House of Lords Report (3 April) Clause 38: Related Provision: Charges for Health Services

House of Lords Report (3 April) Clause 38: Related provision: charges for health services

Amendment 51 not moved.

Amendment 52

Moved by Baroness Masham of Ilton

52: After Clause 38, insert the following new Clause—

“Exemption of charging for primary medical services where charging is not cost-effective or poses a risk to public health

(1) Section 182 of the National Health Service Act 2006 (remission and payment of charges) is amended as follows.

(2) After subsection (1), insert—

“(2) Insofar as any regulations under section 175 provide for charges to be made for the provision of primary medical services, they shall include provision for the remission in full of any charge that falls below the minimum threshold of service cost.

(3) In subsection (2), the “minimum threshold of service cost” shall be the cost to the provider of primary medical services below which no charge is to be made for the provision of those services.

(4) Where regulations under section 175 provide for a charge to be made for the provision of primary medical services, the provider of those services may waive the charge where he or she considers that the cost of recovering the charge is not economical or where the consequences of charging may put the public health at risk.””

Baroness Masham of Ilton (CB): My Lords, Amendment 52 is to do with public health protection. In Committee, the noble Baroness, Lady Cumberlege, spoke to this amendment, for which I was very grateful as unfortunately I had a long-standing commitment which I had to attend. The noble Baroness, like me, is passionate about health safety and knows that the Bill may cause danger to the health of the nation. Some people who have not paid the health levy may not seek help when they become ill because they fear being reported to the authorities and they may not have the money for tests and medication.

I am particularly concerned because, with the resistance to antibiotics and antivirals, diseases may be spread when people leave treatment too late. If they think they have to pay for medication, they will not go to primary healthcare for diagnosis. What will be the point?

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As it is, it is very difficult to find some homeless people who need screening and I congratulate the organisation Find and Treat. I thank both Ministers for the recent meeting we had with the noble Lord, Lord Taylor of Holbeach, and the noble Earl, Lord Howe. It is important that departments work together over this complex matter with Public Health England. This amendment is to do with public health and cost-effectiveness. I declare an interest as an officer of the APPG on Primary Care and Public Health and the groups on HIV and tuberculosis.

The purpose of the amendment is to provide an exemption from NHS charges where the cost of imposing and recovering a charge is not cost-effective or where the imposition of a charge constitutes a risk to public health. Doctors of the World supports this amendment, as do other health organisations.

In its response to last year’s consultation, the Royal College of General Practitioners made clear that it,

“opposes any change to the eligibility rules for migrants accessing GP services”.

Among the reasons given for its opposition were risks to public health and the imposition of new administrative burdens. Dr Mark Porter, the chair of the BMA council, has described the proposed charges as, “impractical, uneconomic and inefficient”. The Academy of Medical Royal Colleges emphasised in its response to the consultation that any proposals adopted,

“should not … create a bureaucratic process and burden that outweighs any tangible benefits”.

The amendment does not prevent charging but provides some flexibility within the proposed system to make it more cost-effective. The requirement to set a,

“minimum threshold of service cost”, introduced in proposed new subsections (2) and (3) of Section 182 of the National Health Service Act 2006, achieves this. It requires the Secretary of State to stipulate a figure in regulations. If the cost of providing primary care falls below the stipulated figure, there is to be no charge. Similarly, if the provider of primary care considers that it will not be cost- effective to recover the charge, the provider may waive the charge. This would be achieved by the amendment in proposed new subsection (4) to Section 182 of the National Health Service Act 2006. Section 182 concerns exemptions from charges, including NHS charges to be made under Section 175, to which Clause 34(2) of the Bill refers. To this extent, the amendment responds to the concerns of the Royal College of General Practitioners, the BMA council and the Academy of Medical Royal Colleges. The Department of Health has acknowledged that,

“the administrative cost may outweigh the recoverable charges for frequently used but relatively inexpensive services”.

3.30 pm

The amendment would be limited to primary care, because in this setting the provision of healthcare is most likely to raise questions about the cost-effectiveness of imposing and seeking to recover a charge. Discrete

3 Apr 2014 : Column 1098 secondary care interventions are likely to be generally more expensive. At a Commons Bill Committee, the then Immigration Minister, Mark Harper MP, said,

“we will not do anything that will worsen public health”.—[

Official Report

, Commons, Immigration Public Bill Committee, 12/11/13; col. 310.]

