Immigration Fees for Healthcare Workers

Margaret Ferrier Excerpts

Monday 30th January 2023 Westminster Hall

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.