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Migrants are 1 in 6 of Bristol’s coronavirus hospital heroes. But many are charged to use NHS.

Thousands of local hospital staff are from 109 countries across the world, but many are charged to use the NHS they work in.

Coronavirus in Bristol

Illustration: Rosie Carmichael

1 in 6 of Bristol’s hospital heroes are immigrants, highlighting the contribution migrants have made in the battle against coronavirus and the reliance of the NHS on non-British workers. However, many of these workers are forced to pay hundreds of pounds per family member just to use the NHS, despite working in it. 

Bristol Cable analysis of NHS employee data* shows that up to 3,200 members of staff at the three local hospitals – the Bristol Royal Infirmary, Southmead and Weston General – are immigrants to the UK. 109 self-reported different nationalities work in the three institutions, from Afghanistan to Zimbabwe with about half from EU countries. Many more will work in other local NHS institutions. 

Nationally, the numbers of hospital staff born outside the UK is as high as 23%, though many of these will be British citizens. 

Responding to the information, Bristol West MP Thangam Debbonaire told the Cable, “this shows the valuable contribution people make to the UK who have come here and made their homes here. They deserve decent pay and conditions, starting with the PPE they were promised for this Covid crisis but beyond that their terms and conditions need a thorough review and uplift.”

However, over a thousand of the same Bristol staff are forced by the government to pay hundreds of pounds a year per family member to access healthcare. 

NHS staff charged to access the NHS

The coronavirus crisis has renewed calls to scrap the financial charges imposed on non-EU migrant NHS employees and their families to use the NHS. The Immigration Health Surcharge (IHS) currently requires most migrants applying for visas to pay £400 a year to access healthcare, including NHS staff. 

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This means that a family of a nurse with a partner and two children applying for three-year visas to work in the UK would have to pay £4,800 upfront – about 20% of a nurse’s starting salary. The charge is due to increase later this year to £625 per family member, the second increase in as many years.

A Zimbabwean pharmacist working in Bristol said, “In whatever industry people work in, they usually get a staff discount. But for us it’s the opposite. We have to pay extra to use the service we work for, which we already pay for through tax, and national insurance”, adding that, “if it is going to be increased – well, that feels like a kick in the teeth.” 

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Under pressure from unions and campaigners, Home Secretary Priti Patel said in April that the IHS is “under review”. Patel also announced a year-long extension to NHS staff visas and a one-year exemption of the IHS. However, the policy does not cover social care workers, a sector reported to have an even higher proportion of non-British workers on the frontline. As of mid-May it has been reported that the review of scrapping the IHS charge for NHS staff has not been undertaken by the Home Office. The 56% increase is set to go ahead this year with the charge extended to EU migrants as of January 2021.

Brexit, the removal of financial support for nursing students and the policies of ‘hostile environment’ introduced by Theresa May are all contributing to chronic staff shortages in the NHS. 

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Along the same lines, the IHS is seen as penalising those who serve in the NHS and are currently risking their lives to do so. Though many migrants will not be black or minority ethnic (BME), the mounting evidence that the BME population is more susceptible to coronavirus will be an added worry for those on the front line. 

A Nigerian NHS worker in Bristol who has to pay for himself and his wife to access the NHS said, “it makes me really really angry to be honest. We are underappreciated – we are here working, contributing to society, but still it seems that’s not good enough.” Moreover, what feels more unjust is that despite the fees that he and his wife pay, they were told they were not eligible for fertility treatment, because his wife is a dependent on his visa. “Working and paying for the NHS but not having access to certain services – it’s just ridiculous!” he said.

The British Medical Association and the Royal College of Nursing are calling for a permanent scrapping of the charge for NHS staff. Lucy Muchina, South West Regional Director of the Royal College of Nursing  told the Cable, “the current crisis only serves to highlight the unfairness of charging overseas nurses working in the UK for healthcare services. It is totally unjustifiable that hard-working nurses from overseas are being penalised in this way. These nurses are giving their all for patients, going to work through this terrible time to care for the most vulnerable members of our society. Before this pandemic our health and social care services were stretched to breaking point, with over 40,000 nurse vacancies in the NHS in England alone, and cannot function without nursing staff from overseas. Nurses from overseas should be treated like the valuable members of the clinical teams that they are.”

Bristol MP Debbonaire also backs the calls to scrap the charges saying “they work for the NHS, they are essential to the NHS, they pay taxes to fund the NHS, they should not have to pay additional money.”

A Home Office spokesperson said the government “fully recognises the contribution international health and care professionals make to the UK”, and described the visa extensions as “an exceptional offer to show our gratitude”, but added: “It is in the public interest for migrants to be financially independent and not burden UK taxpayers. Those who benefit from the state should be contributing to it.” 

Carl, a trainee NHS pharmacist from the Philippines, told the Cable, “I hope something changes because of Covid. Our work pressure has increased, our workload is so much more demanding. I hope if we raise these concerns to the Government now, they might be more understanding and humane.” 

As one NHS worker said, “if the increase goes through, it’s a national disgrace.” 


*Data provided by NHS Digital is based on NHS staff self-reporting nationality and not all staff are required to declare their nationality.

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