations to address comparatively minor health problems, they will eventually present elsewhere—probably at an A&E department—at much greater cost, as I referred to in relation to an earlier amendment.

A different but important point is whether the NHS will be expected to report back to the Home Office if a patient’s migration status requires them to be charged for NHS services. There is a concern about this in view of the comment of the Home Office Permanent Secretary to the Home Affairs Select Committee that the Home Office intends,

“to improve its radar screen into the NHS”.

I find that rather chilling. If it became known that a visit to the doctor could lead to a report to the Home Office, people could be deterred from seeking healthcare. Can the Minister assure the House that this will not be the case?

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The Government have previously recognised the important role of the NHS in identifying victims of abuse and helping them to recognise, consider and exercise their option to escape from that abuse. Also, in the case of FGM—where we have not had a single prosecution—the NHS is seen as probably the best hope of identifying perpetrators and providing evidence to support the prosecution case. I look forward to hearing the Minister’s view on that.

On Amendment 62A, the Government have agreed that no charge will be made for health services to victims of human trafficking. I am dealing with this issue separately because, in a sense, these people are in a different situation. The aim of the amendment is to put this commitment in the Bill and to require the Government to produce a strategy and procedures to ensure that the victims of human trafficking are promptly and effectively identified for the purposes of the clause. This is a probing amendment which I hope the Minister can endorse, thus assuring the House that there will be regulations in place to achieve its aims so that victims receive the necessary medical treatment. The UK would thus satisfy our international obligations.

According to the Catholic Bishops’ Conference, the UK Human Trafficking Centre shows that more than half—54%—of trafficking victims were not recorded by the national referral mechanism in 2011. UKHTC notes that people who have been trafficked are often treated as irregular or illegal migrants. They may, of course, have been given false, stolen or genuine but fraudulently obtained identity documents. They will most likely then be treated as immigration offenders despite not acting under their own volition. This is quite understandable but it will need attention to avoid this kind of thing happening.

As the Bill is currently worded, these victims would not be exempt from the charges for health services if they are in one of these obscure groups. Also understandably, people who have been trafficked and coerced into criminal activities are often treated as offenders rather than victims. They are unlikely to benefit from exemption from health charges. A 2013 report by Anti-Slavery International highlighted a lack of awareness of trafficking indicators among authorities. If these victims are not identified, they are likely to get a criminal record, go missing, be deported and be retrafficked. They become victims a second time round.

All this will increase the fear of victims and their suspicion of the authorities. Help with later investigations is less likely to be forthcoming. At the moment, the authorities rely on those who are trafficked to disclose their status quickly or face detention—and, for obvious reasons, often that does not happen. If not identified immediately on arrival, trafficking victims are unlikely to be identified subsequently, and hence the importance of subsection (2) of the amendment. There is a need for,

“a strategy and procedures to ensure that victims of human trafficking are promptly and effectively identified”.

We are particularly concerned about trafficked children. I understand that at the moment social workers receive no mandatory training in identifying a trafficked child. We know that in the context of the draft Modern

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Slavery Bill there is a commitment to roll out specialist training and other measures. Can the Minister give the Committee a commitment that rigorous enforcement of health charges will not be introduced until the safeguards associated with the Modern Slavery Bill are rolled out?

Let us get things in the right order. Does the Minister agree that before the planned safeguards are introduced, they will be put before the modern slavery commissioner, who is to be appointed under the modern slavery legislation? Indeed, to clarify these matters, can he provide the Committee with information about the planned timing of the introduction of the new enforcement rules for health charges and of the implementation of proposals in relation to the Modern Slavery Bill? I beg to move.

Baroness Finlay of Llandaff (CB): My Lords, my noble friend Lady Meacher has introduced this group of amendments with great clarity. I have added my name to Amendment 62 and I will speak to Amendment 64. Other Peers who have added their name send their apologies for not speaking at this late hour. I do not want to add much more to what has been said about domestic abuse and female genital mutilation except to say that I have a major concern as to how this will actually work in practice unless these groups are exempt.

