Immigration Fees for Healthcare Workers

Rob Roberts Excerpts

Monday 30th January 2023 Westminster Hall

[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.

--- Later in debate ---

[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.

[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?

--- Later in debate ---

[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.

[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.