Olivia Bridge, political correspondent for the Immigration Advice Service which has offices all across the UK and Ireland.

The UK Government’s promise to patch up the NHS and crack the whip on immigration control, coupled with the ‘get Brexit done’ trope, arguably became the golden ticket that awarded the Conservative Party its landslide majority in the 2019 general election.

Indeed, promises to fuel the NHS with wads of cash and fresh new recruits while simultaneously cranking the gates shut to EU labour by 2021 became the pledge of the decade. However, it is now quickly emerging that the two promises are simply incompatible as bit-by-bit, the Government’s NHS promises and reams of pledges announced only a handful of months ago are now failing to materialise.

Staff Shortages and Broken Promises

Prime Minister Boris Johnson’s announcement to ‘build forty new hospitals’ in September last year has already transpired into a statistically-skewed myth: only 6 hospitals are scheduled for upgrades while 38 other hospitals will see some extra funding which will be sprinkled across the next decade.

The pledge to free up 50 million more GP appointments is evidently only possible with more physical hands on deck, yet the Home Office is already in debt to the GP workforce after it promised 5,000 new recruits in 2015 which not only never came to fruition but numbers actually fell. Subsequent changes to the Treasury in 2016 has since seen doctors slash their hours to save themselves from the savage pension tax later down the line.

With this in mind, the Government’s intention to hire 6,000 more GPs barely ameliorates the gaping shortage it has helped to create and is causing to spiral still. Vacancies for doctors nationwide currently sit at 11,500 while the GP-to-patient ratio is considered the worst in 50 years.

Nursing is in an even worse position what with a stubborn 44,000 posts remaining unfilled – a figure which could climb to 70,000 in the next five years according to leaked government documents. Yet the Government’s pre-election vow to recruit and train 50,000 nurses through a combative approach of overseas hires and homegrown apprenticeships actually translates to 31,500. Around a third (18,500) who already work in the sector are supposedly set to be persuaded from leaving. The Government is certainly cutting it fine with this plan.

Of course, one approach to alleviate the struggle could be found in homegrown talent: however, British students are more deterred than ever from taking up a medical degree. A lethal concoction of exhausting and unpaid work placements throughout the course, a £9,000 per year tuition fee and the end of nursing bursaries has seen a 30% decline in nursing applications since 2017.

UK universities are even declaring courses on radiography, mental health nursing, learning disability nursing, podiatry, prosthetics and orthotics to be ‘at risk’ of closure. Yet rather than resurrect bursaries, the Government wants to give students a maintenance grant between £5,000 to £8,000.

Patient Care at Risk

Chronic understaffing is further having a domino impact on patient care and waiting lists which continue to soar. Most alarmingly, skin and bowel cancer sufferers are less likely to receive the potentially life-saving treatment that they urgently need in the face of backlogged queues reaching brand-new heights. As many as 1,100 patients could be missing out on that crucial early diagnosis every year.

And if that’s not bad enough, fatigued and overworked staff is inevitably impacting performance including a spike of improper diagnoses and “inappropriate treatments”, according to Dr Kailash Chand in Pulse Today. In the face of a depleting workforce, unqualified and untrained assistants are stepping in to perform nursing duties, which increases risk of patient harm by 21%. One survey shows 9 out of 10 NHS bosses fear for patient safety as a result of the shortages.

Post-Brexit Immigration Rules

Clearly, a workable and adaptable immigration system is desperately needed to save the NHS from having its issues spiral out of control. In this respect, Brexit appears to come in at a wholly unfortunate time as while the NHS attempts to compete for talent overseas, by the end of 2020 Freedom of Movement will be replaced with costly visas for EU citizens popping over the channel to come and work in the UK.

In a bid to mitigate the potential of even worse shortages that the NHS can’t afford, the Home Office has been flirting with the idea of an NHS Visa which on the surface appears a step in the right direction: the visa cost is halved to £464, there is no cap on the number of allocated spaces and applicants should receive a verdict in a two-week turnaround.

However, to consider the NHS Visa as ‘new’ takes some serious logical contortion as its handful of benefits are almost identical to the existing immigration rules. The current Shortage Occupation List (SOL) grants nurses, doctors, and paramedics an exemption from the main chokepoints of the Tier 2 Work Visa rules – including a halved visa fee.

And that’s not the only striking similarity: migrants of any vocation can opt to have their visa fast-tracked, but this usually comes at an additional fee. It is currently unclear whether or not migrant NHS workers will be expected to pick up this bill – but someone has to cover the admin costs.

The Immigration Health Surcharge

Either way, it certainly seems the spin doctors have been busy at work attempting to disguise the pre-existing Tier 2 route as something new – especially considering the NHS Visa could actually see migrant healthcare workers financially worse off and burdened with debt and that there is nothing on offer whatsoever for social care workers.

The Immigration Health Surcharge (IHS) has been at the heart of controversy for some time within the NHS as the charge dictates all migrants – no matter where they work – must pay thousands-of-pounds upfront alongside each visa application made. This is, in theory, to pay towards any NHS treatments that they may need while living in the UK, but since its inception in 2015 leading NHS experts have been campaigning to abolish the fee for foreign NHS workers. They argue that inflicting the fee on staff who keep the sector from collapse is not only unethical but actively jeopardises recruitment drives.

However, the fee continues to rise without any waiver for those who opt to come and aid the UK’s hospitals or GP surgeries – and the UK Government wants to hike it again from £400 per year to £625 per person per year.

One way to dilute the deterrent, according to Johnson at least, is to deduct the surcharge in regular instalments through NHS workers salary. However, the Royal College of Nursing calls the move “immoral and heartless” as no matter which way it’s dressed up, EU citizens will lose the right to frictionless entry overnight by the end of this year and will wake up to eyewatering visa debts if they decide to come and work in the UK.

Although NHS Trusts could pay the charge on behalf of prospective workers, the fee was theoretically levied to put money back in the NHS’ purse – apparently to no avail as the latest NHS Bill offers an underwhelming budget increase. The cash increase of £34 billion by 2024 is just a drop in the ocean towards the sum needed to expand resources, eradicate the NHS’ workforce woes and its accelerating debt.

Arguably, the ‘NHS Visa’ appears nothing more than a cunning and successfully executed marketing ploy by the Conservatives. It fits well inside the ‘Australian points-based immigration system’ plot which, in line with everything else, has also been abandoned.

After all, there is no mention of the NHS Visa in the most recent publication of the rules, suggesting the idea was wheeled out purely to harvest votes.

If the NHS Visa does become a standalone route, the Home Office seriously needs to reassess the associated fees to be imposed on potential overseas healthcare staff.

As things stand its relentless pursuit of the most restrictive immigration plan in British history may very well serve to undermine the NHS, work against the best interests of the country and jeopardise the survival of backbone industries.


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