Immigration Fees for Healthcare Workers

Robert Jenrick Excerpts

Monday 30th January 2023 Westminster Hall

[The Minister for Immigration (Robert Jenrick)]

I am grateful to the hon. Member for Gower (Tonia Antoniazzi), who opened the debate with a characteristically constructive tone, and to the Petitions Committee for sponsoring the debate. It gives us the opportunity to discuss this important issue, and I recognise the high degree of interest evidenced by the thousands of people who signed the petition. Like the hon. Member, I welcome Mictin to this Chamber, and thank him and others for creating the petition and bringing it to our attention.

The Government provided their initial response to the petition in February 2022 and I am pleased to respond again today, having listened carefully to the many thoughtful contributions. Let me say from the outset that we are extremely grateful for the contribution to the national health service and the whole country made by the many NHS workers who have come here from all over the word—not just in recent times, but from the very foundation of the NHS, as was rightly said earlier, including the early generation of Windrush arrivals.

Although we want to see better domestic recruitment, training and retention of healthcare workers—as others have said, it is essential that we build more healthcare places at UK universities and colleges in the years ahead —it is fair to say that international workers will continue to play a significant role in the NHS for many years to come. It is for that reason that the Government have taken a number of steps to support those individuals coming to the UK, and their employers here in their efforts to recruit them. We want to ensure that the UK is a welcoming place for them and that they are provided with all the support they need as they enter the UK, make their significant contribution to the NHS and, in many cases, choose to make a life here with their families, moving through our immigration system from indefinite leave to remain to citizenship in the years that follow.

[Janet Daby]

I hope the Minister will come on to the point of biometric residence permits, but I want to draw his attention to the fact that when NHS workers come and their biometrics keep being delayed, it prevents them from engaging in society, such as being able to open a bank account or get their kids into school; there is such a knock-on effect. Could he say something about the Home Office’s ability to manage and speed up that work, so that there is an immediate effect for NHS workers?

[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.

[Stuart C. McDonald]

At the crux of the matter are the figures produced by the Petition Committee’s survey, which suggested that significant numbers are deciding not to apply for ILR—that healthcare workers and others are putting off applications. Is that a problem that the Home Office recognises? If not, on what basis is it refusing to recognise that as a problem? If it does recognise that as a problem, surely it has to think again about the fee and its implications.

[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.

[Stuart C. McDonald]

The hon. Member for Delyn (Rob Roberts) made a very valid point: we have to look at the wider picture. As I mentioned, £3 billion is being spent on bank nurses to backfill vacancies, so by losing some money from the Home Office budget, we could be saving money for the NHS. We should not just look at this in isolation. There should be a cross-Government review of the implications for taxpayers.

[Robert Jenrick]

It was for that reason that we took the decision to apply a 50% discount to the initial visa fee, taking into account the broader benefits for the public sector and the taxpayer of bringing more people into the country through a faster, simpler route. I have not seen evidence that individuals are leaving the country because they cannot access ILR at the present time, but if the hon. Gentleman has research suggesting there is a material issue, I strongly encourage him to bring it to my attention or that of the Department of Health and Social Care.

[Janet Daby]

Will the Minister give way on that point?

[Robert Jenrick]

I am happy to give way, but I should then draw my remarks to a close.

[Janet Daby]

Two weeks ago, I met second year medical students studying in our country. The majority said they are not planning to remain in the UK to practise as doctors because of the various pressures and strains on the NHS, feeling undervalued and so on. It is therefore likely that we will continue to need people from overseas to work in our NHS, so—on the same thread on which the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) spoke—we need to do more and make it easier for people to support our treasured NHS.

[Robert Jenrick]

The hon. Lady makes a valid point. Of course, we want to retain as many NHS professionals as possible, whether they grew up in the UK or have come subsequently from overseas. There is a significant challenge with individuals choosing, for a range of reasons, to go to other countries; of course, we in Government have to balance that with broader affordability, taking into account the cross-Government cost and how we would replace that income from general taxation.

Turning to international comparisons, the fees that we charge are broadly comparable with those of other developed countries. There are, of course, competitor countries that charge less, as there are those that charge more. Taking as examples some countries that, anecdotally, doctors and nurses frequently go to as opposed to working in the UK, our ILR fee is higher than that of New Zealand, but lower than that of Australia. It is not clear that the fee in the UK is substantially higher than in those destinations that healthcare professionals might otherwise go to. The hon. Member for Delyn implied that there had been a substantial increase in our fees over recent years, but that is not in fact the case. The ILR fee has increased by £15 between 2018 and the present day, so we have tried, as far as possible, to keep the costs under control in recent years.

The hon. Member for Delyn also asked about the “Life in the UK” test, but I am afraid disagree with him on that point. Integration into UK society, knowledge of our history and pride in our country are extremely important. The previous Labour Government’s decision to introduce the “Life in the UK” test was right, and we have supported it consistently in government. Long may that continue, because it does make a small contribution to encouraging people to better integrate and understand the country to which they are committing.

I again thank the hon. Member for Gower for introducing the debate and all hon. Members who spoke. There is no doubt that we are in agreement on the importance of the NHS and its workforce. We care deeply about those individuals who choose to come here from overseas; I pay tribute to them and thank them for their service. I hope I have set out some of the ways the Government are working to ensure that their time in the UK is as fruitful as possible, and that, if they choose to make a life here, that is as seamless as it can be within the confines of our fiscal situation and affordability for the taxpayer. I assure all hon. Members that we will reflect carefully on the points that have been raised in the debate, and that we will continue to do what is necessary to support our fantastic NHS.