Are Tory proposals to charge foreigners more to use the NHS fair?


The Tories have said that people on a work, study or family visa incur average NHS costs of £625 per year but only pay a £400 surcharge for the service. Increasing the charge, and extending it to EU nationals, will ensure “they are making a sufficient contribution towards our health service”, says the party.


Currently migrants coming to the UK for more than six months from outside the European Economic Area pay an immigration health surcharge of £400 a year when applying for a visa. The charges are the same for their dependants.

Once they have paid, they are entitled to NHS treatment on the same basis as permanent residents for the entirety of their stay. EU nationals who live in the UK get free healthcare.

The Conservatives propose to increase the payment to £625 a year and extend it to all foreign workers, including EU nationals after Brexit. “UK citizens pay for the NHS all year round through their taxes and it is only fair that new migrants make a fair contribution for its long-term sustainability,” the party said.


The surcharge was introduced in April 2015 and was initially £200 a year for most migrants, and £150 a year for students and young people. In January 2019, those charges were doubled.

In a written statement to parliament justifying the change, the immigration minister Caroline Nokes said it followed a review by the Department of Health and Social Care that found “the average annual cost of NHS usage by those paying the surcharge is around £470”.

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That estimate for the cost of treatment was quoted by the government repeatedly in 2018. The new figure of £625 would mean that the average has jumped by a third since the review.

It is not clear how the figure was worked out – in a written answer to a question from a Labour MP, minister Stephen Barclay said the department had looked at surcharge-payers who used the NHS between April 2015 and December 2017 and estimated an average which included all payers.

It is unclear if a similar exercise has been done for a later period, if this figure has been extrapolated, or if the new estimate is based on different data.

The higher fees will raise more money for the NHS, but the service is already struggling with recruitment, staff joining the NHS from overseas still have to pay it, and this is unlikely to help.

Most migrants are charged upfront – so someone who is applying for a five-year visa will pay £2,000 with their application, and under the new regime would need to find £3,125. Last week the Conservatives announced separately that NHS workers would be able to pay the surcharge through their salaries, but ignored calls to give them an exemption.


The £625 cost to the NHS of treating migrants covered by the current scheme has not been sourced this time. It represents a large increase from the Department of Health sum being quoted just last year, but without any details of how it has been worked out it is impossible to prove or disprove.

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What is certain is that the payment is in addition to any tax and national insurance those workers will pay while in the UK. Migrants who are doing a full-time job will also “pay for the NHS all year round”, as well as meeting the cost.



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