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The NHS surcharge and the ongoing costs of overseas recruitment

One of the few silver linings of recent days was the announcement from the Health Minister last Thursday that the Immigrant Health Surcharge (HIS), known by many as the NHS surcharge, would be dropped for overseas healthcare workers.

Having resisted growing calls over a number of weeks from opposition parties, healthcare organisations and, increasingly, voices within the Conservative party, the government announced a U-turn. As late as Wednesday (20th May), the Prime Minister, Boris Johnson, defended the HIS as the ‘right way forward’, but the next day bowed to pressure and reversed his position and that of the government.

The surcharge was introduced in 2015 as part of the then government’s strategy to reduce the net number of immigrant workers in the UK. The fee of £200 a year was doubled to £400 in 2019 and is scheduled to increase further to £624 a year in October this year. The fee is levied in addition to most UK visa applications and is designated to cover use of the UK National Health Service (NHS) by overseas workers and their families. Each family member pays the same amount. A family of four therefore pays £1,600 a year, due to rise to £2,496 in October, more than a month’s salary in many cases.

This fast-rising charge adds increasing burden to individuals and their employers. Certificates of sponsorship, visa applications and then the immigration skills charge – hospitals pay £1,000 per employee per year under this – mean that many highly skilled healthcare workers may well look elsewhere for employment such as Germany or Canada, where costs are much lower and salaries at least equivalent.

While this may be part of government thinking, the pandemic has highlighted all too clearly how dependent the NHS is on overseas workers and expertise to deliver the service it promises. Around 153,000 out of 1.2 million staff, or 13.1%, are non-British, a staggering 200 different nationalities[1]. 37% of hospital doctors gained their primary medical qualification outside the UK. To charge NHS workers and care staff, already paying taxes and National Insurance, to use the service they work in – and sometimes die in – seemed increasingly mean and immoral.

This is not just a temporary situation. Ongoing international recruitment is seen as a critical part of alleviating staff shortages – now and in the future. Nurses, doctors, social workers and many allied health professionals such as occupational therapists, psychologists, radiographers and speech and language therapists are on the Government shortage occupation list, so have priority in terms of recruitment and the upcoming points system. The government’s drive to increase the nursing workforce by 50,000 in the five years includes 12,500 from overseas.

Given the importance of the NHS to so many of us and our families, it really makes sense to encourage not discourage doctors, nurses and carers from around the world to come to the UK and support what is still seen as a world-class healthcare service offering free healthcare to all. Abandoning the HIS was absolutely the right thing to do.

The next step is to examine the gaps in our healthcare workforce and identify how to reduce the friction which prevents qualified overseas professionals from coming to the UK and staying. Ultimately, the costs are not only onerous for individuals and employers, but also for the many thousands of patients and their families who would otherwise benefit so much from their care. 




[1] https://commonslibrary.parliament.uk/research-briefings/cbp-7783/