Westminster Hall

Monday 30th January 2023 Westminster Hall

Monday 30 January 2023

[Mr Virendra Sharma in the Chair]

Immigration Fees for Healthcare Workers

Monday 30th January 2023 Westminster Hall

[Relevant documents: Third Report of the Health and Social Care Committee, Workforce: recruitment, training and retention in health and social care, HC 115; Summary of public engagement by the Petitions Committee on immigration fees for healthcare workers, reported to the House on 24 January 2023, HC 73.]

00:00

[Tonia Antoniazzi (Gower) (Lab)]

I beg to move,

That this House has considered e-petition 604472, relating to immigration fees for healthcare workers.

It is an honour to serve under your chairship, Mr Sharma. It is a privilege to introduce this petition and give voice to the thousands of healthcare workers for whom this discussion is an opportunity to raise an issue that has not only a significant detrimental impact on their lives and careers, but a huge impact on the availability and quality of healthcare in the United Kingdom. Although the petition is focused on changes that are within the remit of the Home Office, to understand the reasons behind it and why this is such an important issues for the petitioner, Mictin, and tens of thousands of his NHS colleagues, we have to understand that the most British of institutions, the national health service, would collapse without staff who are not British nationals.

According to the House of Commons Library, about 16.5% of NHS England staff are not British nationals. Of those 220,000 staff, more than half—just under 120,000—are from outside the European Union. Let me break that down a bit. Figures from the General Medical Council tell us that in 2021, more than half of new doctors working in the NHS came from overseas. There are 146,664 internationally trained professionals on the Nursing and Midwifery Council register—almost one in five of the nursing workforce. The Royal College of Radiologists’ recent workforce census found that in England, 27% of the clinical radiology consultant workforce and 20% of clinical oncology consultant workforce gained their primary medical degree in non-European economic area countries.

The list goes on across roles and specialisms, and that is before we even get to the healthcare workers who work in social care and provide support as home carers or in nursing homes.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Although it is welcome that the scheme has been extended to care workers under a 12-month trial, they are some of the lowest paid in the sector. The at-home care area of healthcare is facing some of the biggest difficulties of any across the UK. Does the hon. Lady share my concern that the costs are completely unaffordable for care workers?

[Tonia Antoniazzi]

I agree with the hon. Lady. The scheme has been extended by 12 months, but care workers are the lowest paid, and these are some of the biggest costs.

The numbers tell only part of the story. Although it is essential that we know the facts and figures, I would like hon. Members to think about what those numbers translate to for patients. Those clinical oncologists are helping to reduce the backlog of patients awaiting checks, scans and treatment, and are delivering life-saving care to cancer patients. Those midwives are guiding mothers through pregnancy and helping to bring their children into the world. Those doctors and nurses gave so much during the covid pandemic, worked all hours, did not see their own families, saved lives and comforted those who could not be with their families in their final hours.

[Janet Daby (Lewisham East) (Lab)]

During the pandemic, I was involved with GMB’s campaign for NHS cleaners and carers to be granted indefinite leave to remain after the sacrifices they made. Does my hon. Friend agree that we need to lower the cost of indefinite leave to remain and show the same level of gratitude to health workers who had to work during one of the most severe crises that our NHS has experienced?

[Tonia Antoniazzi]

It is true that these have been the most challenging of times, and indefinite leave to remain is one way of addressing that.

As we discuss the petition, I urge hon. Members to remember that when we talk about health and care workers, we are not talking in the abstract. We must remember the very real impact that Government decisions have on people’s health and wellbeing. There is little argument that workers from overseas are not essential to the running of our healthcare system. In fact, NHS trusts actively recruit from around the globe.

The health and care worker visa we are discussing was introduced to speed up processes to ensure that much-needed health and care staff could work in the United Kingdom. Despite broad agreement that there is obvious need in our overstretched health and care sector for overseas professionals, the current system is failing to retain these key workers. The expensive, drawn-out indefinite leave to remain process is pushing many key workers away, creating financial and bureaucratic barriers for those who wish to stay and to continue working in this country.

A greater number of healthcare workers settling in the UK would only benefit the health system. Not only does better access to ILR make the UK more attractive to the international workforce; better staff retention provides employers with greater long-term security for workforce planning, which I know at first hand is a key issue. Indefinite leave to remain allows for greater mobility between sectors and employers, as well as greater flexibility to deploy internationally recruited workers where need is greatest, rather than being hamstrung by restrictive visa requirements.

The financial barrier is high. The Migration Advisory Committee has highlighted the general high cost of these fees compared with other countries. The cost to apply for ILR sits at £2,404 per person. However, the latest visa and transparency fees data suggests that the estimated cost of an ILR application is just £491. In the context of a decade of pay erosion and the cost of living crisis, ILR fees may simply be unaffordable for many healthcare workers.

In the online survey of petitioners run by the Petitions Committee, respondents said they found it difficult to save up for indefinite leave to remain fees because of low salaries and a high cost of living, especially where they would need to pay ILR fees for multiple family members. One nurse who answered the survey said,

“I work as a deputy sister. I’m a single mum and my 2 kids have recently joined me in the UK. I cannot afford the ILR fees for me and my 2 children. With the salary of nurses and the cost of living here, a single mum like myself cannot afford it.”

A medical practitioner who responded said,

“As with current pay and cost of living crisis, it’s impossible to save this much. I am forced to buy used and second hand items only. I buy the cheapest groceries. Try and only use heating when absolutely required…I am forced to work weekends to save. I am hardly spending time with family. My mental health is affected. It feels like I’m a slave forced to labor…I don’t understand why the government would keep a fee that would force workers to leave NHS and UK…I survived through all waves of covid and staffing pressure. Had multiple illnesses because of my work. I don’t think I’ll survive this one. I believe these fees will break me.”

The fee is not the only cost; it is in addition to other substantial visa fees paid in the years prior to eligibility.

Workers without ILR are also subject to the no recourse to public funds policy. The cost of living crisis brings into sharp focus the potential financial hardship that internationally educated workers who are unable to access public funds could face. Members of the Royal College of Nursing consistently report the negative impact that the policy has had on their lives and the lives of their families. The covid-19 pandemic has exacerbated the challenges that individuals with no recourse to public funds were already facing, with these families identified as being at high risk of living in insecure and crowded housing.

Making the ILR process more accessible would bring significant benefits to individual workers who report that their mental health is suffering as a result of the financial pressures they are facing to try to meet the costs of ILR. A healthcare assistant who responded to the Committee survey said

“With the ever rising cost of living, [saving for ILR] becomes mentally draining for an already overwhelmed health worker. Reducing the cost shows the government care about the wellbeing of health workers and promotes work life balance because families have to work odd hours to meet up with the fees.”

