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8 January 2021

“We are replaceable”: The migrant NHS staff left behind during the pandemic

Almost a year into the Covid crisis, low-income NHS workers are still being forced to pay extortionate visa fees, racking up thousands of pounds of debt.

By Eleanor Peake

When the pandemic hit the UK last March, Natasha* was working in the kitchen for a hospital in Sheffield. For the next ten months she would cook for doctors and nurses, Covid-19 patients and visitors. She was worried about falling sick. If she became ill, there would be no one to look after her 11-year-old daughter. But that was only the start of her worries. 

As a migrant, Natasha, 44, must pay thousands of pounds in visa fees so she can go to work. Since moving to the UK from Trinidad and Tobago in 2006, she has worked on and off for the NHS. Already on a low salary and supporting her daughter, she has scraped by for years, barely able to pay the fees that allow her to earn money in the UK. The paradox of this is not lost on her.

Every few years, when it is time for Natasha to renew her visa, she must make a complicated selection of payments. First there is the visa fee, which varies depending on your circumstances; the standard fee ranges from £610 to £1,408. Then there is the health surcharge; a fee introduced in 2015, which currently bills migrants £624 per annum for the NHS. Applicants must pay this upfront when visas are renewed, for every year their application covers. If you are applying for a three-year visa, that is £1,872. If you have children, this charge increases. 

Despite working for the NHS for over a decade, Natasha was not exempt from these charges. In total, she has to pay almost £3,000 every three years to keep her status and her job, forcing her to rack up debt she can’t afford. “Sometimes when it gets too much I just cry in the shower so my daughter can’t hear,” she says.

Last year, as coronavirus took over the country, there was a glimmer of hope for workers such as Natasha: in May the government announced free visa extensions for NHS staff, an exemption backdated to 31 March. But when Natasha looked up the exemption, the new policy only protected doctors, nurses and allied professionals, excluding low-income workers.

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“They think we are replaceable, they don’t care if we can’t pay the fees because they can just get someone else.”

“They think we are replaceable, they don’t care if we can’t pay the fees because they can just get someone else,” she says. “They say we are unskilled but I am not unskilled at all, I am a Level 2 professional chef. I love my job.”

This year, the complicated visa routes and application process meant Natasha was denied status after she filled out the wrong form. “I was charged thousands of pounds for the wrong visa, and then denied status,” she says. In desperate need of legal advice and terrified she would lose her job, Natasha searched for support. “I went to see a lawyer and they wanted to charge me £250 for just one hour of advice.

“A lot of these MPs that make these policies are not from the real world. They don’t know what it is like to line up for a visa or to leave a country in fear of your life. Do the Home Office really know what it is to be an immigrant or a refugee or an asylum seeker? Do they have that empathy?”

[see also: Why Boris Johnson’s Tories will want to keep immigration in the spotlight]

Thankfully, a friend put her in touch with the Joint Council for the Welfare of Immigrants, which was able to help Natasha apply for the correct application, meaning she could continue working. But just a few years ago, she did not have this support. 

In 2016, she lost her status just days before the visa application deadline. With such little notice, she didn’t have time to get a new request approved. She lost her job and then her home: “I was homeless for over two years. To just lose everything at the drop of a hat… it was hard to comprehend at that time,” she says.


In 2020, 13.8 per cent of all NHS workers were made up of migrants; that’s around 170,000 people. While a high percentage of those workers are classed as highly skilled, thousands have been forgotten and left to carry the weight of extortionate visa fees that they cannot afford. As coronavirus death rates continue to soar in 2021, the NHS’s migrant workers are being pushed to the brink, emotionally and financially.  

[see also: The crisis in London’s hospitals lays bare the real challenge of a pandemic]

“Those that have to pay the fees are having to choose between putting food on the table or saving ​up for their visa renewal,” says Unison assistant general secretary Christina McAnea. 

“The health and care sector is already facing a recruitment crisis with hundreds of thousands of posts unfilled. Making overseas staff pay extortionate fees to work in the NHS and care sector is short-sighted and ​potentially dangerous,” she adds.

“All overseas health and care workers must be allowed to work in the country without paying the fees. The government needs to learn ​that ​low-paid doesn’t mean low-skilled​. ​It’s been the lowest-paid workers who​’ve kept the country going ​throughout the pandemic.”

Tracy* is one of these key workers. For seven years, she has worked as a nursing assistant for the NHS. She currently works on a dementia ward in Scotland, in a position classed as low-skilled by the new immigration system. 

The hardest part of Tracy’s job is having to explain to patients with dementia why they can’t see their family, or why they can’t go outside. “We used to go out into the community,” she says. “We used to go out to the church for coffee mornings, for walks around the gardens, now I can’t take patients anywhere because some have tested positive and so have some of the staff. It’s been very difficult.” During the pandemic, she has been working longer hours as more and more colleagues test positive for the virus. 

Tracy is on a ten-year route to settled status in the UK, which means she must pay thousands of pounds every two and a half years. Coming to the UK from Ghana, she has two teenage children. Supporting them on £18,600 whilst also paying high immigration fees means she frequently relies on a food bank at the end of the month.

“It is unfair that we are not exempt from visa fees like doctors and nurses. I do a job that doctors couldn’t do,” she says. “I convince patients to take their medication. It’s not like a doctor or nurse, I am there every day with the patient.” 

When at 8pm the country was clapping I was angry. I thought, you are clapping for me?

For Tracy, the national clap for carers in the early days of the pandemic was particularly jarring. “When at 8pm the country was clapping I was angry. I thought, you are clapping for me? While my landlord is knocking at the door, saying your rent is due. I have the Home Office on my back, saying you need to come and pay this money otherwise you’re not getting your visa to go back to work. So wait, are you really clapping for NHS staff?”

[see also: The peak: Inside the mind of Dr Jim Down on the night of the peak number of deaths from Covid-19 in hospitals]

When asked for comment, a Home Office spokesperson said: “We are hugely grateful for the vital contributions all NHS staff have made during the pandemic, which is why we have introduced a range of unprecedented measures to ensure the health and care sector are supported fully.

“This includes exempting health and care workers from payment of the Immigration Health Surcharge and extending the visas of more than 6,000 front-line health workers and their dependents for free so they can continue their crucial work in the fight against coronavirus. Last year, we also launched the Health and Care Visa for eligible health and care professionals and their families, which provides fast-track entry, reduced fees and dedicated support.”

While the Home Office has waived fees for some NHS workers, it has chosen to ignore the people providing the essential infrastructure and care that keeps a hospital running. As the health and care sector continues to be stretched to capacity, so do its low-income workers. 

Coming into the new year, Tracy says it is hard but she has to keep hope. “I have to be thankful to God for giving me strength. People are dead and gone. We had 35 patients die on our ward last year. You have to be thankful.”

*Tracy and Natasha asked to remain anonymous to safeguard any future visa applications.

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