What happens if a girl comes into the country, her status is not established, and she has infected wounds? What happens to the girl who has been mutilated and has urinary and voiding difficulties or suffers chronic pain? What happens during pregnancy, when delivery can be incredibly complicated? If it is not properly managed, a woman may literally burst because scar tissue is not elastic. We recognise FGM as an absolutely awful form of abuse and it is shameful that there have not been prosecutions already. If we put these women into the charging category, we will almost reverse the message we have sent to society about this terrible act.

The other problem arises with domestic abuse. If a woman arrives at A&E with severe facial injuries including fractures to the bones of her face or her chest wall, they may be life-threatening. If her ribs have been stoved in, it may be a life-threatening injury such as a pneumothorax and treatment will have to begin straightaway. Emergency service personnel are going to be put into a terribly difficult position. Another problem is that, in the societies from which many of these women come, sadly they are not afforded the rights they have in our society, and they are not given the respect they deserve. I am fearful that there may be a tendency to blame the woman if attempts to stay fail because she is a burden on the man, thus making it more difficult for him to stay.

Amendment 64 is about people who are released from detention. Currently, people can receive treatment while they are being held in an immigration detention centre and the course of treatment will be ongoing when they leave, but this may not be the case in the future. The consequences will be particularly acute in the area of mental health. It is well documented that the experience of an immigration detention centre is damaging to the mental health of many detainees. Without ongoing support, those mental health problems will be exacerbated rather than ameliorated at the

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point of release. The problem we are faced with is where to set the boundary and how it will actually be implemented.

These are probing amendments, but when regulations come before the House we will not be able to amend them. We will be faced with either accepting or rejecting them. That is why we need to tease out these issues very carefully at this stage.

Baroness Cumberlege (Con): My Lords, I shall speak to Amendment 66A on behalf of the noble Baroness, Lady Masham of Ilton, who sadly has another commitment that she has to honour this evening. Successive Governments have very good track records in safeguarding the public’s health. When I was a Minister, I was deeply involved in the Health of the Nation strategy, which was lauded at the time by the World Health Organisation as a model for other countries to follow. Since then, through the Labour Government and now our present Government, we have concentrated on looking after the public’s health. Indeed, Ministers were saying only in November last year that nothing will be done to worsen public health. Two years ago, this Government extended free treatment regardless of immigration status to include treatment for HIV infection. As was said at the time:

“Reducing transmission will reduce the risk of new infections in the wider UK population and … reduce … NHS costs”.—[Official Report, 29/2/12; col. 1397.]

They have confirmed that treatment for communicable diseases and sexually transmitted infections will remain free to all.

These are really welcome and important commitments but we have to be very careful that this proud record is not undermined by what we are now doing. Many noble Lords, I know, have a crystal-clear understanding of the Bill, as the noble Baroness, Lady Meacher, has explained to us this evening, but I would like to clarify some issues. First, who is actually going to be affected by these charges? I look to my noble friend to provide the clarity that I seek.

8.45 pm

Clause 34 means that non-EEA migrants without permanent residence will be liable for NHS charges. That is clear. Under Clause 33, migrants on student, worker and family visas will remain entitled to free NHS services by paying the charge with their visa applications. That is clear, but it includes a power to exempt some groups from this charge. I want to know whether those groups that are exempted from the charge will also be exempted from all NHS charges or whether they must pay for NHS services. It is clear that visitors will not pay the charge, but they will pay for NHS services. However, those who require a visa, but do not have one, will also pay for those services. That includes people who stay beyond the expiry of their visa and those who entered without one. Visitors, overstayers and those entering without a visa are of course already liable for NHS charges. There will continue to be exemptions for asylum seekers and those formally recognised as victims of trafficking. Those granted refugee status or humanitarian protection will also be exempted from charges.