The RCN also reports that nurses sponsored under the health and care visa often have difficulty reducing their working hours because of the minimum salary threshold —£20,480 per annum—that is applied to their visa. Given that there is no provision for that to be applied pro rata for part-time staff, the RCN understands that the policy often conflicts with nurses’ caring responsibilities.

Better settlement pathways can help to tackle abusive labour practices, reducing the ability of predatory employers to use immigration status to tie staff into exploitative situations. This is particularly relevant in the care sector, where the director of labour market enforcement has identified workers as being at high risk of exploitation. The RCN is aware from member reports that employers will, on occasion, use threats of deportation to coerce staff into paying extortionate repayment fees should they choose to leave employment early.

The current policy means that the UK is already losing overseas healthcare staff to other countries.

“I couldn’t raise the money [for ILR] for the last 2 years to apply, so I’ve gotten a better salary offer in New Zealand…so I’ll be leaving the UK.”

Those are the words of one nurse who responded to the petition. A trainee doctor told us:

“With paying for exams and training, I don’t have enough money to apply for an ILR, which makes me think to leave the UK and work in Australia after I qualify as a GP.”

The petition is not simply asking for a reduced fee for those health and care workers seeking ILR; it is asking for a joined-up approach from Government, and for a better system that will improve the lives of those using it and enable us to provide a strong and sustainable health sector.

Earlier, I told hon. Members that it was essential to remember that behind the figures, statistics and costings, we are talking about people, so I will finish by telling hon. Members about the person who kicked this all off—the petitioner, Mictin, who is here today with his family—and why he started the petition. Mictin was actively recruited to the NHS from India, as NHS trusts use local agents to recruit for them. Of the 23 other overseas workers who started with him when he came to Leicester, only six are still working in the trust. The costs of pursuing ILR were too much for many of them and some have found new work abroad—skilled workers who have left the United Kingdom because we have made it too difficult to stay.

We ask people to make the choice to come to the United Kingdom, but we have not ensured that we have a system that makes that choice an easy one. We force difficult choices on the workers we need. Mictin and his wife have made the choice to stay, but we have not made it easy for them. Mictin’s parents-in-law have never seen their grandchild, because the cost of taking him to India would mean greater delays in applying to ILR. Mictin started the petition because he knows he is not the only one making these difficult choices. While our health sector desperately needs more Mictins, we have to ask why we are making the choice to stay so difficult.

16:43

[Rob Roberts (Delyn) (Ind)]

It is an honour to serve under your chairmanship, Mr Sharma, and a pleasure to speak on a topic that I suspect will have agreement from Members on all sides of the House, with the possible exception of the Minister; we cannot have everything, I suppose.

I thank the Petitions Committee for bringing forward the debate on such an important and timely topic. The issue is close to my heart; I declare an interest as my partner is a healthcare worker from the Philippines and is intrinsically involved in the system we are debating. The debate is also timely, as I have a ten-minute rule Bill on this very topic coming before the House in the next few weeks.

I have spoken on this topic several times in the past, both in Westminster Hall and the Chamber. Last year, I tabled an amendment to exempt NHS clinical workers from paying the fees associated with applying for indefinite leave to remain to the Nationality and Borders Bill. I discussed the amendment with the Minister at the time, the now Minister for Disabled People, Health and Work, the hon. Member for Corby (Tom Pursglove) and his hon. Friend, the Member for Torbay (Kevin Foster), who had responsibilities in that area. I was told that my amendment, which was unusual in this House as having signatures and support from Members from six different parties, was not acceptable to the Government because, “We couldn’t go making special cases out of certain groups of people.”

Shortly afterwards, as the Bill was making its way through the House of Lords, the Government announced that armed forces veterans would be exempt from paying fees for ILR applications, which I thought was interesting given that NHS workers were not worthy of special consideration just a couple of months before. The Home Secretary at the time, the right hon. Member for Witham (Priti Patel), said:

“Waiving the visa fee for those Commonwealth veterans and Gurkhas with six years’ service who want to settle here is a suitable way of acknowledging their personal contribution and service to our nation.”

Taking nothing away from veterans who have put their lives on the line in the service of this country and the Commonwealth, I think one would be hard pressed to find many members of the public who did not believe NHS clinical staff should be worthy of the same consideration.

[Margaret Ferrier]

Some 28% of respondents to the Petitions Committee’s survey on this issue said that they had delayed applying for indefinite leave to remain in the UK due to the high costs. If the public sentiment is that fees should be lowered to resolve the crisis, does the hon. Gentleman share my concern at the Government’s reluctance to do so?

[Rob Roberts]

Completely; this is something I have debated. As I say, my partner is from the Philippines and, because of that, I now have a big extended family and friends who are Filipino and are overseas. They are all in the same boat. As I will explain in a moment, the type of things they have to go through, and the debts they get into, are ridiculous. I completely agree with the hon. Lady.

The NHS has played a vital role. Although the whole NHS deserves our thanks and gratitude, they should in particular go to our NHS workers who have come from overseas. They have travelled huge distances to be here, often separated from their families and putting their own lives at risk to help and save our lives—citizens from a different country to their own. Regardless of their or our citizenship, the duty to care and contribute to the wellbeing of others always comes first with them. It is amazing, and we as a society should highly commend it.

I welcome the number of steps the Government have already taken for foreign NHS workers, including the health and care worker visa and exemption from the immigration health surcharge, but we need to do more than that. These people want to make the UK their home. They put down roots—we have a duty to put in place a framework to allow them to do that without thousands of pounds in costs just to stay in a country to which they have already contributed so much.

[Janet Daby]

So many of my constituents have contacted me to say that these fees are absolutely too expensive for those in the healthcare profession. Why does the hon. Gentleman think the Government have kept the fees so high and have not lowered them?

[Rob Roberts]

The hon. Lady imputes to me knowledge that is far above my pay grade, but I am sure the Minister will be delighted to answer her when he takes to his feet later. I have no clue, but it is ludicrous. As the hon. Member for Gower (Tonia Antoniazzi) said earlier, the cost is £420-odd to process these things. I will come to the fees in a minute, but there cannot be any justification for that cost. Going back 15 years, it was a fraction of what it is now; the fees have increased at an exponential rate over the past five or six years. I am sure that the Minister can enlighten us on that later; I look forward to the answer.

Of course, it is worse in the part of the world of the hon. Member for Lewisham East (Janet Daby). The cost of living in my constituency in north Wales is significantly less than it is down in the London boroughs. The extra pressures and the compounding of that problem are much worse: I completely agree.