Of course it is important for those who are in the UK, even if they are not here legally, to have access to public health treatment because it has an impact, not just on them but on the rest of the community. That is well understood by both the Home Office and the Department of Health. However, the Bill, and the charges for which it is intended to pave the way, will worsen public health.

The Bill extends the range of migrants who may be liable for NHS charges. Currently, those who are living in the UK lawfully for settled purposes as part of the regular order of their life have free access to NHS services. Clause 34 will mean that all non-European Economic Area migrants who do not have indefinite leave to enter or remain—that is, permanent residence— will be liable for NHS charges. The Government further intend to greatly extend the range of NHS services to which these charges apply.

Currently, primary care as accident and emergency treatment is free of charge. The Government are to introduce charging for primary care as accident and emergency treatment, although GP consultations are to remain free. It appears that any treatment that the GP may provide further to that consultation will be charged for. This is to contribute to the hostile environment that the Home Secretary says the Bill is intended to create for undocumented migrants. However, if undocumented migrants, including victims of human trafficking and refused asylum seekers, are to be charged for any treatment that they may need following a GP consultation, it seems highly unlikely that many of them will attend a GP. What will be the point if they cannot pay for any treatment that they may need?

As the RCGP emphasised in its response to the consultation,

“diagnosis of infectious disease is a core activity of general practice”.

The Department of Health has acknowledged this. The Government have committed to retaining free treatment for the specified communicable and sexually transmitted diseases but, as the RCGP said, often people suffering from infectious diseases do not know what is making them ill. It is likely that a significant number of individuals will be deterred from presenting at their GP practice for fear of charges and/or eligibility checks.

Similarly, we are concerned that limiting access to primary care would impact detrimentally on immunisation rates, as it would be more difficult to encourage presentation by parents from non-eligible migrant groups. We note that the royal college is right to be concerned about eligibility checks, particularly given the intention of the Home Office to extend its radar into the NHS via these checks, as revealed by the Home Office Permanent Secretary last year. That matter is not addressed by the amendment. However, the amendment would mitigate the potential deterrent effect of NHS charging by permitting a primary care provider to waive 3 Apr 2014 : Column 1099 a fee where to do so is necessary on public health grounds. This would be included in proposed new subsection (4) to Section 182, referred to earlier. This would provide some amelioration of the concerns of the Academy of Medical Royal Colleges and the Royal College of Psychiatrists. It says:

“Although we welcome the statement that there should be exemptions from charging in respect of infectious diseases including all”, sexually transmitted infections,

“we are concerned about the potential effect of the proposed legislation on migrants with mental health problems and/or those with developmental disorders and intellectual disabilities. There is a strong public health case for considering the needs of these vulnerable groups when making decisions about charging exemptions”.

The amendment would also permit a GP to waive a fee to treat a condition where the likely result of not doing so was that the condition would deteriorate to a point where urgent and much more expensive treatment became necessary. The NHS gains no advantage from not doing this, since the person who cannot pay for an early and relatively inexpensive intervention will be no better placed to pay for a later and very expensive one. An example was given by the Northern Ireland Law Centre in its June 2013 policy briefing of an asylum seeker who required an inhaler due to her asthma. When she was refused asylum she found herself excluded from healthcare, and without an inhaler her condition deteriorated so far that she was admitted to an intensive care unit and remained in hospital for five days. I beg to move.

Baroness Hamwee (LD): My Lords, I appreciate that the charging arrangements are not ones for this Bill. I simply want to say that many of the concerns voiced by the noble Baroness are ones that we share. We had amendments on issues around this at the previous stage, and we look forward to discussing how arrangements brought in by the Department of Health will be implemented. However, I realise that that is a matter for another day.

Baroness Williams of Crosby (LD): My Lords, I very much hope that the Minister will have a deep discussion with his colleague, the noble Earl, Lord Howe, from the Department of Health, not necessarily about every single word of this quite lengthy amendment but about the general questions that it raises. I have in my hand a letter from the president of the Royal College of Physicians, Sir Richard Thompson, which was not one of those colleges mentioned by the noble Baroness, Lady Masham, but which raises serious questions about the public health implications unless we can look very carefully at them in the short while before Third Reading.

