NHS budgets could have to absorb millions of pounds in additional visa fees due to the government push to reduce reliance on migrant workers
The stretched health budget faces absorbing millions of pounds more in migrant visa fees under Home Office plans to hike the cost of hiring from overseas.
Measures designed to cut the number of migrant workers will include an increase to the cost for employers to sponsor work visas.
NHS England currently pays for the so-called immigration skills charge (ISC) to cover trainee medics and dentists hired overseas.
This cost will rise by around £5m under changes announced by Home Secretary Yvette Cooper and Prime Minister Sir Keir Starmer – enough to pay for 150 nurses for a year.
But this NHS England spend on such visas does not cover the thousands of other healthcare professionals hired overseas.
According to NHS England, the spend on sponsoring visas for doctors and medics in training was just over £16m in 2024/25.
Under the rise this will reach £21.2m – an increase in £5.1m which is currently set to be absorbed by the central health budget.
But the costs for other workers are likely to far exceed this.
Overseas workers in the NHS
Fees for nurses and other staff are paid for by “employers” – which can mean NHS Trusts, private providers such as social care companies and the owners of GP or dental surgeries.
Reliance on overseas workers to staff the stretched health care system has considerably increased in recent years.
A Migration Observatory report, published in 2023, found almost 100,000 overseas health and care workers were sponsored for skilled work visas in the year ending March 2023.
This is compared to the previous peak, in the early 2000s, when the equivalent work permit grants reached around 26,000 applicants.
“In other words, the health and care sector has never admitted such large numbers of work visa holders as in the immediate post-pandemic period under the post-Brexit immigration system,” the report said.
It currently costs between £364 and £1,000 for each employer during the first year of employment, before falling to between £182 and £500 for every six months that follows.
Under the changes this will increase to a projected £1,320 for the highest band.
Concerns over increased costs
Sponsoring a workforce of 100,000, for example, would therefore represent an increase of more than £32m at the highest band.
Details about how the increased cost would be managed will be set out in the Chancellor’s upcoming spending review.
And the Home Office said the charge had not risen since 2017, arguing that the 32 per cent rise was bringing it in line with inflation.
An advert for international recruitement
But there are concerns about how the NHS will be able to absorb additional costs – and whether the changes will create challenges in meeting recruitment needs.
The care sector has already warned that the extra costs will lead to care home closures, with one describing the increase in fees as a “grenade in the room”.
Last year, however, health secretary Wes Sreeting said relying on migration to staff the NHS was “immoral” and “unfair” – as Labour pledged to pay medics overtime for extra shifts at evenings and weekends to fill gaps in the health service.
A survey by NHS Providers, published last week, revealed trusts are already being forced to cut jobs to reduce the £7bn financial shortfall.
‘Worrying lack of clarity’
NHS England is in the process of being abolished, with its services taken back under the control of the Department for Health and Social Care, leaving uncertainty as to whether that means individual trusts will have to shoulder more of the financial burden of the visa costs.
Acting Chair of the Health and Social Care Select Committee, Labour MP Paulette Hamilton, told The i Paper: “It is worrying that there is a lack of clarity as to who will become responsible for paying the costs for immigration skills charge for NHS staff hired from overseas, after NHSE is abolished.
“It would be alarming if it turns out that the charge has to be borne directly by NHS Trusts, given all we know about how stretched they are already.”
A GMB Union spokesperson said: “Our concern over the impact of the 32 per cent increase is that it, in theory, attempts to incentivise employers to train and recruit UK workers rather than workers from abroad.
“The Government White Paper has set out a transition period between now and 2028 to continue with migrant workers already in the UK filling the gap, while improving terms and conditions to make health and social care roles more attractive in the UK.
“However, combining the increased charge paid by employers, the increased earnings thresholds to qualify for a health and social care visa and the increasing climate of confusion, employers will be unwilling and unable to fill roles in the meantime.”
NHS England and the Department of Health and Social Care were approached for comment.