Indefinite Leave to Repay

Hannah Dewhirst

Thousands of healthcare workers - whom our NHS desperately needs - are being crippled by extortionate Home Office fees when applying for Indefinite Leave to Remain.

The NHS wouldn’t be here today without our international colleagues. Ever since its birth in 1948, we’ve relied on health professionals born or trained outside the UK to enrich our public health service with their skills and knowledge.

Today, around 190,000 out of 1.35 million NHS staff in England report a non-British nationality; that’s 14.6% or one in every seven. And this ratio jumps even higher, to 29% when looking at doctors working in English hospital and community health services, and doesn’t include GPs.

NHS staff come from over 212 countries around the world and, particularly given the 110,000+ vacancies our health service currently faces, we simply couldn’t cope without them. But in spite of their hard work and sacrifice over recent years fighting the pandemic; our overseas healthcare workers face an increasingly hostile environment. 

A recent BMA survey found levels of racism in the NHS to be a ‘debilitating’ problem. Non-UK doctors have a 2.5 times higher rate of being referred to the General Medical Council (GMC) by an employer compared to UK graduate doctors and international medical graduates were also the group hardest hit by the pandemic; the first 8 doctors to die from COVID-19 in the UK were immigrants. 

These statistics reflect deep-rooted systematic issues of racism not only in the NHS, but across our society. This blog does not seek to delve into these today but instead to focus on one small tip of this iceberg; Indefinite Leave to Remain (ILR) fees, which have skyrocketed in recent years. 

Why? ILR is an important step towards permanent UK citizenship. It is only open to those who have lived and worked in the UK for 5-10 years but once granted, has no time limit and allows the recipient to take up employment or study, and those with ILR also become eligible to receive public funds or benefits. Indefinite leave is not a permanent status but you must have held ILR status for at least one year (and meet other criteria) before you can apply for full UK citizenship. 

However, this step is becoming harder and harder to climb given the exorbitant costs associated with the application which can leave a family of four facing an almost £10,000 bill. 

Other countries have valued their healthcare workers on visas; for example France fast-tracked citizenship for healthcare workers on visas who worked on the COVID-19 frontlines. There’s so much more the UK could and should be doing to welcome our international colleagues; the very least they can do is reduce the ILR fee down from the eye-watering £2,389 to the actual cost of processing it, which the government’s own figures show to be just £243

Beyond the cost of the ILR application itself, are a raft of hidden fees which bump the total cost up for an individual even further, particularly if stringent time frames are missed due to delays out of applicants’ control such as a backlog at application centres or within government departments. 

Right now, NHS staff are overwhelmed, exhausted and three-quarters have considered leaving. 

It takes at least ten years to train a doctor, and we don’t have that kind of time. Our aging population plus the backlog caused by COVID-19, coupled with over a decade of chronic underfunding, means millions of us are in dire need of care. We need action now. 

Lowering ILR fees certainly won’t solve everything for our international colleagues, but it would have a huge and immediate financial impact on their lives. Especially now as we face the worst cost of living crisis in a generation, which is only expected to worsen after April

Mictin Ponmala; an NHS nurse working in Luton and originally from India, launched this petition on the government’s website to reduce ILR fees to £243 earlier this year. Almost 25,000 people have signed so far, and if it reaches 100,000 a debate must be held in parliament, while not a guarantee, it would be a vital step in raising this crucial issue. Add your name here.

The government should embrace - not exploit - healthcare workers on visas. We must all be honest and appreciate these thousands of vital and valuable staff who have made the UK their home and the NHS part of their family. 

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