Bishop & Sewell

The Immigration Health Surcharge is set to be doubled in December this year subject to Parliamentary approval. Under new proposals set out last week by the Immigration Minister, Caroline Noakes, migrants making visa applications or extending their leave from December will have to pay £400 per year to access the NHS. On 11 October 2018, the Home Office laid an order before Parliament in accordance with section 38 of the Immigration Act 2014, ‘The Immigration (Health Charge) (Amendment) Order 2018’  seeking to double the NHS immigration health surcharge paid by temporary migrants to the UK. The discounted rate for students and those on the Youth Mobility Scheme will increase from £150 to £300.

I H S – What is it?

The Immigration Health Surcharge (IHS) was introduced in 2015 and is currently £200 per year per applicant and each dependent (those applying for student visas or on the Youth Mobility Scheme are required to pay £150 per year). It applies to migrants from outside the European Economic Area (EEA) who want to stay in the UK for more than six months. It is payable at the point of submitting a visa application and has to be paid before a visa is issued, so there is no opportunity for people to avoid paying (a common misconception). The Immigration Health Surcharge has however caused controversy since its inception in 2015. Many people are of the opinion that those coming to the UK to work already help to fund the NHS through the payment of taxes and National Insurance and should not be subject to an additional charge.

Health Health Surcharge

What’s the problem?

The proposed changes means that a migrant will at the very least now need to have access to just under £2000 in Home Office fees and for the IHS double this amount if they have a dependent or quadruple it if they have a partner and two children. Unfortunately, it is not uncommon to see applicants have to borrow this money and rack up debt in order to make their immigration applications. Some migrants living in the UK have previously had to return home or send their children home because they cannot afford to pay the surcharge. The Independent reports of a nurse from Kenya working for the NHS being forced to send her two young children back to Kenya after she was asked to pay £3,600 in IHS fees for two adults and her four children.

The Royal College of Nursing has called for NHS staff to be exempted from the IHS, saying the charge is “tearing families apart”. This is especially so when costs can represent a significant proportion of a health worker’s earning potential, such as for nurses for whom the basic starting salary is £22,128 a year. In an article in the New Statesman earlier this year, they report that in practice, many NHS trusts are already having to loan overseas recruits funds to pay upfront costs such as the health surcharge.

The government’s rationale is that migrants should be contributing to the NHS and on 11 October Noakes said in her written statement that “it is only fair that people who come to the UK make a contribution to the running of the NHS”. However, it seems the government is using migrants to help fund the NHS when they already contribute towards its running in the same way British citizens do  – through taxation and national insurance contributions. The overwhelming majority of migrants work in the UK and therefore are contributing to the NHS by collection of their taxes and NI. In fact, many are actually contributing to the NHS threefold, one because when they work in the UK they pay tax and NI which goes towards funding the NHS; two because many already have private medical insurance policies to cover themselves and their family members, and thirdly, by being compelled to pay the Immigration Health Surcharge. It could be said that migrants are actually contributing more towards the NHS than British citizens are.

Despite the controversy, it looks like the proposed increase will go ahead because the Home Office can increase the IHS giving the reason of it raising a considerable amount of funds for the NHS. Our advice to applicants and employers is that if at all possible, they should consider submitting their applications for entry or leave to remain before the increase, currently timetabled for December this year. We can advise on the earliest possible date for submission of such applications in accordance with the immigration rules.

For advice and assistance on making a visa, immigration or nationality application or for any other immigration enquiry, please contact Mariam or another member of our expert Immigration team on 020 7631 4141 or email

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