As we have mentioned, fees for ILR are over £2,400. Citizenship, 12 months later if so desired, costs another £1,800 or so, plus a few £100 for biometrics, English language tests and all the other supplementary things that have to be done. The naturalisation process costs more than £4,000. That is one of the most expensive in the world. The process of becoming a citizen for NHS workers is costly and challenging.

The process includes the ridiculous “Life in the UK” test. I am not sure whether anyone is familiar with that test: it is a wonderful thing. It asks questions such as, “Which palace was a cast-iron and plate glass building originally erected in Hyde Park to house the Great Expedition of 1851?”, “In which century did the first Christian communities appear in Britain?” and, “Which two British film actors have recently won Oscars?” Quite how anyone can be expected to properly integrate into British society without that pivotal knowledge, I have no clue, but there we are. They have to pass that sensible test.

In similar debates, I have told the tale of Carrie, a real-life case using a different name. She moved to the UK in 2016, leaving her husband and four-year-old child back home in south Asia. It took another year for her husband and daughter to join her because of the cost involved in a dependant visa. They could be together again as a family only once she took out a loan, which she paid for over the next three years. She had to get another loan three years later because she was due for a renewal of that visa, adding a load more fees.

In 2021, Carrie was entitled to apply for ILR. With loans still ongoing from previous renewals, what choice did she have? What could she do? She had to take another loan—even bigger than before—just to have the right to occupy a space in this country and call it home. She pays her taxes every month; she has done for years. She works in an intensive care unit. She has spent all her working life in this country saving lives, especially during the pandemic. As I have said before, she should not be in debt. We should be in her debt.

It is our duty in this place to create a new route for citizenship for NHS workers that will not leave them in debt, in poverty or—as the hon. Member for Gower said—in mental anguish with the constant worry of funding the next application. By reducing the costs associated with ILR and citizenship, and in time abolishing them completely, we can help to do just that.

I am proud that our NHS attracts global talent and recruits from around the world. Quite frankly, we would be—I was going to swear there—we would not be able to run it without them. We would be in difficulty. In 2021, over 160,000 NHS staff stated that they were of a non-British nationality, from over 200 different countries. That accounts for nearly 15% of all staff for whom a nationality is known. However, the current fees and process are a huge barrier to both future NHS workers, who are put off coming because they do not feel they will be able to stay long term, and to current NHS workers, who are unable to afford the final step to have the permanent residency that they have earned through service to our country.

Residency and citizenship should not be about cost. They should be about contribution and inclusion in our communities. NHS workers have perhaps given the biggest contribution of all by saving our lives and keeping us safe. If they are not citizens, they cannot be fully part of the communities in which they live and work, despite being such valued members. Without ILR, individuals face barriers to home ownership, as it is almost impossible to get a mortgage without it. It is difficult in the job market and higher education. There are barriers wherever we look. Reducing the fees, or even scrapping them entirely, would not only make residency and citizenship more achievable, but create a more diverse and, crucially, a more integrated society. People from other countries who have worked in our NHS during the pandemic and throughout their lives deserve to be able to call the UK their home, and actually feel like it is.

The pandemic has been horrendous, but it has had one benefit. It has highlighted what many of us already knew: our NHS workers, whether British or not, are the backbone of our health service and our country. Those who have come here to provide such incredible care should not be penalised for it, but the high application fees do just that. It is time to reduce, if not entirely abolish, the fees for ILR and citizenship for those who work in our NHS so that those who spend time helping and treating us can finally feel like they belong and are welcomed with open arms.

16:55

[Bell Ribeiro-Addy (Streatham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Gower (Tonia Antoniazzi) on the way she laid out the debate.

Everybody should realise that the NHS has always relied on staff from all over the world. It literally would not exist without the contribution of doctors, nurses and NHS staff from outside the UK, starting with the Windrush generation, who were also treated terribly by this Government’s Home Office.

The NHS is currently in a dire state, and the industrial action being taken by care workers is a clear example of that. At the heart of the crisis facing our health service is the struggle to recruit and retain healthcare staff, and the cost of living makes that even worse. Some healthcare workers who are paid less are having to use food banks, and in-work poverty is even greater for migrant workers due to the cost of living.

Reducing the cost of visa applications for overseas healthcare workers seeking indefinite leave to remain is not only just and fair, particularly for their families, but it would address the recruitment and retention crisis in the NHS by encouraging overseas workers to remain in the profession. It lacks humanity and economic sense to leave those key workers living in perpetual uncertainty about whether they can remain in the UK. They have to pay extortionate fees to do so, but they are working and contributing to the economy of this country.

The Government have repeatedly argued—the hon. Member for Delyn (Rob Roberts) said this too—that not giving special treatment to NHS workers is about creating a level immigration system, but our immigration system has never been equal and the people making applications have never been treated the same. That is reinforced by the Government’s points-based system. A millionaire who wants permanent residency in the UK can move things along a lot faster just by putting millions in a bank account in the UK. There is a shortage occupation list. There are thresholds for being able to bring family members over. We differentiate between people who have ILR and certain visas on the basis of whether children they have here are automatically granted British citizenship. We have never treated everybody equally, and on top of that we charge some the immigration health surcharge—even NHS workers.

Several healthcare professionals from across the country, both from migrant backgrounds and not, support this petition. I will talk about what one of them said to me. It costs £2,400 for an ILR visa, but he is being asked to pay 10 times more for his family. That family of four is being asked to pay £12,000 just to have indefinite leave to remain. He said:

“NHS staff get recruited to work in terrible conditions. We can’t pay our bills, and then we’re charged thousands of pounds just to stay here and work. Given the terrible NHS staff shortages, this policy reaches next-level stupidity.”

I agree with that doctor. We cannot afford to lose doctors such as him, especially when other countries are taking steps to attract them. We have already heard about how some people are leaving us. Given the shortages of NHS staff in this country, we simply cannot afford that. We will tackle the chronic shortages only by treating all staff decently.

The Government have explained again that they are maintaining their hostile environment—I know they call it something else—to make the country less attractive to people who want to enter it illegally. Obviously, I take issue with the people they term “illegal”, but they are also making it hostile for people who, by their own definition, are legal. How does that make any sense? Those people have been asked to come here to support our services. We are not talking about people who are visitors, or who want to take from our country. We are talking about people who are saving people’s lives—who are working in our NHS daily, who saw us right through the pandemic. Those people have left their own countries to come and serve ours, and they are doing a fantastic job.

[Janet Daby]

My hon. Friend is making an excellent speech. Does she agree that the Government are behaving in a rather ironic way by encouraging people from skilled professions and backgrounds to come to our country to work, but then making it very difficult for them to settle?

[Bell Ribeiro-Addy]

My hon. Friend is absolutely right. Why are we making overtures to people in other countries and waiting for them to come here, only to treat them with complete contempt and disrespect and leave them in really serious situations where they are trying to support their families, and also making it difficult for their families to remain here? We all understand how important it is to have our families around us, but as we have already heard, some people have to leave their families behind and then face unreasonable barriers to bringing them into the country.