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I very much welcome these exceptions but I presume that those refused asylum will face charges, as will most victims of trafficking who are not recognised through the national referral mechanism, including many who are still being exploited. In the debate on Monday, it was said that the children of those liable for NHS charges will also not get free NHS treatment. Then there are those who come on a visa, with which they paid the charge, and who are later refused an extension of that visa. Will they still get free NHS treatment while waiting for an administrative review decision? What if the period for which they paid the charge has already expired? What if their review is refused and they bring a human rights appeal? There are concerns that Schedule 9 removes the protections that appellants have currently to be treated as lawfully resident while their appeal is considered. Are those concerns correct? In any case, will NHS treatment be free during their appeal?

Subject to this last matter, it may seem nothing very much is changing, but I do not think that is the case. Primary care and accident and emergency treatment are currently free to all but, in future, those I have identified will have to pay for them. This Government made HIV treatment freely available because they recognised that,

“late diagnosis results in increased mortality and morbidity and more expensive treatment”.—[

Official Report

, 29/2/12; col. 1397.]

That does not apply just for HIV but to any injury or illness. Public Health England advises that approximately 70% of HIV, TB and malaria cases are diagnosed in people born abroad and points to economic disadvantage and overcrowded living conditions as factors increasing the risk of infection. Undocumented migrants and refused asylum seekers will be disproportionately represented among these at-risk groups.

Not engaging with NHS services, particularly primary care, will exacerbate the risk of undiagnosed infection, but introducing charges for primary care will deter people from doing so. GP consultations will remain free but what, if any, treatment will the GP be permitted to provide without charging? I think other noble Lords have raised that point. If the GP cannot provide free treatment, there is no incentive for someone who cannot afford to pay to attend. The Royal College of General Practitioners has warned that most people who are ill,

“from infectious diseases do not know what is making them ill”.

I am sure my noble friend will agree that permitting free treatment for infectious diseases is inadequate if infection remains undiagnosed or people do not know what is making them ill. If infections are to be diagnosed, it is vital that people engage with primary care, including GPs. If children are to receive immunisations, it is vital that their families engage. Amendment 66A, in the name of the noble Baroness, Lady Masham, would help to encourage that engagement. We believe that charging would deter engagement, putting public health at risk. We also believe that it would not be cost-effective to impose and seek to recover a charge.

Ministers have made clear that they,

“will never refuse urgent or necessary treatment to somebody because they cannot pay for it”.—[

Official Report

, Commons, Immigration Bill Committee, 7/11/13; col. 303.]

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That is welcome. However, early and preventive treatment is better before urgent and much more expensive treatment becomes necessary. One straightforward example concerns a refused asylum seeker in Northern Ireland who suffered from asthma. For want of an inhaler, her health deteriorated. She was admitted to an intensive care unit and hospitalised for several days. For want of a few pounds, she eventually required treatment costing thousands of pounds. This caused her unnecessary suffering and substantial unnecessary cost to the Northern Ireland health service. Amendment 66A would address this. If the cost of treatment falls below a level set by the Secretary of State for Health, there would be no charge, saving the NHS money in the long run and, again, encouraging people to engage with primary care.

I want to raise one final matter. The Home Office Permanent Secretary told the Home Affairs Select Committee that the Home Office intends,

“to improve our radar screen into the health service”,

to identify people for immigration enforcement purposes. At Second Reading my noble friend assured the House that GPs will not become immigration officers, and I think he reiterated that on Monday evening when we were debating the pregnancy issues. GPs and other healthcare providers will have to check whether a person is eligible for free treatment. If this involves bringing someone to the attention of the Home Office, I fear that many people will not seek treatment. Already, around one in five service users attending the Doctors of the World clinic in east London has not attempted to access healthcare for fear of being arrested or reported. That includes many of the people about whom concerns are being raised in these amendments.

If the Government are to make good their commitment to protect public health, plans to extend the Home Office radar screen in this way should be reconsidered. I hope my noble friend will do that and perhaps not pursue these plans. I look forward to his reply.

Baroness Barker (LD): My Lords, I will briefly address Amendments 66A, 66B, 66C and 66D and leave my noble friend Lady Hamwee to address Amendment 66E.

