Immigration Fees for Healthcare Workers

Tonia Antoniazzi 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.

[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.

--- Later in debate ---

[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.