These people are doing so much for us, coming to our country to serve us as NHS workers at all levels: doctors, nurses, cleaners and porters, and let us not forget our social care workers. We need to make sure that we are treating them with the respect they deserve, no matter where they happen to have been born.

17:01

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

It is good to see you in the Chair, Mr Sharma, and it is a pleasure to take part in this debate. I thank the hon. Member for Gower (Tonia Antoniazzi) for introducing the subject so comprehensively and eloquently, and I also thank her and her colleagues on the Petitions Committee for bringing it before us for debate in Westminster Hall. The Committee also did a great job in carrying out the survey that has helped inform some of the contributions that have already been made, and which I will come to shortly. I thank colleagues for those contributions, which have all been very powerful.

As colleagues have said, the starting point of this debate must be praising the international NHS staff. We have heard about the extraordinary contribution of those overseas nationals who come to join with UK nationals in order to keep our national health services “brilliant”—to use the word that the petitioners have used—and we have heard facts and figures about how significant the contribution of those overseas nationals is. Around one in six NHS staff members in England is non-British, and if I have understood the figures correctly, it is pushing on one in three doctors and one in four nurses. Overall, there are over 200,000 overseas NHS staff, coming from over 200 countries. GP practices are no different: we had a very constructive debate in Westminster Hall a couple of months back about some of the problems with keeping international medical graduates here as GPs, and the Minister took some points away from that debate. It will be interesting to see whether there has been any progress in the work being done to encourage more of those graduates to stay, because there is a gap in how the visa process works in relation to people wanting to stay on as GPs.

In particular, we should all recognise the extraordinary role that overseas workers in our NHS played during the pandemic, and indeed the sacrifices they made in protecting us from covid and treating those who suffered from it. I think I am right in saying that overseas nationals were disproportionately represented in the number of health workers who lost their lives during the pandemic.

The next part of the equation is, of course, that the NHS continues to face unparalleled challenges, particularly in terms of vacancies. Despite the huge contribution of the overseas workforce, figures also show that massive vacancy rates remain. As of September, NHS England had a growing vacancy rate of just shy of 12% for registered nursing staff: full-time equivalent staff vacancies in NHS trusts in England increased from about 133,100 in June to 133,400 in the quarter to September 2022, which I think is a five-year high. Overall, the vacancy rate in the quarter to September 2022 was 9.7%—again, a five-year high.

The important point, putting aside all the numbers, is what those vacancy rates mean in practice. Last year, a RCN survey found that only a quarter of nursing shifts have the planned number of registered staff on duty, which means that three quarters of shifts are going ahead with a shortage of nurses. In the ideal world, even if some nursing staff had to call in sick, we would have enough nursing staff to cover for them, but even with the full complement on, we are still short-staffed—we spend £3 billion every year on agency staff.

It is absolutely valid to say that the answer has to be partly about improving training and recruitment locally and ensuring that we can rely on the domestic workforce much more in the longer term. However, as the Health and Social Care Committee recently pointed out, overseas workers are essential to the health and social care system in the short term and in medium to long term: any move to shift to more domestic supply is likely to take time. We will have to continue to rely on overseas nationals filling those jobs in the years ahead.

[Margaret Ferrier]

Although health policy is devolved, visa and immigration policy is not, which means that the decisions of Ministers here in Westminster are having a direct impact on the devolved Administrations’ ability to build resilience in healthcare staffing and to resolve the crisis. Does my hon. Friend know how Ministers have sought to engage with the Scottish Government on this issue?

[Stuart C. McDonald]

I do not, but I would be interested to hear from the Minister about that. I will come shortly to how visas will impact on the Prime Minister’s and the UK Health Secretary’s own plans for turning the NHS around, but to put it succinctly: we can have all the action plans in the world, but they will be made significantly more difficult to implement if the recruitment shortages are allowed to continue.

The argument made a few times in Government responses during similar Westminster Hall debates is that the Home Office does not make a profit on ILR visas. That seems to defy the normal understanding of the word “profit”. The fact that the Home Office reinvests into other border and immigration functions is utterly irrelevant. The Home Office charge for that type of leave is several times the cost of processing the ILR application: it is a profit. Those profits have been increasing exponentially in recent years. Research by the Migration Observatory at the University of Oxford shows that since the £155 fee was introduced in 2003, it had risen to £840 by 2010 and now stands at £2,404. At one point during the debate, the question of why that is was asked: I will be brave enough to hazard a guess. To my mind, the reason is quite simply that the Home Office is one of the unprotected Departments sat right in the eye of the storm of austerity. Baroness Williams, a former Minister of State, pretty much said that in an answer to a written question:

“Application fees have increased in recent years as the Home Office aims to reduce the overall level of funding that comes from general taxation.”

The long and short of it is that the Home Office is struggling for money and has therefore been ramping up fees in an extraordinary manner over the past 10 to 15 years. As we have heard from various hon. Members today, that profit margin is having hugely negative impacts, including the uncertainty that it causes staff on the front line and the effect it has on their health and wellbeing, particularly during this cost of living crisis. We even heard about the dangers of debt and exploitation as a result. Ultimately, all that impacts on patient care. How can we look after patients properly when we are struggling to recruit staff while making it more difficult to retain the excellent staff we have already managed to recruit?

The Doctors’ Association UK has pointed out that the fee is more than many health professionals will make in a month and that it is pushing skilled staff to consider careers outside the United Kingdom instead. I turn to the survey of the Petitions Committee, which showed that 71% of foreign healthcare workers did not intend to apply for ILR because of the cost, with a further 28% saying, as has been pointed out, that they had delayed their application due to the costs involved.

[Rob Roberts]

Does the hon. Gentleman agree that it is not just the cost of the applications themselves, but all the supplementary stuff that goes with it? When my partner applied for ILR 18 months ago, he had to do the IELTS English language test again, which he had had to do when he came into the country. I am not sure that anyone will be able to convince me that his standard of English will have gone down since he passed the test on coming into the country. Why would he have to do it again? Going from doing an ILR application to citizenship 12 months later, he had to do biometrics twice and pay for them twice—often £100 or £200 just to go to an office, hand over documents and have someone say, “Thank you very much—we’ll be in touch.” Those other supplementary bits make such a huge difference.

[Stuart C. McDonald]

I absolutely agree. In terms of financial cost and complexity, it is so easy to put a foot wrong. Far too often in the process, when a foot is put even a tiny bit out of place it can result in someone losing their leave altogether, falling off the conveyor belt to settlement and not being able ever to get back on it. It can have dire consequences for people if they make one mistake in this complicated process. The hon. Gentleman makes a very powerful point.

