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.
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
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.
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