Amendment 66A stands in the name of my noble friend Lady Williams of Crosby. It is a shame that she is not here because, as Members of this House will know, among her many areas of expertise is an encyclopaedic knowledge of the United States. She and I talked a lot, particularly during the passage of the Health and Social Care Bill, about the comparisons and contrasts between our health system and that of the United States. One of the most graphic contrasts is in A&E. When Americans go to A&E they are there for a very long time because they ask every conceivable question they can and fill their pockets with everything that is going. Millions of them do not have any healthcare cover at all. By contrast, we do. Per capita we spend about a third of what they spend in the USA but study after study shows that our health outcomes are better. Our systems are better because, by and large, we get people at the right place at the right time—and most people, because they have access to a GP and a certainty that they will be treated, present themselves early.

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The amendments in this group are not about trying to gain exemptions for one group of people and putting some kind of moral case that puts them in a different category from other people; they are about saying what is the most effective National Health Service for everybody—those who live here permanently and those whose leave to remain is as yet uncertain.

I do not see the purpose in making a charge for A&E. There may be some belief on the part of the Government that if they charge people for being seen in A&E it will somehow have the effect of pushing them to go to their GP. I would love to see the evidence for that; I do not think that people are either that calculating or that logical about the way in which they use the NHS, particularly A&E. I would be grateful if the Minister could set out the case on which the Government have based the proposal to charge people for turning up in A&E.

What discussions have they had with the College of Emergency Medicine about how this will work? I have recently been a member of the committee of your Lordships’ House reviewing the Mental Capacity Act. When we talked to representatives of the College of Emergency Medicine, they were in no doubt. We talked to them about advance statements and how much they found out about people’s wishes and so on, and they just said, “If somebody’s ill, you don’t do that; you just treat them”. It is naive to assume that they will change their entire practice for thousands of people who come through their doors on a weekly basis just because somebody happens to fall into a different immigration category; that is perhaps wishful thinking.

Amendment 66C poses a very simple question: are we going to charge people for diagnostic tests and, if so, on what basis will we do so? Frankly, I cannot see the incentive for somebody to go and see a GP if the consultation is free but they then have to pay for any diagnostic tests. That is what most GPs do above anything else; they run a set of diagnostic tests and they look at them. There is also a public health implication here. The issue that we have with a number of conditions is trying to persuade people to be tested so that we can then make plans for their individual health and also plot the health of the community. What exactly are the proposals on diagnostic tests?

Perhaps the most important and relevant amendment in this group is Amendment 66D. My understanding, and that of the people and organisations which have briefed us, including the National AIDS Trust, is that, should the Bill remain unamended, the Department of Health will have the power to levy charges for mental health services outside those provided by hospitals. Clearly, it will not be able to charge people who are detained under the Mental Health Act, and I doubt that if somebody was sufficiently ill to be receiving mental health treatment in a hospital they would be charged for that—I may be wrong—but community and primary care service mental health treatments could be charged for.

On that, we should follow the point made firmly by the Academy of Medical Royal Colleges in its response to the Department of Health consultation: that access to primary mental health services is a public health issue. We should not leave mentally distressed people

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to get to the point where they become a danger to themselves and to others. This measure would fly in the face of the intentions of the most recent Mental Health Act to go through this House, in which there was an emphasis on ensuring that people were subject to compulsory treatment in the community. I have no wish go back over some of the worst legislation that we have ever passed in your Lordships’ House, but this measure seems to undermine that considerably. I would like a full statement from the Minister on exactly what the Government’s intentions are on mental health services.

9 pm

Baroness Hamwee (LD): My Lords, I may be quite wrong in my recollection, but I remember reading somewhere that only a single consultation with a GP would not be charged for. I hope that I am wrong in thinking that, but if that is the case, I am really worried. It builds on my noble friend’s point about diagnostic testing. I have a wonderful GP, but on the, happily, rare occasions on which I see him, he usually says, “Go to have a blood test and come back”, or “Let’s see how it goes and come back”.