In light of the Petitions Committee’s survey, the question is whether the Home Office and the Department of Health and Social Care agree that the fees are having such an impact. Are people deciding not to apply for ILR, or to put off their applications for it? If the Home Office does not agree that that is the implication of the high fee, on what basis does it reject that? Has it done research and decided that the fee does not have that impact? If so, can we see that research? If it accepts the implications of the Petitions Committee’s report, what is it going to do about it?

Otherwise, the Home Office is providing another reason for medical professionals to decide that it is no longer worth remaining in the UK, and to take their expertise elsewhere. There is evidence that recruitment agencies in Australia, Canada and elsewhere are aware of those challenges and are proactively advertising here to attract medical professionals. The British Medical Association believes that one in three junior doctors is considering a move abroad. That is all a function of the Home Office handing skilled staff an incentive to leave rather than stay.

That brings me to the point about fees in general—but this fee in particular. Our whole process of setting immigration fees has become absolutely obscure and is not subject to enough scrutiny. That is another reason the Petitions Committee should be praised for bringing the subject to the Chamber for debate. As it stands, the Home Office can lawfully take into account only the following criteria when it sets fees: processing costs; the benefits that will accrue to the applicant and others; the costs of other immigration and nationality functions, hence its profit; economic growth; international comparisons; and international agreements. There are problems with that framework that we should revisit, but we will come to that another day. There are problems with how it is applied in cases regarding children and families.

In another debate a couple of years ago, the point was made that it is the other way around with visit visas. We actually subsidise them. It will be interesting to know whether people who are applying for a visit visa are still paying less than the cost of processing that visa. It would be quite extraordinary if we were taking money from healthcare professionals and using that to subsidise folk to come visit. I understand that the Home Office wants to encourage visitors, but I think we would struggle to justify that arrangement.

Even if we just apply those factors to the visa for healthcare workers, it still makes sense to set a greatly reduced fee. We know that the processing costs are a fraction of the fee. As for the criterion about benefits that will accrue to others, the NHS is in crisis—what bigger benefit could there be than people to help get us out of the crises that we face?

We are also supposed to consider international comparisons. It would be interesting to hear what work has been done there. For example, on citizenship fees, the UK is a wild outlier in how much we charge folk for citizenship. I do not know whether the same is true of permanent resident fees. I suspect that it is, but I would be interested to know whether the Home Office has done research on that—otherwise I am sure that hon. Members will do that themselves.

We also have to speak about Brexit. My party thought that Brexit and the end of free movement was an utterly awful event. It does make a difference, because it makes it particularly difficult to attract NHS workers from the European Union. A talented doctor or nurse from any one of our neighbours has 27 other countries they can go to with barely the need to fill out a form, never mind pay a fee. The NHS visa helps—it is right to acknowledge that—but it does not change the fundamental position that we are less competitive in attracting people from our nearest neighbours. Until we fix those problems, we are going to struggle to recruit the people we need. All the action plans in the world— announced by the Prime Minister, the Health Secretary or anybody else—whatever their merits, are going to struggle to be fulfilled until we resolve that issue.

It is not just about the fees; other things have been raised. For example, my hon. Friend the Member for Rutherglen and Hamilton West (Margaret Ferrier) mentioned social care workers. We had a debate on the functioning of GP visas for international graduates; I would be interested to hear what further work has been done on that. We heard about families; that was not something I had thought about, but how we treat families is really important. We expect people to come and work, but to leave their families behind sometimes. That is completely illogical and counterproductive.

Some steps have been taken, which should be welcomed. The existence of the NHS visa is of course one of them. The non-application of the immigration health surcharge is another. I thought that this was a really powerful point: by taking those steps, we have encouraged people to come here to work; why do we now discourage them from staying? That seems utterly illogical. The Home Office has gone halfway down the road of treating NHS staff in a fair and supportive manner; let us just complete that journey.

A powerful case has been made by the petitioners. I acknowledge that this is not a straightforward matter for the Home Office. There are arguments as to whether a similar case can be made for others. But the hon. Members for Delyn (Rob Roberts) and for Streatham (Bell Ribeiro-Addy) made powerful points. The Home Office does make special rules for special categories all over the place. This is the most special of categories and it requires a bespoke response—something that the Home Office itself has argued by coming this far. Let us just complete that journey. The Home Office needs to look at the matter very carefully, because real damage is being done to the NHS now by persisting with this high fee, so I hope that the Minister will be open to engaging on the matter and will look again at the fee and listen sympathetically to the case that the petitioners are making.

17:16

[Stephen Kinnock (Aberavon) (Lab)]

It is a real pleasure to serve under your chairship, Mr Sharma. I add my tribute to my hon. Friend the Member for Gower (Tonia Antoniazzi) and the rest of the Petitions Committee for initiating this important debate today. I congratulate my hon. Friend on a very eloquent and powerful speech.

I also thank my hon. Friends the Members for Lewisham East (Janet Daby) and for Streatham (Bell Ribeiro-Addy) for their eloquent contributions. They made crucial points. In particular, the points about the Windrush generation were very apposite and also prompted me to think that it was quite disgraceful that the Home Secretary made an announcement under the radar, really, about dropping so many recommendations from the Williams review, without even having the decency to bring that to Parliament. My hon. Friends made important points in that context.

I also thank the hon. Member for Delyn (Rob Roberts), who made a very eloquent and powerful case for the points that he clearly holds dear, both personally and more broadly. Of course, 34,392 members of the public signed this petition, and that is really important in terms of the engagement in our democratic process. I again congratulate the Petitions Committee for selecting this matter; and of course I congratulate Mictin, who is in the Chamber today and has done so much to organise and drive the whole process forward.

The petition before us reflects two important policy considerations within the British Government’s system of work-based migration. The first is the fact that our national health service relies heavily on the vital contribution of migrant workers—a contribution that I am sure we in this room are all very grateful for—but that reliance is of course also a reflection of the Government’s failure to recruit and train home-grown talent here in the UK. Secondly, today’s debate is about whether current policy reflects the level of respect and gratitude that we have towards migrant health workers and ultimately, therefore, whether the fees that migrant health workers are required to pay are fair and just. With your permission, Mr Sharma, I will address that first point by saying a few words about Labour’s approach to work-based migration.

The key point to make is that we support the principle of a points-based system for migrant workers. It was of course the Labour party, a Labour Government, that introduced the points-based system for non-EU citizens back in 2008. Under the incoming Labour Government—when we enter government—there will be no return to the EU’s freedom of movement. In government, Labour will build on the points-based system that is currently in place, but we will make sure that it is a fair, firm and well-managed system that balances the requirements of businesses and public services with the need to provide the right levels of training and support for home-grown talent while recognising the critical role that immigration can play and ensuring that we treat migrant workers with the dignity and respect that they deserve. Labour’s long-term ambition is to make sure that all businesses in every sector, and our public services, recruit and train more home-grown talent to fill vacancies before looking overseas as the default position.

