On 31 January 2021 the UK Government launched a new immigration route for British National (Overseas) (BN(O)) status holders, providing the opportunity for them and their eligible family members to live, work and study in the UK.

Having a valid TB test certificate is an essential requirement for the BN(O) route. All those who have been in the UK for less than six months and who have previously travelled from a country with a high incidence of TB will need a certificate confirming they are free of the disease. This is a matter of public health.

There are already eight approved TB test clinics across the UK and we are working hard to get more clinics accredited. In particular, the Home Office is working closely with clinics across Northern Ireland to ensure a clinic can be accredited soon and available for appointments.

TB test clinics are open across the UK. We understand restrictions as a result of the Covid-19 pandemic may impact on an applicant’s ability to travel and we would urge applicants to assess the risk and only travel to a TB test appointment where necessary. Where an applicant’s leave is about to expire and they cannot travel to an approved clinic, we will consider these applications on a case-by-case basis.

Test uptake among the eligible invited population in 2017 ranged between 19.4% and 82.4% depending on clinical commissioning group (CCG) area.

In 2017, 27 CCGs reported treatment data; for the 1,364 people who tested positive for latent tuberculosis infection (LTBI) in these areas, 60.3% accessed treatment. Overall treatment completion among this group stood at 71.0% in 2017.

NHS England has invited CCGs with high incidence of tuberculosis (TB) to submit plans on how they will locally increase uptake of testing and treatment for LTBI, with the ability to access NHS England funding to support implementation of their plans. £35 million has been made available to support this work over the past four years. NHS England supports CCGs to develop local plans for increasing uptake of LTBI testing, including sharing best practice. This contributes to reducing variation between local authority areas.

Modelling undertaken as part of the five-year TB strategy indicated that return on investment should begin to be recovered from year five onwards, with net savings at year 10 and beyond.

People admitted to immigration removal centres (IRCs) are not currently screened for latent tuberculosis infection (LTBI). However, a national partnership agreement between Home Office Immigration Enforcement (HOIE), NHS England and Public Health England (PHE) published in April 2015 committed all three organisations to work together to improve the pro-active detection, surveillance and management of infectious diseases in IRCs and improve capability to detect and respond to outbreaks and incidents. A copy of the ‘Partnership Agreement between Home Office Immigration Enforcement, NHS England & Public Health England’ is available at the following link and is attached.

http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/04/hoie-partnership-final.pdf.

A working group on LTBI among detainees in IRCs is being established this summer by PHE (health and justice, travel and migrant health and tuberculosis (TB) sections) to explore these issues. This work will contribute to the overarching joint PHE and NHS five year TB strategy for England which was published in January 2015. A copy of ‘Collaborative Tuberculosis Strategy for England, 2015-2020’ is available at the following link and is attached.

https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-england.

Included among several identified areas for priority action are: tackling TB in under-served populations (including migrants and those in secure and detained settings) and systematic implementation of new entrant LTBI screening.

PHE will work to provide expert advice to NHS England and HOIE on how to implement LTBI screening in IRCs once this work has been completed.

All detainees are seen by a nurse within 2 hours of arrival at an immigration removal centre for a health screening. The purpose of the initial health assessment is to identify any immediate and significant mental or physical health needs, the presence of a communicable disease and whether the individual may have been the victim of torture.

The individual will be referred straight away to a GP if the nurse feels an issue has been identified which requires immediate attention. Otherwise detainees are given an appointment to see the GP within 24 hours.

On 21 May 2012 the Government announced its intention to expand upon the existing pre-entry tuberculosis (TB) screening programme to allow for more extensive screening. Entry clearance applicants intending to come to the UK for over six months from countries where pre-entry screening is available are required to present a certificate from a designated screening provider confirming that screening has been conducted and that the applicant has been diagnosed as free from active pulmonary tuberculosis. Where tuberculosis is detected, the applicant will be required to undertake treatment and further screening before any entry clearance application can be made.

As these applicants have to present a certificate stating that they are clear of active TB, entry clearance staff do not see applications from applicants with active TB. For all other entry clearance applications, the entry clearance officer has powers to refer any applicant for medical screening. We do not maintain a record of the number of individuals who have been refused entry clearance on the basis of having active pulmonary tuberculosis.

The Department sets NHS England a Mandate and provides a total funding envelope. It is then for NHS England to decide how best to fulfil the Mandate objectives including how much funding is allocated to clinical commissioning groups (CCGs) who commission health services on behalf of their local population. It is for local CCGs to decide how to best use the funding allocated to them, underpinned by clinical insight and knowledge of local health care needs.

All patients with TB are exempt from charge for the treatment of their TB until treatment is complete.

There are no new or modified measures to require immigrants to submit a valid certificate of health from their country of origin or to undergo an immediate health examination on arrival in the United Kingdom, apart from the arrangements for screening migrants from high incidence countries for active pulmonary tuberculosis (TB) announced on 21 May 2012 by, former Minister of State for Immigration (Damian Green) as follows:

www.ukba.homeoffice.gov.uk/sitecontent/documents/news/wms-tb.pdf

The new arrangements mean that all entrants from high TB incidence countries applying for visas over six months will be required to submit for pulmonary TB screening prior to and be certified as free of TB before they can be issued a visa. This system is currently being rolled out and it is anticipated that on completion the current system of on-entry screening for TB will

cease. Countries like Romania, as European Union countries, do not fall within the remit of the pre-entry TB screening programme.