I think the noble Baroness, Lady Jay, who has played a crucial role in the whole area of sexual diseases, particularly AIDS, would bear out the argument made by Sir Richard. The major point he makes, and it is a very important one, is that there is considerable evidence that people who are invited to clinics, particularly the Doctors of the World Clinic in east London, to be tested for very dangerous and infectious diseases such as AIDS and drug- resistant tuberculosis—which is growing rapidly and now becoming a significant 3 Apr 2014 : Column 1100 international threat to the good health even of people in relatively healthy countries such as our own—will see even relatively limited financial barriers as reasons not to attend. One of the prime difficulties is that when somebody attends a primary care facility, which is still generally available, or an A&E clinic and is referred on for testing to a hospital or another A&E clinic the real danger is that they will find this a reason not to attend. One has to accept that many people do not want to know what may be wrong with them. They are frightened of learning the results so any kind of hindrance is used as an excuse for not going.

The House will know, because it has had many discussions on infectious diseases and among its Members contains many experts in the field, the lethal consequences of people with AIDS or drug-resistant tuberculosis moving among the community where they live without being aware of the very serious, often lethal, consequences of passing on that infection. Sir Richard points out in his letter to me that one experience of that east London clinic is precisely that. There is a very rapid multiplying consequence of people not knowing what they have or knowing it and continuing to act as if they do not have to be treated. I simply plead with the House, from a non-partisan point of view, to look very closely at this amendment and consider what can best be done about it, in the interests of every citizen of this country and overseas visitors, to ensure that every possible step will be taken to ensure that highly infectious diseases are not passed on to innocent passers-by, friends or members of the family.

The Earl of Sandwich (CB): My Lords, I congratulate my noble friend on speaking so powerfully on behalf of a vulnerable group. This is an important amendment. I spoke on this issue at Second Reading and I am sorry to have missed the Committee stage, when I think the noble Earl, Lord Howe, gave another response, but I am still not satisfied that the Government have taken a serious interest in this. When I spoke at Second Reading the report of Médecins du Monde seemed to me very compelling. Has the Minister seen it? The noble Baroness quoted several authorities and I will not repeat them but I think this has serious consequences, not only for that group but for the population at large, especially in the field of mental health.

Baroness Smith of Basildon (Lab): My Lords, briefly, when we look at the Second Reading and Committee debates, one area of the Bill where there has been the least clarity for noble Lords is in trying to understand the implications beyond what are now Clauses 37 and 38. It is not necessarily the words of the clauses but some of the rhetoric that the Government have used in describing the Bill, such as “health tourism”. I know that there are expectations of what this Bill was going to do and concerns about the implications. I think there is an opportunity for the noble Lord. The noble Baroness, Lady Masham, is to be congratulated on bringing this forward to give some clarity to what is involved. I have had several e-mails and letters from organisations that are extremely concerned. They are not trying to scaremonger; they are trying to understand the public health implications.

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In a meeting I had with noble Lord, he was very helpful in explaining that he did not feel that there would be any public health implications and that people who needed treatment would receive it at the point at which they needed it. However, I think a little clarity would be helpful. The two issues of the public health of the nation and cost-effectiveness have exercised your Lordships in looking at this matter. If the Minister can bring some clarity to the two issues raised by the noble Baroness, Lady Masham, it would be extremely helpful and perhaps helpful to the wider audience outside your Lordships’ House, who have genuine concerns and are trying to ensure that they operate in the best interests of public health and within the law. There is considerable confusion as to what that will be.

3.45 pm

Lord Taylor of Holbeach: My Lords, I agree that this is a very useful opportunity to inform the House of where we are on this issue. The noble Baroness, Lady Masham, will understand that the provisions in the Bill are one thing and the wider provisions for implementing health service charging are another. We had a really useful meeting with my noble friend Lord Howe where a number of noble Lords present came to talk about this issue. I think noble Lords will agree he is very much focused on the full implications of any changes. I reassure the noble Earl, Lord Sandwich, that Médecins du Monde corresponds with me on a fairly regular basis so I know what its concerns are and unfortunately it was not at the meeting with the noble Earl, Lord Howe. If it had been I think it would have understood better the way in which the health service reforms were being taken forward. The other thing which they would certainly have picked up is that it is absolutely clear that treatment for infectious public health conditions is free to all and will remain so. We should just make that clear; I hope that it reassures my noble friend Lady Williams and the noble Baroness, Lady Masham.

