Yesterday the government announced plans to double the immigration health surcharge from £200 to £400 a year. The increase is not as steep as the tripling of the health surcharge promised in the Conservative Party 2017 election manifesto. Still, the government estimates that the increase may raise an extra £220m a year for the NHS.
Public debate about the health surcharge sometimes ties it to efforts to tackle so called "health tourism", where someone comes to the UK, usually for a short period, specifically to access NHS services and then return home. Yet in reality it’s actually people from outside the EU applying for visas to move to the UK longer-term (six months or more) to work, join family, or study, who have to pay the surcharge (there is a discounted rate for students). And it has to be paid before a visa is issued, so there is no opportunity for people to avoid paying (another common misconception). This could be someone who wants to join their spouse or partner or someone who has been offered a skilled job in the UK. Of course, those applying to take up a skilled job, and many of those joining a spouse or partner who choose to take on a job, will also make tax and national insurance contributions to funding the NHS on top of the surcharge.
An irony of the health surcharge, however, is that while it may add a couple of hundred million to NHS funds, it also makes it harder for trusts to recruit much needed health workers from overseas. In our recent report, There for us: a better future for the NHS workforce, two thirds of trust leaders told us that workforce is the most pressing challenge to delivering high-quality healthcare at their trust. There are shortages of staff such as nurses and doctors and though the government has plans to boost domestic supply these will take years to bear fruit.
It’s no surprise then that 85% of trust leaders told us that it will be very important or important for their trust to recruit from outside the UK over the next three years. When an NHS trust recruits health workers from outside the EU, they need to have a work visa before they can take up their jobs in the health service. Often their visa application may be for an initial period of up to three years and under the plans announced yesterday they would now need to pay a health surcharge of up to £1200, compared to £600 at present. They will also need to pay a visa application fee, currently £587 (or £446 if like nurses a profession is on the official shortage occupation list) for visas for periods of up to three years. If health workers want to bring dependents with them – a spouse or partner or children – there will be health surcharges and visa application fees to pay for them too.
It’s no surprise then that 85% of trust leaders told us that it will be very important or important for their trust to recruit from outside the UK over the next three years.Policy advisor - workforce
So, greater up front costs of getting into the UK to work – also including professional registration fees – are likely to make the prospect of working in the health service less attractive for overseas health workers and make NHS trusts’ efforts to recruit from overseas in the face of staff shortages even more challenging. This is especially so when costs can represent a significant proportion of a health worker’s earning potential, such as for nurses for who the basic starting salary is £22,128. In practice many NHS trusts are already having to loan overseas recruits funds pay up front costs such as the health surcharge and it’s difficult to see that trend changing anytime soon. Trusts themselves also have to pay a separate immigration skills charge of £1,000 for every health worker they recruit from outside of the EU.
So, all in all, government policy – including the doubling of the health surcharge – is making it harder for NHS trusts to recruit from overseas, even though this is essential for them to deliver safe high-quality care. Patients, and the NHS trusts that care for them, need the government to commit to a future immigration policy supporting trusts to recruit and retain health workers from around the world to fill posts that cannot be filled by the domestic workforce in the short to medium-term. By doubling the surcharge we are sending precisely the wrong signals.
This article was originally published on the New Statesman on 6 February.