In addition to this there is a longstanding provision in the Immigration Act which allows for the medical inspection of an arriving passenger should the admitting immigration officer deem it appropriate.

The Department will continue to provide policy leadership and support Public Health England in ensuring co-ordination of international and domestic approaches to TB.

The National Institute for Health and Clinical Excellence guidance published in 2011, includes section 1.8.7 on screening new entrants and identifies key points in a new arrival's entry to the UK where the need for TB screening should be identified from the following information:

Port of Arrival reports;

new registrations with primary care;

entry to education (including universities); and

links with statutory and voluntary groups working with new entrants.

The guidance also recommends that any healthcare professional working with new entrants should encourage them to register with a General Practitioner, and we are also funding TB Alert, to raise public and professional awareness of TB.

The Home Office has had in place the requirement for pre-screening for tuberculosis in 15 countries since 2005 as part of the UK visa application process. We are in the process of implementing the requirement for TB pre-screening in a further 67 high incidence countries (as defined by the World Health Organisation).This will be completed by the end of 2013. We do not require screening for TB in low incidence countries. Pre- screening for TB is required by an individual who is travelling to the UK from one of the designated countries for more than six months.

There have been ongoing discussions between the Home Office, Public Health England and Department of Health officials as part of the Government's current roll-out of pre-migration tuberculosis screening for non-European Economic Area nationals applying for visas to enter the United Kingdom for more than six months. I have met the Minister for Immigration, my hon. Friend the Member for Forest of Dean (Mr Harper), to discuss the wider impact of immigration on the national health service of which pre-migration screening was discussed.

To ask Her Majesty’s Government whether they will introduce blood tests for latent tuberculosis for immigrants from countries where tuberculosis is common.

My Lords, my noble friend is absolutely right. Overseas tests already take place, first by X-ray and then by a sputum test in the event of a positive result. This results in cost savings because we do not need to treat someone suffering from tuberculosis if they come to the UK.

My Lords, is the Minister aware that the moment you arrive here you become the responsibility of the National Health Service? Would it therefore not be much wiser to have these tests carried out in the country of origin where the visa application is made? As I understand it, something like three-quarters of the people diagnosed in the past year would have been missed with the present test. Can he assure me that, if country-of-origin testing is introduced, the Home Office will take action to ensure that the tests are up to standard and not subject to interference or even possible corruption?

My Lords, sadly, about 30% of the world’s population have latent TB. We would not test people from other European states even if they have a TB problem.

My Lords, given that tuberculosis is not exclusive to immigrants, does the Minister agree that everyone coming into the United Kingdom from some of the suspect countries should be tested?

My Lords, eventually for all the 82 high- risk countries, you will not be able to get a visa to the UK unless you are clear of TB. To clarify further my answer to the noble Lord, Lord Morris, arrivals from the other European states are not tested for TB because of course they do not need to be tested. They can come and go as they please.

My Lords, TB and HIV co-exist. The NHS is required to test all new healthcare workers for tuberculosis and blood-born viruses, including HIV. In relation to overseas recruitment, it is recommended that the tests are performed in the country of origin before applying for employment. Can the Minister confirm that compliance with this guidance is being maintained and is it possible to move towards the situation that currently pertains in Australia, New Zealand and Canada?

The noble Lord is absolutely right: it is a problem in the big conurbations, due to deprivation and very dense accommodation. I can assure the noble Lord that the Government are on the case. We regard it as a serious problem. Further to the article in the Financial Times, we recognise that we must not let it get out of control. That is partially why we are insisting on testing people outside the UK so that we do not incur the costs for the NHS. It costs about £6,000 to treat someone who is very susceptible to treatment with antibiotics but if they are multiresistant it can cost £100,000 to treat them. We need to make sure that we do not import health problems and we concentrate on solving our own health problems—not just by activities in the NHS but also by improving housing, which I am sure all Governments have striven to do over the years.

My Lords, is the noble Earl aware that the growing incidence of TB is actually a feature now in the UK, particularly in cities such as London and Birmingham? What priority are the Government giving within the National Health Service to dealing with a problem that is causing a great deal of concern?

My Lords, I look forward to reading my noble friend’s comments in Hansard in the morning but it is important that testing is targeted. The health professionals will offer tests where they are most effective and most likely to find a problem.

My Lords, as blood tests for latent TB are already available to migrants through their GPs, is not the answer to encourage greater voluntary take-up in areas such as the noble Lord opposite mentioned—Birmingham, Hounslow and Newham—and enlist the help of diaspora organisations from the 67 countries where TB is most prevalent to increase the rates of take-up? Since the countries that undertake pre-emptive screening all depend on X-rays, as we are now doing with overseas checking of would-be migrants from those countries where active TB exists, and none is contemplating pre-emptive blood testing, should we not have discussions with those countries to concert a common approach on what should be done about pre-entry blood testing in overseas countries?