Amendment 66E covers ground that has already been thoroughly covered by the noble Baronesses, Lady Meacher and Lady Cumberlege, about both victims of domestic abuse and persons who are believed to be victims of trafficking. The point about identifying both those groups—not all of them, but many of them, women—is very important. Often, they may not even be suspected of falling within those groups until they see a doctor. Doctors are in the best place gently to investigate how certain conditions have come about, because the patient may not be prepared to disclose the information without being encouraged to do so, and may not have disclosed it to anyone else—possibly not even to a doctor on initial consultation. Although the intention here is good, we have to be clear about how the provision will be implemented, as well as getting assurances that what we understand to be the case will be the case.

Baroness Smith of Basildon (Lab): My Lords, there is little I can add to the points made eloquently by noble Lords—although, in an all-female debate, perhaps I should say noble Baronesses. Some points are not dissimilar to the principles that we raised on Monday about exemptions on housing issues and the rate of pregnancy and domestic violence. Again, the debate highlights confusion and a lack of clarity. The Government have to accept some responsibility for that confusion and lack of clarity.

The case raised by the noble Baroness, Lady Meacher, and reinforced by the noble Baroness, Lady Finlay, is that victims of domestic violence and victims of female genital mutilation are not just vulnerable but are victims of crime. That is a step further than vulnerable.

I recall that when I was a PPS at the Home Office many years ago, the Government piloted working with A&E departments to identify women who presented with injuries that were likely to be the result of domestic violence, to see whether we could get those cases through the courts and protect the women from being

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victims again. That was a very important part of A&E working as part of the whole criminal justice system. I worry that women who should present themselves to health services to receive treatment for violent injuries and FGM—the case presented by the noble Baroness, Lady Finlay, was horrific—will be victims of trafficking. We have to imagine the terror of someone who has been trafficked to the UK, often for sex or slavery. They may not speak English; they may not be aware of their legal status; they will have little trust; they will be fearful and in poor health; and they will be worried about going to the authorities in the first place because of worry about their own status.

There needs to be careful thought about how that can be managed. The Minister and the Government have been helpful in saying that victims of human trafficking will be exempt from charges. They have been very clear on that, but much concern has been raised about how to identify those women and help them come forward. What the noble Lord said was helpful, but he needs to say more.

I return to the question of what this means and the complications that other noble Lords have raised. What is the Government’s definition of success here? If their policy is successful, health services will be able to check the eligibility of those who are entitled to free healthcare and, consequently, charge those who are not eligible. The second aim is to draw to the attention of the authorities those who present and do not have a legal right to stay in this country. The point about public health is particularly pertinent here, and I would like to know what the Government are thinking on this and how they identify the problems.

If identifying those who are not legal migrants and reporting them to the authorities means that those people are less likely to report for healthcare, what are the implications for public health if someone has an infectious disease that needs treatment or a condition where a lack of early intervention means more expensive, or even emergency, care? We heard about the case in Northern Ireland. Another case I have been aware of is that of a young woman who had asthma. Simple preventive treatment would have been cheap and easy, but the care later on that was necessary because she had not had that treatment was very dangerous to her health and expensive to the public purse.

The question of far greater cost comes back to the issue of mental health cases. I take the point made by the noble Baroness, Lady Barker, on this. If someone has mental health problems, they are likely to be a danger to themselves and to others. I am sure that it is not the Government’s intention that those people should go without healthcare, but we have to recognise that there are specific obligations in those cases. I am seeking from the Minister an explanation of what thought the Government have given to these issues prior to bringing the Bill forward, and what plans are in place to deal with these kinds of issues regarding the most vulnerable—the victims of crime, those who could be a danger to themselves or to others, and those who could present at even greater cost to the public purse if they do not get the treatment that they need? I am particularly interested in the Minister’s response on this matter.