As we discussed at length when we were talking about this issue, any exemptions from the NHS charging of short-term visitors and illegal migrants are not really a matter for the Home Office. This is not a provision that is being enacted in the Bill and is not a question on which the Home Office would make a decision. Exemptions are a matter for the Department of Health. I know that they are being considered very sensitively. Let us not forget that, within the devolved remit, while there is one United Kingdom for immigration purposes there are four national health services within the United Kingdom. It is not for me from this Despatch Box to speak on their behalf. I have no wish to cause a constitutional crisis by inadvertently taking over responsibilities for which I have no responsibility.

My noble friend Lord Howe has agreed to meet again with noble Lords. I think that everybody felt that that was a helpful meeting. I want to keep everybody in the loop; I can act as a facilitator in this respect. When my noble friend’s department has developed more detailed proposals for reforming NHS overseas visitor charging arrangements—and it is that charging which is being looked at in particular, for people on

3 Apr 2014 : Column 1102 short visits here—this will provide the appropriate time and context for discussions on the NHS charging arrangements for these groups.

Going back to the beginning, I confirm that treatment for infectious public health conditions is free for all and will remain so. I hope that that is a big reassurance. Given that reassurance, alongside our existing commitment that GP and nurse consultations will remain free to all and that that is not limited to the first consultation, I hope that the noble Baroness will indeed withdraw her amendment. I look forward to having further discussions with her and my noble friend Lord Howe in the future. Baroness Masham of Ilton: My Lords, I thank the Minister and all who have supported the amendment. What is confusing is that Clauses 37 and 38 cover the new charges and restrictions of healthcare access in this Bill. Therefore, it is surely an immigration and health matter. Therefore, unless there is a combination working together on this complex matter, there will be confusion and people may fall through the net. I hope that I have helped to get the message across that public health and protection are vital, especially when dealing with vulnerable people. I beg leave to withdraw the amendment.

Amendment 52 withdrawn.

Amendment 54

Moved by Lord Roberts of Llandudno

54: After Clause 44, insert the following new Clause—

“Permission to work

(1) The Immigration Act 1971 is amended as follows.

(2) After section 3(9) (general provisions for regulation and control) insert—

“(10) In making rules under subsection (2), the Secretary of State must have regard to the following.

(11) Rules must provide for persons seeking asylum, within the meaning of the rules, to apply to the Secretary of State for permission to take up employment and that permission must be granted if—

(a) a decision has not been taken on the applicant’s asylum application within six months of the date on which it was recorded, or

(b) an individual makes further submissions which raise asylum grounds and a decision on that fresh claim or to refuse to treat such further submissions as a fresh claim has not been taken within six months of the date on which they were recorded.

(12) Permission for a person seeking asylum to take up employment shall be on terms no less favourable than those upon which permission is granted to a person recognised as a refugee to take up employment.””

Lord Roberts of Llandudno (LD): My Lords, full employment with a job for every person has been the ideal of every party here over generations. When I

3 Apr 2014 : Column 1110 look at the Labour Benches I remember people such as Keir Hardie and those who, in 1908, wanted their party to be one which united the workers of the world:

“Workers of the world, unite!”. Then, of course, being on these Benches, I remember the name—as a Welshman would—of David Lloyd George, who in 1928 published his “Yellow Book”, followed by We Can Conquer Unemployment. Looking at the Conservative Benches, we know that only last week George Osborne said that the aspiration was that every person should have a job and that we should have full employment.

