NHS Surcharge
 

This was still on the BBC website an hour ago.

The government has defended charging overseas health workers to use the NHS, despite criticism from its own party.
The health immigration surcharge on non-EU migrants is £400 per year and set to rise to £624 in October.


Delighted to see it Removed.

That does not seem fair if they are working here. Does it depend on how long they have been here?

macafee2

Don’t existing NHS workers from overseas qualify for it to be refunded? I heard it’s only new arrivals that won’t.

Same here.. Shouldn't have been there in the first place though :duh:

Can't see the problem another tick for Boris

The fact that the charge was there in the first place!!

Just 24 hours before his climbdown, Mr Johnson told the House of Commons that imposing the immigration health surcharge on foreign-born NHS workers was “the right way forward”.

Simple solution really, get British people to do the job then we might be able to understand them. I go to Bedford hospital to visit my aunt who's in the final stages of cancer and the wards are like yarl's wood immigration centre :duh:

There should be a charge (at least cost) for all the retards that commit crime and injure themselves (and others) in the process!

I'm sure that would recover a much larger sum from the right place. Only my opinion.

I think you will find that without the 'immigrant workforce' The NHS would be in a worse state than its in now.

I don't care what creed or colour is staffing the NHS, I'm just thankful that they have chose to come to the UK to do their job.

That is my question too. Why are we not training our own people? Successive governments since the '80's chose to reduce training of doctors and nurses (and dentists) in the UK despite being advised by the professions that demand would dramatically increase as baby boomers retired. It's much cheaper to go to trade fairs in other countries where labour costs are significantly lower and recruit there for the NHS and not train our own young people. I feel that trend should to be reversed. Some diversity is a plus of course, especially in major cities, as the language skills are needed for the diverse population we now have, but enough is enough. The debate and disagreement is always about where the balance is.

The only problem with that being the criminal classes would not pay the charges and some very liberal judges would let them off as it’s against their human rights!

Fair point, but not a good enough reason why this should be worked out, certainly above the the original post. (IMO)

I'm sympathetic to that idea but it looks like a zero return with no redeeming features.

It starts with a reduction from nationwide free treatment for the sick and injured, all the way to imprisonment for non-payment of fines imposed for causing or sustaining personal injuries following arrest for a breach of the peace. Occasionally, against the police! Political suicide.

Then take into account the additional legal costs - paid by the rest of us. And I'm sure that a sizeable percentage of them are far from retarded, quite the reverse! Primitive cunning and the skill to use it will usually outpace justice.

IMHO it's a number of related issues causing confusion by being illogically conflated.
Most of us would agree there is insufficient NHS funding - but there will never be 'enough money' to satisfy the demands of a growing population (arguably skewed by unmanaged/targetted immigration), wider range of treatments, medical technology and research 'fixing' more issues (whether or not justified on sound health reasons), lack of prevention culture/better lifestyle choices etc. so unless something changes demand will continue to outstrip capacity.... but:
1. Our system is based on the premis that everyone contributes and receives treatment, medication etc. according to their needs with latterly a hybrid private sector operating in parallel.
2. Citizen funding is 'assured/calculated' over approx. 5 decades, our forebears being responsible for funding our future needs et al.
3. It started off as a national 'brave new world' closed system with a load of start-up public (government) dosh + nationlisation of what was essentially a private sector service (today, classed as a business).
4. Transients (those not taking up long stay/resident status) should be covered by some form of third party insurance to fund their health requirements

OK, fag packet history lesson over. Recognising that anyone (anyone, even if they end up being employed by the NHS) outside the closed system/taking advantage of the NHS ipso facto has not contributed and it's entirely reasonable (indeed financially/morally logical) that a means is found whereby that shortfall can be rectified - regardless of whether they ever have a need of the sharp end of the NHS (ie according to their needs).
For those EU migrants using the closed system there is a financial contra system in place (criminally, something not particularly well managed by the NHS/the British Civil Service - that's not the fault of the EU who do a far better job of clawing back their due charges).
For non-EU migrants there is the Health Surcharge (so if you accept the above arguement), and why not! Setting the proper level of tariff might be a moot point but charged they should be.

can you explain your post as I'm wondering if you are agreeing with charging foreign NHS workers to use the NHS.