[Rob Roberts]

I appreciate all the things the shadow Minister is saying about home-grown talent. What is his and his party’s opinion about having much more of an emphasis on non-degree-based routes into things such as nursing? Cousins of mine who have been nurses for an awfully long time say, “Thirty-odd years ago, we just learned as we went. You learned on the job. You had a mentor and could learn all the skills that you needed in role, without needing academic qualifications and book smarts to be able to complete a degree.” What is his party’s opinion of that method of training?

[Stephen Kinnock]

The hon. Member raises a very important and interesting point. Of course, on education, it prompts me to think about how mad it was for the Government to cancel the nurses’ bursary. It is very good that it is now being reinstated, but terrible damage was done by that. However, I agree with him that we need a more vocational route into healthcare, health work and, indeed, many other professions. For too long we have not had parity of esteem between academic and vocational routes, and the fact is that we have a vast number of vacancies in our NHS and care system, so we need to take a broader and more inclusive approach. I agree with the hon. Member in principle, but the devil is in the detail. We have to make sure that we have people who are qualified, given that they do such important work looking after the nation’s health. We must make sure that they have the right qualifications, but I agree with the principle behind his point.

As I was saying, Labour’s long-term ambition is to maximise opportunities for home-grown talent, but we recognise that if we simply turn off the tap to foreign labour without the appropriate workforce structures and terms and conditions, and without adequate training in place, our public services will deteriorate further and our businesses will struggle. That is why we as a party will undertake a comprehensive review of the points-based system this year, based on real dialogue with business, trade unions, the public sector, the private sector, communities and other key stakeholders, such as the Migration Advisory Committee, to ensure that we are ready to upgrade the system and make it more fit for purpose when we enter government. The current immigration system exists entirely in isolation from long-term workforce planning, but a Labour Government would seek to connect immigration to wider workforce planning, productivity strategies and training and recruitment strategies, all the way from jobcentre reform to getting people off the record-high NHS waiting list of 7.2 million and back into work.

Presently, healthcare is one of the professions where migrant labour plays an absolutely critical role in filling vacancies, which is why our shadow Health and Social Care Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), has already committed to delivering a long-term workforce plan for the NHS. It will be paid for by scrapping non-domiciled status, which will enable us to double the number of medical school places to 15,000 per year, and to create 10,000 more nursing and midwifery clinical placements each year, as part of setting a long-term NHS workforce plan for the next five, 10 and 15 years to ensure that we always have the NHS staff we need, so that patients can get the treatment they need on time. Not only will that provide good jobs for British workers and fill shortages in our NHS, it will also prevent us from having us to do the morally dubious deals that are going on with some of the poorest countries in the world, which involve recruiting medical professionals from impoverished communities that desperately need that medical knowledge to stay in-country, as is the case in countries such as Nepal, Kenya and, to some extent, the Philippines, where lifesaving talent plays a very important role. There are some morally dubious deals taking place with some of the so-called red list countries, as defined by the World Health Organisation.

Migrant workers’ contribution to and importance in our healthcare system is even more reason to treat them with the highest level of respect and dignity. It is important that their contribution is reflected within the specific policy that we are debating today: the fees charged to healthcare workers who apply for indefinite leave to remain.

As has been said, under the current Government arrangements, introduced in August 2020, healthcare visa applicants pay a fee of either £247 or £479 depending on whether they intend to stay in the UK for up to three or five years, and they are exempt from paying the immigration health surcharge, which is right and fair. However, the petition points out that despite the contribution that our international healthcare workers make, to apply for indefinite leave to remain they still face the eye-wateringly high fee of around £2,404.

Let us not forget that an individual on a skilled worker or tier 2 visa, such as a healthcare worker, who is applying for indefinite leave to remain must already demonstrate that they have lived and worked in the UK for five years, that they meet certain salary requirements and that there is a continued need for them to continue in that role. In effect, the Government are saying, “We still need you, we want you to stay in Britain and your job is critically important to us, but your time is up and you need to pay us £2,404 if you want to stay.”

UK Visas and Immigration transparency data shows the estimated unit cost to the Government for each indefinite leave to remain application is £491 as of November 2022. The data published in February 2022 estimated that cost to be £243, which is the figure referenced in the petition. I am sure the Minister will recognise that even the more recent figures show a huge mark-up in difference between the cost and the charge. That cost has to be shouldered by the hard-working international health and care workers who do so much to support our NHS and our care system. The Government claim the Home Office does not make a profit from those applications and that the money funds part of the wider border and migration system, but the mark-up on the fees is enormous by any benchmark.

We recognise the budgeting implications of any change to the current policy, and therefore Labour will need to look at it closely when we enter government. As a party that believes in the sound management of public finances, we have no choice but to take a cautious approach given the extent of the financial and fiscal mess that we will inherit.

To help us develop our thinking, I am keen to hear from the Minister on the following points. First, does he think that the current system and the fees associated with it are fair, given the extent of the mark-up? Does he have any plans to review that?

Secondly, have the Government undertaken an impact assessment on reducing the fees, not just as regards the border and immigration budget but looking at the wider benefits that a reduced turnover of migrant workers would bring to the healthcare system and community integration more broadly? That would also allow migrant workers more money in their pockets that they would spend in the local economy.

Thirdly, does the Minister feel that some of the language used in recent months by the Home Secretary about certain types of migrant—the use of the word “invasion” springs to mind—will be a help or a hindrance in persuading much-valued, hard-working migrant workers to spend £2,400 to continue supporting our country’s creaking health and social care system?

Fourthly, when will the Government publish their response to the Migration Advisory Committee’s April 2022 report into adult social care and immigration?

Finally, when will the Minister and this Government follow the Labour party’s lead in bringing forward a long-term NHS workforce plan that will encourage nurses to train up and stay in post, ease the burden on staffing, significantly reduce our record high NHS waiting times, reduce our dependence on recruitment from overseas and bring the quality of health and care that the British public truly deserve?

17:29

[The Minister for Immigration (Robert Jenrick)]

I am grateful to the hon. Member for Gower (Tonia Antoniazzi), who opened the debate with a characteristically constructive tone, and to the Petitions Committee for sponsoring the debate. It gives us the opportunity to discuss this important issue, and I recognise the high degree of interest evidenced by the thousands of people who signed the petition. Like the hon. Member, I welcome Mictin to this Chamber, and thank him and others for creating the petition and bringing it to our attention.