Every person has potential. They have skills and dreams, so I suggest that it should be our direction in this House to make sure that we enable as many as possible of those dreams to be fulfilled. We should not shatter those dreams. Even those who are asylum seekers among us —they, too, have hopes and dreams. They are people just like us. There are 6,200 asylum seekers lawfully present in the UK who, because of present regulations, are denied that right —and more often than not, it is not their fault. It is because of the backlog of applications. So they get perhaps £36 a week, which is half the minimum amount recommended for UK citizens, and they are given an Azure card which forces them to buy their goods in the more expensive stores rather than the cheaper ones and the corner shops. Even if nothing else happens as a result of this debate, I hope that the Minister will look at the state of the Azure card. People should be able to buy their goods in the most competitive places.

Of course, some people will turn to crime or, like the Morecambe Bay cockle pickers, who were not asylum seekers, will have to work for £1 an hour. Those Chinese workers were caused to take on employment that destroyed their lives. I suggest that the present situation is not fit for purpose. What can we do? We can keep people in poverty and destitution for 12 months, which is the present statutory period. I would remind noble Lords opposite that it was in July 2002 that the term was increased from six months to 12 months. However, we could change the period—and, indeed we are the only European country not to have done so. We could reduce it to six months, and that is all I am asking for in this amendment.

There is no evidence whatever that doing this would blur the boundary between economic migration and asylum or that it would act as a pull factor. Other European countries do not find that to be the case. Also, there is no evidence that such a change would lead to unfounded claims. A pilot would show that. I have a Private Member’s Bill which requests this change, and possibly it will have to be reintroduced in the next Session of Parliament. I hope that the Minister will accept the amendment I am moving today—or, if not, that I will be assured of the Government’s encouragement if this proposal is presented in the form of a Private Member’s Bill in the coming Parliament. I beg to move.

Baroness Lister of Burtersett: My Lords, I am pleased to speak as a co-sponsor of Amendment 54, and I shall recap briefly the case that was made in Committee. The right to work is a human right enshrined in the

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UN Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights. Social policy in this country is premised on the importance of paid work as both a primary responsibility and the primary contribution that people can make. I drew attention to the damaging effects on asylum seekers and any children, and I cited evidence from a cross-parliamentary inquiry into asylum support for children and young people, of which I was a member, and a Freedom From Torture report which showed the hardship resulting from the policy of not allowing asylum seekers to take paid work for 12 months. During the debate the Minister challenged the noble Baroness, Lady Williams, when she talked about people having to live on £5 a day by pointing out that families with children receive more than that. However, my understanding is that in 2013, 80% of applications for asylum were made by single adults, so the figure of £5 a day is in fact the typical sum on which someone has to live. That sum has been frozen since April 2011, and I wonder whether the Minister could explain the justification for freezing the level of support provided for one of the most vulnerable groups in our country. I also wonder whether he would be able to live on £5 a day, because I could not.

4.30 pm

However, none of these arguments cuts any ice. I cannot say that I was disappointed by the Minister’s response in Committee because it was pretty much what I expected, but I was desperately depressed as a result. The response reflected an obsessive fear that providing this basic right could lead to a flood of economic migrants posing as asylum seekers. Why would anyone want to do that? If you want to come into this country illegally, it is not the best idea to go and make yourself known to the authorities. That argument seems odd.

What evidence is it based on? There is none—as, in fact, the Minister conceded in his letter to the noble Lord, Lord Roberts. The evidence we have points in the opposite direction when one considers that there is no relationship between other European countries allowing the right to work—admittedly often with conditions around it—and that right acting as a pull factor for asylum seekers. Indeed, I went back to the Home Office’s own study, which could find no evidence from which to reach the conclusion—upon which current policy is based— that providing the right to work after six months would act as an invitation to economic migrants to come here as asylum seekers.

I have not yet heard a convincing response to the argument that, far from protecting British workers, the policy pushes asylum seekers into the shadow economy, where they will be at the mercy of exploitative employers. Does the Minister have any estimate of the extent to which this is happening? Nor have I had any real response to the argument that the policy seriously disadvantages those who go on to be granted refugee status, because employers do not want to employ people who have no work experience in this country and no references from employers in this country. That was cited as one of the barriers by respondents in the Freedom from Torture study, who said that some

3 Apr 2014 : Column 1112 of their problems began when they gained refugee status because they had not been adequately prepared, they did not have experience of employment in this country, and they had enormous difficulties making the transition from asylum seeking to full refugee status. We are making it harder for them. The Home Office’s own research has shown how the loss of skills and confidence, and difficulties getting qualifications, can mean unemployment or underemployment when refugee status is finally granted.