If my understanding is correct, on what grounds do you think it right to charge foreigners that are working and paying tax etc just like a British born person? If they were not working and paying tax I may see it differently.

macafee2

When you mention immigration you also need to mention the figures for those that emigrate.

macafee2

if you use the NHS you should pay for it regardless - no free meals chris.s

I have paid, and continue to pay tax since I was 16 - are you suggesting I pay a further ‘surcharge’ to use the NHS?

I refer you to how Christopher (Mileshawke56) succinctly puts it.
May I offer you an hypothetical scenario -
'Foreign' medical worker 'A' takes up a post in the UK after being recruited by an overseas agency (obo NHS) with the idea of spending 4-5 years in the system (or even contemplating becoming a UK citizen). By accepting the post we should assume 'A' has a contract with all the usual relevant details of employment etc. and also meets all the experience/qualification requirements. It is a given that 'A' is seeking employment in the UK and finds the offer/T&C's suitably attractive - there's no force or coercion involved.
'A' proves a very competent and diligent worker but after 9 months is involved in a serious rail accident together with 'B' a UK born colleague (of similar age/experience demographic - say has worked for 8 years after qualifiying) whilst in transit to work one day - they both suffer similar multiple injuries and are justifiably off work for 3 months (each spending 7 weeks in the various stages of hospitalisation); thankfully both fully recover and return to duties.
So far, 'B' has paid UK tax and NI for 8 of their qualified working years, 'A' has probably paid 8 months emergency tax and perhaps NI contributions. They both receive the same treatment and benefits whilst in hospital and throughout R&R at a conservative total cost to the system of £180K (£90K each) including all the special services whilst being recovered from the rail crash.
At the time of the accident clearly 'B' has paid more tax and NI into the system (for arguements sake let's say their contribution is £28K), 'A' meantime has paid £2K.
Neither of these figures comes anywhere close to the actual costs to the system but WE (you, me and millions of others and our forbears) meantime take care of the deficit.
Subsequently, after 4 years happily working in the UK 'A' takes up a post in the USA whilst 'B' works a further 20 years in the system (that = a 28 year NHS shift including that damned Covid-19 pandemic back in 2020/21...) and takes a slightly early retirement due to their back never fully recovering from the rail accident.
Over their working life, 'B' was promoted 5 grades, later had a child and had their appendix removed (NHS) and overall pays £120K into the system before retirement. 'A' didn't have further need of the NHS and over 4 years paid £9K into the system and received a tax refund of £1.3K on departing for the USA; the Health Charge in this scenario was applied and secured a further (massive...) £2K NHS contribution during the period of their time in the UK.
You can pick holes in it but I rest my case and just boggle at the thought of what many percieve as a massive magic money pit, FOC NHS for all - wake up and smell the coffee! The fact that an NHS worker also may have to use the system is a fact but not an excuse.
Not the original question but by all means let's value/pay NHS workers more (specifically those on the front line) but get real in the process.

Just read the comments quickly, I think the surcharge has got lost in translation.

Anyone coming from a commonwealth or non-EU country on a residence visa has to pay £400 per year per person for a NHS surcharge, this will be every year until Indefinite Leave to remain is achieved-this could take upto 10 years, but is usually 5. So this will be around £3000 over and above the visa etc fees which will be a further £6000 or so. For a family of 4 this mounts up quite quickly. Taking into consideration that during those 5-10 years, they will also be paying NI, income tax and VAT anyway.

Many of these people are on tier 2 or 5, skilled workers visa's, given to people that are employed from outside the EU where a UK (and EU) worker has not met the requirements.