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The Parliamentary Under-Secretary of State, Home Office (Lord Taylor of Holbeach) (Con): My Lords, this has been a very reasoned debate and I am pleased that we have had a chance to return to it. It has taken us slightly further along the track than the legislation takes us, but that is a feature of where we are. We have an Immigration Bill, a Home Office measure, that is designed to provide for a surcharge, which in turn is to provide free healthcare for those covered by the surcharge, and we have the health service itself, under the Department of Health, looking at ways in which it can more effectively recover sums that are due, under current legislation, from visitors—and, for that matter, illegal migrants and the like—to see how that can fit in with all the other considerations; public health has been mentioned, as well as the vulnerability of some of the patients who present themselves who may have become victims through no fault of their own and need proper medical attention. Those two things are going on at the same time. I suspect that at bottom that is why we are finding it a bit difficult to discuss this issue.

If I may, I will turn to the Bill itself to start with, as that is the most important thing. I am aware that I speak for the Government and I cannot say, “Well, this is my dear noble friend Lord Howe’s responsibility”, so I will do my best to integrate into one proposal both the Bill and the health service reforms. I reassure noble Lords that there is nothing in the Bill that will impact on the current arrangement for migrants in any of the areas covered by these amendments that have been debated this evening. Our intention is that the payment of the surcharge, which takes place when people make an immigration application, will entitle migrants to free access to the NHS in the same way as a permanent resident. This will include treatment for injuries sustained as a result of domestic violence, which the noble Baroness, Lady Meacher, mentioned, or female genital mutilation, which was mentioned by the noble Baronesses, Lady Meacher and Lady Finlay. It will also include mental health, to reassure my noble friend Lady Barker, and maternity services, as we discussed when we were debating previous amendments. We have also committed, as the noble Baroness, Lady Smith, said, to exempting victims of human trafficking. I can say to the noble Baroness, Lady Finlay, that there is no charge for anyone in detention accessing NHS healthcare.

Secondly—this is the second element of the debate—as my noble friend Lord Howe set out in his recent letter to noble Lords, the Bill does not make any changes to the way in which short-term visitors and, for that matter, illegal migrants access medical care. Any NHS charging exemptions for health purposes for these groups are a matter for the Department of Health and, within their devolved remit, the devolved Administrations. Within the framework of government, they are not the responsibility of the Home Office.

The noble Baroness, Lady Meacher, asked me how we will ensure that NHS staff can effectively identify potential victims of trafficking. The Department of Health already identifies patients who are victims or potential victims of human trafficking in order to waive treatment charges. We will work closely with the Department of Health on this matter in order to ensure that proper

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guidance and training are provided to NHS staff. I am not convinced that the amendments proposed by the noble Baroness are necessary.

I was asked why the national referral mechanism was not put on a statutory footing. It was set up to ensure that victims of human trafficking are identified and given the support they need. We want to make sure that the NRM is working as effectively and supportively as possible, and healthcare is part of that mechanism. That is why the National Health Service announced a review of the NRM on 3 December. It will commence shortly, and we await it.

The Department of Health has already confirmed that it will be exempting certain treatments from charging, including GP and nurse consultations, specified infectious diseases—we have talked about HIV and tuberculosis—and sexually transmitted infections. This will ensure that everyone has unrestricted access to prompt diagnosis and intervention and that public health is safeguarded.

The Department of Health has, however, signalled an intention to introduce overseas visitor charges for some primary care services, including A&E, as part of its extensive reform of NHS charging in England. It is carrying out detailed analysis to inform decisions in this area. I am confident that cost-effectiveness—noble Lords mentioned some of the consequences of poor primary care leading to complications that can be very expensive as a consequence—public health and the moral case for protecting vulnerable groups will remain key factors in this consideration. I can reassure noble Lords that any agreed changes will be put to Parliament in the form of revised NHS charging regulations. That is not an unusual situation. We are talking about a consultation. This aspect of health service reform is not appropriate in an Immigration Bill because it is not about immigration but the practice of charging within the health service.

Without getting involved in the argument as to whether that is the right or wrong thing to be doing, as we know, we have all been fortunate to grow up in a world in which, for most of us, all healthcare—well, not all healthcare; not dental care and things like that—has been free at the point of use. That is a remarkable privilege, but it is an expense and one has to argue whether the resources are properly justified if they are extended to visitors, for example, or illegal migrants. That is not an unreasonable position to take.

