The Immigration (Health) Surcharge: another subscription to populism

One of the, perhaps, lesser items in this week’s budget was the 56% hike in the annual Immigration (Health) Surcharge, from £400 to £624. The new amount is curiously precise. Its (currently) stated purpose is to ensure that migrants pay the ‘full cost of use’, although the government stated this only last October as being £480. The only reference to a figure of the order to which the IHS will rise is, curiously*, an article in the Mail on Sunday quoting £625. I don’t want to drive traffic there, so here’s the Full Fact briefing on the issue which also cites it.

The somewhat unchristian origin of this particular IHS is the 2015 Coalition Government’s moves to ensure that ‘temporary’ (note carefully, with regard to the hostile environment) migrants ‘make a proper financial contribution to the cost of their NHS care’. As the accompanying Press Release went on to document, the surcharge was part of the 2014 Immigration Act whose aim was to deliver an immigration system that ‘works in the national interest’ specifically, amongst others, as regards ‘reducing the pull factors which encourage people to come to the UK for the wrong reasons’ – i.e. ‘health tourism’. Given the dates, we can see this very much as part of clumsy official government rhetoric which turned out only to feed the 2016 referendum vote – and which, of course, still continues.

Now, according to the government itself, ‘health tourism’ costs the UK c. £100-£300m/year – an interesting figure in the light of the Budget’s estimates of a gain of £335m/year from the measure (although this is presumably additional to the sums already being raised) – but pretty small beer, really, in the light of the annual NHS budget. And against which we should also offset the costs of the health tourism engaged in by UK citizens ourselves – it being cheaper to have your teeth sorted by Lithuanian dentists, for example, was one of the major areas of interest in Tom Chesshyre’s look at budget airlines in How Low Can You Go?

But the surcharge of course has only a tangential relevance to the NHS. In a hospital, if you encounter people from other countries, they’re far more likely to be treating you than sat waiting in the queue with you: as regards the ‘consumption’ of health services by people from the European Economic Area, it’s worthwhile recalling at length the exhaustive work of the government’s own Migration Advisory Commission into this issue (para 22):

EEA migrants contribute much more to the health service and the provision of social care in financial resources and through work than they consume in services. EEA workers are an increasing share of the health and social care workforces though these sectors employ greater numbers of non-EEA migrants. There is no evidence that migration has reduced the quality of healthcare.

The NHS is of course funded out of taxes, also paid by migrants – who, we should remember, don’t get to vote in general elections on how their taxes are spent. When all new migrants – including those coming to work in the NHS – have to pay both the Immigration Surcharge and taxes, this is really taxation without representation (x2).

The Surcharge is paid, as part of the process of applying for a visa, into the Treasury from which it goes to any number of spending projects. The sum is paid, up front, and for the full length of the visa, by all those seeking a visa and regardless of whether or not they use the NHS during their stay or even, critically, if they have private medical insurance anyway, thus meaning that – outside of the arrangements between private medical insurers and the NHS – they would have no call on the NHS during their stay in the UK. It is most emphatically not, therefore, a ‘charge on people using the NHS’. Though that is, of course, the shorthand which the government would like people, including the commentariat, to use. The citation of the NHS in its context is simply to use the NHS as a political tool against immigration, to play on people’s fears as part of the hostile environment and to turn us against each other.

Furthermore, it’s not paid by those in the UK on visitor visas or in the country for less than six months – so it’s pretty clear that it doesn’t actually even do the main job required of it to ‘stop people abusing the system’.

The Immigration (Health) Surcharge is instead, essentially a tax on people coming to the UK to work – and one which, according to the Institute for Government, makes the UK already a more expensive destination than any of Australia, France, Germany or Canada. For a single person, a three-year visa, including all fees, now costs some £5,250 before you even step into the country. On top of the unwelcoming, anti-migrant nature of much of our political discourse, and over an extended period now, the stated aim of the new immigration policy to attract the ‘brightest and best’ seems likely to stand simply instead for welcoming ‘those who can afford to come’. And there is, perhaps, not necessarily any link between being able to afford to come and ‘brightest and best’.

And, more seriously, given pay rates in the public sector, neither is there any link between skills and ‘brightest and best’. Any sort of rise in tax on people coming to the UK to work will, inevitably, lead to staff shortages in critical services. The universality of the English language, at a time when the UK is becoming less welcoming, is, in this context, quite clearly our enemy. And ‘the brightest and best’ who could come here will, most likely, choose instead to go to Canada, or Australia.

None of this should surprise about a bystander government whose budget aims to inoculate the UK economy, but not its people, against the effects of coronavirus and whose aims – in respect of the virus itself – seem to be to let it ravage through and take the hindmost, according to Peston, or in the words of the Telegraph, that it might even be ‘mildly beneficial in the long-term by disproportionately culling elderly dependents’ (sic). Neither should that be a surprise given Johnson’s kite flying on the issue while sat on the GMB sofas last Thursday morning. The Cabinet has clearly seen papers floating this very approach and the source of those, even post-Sabisky, is quite clear. And unelected.

Who was it who once warned people not to fall ill, or grow old, under a Tory government?

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