The plan is to exclude NHS applicant; nurses, Dr's dentists, physios etc to encourage them to apply. Much like staff discounts are given in many industries.


Another lesser known fact in the same vein, is that UK citizens living and working overseas, expats I suppose, are also required to pay a NHS surcharge when visiting the Uk, if they have been back here for less than 6 months. This would and does include UK born citizens. :}

Not a bad idea (with some limitations) but better you read the whole thread...otherwise we'll go off at a tangent

I started the thread!
It went well off the tangent when I Re-read some of the comments.

I can see and agree with some of your arguement but staff discount - noooo!
If you mean a bit like a company vehicle for a Ford Maindealer Salesman - HMCR class that as payment in kind which is subject to Income Tax ain't it!!
IMHO that's still a dumb deal for the country and the NHS - just look at the numbers in my little scenario (not actuals but fair guesses - and on the low side I may be so bold) - then I'd hope you'll agree it's financial lunacy.

Not my argument or idea at all, just what does happen with visa's applicants and the government's proposal that is currently under review.

ok I understand what you say but I don't not agree with your view.
I worked for 38ish years paying tax, I was born in the UK, am I any more entitled to NHS care then the 17 year old UK born teenager injured on his first day of work? Neither of us work for the NHS!

Using your example I still do not think the foreign NHS worked should pay, can we agree to disagree?

macafee2

They will be paying,probably more than the 17 year old, as their NI and tax will be considerably higher. If, by them not paying a surcharge, we and our families have a better healthcare system, I am game for that.

A fair alternative example to quote - but assuming your 17 year old isn't injured for life (perish that terrible thought) he would expect/accept entering the system and using it as his needs required whilst contributing to support that system just like millions of others (the wide based cone funding theory works, the inverse truncated cone is simply impossible) otherwise the whole thing doesn't and cannot work.
Covid-19 apart, we see the NHS can barely keep up as it is, adding deliberate funding exceptions whilst acknowledging the NHS is already treated too loosely as 'free to everyone' and equally abused by some (a significant number) from outside the system who have/will never contribute just makes it worse.
It's one of the few great 'socialist' ideas this country has adopted but it was never intended to deal with the spectrum and shear number of ills that it contends with today - after just 75 years we're killing it stone dead by remaining a soft option for a path to good health that appears to some as FREE, paid for by somebody else (and I'm not referreing to the foreign NHS worker that's been the subject of this thread!)
Let's agree to disagree...

Forward to your post 23. Let's just consider the surcharge as a modest 'top-up' for someone joining 'the Club' later than their contemporaries. You're a long standing Club member so the surcharge wouldn't apply.

If you are trying to suggest that NHS treatment FOC at point of delivery, the whole premis of the NHS isn't possible, then I'd suggest you take another look at public finance. The truth is that successive governments would rather spend tax-payers money on the 'defence' budget and run down the NHS. And that this, up until now has been supported by the active electorate and accepted by the inactive electorate. It takes an active electorate with a will to make things happen any differently. The truth is, it is possible. Just that there's a lack of will to support it. Perhaps in future things might change...

The point of the discussion is that our UK health service is not free, all citizens have to contribute to the NHS pot (sort of "from cradle to grave" - but paid into over +5 decades of their working/earning/contributing lives). Some choose not to use the service (prefer private, separately funded healthcare) but regardless they still significantly/fairly contribute to the NHS (thus viewed as a 'closed' circulating system of health needs and care for all).
Anyone (without distinction other than being an adult of working age) not fitting the closed system profile should anticipate/expect some sort of 'catch-up' payment/surchage (whether it's a 100% or a proportional contribution can be debated but the principal remains) should they subsequently have need to access benefit of the NHS (or alternatively provide private insurance cover for any personal health eventuality meantime).
You are quite correct to point out the wider choice governments must make where national healthcare is concerned but that is a very different more long term question of policy and political will - for all the best reasons the UK made it's decision in 1946 and adjustments (rightly or wrongly) have been made in the interim. Crass decisions in the meantime don't make things better and that's one such situation that we are discussing here.
Maybe it's a subject not specifically appropriate to this Forum but it's an interesting, eye opening response...

