The Immigration Health Surcharge and the Value of Migrants

On 21st May, the UK Government scrapped the Immigration Health Surcharge (IHS) for migrant NHS staff and care workers – a fee which migrant workers must pay in order to access the NHS, in addition to ever-increasing Tier 2 work visafees [1]. This exemption was sorely needed and long fought for, particularly since the government revealed its plans to increase the IHS from £400 to £624 per year from October 2020.

In light of Covid-19, this became a pressing concern as migrant NHS workers who have selflessly worked to protect the British public throughout this pandemic would continue to be charged such an extortionate fee to access the service they themselves provide.

Yet, despite welcome news of the exemption, the government’s decision to scrap the IHS for NHS workers has been met with justifiable scrutiny and criticism. One such criticism voiced by campaigners and the general public was that the government’s initial announcement awarded this exemption to doctors and nurses only, neglecting all other NHS staff and professionals in the care sector.

Initially, the Government hoped that by exempting doctors, nurses and paramedics from the Immigration Surcharge, they were paying their respects to frontline hospital and health staff. Yet this demonstrates a clear failure to appreciate or even to recognise the sacrifice of all other NHS and care workers, who ensure that the wheels of the NHS function properly and are essentially the backbone of the health service. From porters, to care workers who are dedicated to supporting and assisting the most vulnerable residents, the government’s disregard of these workers hints at a pervasive attitude which looks upon vital but lower paid migrants as unworthy.

Thankfully, as a result of mounting pressure, the government extended this exemption to all NHS and care workers – including those previously overlooked low-paid workers – confirming that they would no longer be subject to paying the health surcharge. Covid-19 has no doubt increased a small sea change in attitudes – no longer viewing these individuals as statistical income but essential workers who are providing a crucial job in the health service overall. Yet this demeaning attitude towards low-paid workers regrettably remains within the UK’s immigration system. And unfortunately, concerns regarding the IHS exemption do not end here.

At the end of May, the Prime Minister was confronted with questions regarding why the surcharge is still in place for NHS and care workers, 4 weeks after his May 21st announcement [2] that it would no longer apply to these individuals. Johnson responded that he is ‘working to drop the fee’, which only served to confirm accusations that the workers in question are still being charged. He insisted that they would be issued a refund. However, at present, there is no information regarding how a refund may be claimed or how long it will take for the exemption to come into effect.

One doctor highlighted how he has had to pay £6,000 in IHS fees so far to cover himself, along with his wife and four children [3]. The Home Secretary is therefore now being asked to ensure that not only NHS and care staff are exempt from paying the migrant surcharge but that their spouses and dependents are too. In June, the British Medical Journal, Royal College of Physicians, Royal College of Nursing and Unison wrote to the Prime Minister, asking for the surcharge exemption to be extended to spouses and dependents, along with a recommendation that the charges be exempt permanently.

What’s more, what the government’s current IHS exemption fails to address is the invaluable work and dedication of all other migrant workers who have similarly helped to keep the country running at such an unprecedented time. Those who work in other industries yet still provide key services – such as cleaners, delivery drivers, teachers and public transport workers to name just a few – all continue to be subjected to the rapidly rising surcharge. Many low-paid migrant workers in the UK struggle to fund the IHS and this is only set to be exacerbated with the rise of the fee in October. In addition to this, the introduction of the new points-based system due to come into force in January 2021 is set to have a catastrophic impact on many industries – including the NHS. The annual salary threshold will be lowered to £25,600 from £30,000 yet this still fails to account for lower paid workers, including those mentioned previously, many of whom earn well below the £25,600 threshold. Now more than ever, the Government ought to be encouraging and welcoming these vital workers, yet many will be deterred as a result of hiking visa and health surcharge fees.

What Must Change

A lot of the government’s approaches up until this point could be exemplified by comments such as “It’s the National Health Service, not the International Health Service” – said by Health Secretary, Matt Hancock [4]. This positions migrant key workers as spongers, unnecessary and a drain on the system yet the figures show we need them more than ever. If we are to take any lessons from the tragedy of Covid-19, valuing all migrants – and therefore scrapping the surcharge for all vital workers, not just health and care staff – would be one step in the right direction.




[1] Immigration Advice Service (2020) Tier 2 Visa Application. Available at:

[2] Lay, K. (2020) ‘Foreign NHS workers still charged despite Boris Johnson’s pledge’ The Times, 10 June. Available at:   [Paywall]

[3] Marsh, S. and Gentleman, A. (2020) ‘Migrant healthcare staff still paying NHS fee despite Johnson U-turn’ Guardian, 15 June. Available at:

[4] Hancock, M. (2019) Twitter, 17 November. Available at:


Paul McShane
Paul is a content writer for the Immigration Advice Service; an organisation of immigration lawyers based in the UK & Ireland

This blog was also published in the quarterly newsletter of Doctors for the NHS (July 2020)

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