Governments like to talk about evidence-based policy-making, but when it comes to asylum seekers it seems to me that it is more a case of prejudice-based policy-making—despite the evidence that public opinion, which is so often prejudiced against asylum seekers, supports this policy. For me, this prejudice-based policy-making diminishes us as a country and makes me ashamed of how we treat those who seek sanctuary among us. The Earl of Sandwich: My Lords, the noble Lord, Lord Roberts, has one of the most prophetic voices in this House. He can see so far ahead of us that he can see someone in government accepting his amendment—just over the horizon but not yet. I am most impressed by his fortitude because this is an issue at which all the refugee agencies and people working with refugees have looked again and again. They have presented evidence that still has not convinced the Government because they have not got rid of the backlog. As soon as they have got rid of the backlog they will seriously look at this kind of proposal. They are therefore worried about the consequences of opening up what they see as an economic draw. I do not do so and I am absolutely convinced that the noble Lord is right about this, but these are things to come.

Perhaps I may again bring in the issue of assisted voluntary return that we discussed on Tuesday, when the Minister kindly responded to a question about why it was being withdrawn, because it is very pertinent to this subject. He kindly also offered to write to me about that. I formally accept the idea that he writes to me fully.

The Earl of Listowel (CB): My Lords, I cannot resist speaking on this because I so admire what the Government are doing in encouraging people in this country into work: the work of the noble Lord, Lord Freud, and the Secretary of State on the introduction of universal credit. We may have concerns about the details of this policy but I think we all recognise that it is vital to encourage people off benefit and into work wherever possible.

I have a very long-standing acquaintance who, unfortunately, has mental health problems. I know him very well indeed. Thanks to the fact that he is taking benefit, he is obliged to work in a charity shop for half a day, four days a week. While this is very much against his wishes, he is being obliged to have contact with other human beings, which, I think, is a way to his recovery. I have to reflect on how deeply demoralising it must be for these people not to be allowed to work and what the consequences may

3 Apr 2014 : Column 1113 be for their children to have their parents becoming depressed because they have nothing useful to do in their lives.

I hesitate to come in without being better informed about this particular debate, but I have a great deal of sympathy with what the noble Lord, Lord Roberts, and other speakers have said, and I hope the Minister may be able to offer some comfort to them.

Baroness Hamwee: My Lords, in answer to the noble Earl, Lord Sandwich, we need prophets and optimists, and I am glad that we have at least one.

I very much support what my noble friend has been urging us so consistently to do: for reasons of integration; for individuals to keep up skills and be able to practise their English in the context of work; and, of course, for the financial reasons that the noble Baroness has dealt with. Most of all, work is valuable for self-respect and mental health. I do not put the two situations on a par with one another but clearly we all value working: there are a lot of noble Lords in the Chamber this afternoon, and who have been in this building, who could probably have been taking advantage of what I understand has been quite nice weather outside but have chosen to spend the day working. Lord Hussain (LD): My Lords, when the Government brought in this law, withdrawing the right of asylum seekers who have been here for more than six months to work, I do not know what they intended to achieve, or what they have achieved so far by having that law. It does not prevent any people coming into the country. It is not an immigration issue at all. We are talking about people who are already in this country, asylum seekers whose applications are being dealt with. Through no fault of their own, their applications are taking longer than six months. We are still saying that they should not be able to work.

This law drives people into deep poverty. They are more vulnerable to exploitation. They should have a right to work, like everyone else, and they should be able to feel proud that they are not living on handouts but working for their families. This is one good thing that the children can be proud of as well. Therefore, the amendment moved by my noble friend Lord Roberts should be supported. I support it. I hope that the Minister will look into this and be sympathetic to the cause of the asylum seekers.

Baroness Manzoor (LD): My Lords, I briefly add my support because, although I have listened very carefully to the argument made by the Minister, I genuinely do not understand why people should not be allowed to work for perhaps six months because of the backlog of cases. Perhaps there should be a time limit, so that if someone has not heard about their case then they have the right to work. However, we must think very carefully about what the implications of that may be. As was said by the noble Baroness, Lady Lister, maybe something should be put around that to keep the criteria very visible to the Home Office.

