A letter I wrote to the Department of Social Health about the proposed increases in the immigration health surcharge.

1. Dr. Anahita Sharma
Flat 2, 58 Rawcliffe Road
Liverpool L9 1AW
United Kingdom
anahitasharma@doctors.org.uk
27 July 2018
Ministerial Correspondence and Public Enquiries Unit
Department of Health and Social Care
39 Victoria Street
London SW1H 0EU
United Kingdom
Dear Department of Health and Social Care,
Thank you for receiving this letter and for giving it due attention and consideration. I
write to express my concerns regarding the proposed doubling of the Immigration
Health Surcharge – as per your announcement in February 2018 – to £400 per
year. I would like to present as fair and personal a perspective as I can; as far as I am
aware, no consultation was associated with this recent announcement.
To provide some context, I am a British-trained medical doctor recently graduated
from the University of Manchester, and holder of a non-EU (Hong Kong) passport. I
am currently a Foundation Year 1 doctor – embarking on a gruelling training process
– with the intention to contribute to the NHS and its inspiring ethic for years to come,
with a serious commitment to the service and its accessibility.
Effects of the surcharge
The NHS medical workforce already faces difficulties regarding retention and
recruitment. A subgroup of us will face work pressures in addition to the uncertainty
and anxiety of applying and reapplying for visas for the duration of our training. I am
currently on a Tier 4 visa as a postgraduate doctor on the Foundation programme,
and will have to switch to and extend a Tier 2 visas on at least two further occasions
given the structure of our training.
I paid the immigration health surcharge whilst in Manchester as a student, and believe
this was fair as I was making no direction contribution to the health or social care
system at the time. Even though, as a young student, I only accessed NHS services by
visiting my G.P. on one occasion over a period of six years, it was reassuring that the
service was always available to me should there have been need.

2. However, I am now not a tourist, nor a student, and have no family dependants.
Nevertheless, I am still expected to pay the surcharge as an NHS employee whilst also
paying taxes on my income, making national insurance contributions, and making
further social care contributions through council tax payments. As a migrant, I have
never had and will continue not to have recourse to public funds. I am entirely my
own dependant, and it is likely that in the event I develop serious chronic health
problems, I would have to suspend work thereby losing my right to stay.
On a capped junior doctor’s income, having to budget through years of postgraduate
training, an annual doubling of the health surcharge will be acutely felt. The cost is
significant, exceeding many times that of the visa. In fact, its level now approaches
that of comprehensive private healthcare insurance premiums (see attached).
Aims of the surcharge
I understand that it was originally introduced as a rebalancing mechanism that
accounts that existing British citizens have made contributions to NHS infrastructure
over their lifetimes, whilst temporary migrants have not.
However, consultation documents have rarely referenced that citizens and their
families have also benefited from this care from the point of their births, and will
continue to benefit from NHS-delivered care for a much longer period of time as well.
Temporary working migrants may make a smaller absolute contribution, but I believe
this should be viewed in proportion with the duration of their utilisation of these
services.
In fact, my experience in the NHS in both England and Scotland, across numerous
contexts, tells me that working migrants – whose immigration status is effectively
dependent on their health and ability to work – are not burdening the healthcare
system.
I am contributing no less to the system than any of my ‘ordinarily resident’
contemporaries. In fact, my understanding is that any eligible ordinarily resident
citizen, regardless of the level of their contributions or of their service utilisation, is
eligible for NHS care. With this in mind, working temporary migrants are already
uniformly making fair and positive contributions to the health and social care system,
as our immigration status is contingent on our employment and also bars us from
accessing public funds.
In summary, I oppose the imposition and increase of the surcharge for this category
of migrants, and have presented my case for this. As a young house officer with
limited resource – and having never breached U.K. immigration rules – the policy
feels disproportionate and discriminatory. It undermines the legitimacy of the
contributions I do make.

3. I simply ask for greater transparency and a degree of compassion applied with regards
to a 200% proposed increase. I would greatly welcome available data regarding
contributions of Tier 2 migrants versus cost estimates of their healthcare use.
Thank you for your time.
Sincerely yours,
Anahita Sharma
FY1 Doctor, Aintree University Hospitals NHS Foundation Trust