The Government provided their initial response to the petition in February 2022 and I am pleased to respond again today, having listened carefully to the many thoughtful contributions. Let me say from the outset that we are extremely grateful for the contribution to the national health service and the whole country made by the many NHS workers who have come here from all over the word—not just in recent times, but from the very foundation of the NHS, as was rightly said earlier, including the early generation of Windrush arrivals.

Although we want to see better domestic recruitment, training and retention of healthcare workers—as others have said, it is essential that we build more healthcare places at UK universities and colleges in the years ahead —it is fair to say that international workers will continue to play a significant role in the NHS for many years to come. It is for that reason that the Government have taken a number of steps to support those individuals coming to the UK, and their employers here in their efforts to recruit them. We want to ensure that the UK is a welcoming place for them and that they are provided with all the support they need as they enter the UK, make their significant contribution to the NHS and, in many cases, choose to make a life here with their families, moving through our immigration system from indefinite leave to remain to citizenship in the years that follow.

[Janet Daby]

I hope the Minister will come on to the point of biometric residence permits, but I want to draw his attention to the fact that when NHS workers come and their biometrics keep being delayed, it prevents them from engaging in society, such as being able to open a bank account or get their kids into school; there is such a knock-on effect. Could he say something about the Home Office’s ability to manage and speed up that work, so that there is an immediate effect for NHS workers?

[Robert Jenrick]

I would be more than happy to say something on that now in answer to both the hon. Member and the hon. Member for Delyn (Rob Roberts). As I understand it, the Home Office is meeting its service standards on biometrics, but none the less I have had correspondence from a small number of colleagues across the House who have said that recent arrivals in the UK are struggling to obtain appointments. I have taken the matter up with my officials, and have asked them to improve the quality of the service. If the hon. Lady has specific constituents who are struggling to get the service they want, I would encourage her to come to me. The hon. Member for Delyn made the point about individuals repeatedly providing their biometrics with each application. I am told that although the Department is increasingly using more robust biometrics, we have started reusing biometrics to reduce the need to reprocess them time and again, so I hope that issue will decline over time.

Let me turn to the main point of the petition: the cost of indefinite leave to remain. ILR is one of the most valuable entitlements we offer, and the fee for the application generally reflects that. Fees are set in line with the charging principles set out in the Immigration Act 2014, which include the cost of processing the application, the wider cost of running the migration and borders system, and all the benefits enjoyed by a successful application. The Home Office does not profit from these fees. All income generated above the estimated unit cost is used to fund the wider migration and borders system and is vital for the Home Office to run a sustainable migration and borders system that keeps the UK and all of us safe and secure.

The published full operating cost of our migration and borders system in 2021-22 was £4.8 billion. The fees under debate today are significantly lower, but they make an important contribution to the whole body of work that goes into an efficient and safe borders system.

[Rob Roberts]

I used to work in financial services, and this term is commonly used in financial services. Is the Minister seriously telling me that NHS workers are being used to cross-subsidise other areas of the system? Have we got nowhere else that we could potentially draw additional funds from, other than levying higher fees on NHS workers to subsidise others? Is that really what he is saying?

[Robert Jenrick]

The hon. Gentleman makes an emotive point, but the reality is that we must fund our immigration and borders system somehow. We can either do that through general taxation, the fees that we levy through all the points of entry into the UK and our visa system, or we can find it through other means undetermined. We have chosen to do a combination of general taxation and the fees that we charge for our visas and immigration services. That is right, because we do not want to put further unsustainable pressure on the general taxpayer.

In a moment, I will come to the specific support that we have provided to health and social care workers, and how that sets them apart from almost all other recipients of our system. We have to fund this substantial cost one way or another, and it is right that a significant proportion comes from those who benefit from it. It is also important that we fund it appropriately, because it is in all our interests that the system operates efficiently. We have seen in recent years—as we have been in the long shadow of covid—how challenging it is when we are not processing visas and immigration applications appropriately. We also see every day how important it is to have a safe and secure border and a well-resourced Border Force and Immigration Enforcement system.

[Stuart C. McDonald]

At the crux of the matter are the figures produced by the Petition Committee’s survey, which suggested that significant numbers are deciding not to apply for ILR—that healthcare workers and others are putting off applications. Is that a problem that the Home Office recognises? If not, on what basis is it refusing to recognise that as a problem? If it does recognise that as a problem, surely it has to think again about the fee and its implications.

[Robert Jenrick]

I will come to that point in a moment, because I would like to answer it directly. We have given it careful thought and responded to it in recent years.

The petition rightly notes that the Government have taken significant measures to ensure that health and care staff are supported. Those measures have included automatically extending visas at no cost, refunding fees to those who have already paid to extend their visa, and a bereavement scheme that allowed relevant family members of NHS care workers who passed away as a result of contracting covid-19 to be granted ILR free of charge. As with any other visa or immigration product, we also provide a route for those in exceptional circumstances who cannot meet the costs.

Further to that, the Government introduced the health and care visa itself—the subject of the debate—back in August 2020, and extended the commitment in January 2021. It is a successful visa route in its own terms. The most recently published statistics say that 61,414 visa applications were made, which account for around half of all skilled worker visa applications to the UK in that period. The package of support we have built up since we introduced the route has made it substantially quicker and easier for eligible people working in health and social care to come to the UK with their families and, in time, to extend their leave.

The Home Office has worked closely with the Department of Health and Social Care to ensure that this support is as flexible as it can be. In my previous role—by happy coincidence—as the Health Minister responsible for the recruitment of nurses, care workers and clinicians to the NHS, I saw that at first hand when we met representatives of organisations from the UK and other countries with whom we were transacting. On that point, I would simply say that we take seriously our responsibility to avoid depleting of those individuals countries with most need of healthcare professionals, and have focused our efforts on countries that are able—where we can verify that—to export trained individuals to the UK.

A previous debate, which has been referenced, on barriers to the visa process focused particularly on GPs and smaller GP practices, which might struggle to navigate the system. My officials have followed up on these issues and are now working with the Department of Health, the BMA and others to explore whether there is demand for and practicality in pursuing an umbrella route for that area of the health service.

The application fee for a health and care visa is significantly cheaper than for wider skilled worker routes, with a visa for up to three years costing £247 and one for more than three years costing £479 for both the main applicant and their dependants. That amounts to around a 50% reduction on the equivalent skilled worker fees. There is also no requirement to pay the immigration health surcharge. The subject of dependants was raised earlier; the same reduced fee and faster processing times apply for dependants of health and social care visa holders, and dependants have access to all the other benefits as well. The offer was further improved when we added care workers to the list of eligible occupations in February 2022, based on a recommendation from the Migration Advisory Committee. I refer hon. Members to the delivery plan for recovering urgent and emergency care services, which was published today, and the work that the Home Secretary and I have been doing with the Health Secretary to deliver that.

