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Immigration and Nationality Fees (Exemption for NHS Clinical Staff)

Volume 730: debated on Monday 20 March 2023

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to exempt NHS clinical staff from the requirement to pay fees under section 68 of the Immigration Act 2014; and for connected purposes.

I declare a partial interest for the avoidance of doubt, as my fiancé is a healthcare professional from overseas. However, he already has his British citizenship, so would derive no benefit from this Bill whatever.

The NHS is a fundamental part of British life, as it has been for decades. It has been under a particular spotlight for the past couple of years as we have battled with the most significant public health crisis in our lifetimes, and right hon. and hon. Members from all parts of the House have spoken at length about the debt we owe to the NHS clinicians who put themselves in harm’s way to make sure they could provide healthcare to the rest of us, who rely on them so profoundly.

I have spoken on this topic several times both in the Chamber and in Westminster Hall, and last year I tabled an amendment to the Nationality and Borders Bill to exempt NHS clinical workers from paying the fees associated with applying for indefinite leave to remain. I discussed the amendment with the Minister at the time, the hon. Member for Corby (Tom Pursglove), as well as with the hon. Member for Torbay (Kevin Foster), who had responsibilities in this area. I was told that the amendment, which was unusual in this House in having signatures and support from Members from six different parties, was not acceptable to the Government because we could not make special cases out of certain groups of people. Shortly afterwards, as the Bill was making its way through the House of Lords, the Government announced that armed forces veterans would be exempted from paying fees for ILR applications. I thought that was interesting, given that NHS workers had not been worthy of a special classification just a couple of months before.

The Home Secretary at the time, the right hon. Member for Witham (Priti Patel), said:

“Waiving the visa fee for those Commonwealth veterans and Gurkhas with six years’ service who want to settle here is a suitable way of acknowledging their personal contribution and service to our nation.”

To take nothing away from the veterans who have put their lives on the line in service of the country and the Commonwealth, we would be hard-pressed to find many members of the public who do not believe that our NHS clinical staff are worthy of the same consideration.

While the entire NHS played a vital role, our thanks and gratitude should go in particular to NHS workers who have come from other countries. Those individuals have travelled huge distances to be here, are often separated from their families, and have put their own lives at risk to help and save our lives—citizens from a different country to their own. Regardless of their or our citizenship, the duty and responsibility to care and contribute to the wellbeing of others always comes first for them. It is amazing, and it should be highly commended.

I welcome the many steps that the Government have already taken for foreign NHS workers, including the health and care worker visa and the exemption from the immigration health surcharge, but we need to go further. These people want to make the UK their home. They have put down roots, and we have a duty to put in place a framework that allows them to do just that, without thousands of pounds-worth of costs just to stay in a country to which they have already contributed so much.

With fees for indefinite leave to remain at more than £2,400 and citizenship applications costing another £1,800 or so, plus another few hundred for biometrics, English language tests and all the supplementary things that need to be done, the total cost of the naturalisation process is more like £5,000—among the highest in the world. The process of becoming a citizen for our NHS workers is costly and challenging, and includes the ridiculous “Life in the UK” test, which asks questions about such useful topics as the Great Exhibition of 1851 and which British actors have won Oscars recently. Quite how anyone could be expected to integrate into British society without that pivotal knowledge remains a mystery.

Doctors, nurses, physiotherapists, occupational therapists, psychiatrists and all manner of clinicians come to our shores to work in the NHS. They pay their taxes every month. They work in intensive care units, high dependency units, paediatric cancer centres and in everything from obstetrics and neonatal units to geriatrics and palliative care. They spend their working life in this country saving lives, and that was especially so during the pandemic. They have to take out loans to pay for their residency applications. As I have said a number of times before, we should not be driving them into debt; we should be in their debt.

It is our duty to create a new route to citizenship for NHS clinicians—one that will not leave workers in debt, in poverty or in constant worry about funding their next application—by abolishing the costs associated with applying for indefinite leave to remain and citizenship for NHS clinical workers. There would obviously have to be some caveats, in that those workers would need to have worked in the NHS for at least three years and would also need to commit to remaining in the NHS for at least a further three years; otherwise, the fees that they would have paid would become due. That is necessary to stop people gaining the benefit that I hope would benefit clinicians in our NHS, then deciding to go into the private sector immediately after they have received their right to reside. That would be counterproductive to what I am trying to achieve.

I am proud that our NHS attracts such global talent and recruits from around the world; quite frankly, we would not be able to run it without them. In 2021, over 160,000 NHS staff from over 200 different countries stated that they were a non-British nationality, accounting for nearly 15% of all staff for whom a nationality is known. However, the current fees and process is a huge barrier for both future NHS workers, who are put off coming to the UK to fill our many vacancies, and current NHS workers, who are unable to afford the final step and receive the permanent residency that they have earned through their service to our country.

Residency and citizenship should not be about cost—whether a person can afford it—but about contribution and inclusion in our communities. NHS workers have perhaps made the biggest contribution of all, saving our lives and keeping us safe. Despite being such valued members of the communities in which they live and work, without being citizens they struggle to be fully part of those communities. Without ILR, individuals face barriers to home ownership, as it is almost impossible to get a mortgage, as well as barriers in higher education and so many other aspects of life. Therefore, scrapping the fees would not only make residency and citizenship more affordable and a viable option for foreign workers in our NHS, but would create a more diverse and, crucially, a more integrated society.

People from other countries who have worked in our NHS during this pandemic and throughout their lives deserve to be able to call the UK their home, and actually feel as though it is. The pandemic had one benefit, in that it highlighted what many of us already knew: that our NHS workers, whether British or not, are the backbone of our health service and our country. Those who have come here to provide such incredible care should not be penalised for it, but currently, the high application fees do just that. In conclusion, it is time to abolish the fees for indefinite leave to remain and citizenship for those clinical staff who work in our NHS, so that those who spend time helping and treating us can finally feel like they belong, and are welcomed in our country with open arms.

Question put and agreed to.


That Rob Roberts, Dr Philippa Whitford, Martyn Day, Margaret Ferrier, Ben Lake, Sarah Atherton, Mark Fletcher, Henry Smith, Jim Shannon and Claudia Webbe present the Bill.

Rob Roberts accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 24 March, and to be printed (Bill 272).