Earl Attlee (Con): My Lords, I think the whole House will admire the heroic efforts of my noble friend Lord Roberts of Llandudno for making just

3 Apr 2014 : Column 1114 one more try at this issue. I have listened very carefully to the arguments in favour of allowing asylum seekers to work if their asylum claim is not determined after six months instead of the current period of 12 months. I am not convinced that it is sensible. In the Government’s view, the proposed change clearly creates a risk that some people will make unfounded asylum claims in order to take advantage of the more generous employment opportunities. Indeed, the amendment as drafted would enable the person to take any employment of their choice, rather than be restricted to those on the shortage occupation list published by the Home Office.

I agree with my noble friend and with the House about the importance of being able to work. Although paid work might not be permitted except in certain circumstances, voluntary work is allowed, as I explained on the previous occasion when we debated this. My noble friend and the noble Baroness, Lady Lister, talked about the level of support provided. I remind the House that two levels of support are provided, to cover asylum seekers and failed asylum seekers. The noble Baroness asked me to justify keeping the support rate the same since 2011. The Government conducted a full review of asylum support levels last year, in June 2013. The review concluded that the payment levels were adequate to meet essential living needs. They are only to meet essential living needs.

Many noble Lords asked why we do not let failed asylum seekers work so that they can support themselves. It is important to maintain a distinction between economic migration and asylum. Failed asylum seekers, whose further asylum-related submissions have been outstanding for at least one year, may apply for permission to work. This is in line with our obligations under the 2003 EU reception conditions directive. We have considered the merits of reducing this threshold, but such a reduction could encourage those who are not genuinely in need of protection to enter the asylum system for economic reasons.

The noble Earl, Lord Sandwich, asked about the assisted voluntary return package, and my noble and learned friend Lord Wallace of Tankerness said that he will write to the noble Earl on this point. In answer to the noble Baroness, Lady Lister, the desirability of the UK as a destination for economic migrants is not in doubt; one only has to look at some of yesterday’s newspapers. The Government have been successful at reducing non-EEA net migration but EEA migration remains high, as those who benefit from EU free movement come here looking for work. We are dealing with the imbalances in European migration. Throwing open access to the labour market as proposed by this amendment would send the wrong signals, and damage the significant progress this Government have made in controlling migration.

Baroness Manzoor: Surely the Home Office would be able to tell the difference between an economic migrant and an asylum seeker. That is why it has the caseload.

Earl Attlee: My Lords, if they are a genuine asylum seeker, in some cases it will be easy to determine that they have a good case. Once asylum is granted, people

3 Apr 2014 : Column 1115 are able to work straightaway. However, if the case is difficult, possibly because the asylum seeker has made it difficult, unfortunately it takes considerably more time to determine the application.

As I was saying before my noble friend intervened, we do not believe that it is worth taking a risk with the progress that we have made so far. It is true that some asylum claims take too long to consider, but the Home Office is addressing the issue. In year 2012-13, 78% of claims received a decision within six months.

It may be generally true that unfounded claims can be considered faster than other claims, but they still need to be considered individually, which takes time and resources. Consideration of these claims therefore slows down consideration of genuine claims, at the expense of people who need international protection.

The current policy strikes the right balance. Asylum seekers are provided with support and accommodation if they are destitute. If their asylum claims are undetermined after 12 months for reasons outside their control, they can apply for permission to work. This is a fair and reasonable policy and we should keep to it. In the light of these points, I hope that my noble friend will feel able to withdraw this amendment.

Lord Roberts of Llandudno: I thank the Minister for his reply and say how terribly disappointed I am, even though we have brought this issue up time and again, that that there is no movement whatever on the part of the Conservative Front Bench. I note that the Labour Front Bench has not intervened in this debate and am also very sad for that; I wish that it would join us in this campaign. I will not test the feeling of the House today, but I propose to bring forward a Private Member’s Bill again in the next Session of Parliament. I therefore, most reluctantly, beg leave to withdraw the amendment. Amendment 54 withdrawn.