9.15 pm

Baroness Meacher: I am sorry to interrupt the Minister. He understandably said that this was a matter for the Department of Health and therefore not really appropriate for discussion here. Can he assure the Committee that we will therefore have another opportunity to influence the design of these regulations, which will indeed determine whether people suffering with FGM, domestic violence and so forth will be excluded from health charges or not? That is a matter of great concern to many of us. If we cannot discuss it here, will there be another opportunity?

Lord Taylor of Holbeach: That is why I am going to try to address some of these matters. It is right to seek to do so, allowing for the limitations of my knowledge in this area, which I hope that noble Lords will understand.

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This House has a good reputation for debating these sorts of things not, if I may say so, through the statutory instrument process so much as generally. I am absolutely certain that my noble friend Lord Howe would be quite prepared to come at a suitable point during the consultation to discuss the basis of changes that would be made. I am sure that I am not losing a friend for life by committing him to do just that.

As if to show that I need to brush up a little bit, apparently I may not have said, through mis-speaking or a slip of the tongue, that the Home Secretary announced the review of the NRM. I thought that I had implied that, but if I had not, I should have done so. Let us hope that I do not fall out with another friend for not crediting the Home Secretary.

The noble Baroness, Lady Meacher, asked about training for the enforcement of new NHS rules, and also about the Modern Slavery Bill which, as noble Lords know, is in pre-legislative scrutiny. The Department of Health will publish its implementation plan on the health service rules during the course of this year. The Modern Slavery Bill will be a fourth Session measure. I must not anticipate the Queen’s Speech, but the fact that that Bill is going through pre-legislative scrutiny rather suggests that it will be in the fourth Session legislation.

The noble Baroness, Lady Finlay, asked about a victim of FGM who has infected wounds. Under the NHS charging regulations and policy, immediate necessary treatment is not held up because of charging. I think that the noble Baroness has enough experience of how the health service operates charging principles, and I do not think that that is likely to change. GP care is not charged for, as I have said. The Department of Health is reviewing provisions for vulnerable individuals under these NHS regulations.

The noble Baroness asked why we were planning to charge migrants for accident and emergency services. Surcharge payers will obviously not have to pay for A&E services. The Department of Health has indicated that there is a good case for introducing overseas visitor charges for A&E, for those short-term visitors and illegal migrants who do not pay the surcharge. It is giving this detailed consideration, but will not make any changes unless it is confident that the new systems will work well without compromising rapid access to emergency care for those in immediate or urgent need, which will never be withheld or delayed pending payment. However, as I said, that is not a matter for the Bill. It is part of the review into regulations which is going on at the moment.

My noble friend Lady Cumberlege asked whether those exempted from the charges will be exempted from NHS charges. Our policy intention is that those who are exempt from the surcharge will also be exempt from subsequent National Health Service charging for health services under NHS regulations. However, obviously they will be liable for dentistry; as I mentioned before, at the moment that is not free other than in exceptional cases.

Under the Bill it is possible for surcharge payers to be charged for certain expensive discretionary treatments —I think we have discussed that already. However, we have made it clear that we intend that no such additional

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charges will apply when the surcharge is introduced. The Department of Health has made it clear that it would consider those in the future only in the event of any exceptional and compelling specific justification for health purposes, and, as I have already said, any changes would need to be put before Parliament.

My noble friend welcomed the exemptions, but those refused asylum will face charges, as will most victims of trafficking who are not recognised through the national referral mechanism. I emphasise to my noble friend that refused asylum seekers will not pay a surcharge. Health charging for refused asylum seekers is a matter for the Department of Health and the devolved health administrations within its remit. We have already confirmed that trafficking victims will not have to pay the surcharge.

The NRM is the only process by which an individual can be formally identified as a victim of trafficking and matched with appropriate support. Someone who has not been identified as a victim through the NRM and who is an illegal migrant or visitor would not be covered by the exemption for NHS charging under the existing regime. However, the NHS can write off NHS debts if individuals are subsequently identified as victims of trafficking, so there is a retrospective exemption in that regard.