Immigration Fees for Healthcare Workers

Debate between Stuart C McDonald and Rob Roberts

Monday 30th January 2023 Westminster Hall

[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.

Nationality and Borders Bill

Debate between Stuart C McDonald and Rob Roberts

2nd reading
Tuesday 20th July 2021 Commons Chamber

[Rob Roberts (Delyn) (Ind)]

It is a pleasure to follow the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed). It will come as no surprise that I do not agree with a great number of things that she said, but she may get some comfort from one of the proposals that I will make later to improve the Bill.

I welcome any Bill that aims to address historical anomalies and areas of unfairness in British nationality law, and to make the current system of applying for asylum fairer and more efficient. This Bill will ensure that those who are in genuine need can be supported, and, at the same time, deter illegal entry into the UK. This is a timely and important topic and an area of law that we have needed to address for some time.

In recent years, we have sadly been haunted by terrible scenes and tragic reports of migrants losing their lives while attempting to enter the UK. That is why I welcome the changes proposed in this Bill. The Bill aims to save and protect lives by ensuring that only safe and legal routes into the UK remain, and proposes harsher punishments for human smugglers and traffickers, who are responsible for so much suffering. The introduction of life sentences for human smuggling, by way of which so many lives have been endangered, will attempt to combat and condemn the exploitation of migrants. Tougher criminal sentences for those attempting to enter the UK illegally will also steer those seeking asylum towards safe and legal routes, and ultimately protect their lives.

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

What the hon. Member is advocating and what the Government have in this Bill is a criminal offence punishable by up to four years in prison that would apply to a Uyghur fleeing ethnic cleansing in China, to a Syrian fleeing war crimes there, or to a persecuted Christian fleeing for their life. How can any Government or any party justify locking up these people for four years?

[Rob Roberts]

I recall serving with the hon. Gentleman on the Immigration and Social Security Co-ordination (EU Withdrawal) Bill Committee, so I am very much aware of the experience and expertise that he brings to this debate. The short answer is that this Bill does an awful lot to end human trafficking and the nasty, awful environment that is being fostered by the criminal gangs who are putting lives at risk. I appreciate everything that the hon. Gentleman says and the expertise that he brings to the debate, but I do not necessarily see it in the same way as he does.

The UK has a proud history of supporting the most vulnerable people worldwide, having resettled more refugees than any other country in Europe. The Bill ensures that the Government stand by their moral and legal obligations to help people fleeing cruelty around the world, while condemning those who break the law.

Let me turn briefly to another element of the Bill. Attention needs to be given to the costly and arduous routes to citizenship that are bureaucratic and expensive for those who are already settled and working in the UK. I declare an interest, as my partner is an overseas NHS worker. This is a perfect example of what I mean: many of our NHS workers who have worked day in, day out to provide the best possible care to patients throughout the pandemic have come from other countries. Often these individuals have travelled great distances and put their own lives at risk to help and save our lives, regardless of their or our citizenship; their duty to care and contribute to the wellbeing of their patients is what comes first and I commend their hard work.

However, with fees for indefinite leave to remain at almost £2,400 and citizenship applications another £1,330, the process of becoming a citizen for many of our NHS workers is a costly and challenging one. As the hon. Member for Edinburgh West (Christine Jardine) said last week during an intervention in the Health and Care Bill debate, if we offered indefinite leave to remain to all of our NHS workers who are here on renewable visas, I feel confident that the gap in the NHS workforce would almost certainly close and, simultaneously, we would be recognising their hard work and sacrifices. The over 160,000 NHS staff from over 200 different countries who stated that they were of non-British nationality account for nearly 15% of all NHS staff for whom a nationality is known. It is undeniable that we would be in dire straits without them. Should we not therefore consider changing our current citizenship process to one that does not deter NHS workers through high costs and time-consuming processes, one that does not leave them in debt and in poverty but instead rewards their commitment to their communities?

I welcome the many steps that the Bill takes to improve the UK’s asylum and immigration system to make it one that is based on needs, and I welcome the new NHS visa that has been announced by the Home Office. Given that the Government themselves have already recognised the importance of creating a bespoke route for incoming NHS workers, I feel it is also our duty to focus on those who have already given so much to our country, by creating a new route to citizenship for existing NHS workers.

One of the objections to this could be that once indefinite leave to remain or citizenship had been conferred, the NHS worker would be free to go to the private sector or to a different role altogether, having benefited from the fee abolition. That could be easily resolved. Companies do this all the time, paying fees for qualifications for individuals that would become repayable if that individual then left the company’s service. There does not seem to be any reasonable reason why a similar scheme could not be put in place to make this workable.

As I have said before, in this place and in Westminster Hall, it is time to abolish the fees for indefinite leave to remain and for 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 in our country with open arms.