NHS

By Holly Mogford – PhD student at Swansea University and Patients not Passports (PNP) campaigner.

In recent years, and amidst the hostile environment, immigration and nationality fees have broadened in scope and increased in amount. In doing so, the lives of many migrants have become extremely challenging. As documented by Migrant Voice (n.d.), the financial burden, for many, is combined with “mental and physical health problems, with some sacrificing food, heating, and electricity to save up for their visas”.

At the time of writing, there are a total of 168 immigration and nationality fee categories listed by the Home Office (UKVI, 2023). Among these categories is indefinite leave to remain (ILR) – main applicants and dependents, which is currently set at £2,885. In setting the fee at this rate, a significant profit is made. In October 2021, for example, when ILR was set at £2,389, the unit cost was £243, this resulted in profits of 883% (see Migrant Voice, 2022, p. 18).

In the summer of 2023, the government announced plans to increase visa fees and the Immigration Health Surcharge to fund part of the public sector pay offer. The Immigration Health Surcharge is a requisite component of visa and immigration applications. It was introduced in 2015 and was initially set at £200 (Burnett & Chebe, 2020). It has since increased to £624 and is again set to increase at the start of 2024 to £1035 (McKinney et al., 2023). This proposal has encountered significant resistance from public sectors workers, migrants, and campaigners, among many others invested in migrant justice.

Resistance against extortionate visa fees and the Immigration Health Surcharge existed prior to this recent juncture. Migrant Action respond directly to these fees. Hence, it was within this existing pursuit of migrant justice that Migrant Action joined the National Day of Action called by Migrant Voice, pursuing efforts of structural change.

On the 31^st of October, Migrant Action joined in solidarity with individuals and organisations across the United Kingdom to resist the announced increases to visa fees and the Immigration Health Surcharge. The date of the event, Halloween, was aptly symbolic of the devasting impact of visa and immigration fees.

In hoping to spread awareness of this impact, Migrant Action organised a sign-making session at Leeds University followed by a series of presentations which focused on related research. The first speaker was Holly Mogford, a PhD student at Swansea University and a Patient’s not Passports campaigner. The presentation documented the socio-legal framework of NHS (sur)charging which has eroded the principle of universality in the NHS (Potter, 2018). This was followed by a presentation delivered by Dr Jon Burnett, a lecturer at the University of Hull. The presentation reflected upon a report by Migrant Voice (2022), in which Jon contributed by situating immigration fees in 21^st century Britain, highlighting the profit made from certain immigration fees and visas. These presentations initiated discussion around the distinct, but inevitably related implications of NHS (sur)charges, immigration and visa fees. This was followed by an informative stall and demonstration in Leeds led by students.

The National Day of Action showcased the unity and support in resisting increasing visa fees and the Immigration Health Surcharge. This action powerfully cut across a vast array of organisations and individuals working towards migrant justice. It was a significant moment in time, yet, crucially, efforts to prevent the suffering imposed by extortionate visa fees and the Immigration Health Surcharge continue each day, whether this be by spreading awareness, lobbying to MP’s or providing direct support and advocacy to those impacted by these fees.

References

Burnett, J., & Chebe, F. (2020). Towards a political economy of charging regimes: Fines, fees and force in UK immigration control. The British Journal of Criminology, 60(3), 579-599. https://doi.org/10.1093/bjc/azz070

McKinney, CJ, Meade, L., Sturge, G., & Barton, C. (2023). UK Immigration Fees. UK Parliament. https://commonslibrary.parliament.uk/research-briefings/cbp-9859/#:~:text=Application%20fees%20recently%20went%20up,and%20student%20visas%20by%2035%25.

Migrant Voice. (n.d.). Our campaign against the extortionate cost of visas. https://www.migrantvoice.org/visa-costs-campaign

Migrant Voice. (2022). Destroying Hopes, Dreams and Lives: How the UK visa costs and process impact migrants lives. https://www.migrantvoice.org/img/upload/Visa_fees_report_-_digital_final_to_upload.pdf

Potter, J. (2018). Patients Not Passports-No borders in the NHS! Justice, Power and Resistance, 2(2), 417‐429. https://www.researchgate.net/publication/327252907_Patients_Not_Passports-No_borders_in_the_NHS/citations

UKVI. (2023). Home Office immigration and nationality fees: 25 October 2023. Home Office. https://www.gov.uk/government/publications/visa-regulations-revised-table/home-office-immigration-and-nationality-fees-25-october-2023

Covid-19 has highlighted the importance of migrant key workers, who make up 20% of the NHS workforce. The NHS surcharge is paid by migrants from outside the EEA, or anyone applying for a visa lasting for more than 6 months, which demands a yearly sum of £400 per person to use the health service. Boris Johnson initially rejected appeals to exclude migrant Covid-19 NHS workers from paying. However, on the 26th April, it was announced the surcharge was ‘under review’ and since, it has been agreed that those covered by the one-year free visa extension will be exempt from the charge. Furthermore, Health Secretary Priti Patel announced a Coronavirus (COVID-19) bereavement scheme to support the dependants of workers who have lost their lives due to the virus- controversially excluding many lower-paid NHS roles. Following backlash, the UK government has since made a U-turn by extending the provision of the scheme to cover all families of migrant social care workers, including hospital cleaners and porters. For some, the extension comes too late, with NHS staff fearful of losing their jobs as a result of visa complications.

Summary of U-Turns:

March 2020: Home Office announces an automatic renewal of visas for NHS overseas workers (limited to doctors, paramedics and nurses).

April 2020: Home Secretary Priti Patel confirms families and dependants of all NHS workers who have tragically lost their lives to the virus will be granted indefinite leave to remain.

Extends scheme to midwives, radiographers, and some social care workers
Those covered by the visa extension will now be exempt from the NHS surcharge
Applies to all visas expiring between 31 March – October 2020

The broader significance of this:

Despite these changes being a positive step by the government, they have highlighted the hostility inherent within the government’s immigration policies on the one hand and the importance of public scrutiny of these policies on the other. It also exposes the political economy of the government’s charging regimes whereby revenue extraction override compassion and humanity. It took immense pressure from the public, the Labour party and even Conservative MP’s for the government to lift the immigration health surcharge.

The fact it has taken a global pandemic and public outrage to shift government policy is indicative of the potency of public advocacy, however it is important that these are not reactive measures and short term gains but should translate into lasting policy changes. This also highlights the hypocrisy of the new skills-based migration system, which will further reduce low-wage and low-skilled EU migrants access to the UK. However, recognising the human value of migrants should not be dependent on their utility in a time of crisis.

Galvanising resistance against increasing visa fees and the Immigration Health Surcharge: The power of collaboration

“The Right Thing To Do”; In light of the global pandemic, have the Conservatives finally learnt the true value of migrants to the UK?

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