The hon. Member for Gower referenced those who have sadly left the country in part because they could not afford the fees for ILR, which the hon. Member for Delyn restated in his intervention. When we introduced the points-based system, we removed the limit on time that an individual could spend on the skilled worker route. Under the old system, a person needed to be able to apply for settlement after six years, or they had to leave the UK. Under the current system, if a person is unable to apply for settlement for any reason—including, potentially, that they cannot afford to apply—they have the option to continue being sponsored until they are able to meet the requirements for settlement. There is absolutely no reason why an individual should feel compelled to leave the UK if they are not yet able, for whatever reason, to begin an ILR application.

[Rob Roberts]

The Minister is being generous with his time. There are other reasons, though—it is not just cost. People on a series of temporary visas cannot get a mortgage; they need full right to remain. There are various things that people without permanent residency cannot do in the financial system. It is about not just being allowed to stay, but being allowed to stay and fully take part in society. That is what is missing in the Minister’s answer.

[Robert Jenrick]

Although I appreciate the hon. Gentleman’s point, I do think it is an important to clarify that no one listening to or reading this debate should feel that they will need to leave the UK at any point; they can continue to remain here for as long as they are able to be sponsored, and should demand for health and social care services remain as high as it is today, it is very likely that they will be able to do so. However, I appreciate the wider point that those who come here for a sustained period of time and feel committed to the United Kingdom will want to progress to indefinite leave to remain and, indeed, citizenship. We in this Government and, I think, Members across the House do not take a passive view of ILR or citizenship; we want to encourage people to ultimately commit to the UK to the extent that they choose to become permanent residents and, indeed, citizens.

The proposal to waive fees for ILR, which is the substance of the debate, would clearly have a significant impact on the funding of the migration and borders system. As I said, we have in recent months been able to negotiate funding from the Treasury for a significant reduction in the initial visa fee, but any further reduction in income would have to be reconciled with additional taxpayer funding, reductions in funding for public services such as the NHS, or increases in other visa fees. Therefore, as much as one would want to do so, I am afraid that it would be very challenging for the Government to progress that proposal.

[Stuart C. McDonald]

The hon. Member for Delyn (Rob Roberts) made a very valid point: we have to look at the wider picture. As I mentioned, £3 billion is being spent on bank nurses to backfill vacancies, so by losing some money from the Home Office budget, we could be saving money for the NHS. We should not just look at this in isolation. There should be a cross-Government review of the implications for taxpayers.

[Robert Jenrick]

It was for that reason that we took the decision to apply a 50% discount to the initial visa fee, taking into account the broader benefits for the public sector and the taxpayer of bringing more people into the country through a faster, simpler route. I have not seen evidence that individuals are leaving the country because they cannot access ILR at the present time, but if the hon. Gentleman has research suggesting there is a material issue, I strongly encourage him to bring it to my attention or that of the Department of Health and Social Care.

[Janet Daby]

Will the Minister give way on that point?

[Robert Jenrick]

I am happy to give way, but I should then draw my remarks to a close.

[Janet Daby]

Two weeks ago, I met second year medical students studying in our country. The majority said they are not planning to remain in the UK to practise as doctors because of the various pressures and strains on the NHS, feeling undervalued and so on. It is therefore likely that we will continue to need people from overseas to work in our NHS, so—on the same thread on which the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) spoke—we need to do more and make it easier for people to support our treasured NHS.

[Robert Jenrick]

The hon. Lady makes a valid point. Of course, we want to retain as many NHS professionals as possible, whether they grew up in the UK or have come subsequently from overseas. There is a significant challenge with individuals choosing, for a range of reasons, to go to other countries; of course, we in Government have to balance that with broader affordability, taking into account the cross-Government cost and how we would replace that income from general taxation.

Turning to international comparisons, the fees that we charge are broadly comparable with those of other developed countries. There are, of course, competitor countries that charge less, as there are those that charge more. Taking as examples some countries that, anecdotally, doctors and nurses frequently go to as opposed to working in the UK, our ILR fee is higher than that of New Zealand, but lower than that of Australia. It is not clear that the fee in the UK is substantially higher than in those destinations that healthcare professionals might otherwise go to. The hon. Member for Delyn implied that there had been a substantial increase in our fees over recent years, but that is not in fact the case. The ILR fee has increased by £15 between 2018 and the present day, so we have tried, as far as possible, to keep the costs under control in recent years.

The hon. Member for Delyn also asked about the “Life in the UK” test, but I am afraid disagree with him on that point. Integration into UK society, knowledge of our history and pride in our country are extremely important. The previous Labour Government’s decision to introduce the “Life in the UK” test was right, and we have supported it consistently in government. Long may that continue, because it does make a small contribution to encouraging people to better integrate and understand the country to which they are committing.

I again thank the hon. Member for Gower for introducing the debate and all hon. Members who spoke. There is no doubt that we are in agreement on the importance of the NHS and its workforce. We care deeply about those individuals who choose to come here from overseas; I pay tribute to them and thank them for their service. I hope I have set out some of the ways the Government are working to ensure that their time in the UK is as fruitful as possible, and that, if they choose to make a life here, that is as seamless as it can be within the confines of our fiscal situation and affordability for the taxpayer. I assure all hon. Members that we will reflect carefully on the points that have been raised in the debate, and that we will continue to do what is necessary to support our fantastic NHS.

17:51

[Tonia Antoniazzi]

I thank the Minister for his remarks, but they are disappointing. I share the concerns of the hon. Member for Delyn (Rob Roberts)—this is probably the only time that I have shared his views—about the cross-subsidisation of the cost. I understand the theory behind it, but I do not think it makes Mictin and his family, and others like them, feel any better. I know the Minister cannot respond now, but the fact that £140 million has been spent on the Rwanda scheme, which is not even up and running, sticks a bit. When people learn that that money is cross-subsidised, it hurts—I know it will hurt those listening to the debate.

I appreciate the Minister saying that he and his officials will listen to what has been said today, but good governance would be to reflect and amend, if possible, the current legislation. I appreciate what has been done, but more can be done. I have listened and spoken to Mictin and his family, so I know it is about the cumulative cost of everything. It is about the ongoing financial pressure that those people face when their families are settled here. The United Kingdom is a great place to live and grow up, and it is where we want people to live their best lives. Those who have served in the NHS—I use the word “served”, because to work in the NHS as a healthcare worker, especially given what we have been through in the past few years, is a duty—deserve better.

Question put and agreed to.

Resolved,

That this House has considered e-petition 604472, relating to immigration fees for healthcare workers.

17:54

Sitting adjourned.