No-one is claiming the NHS is 'Free' but 'Free of charge at point of delivery'. UK taxpayers pay for the NHS, notice I said 'taxpayers'. There are many UK citizens who are not tax payers that benefit from the NHS - should all these also be being charged in your view? How many generations of UK citizens should I count as my ancestors before I qualify in your view?



What decision(s) are you labelling as 'Crass' (stupid and insensitive)?

Semantics - the arguments recognise citizen funding and no, you don't open your wallet each time you leave the doctors surgery or hospital.
The NHS is treated/considered and abused by many as a 'free service' ie not valued - as one example just look at the number of missed GP appointments alone (and the attributed costs that some bean counter has used to illustrate the financial waste to the system) proof of attitudinal disregard of the 'no cost (to me)' service; administrational cost would not support the idea but if there were to be a refundable £15/appointment fee we'd soon see a huge increase in appoinment take-up (conversely, probably a significant drop in appointment numbers requested .....win win NHS, less pressure on the system, more time for treating genuine ailments).
As already mentioned, +5 decades funded by every citizen (taxpaying citizens if you insist), each to their means. True not all contribute and that fact was part of the equation for the original funding formula but the model was supposed to follow a right cone (wide funding base, relatively smaller usage frustrum) and not the trend to an inverse shape that has been allowed to develop through crass decisions and muddled thinking by successive administrations/dogmas.
Within the model, contributions by preceding generations essentially fund the future infrastructure/user. Once the model is unduly influenced from outside the system it starts to break down (inverted cone sydrome..).
Final word from me 'cos we can't solve anything; new joiners of the NHS club from 'outside' should contribute via a surcharge - it's a contribution and not full compensation for what they haven't paid (by comparison with a contemporary as I attempted to illustrate in an earlier post) - it's not perfect but it is logical and fair.

It is not often I am in both camps, but this is where I find myself.

I think it prudent to fill vacancies in the NHS in the most prudent fashion in the short term, and that includes the employment of foreign medical staff where necessary.

In the long term, there should be value placed upon vocational training to encourage the next generation of home grown medical professionals, to reduce reliance on imported labour, note the use of reduction, not eradication, as I strongly believe there to be many merits in diversity in all walks of life, and the enrichment it brings.

However back to the thread title, NHS surcharge, any foreign national irrespective of their employer or employment status, or indeed any ex pat UK national should be required to pay this nominal charge, and it should be looked upon as an insurance payment, in the same manner as a National Insurance contribution is levied upon other UK taxpayers.

I have been in receipt of superlative care from the NHS in the past, and I am in awe of what is achieved by the tireless work of the staff employed in this fantastic organisation, but to say that certain sections of the population who are aliens as far as nationality is concerned should be exempted from paying simply because of who their employer happens to be, is patently wrong, and unfair to other individuals who have chosen to live and work in the UK, who are not exempted.

The NHS as an organisation has evolved from the vision of Aneurin Bevan, of a reactive service to treat ill people, into one where proactive care is more prevalent and people's expectations of treatment they might receive is much higher.

This of course puts an ever growing financial strain on what is effectively a publicly funded enterprise.

So in my view this is not an unfair charge, unless it is levied differently upon some immigrant workers based solely upon their employer, and as such should not be abolished.

Brian :D

I totally agree with the Brian. The problem is that some professionals are being turned away due to the extremely high costs of bringing their skills to the UK. As a result they are going to Canada, Auz, NZ and even S.America. Even getting paid to do so in some cases. many companies are now paying large parts of the immigration fees to lure these skills to the UK.

I suppose one solution that would level the playing field is to pay the people in the medical skills shortage rolls, extra and then everyone pays the surcharge.
Remembering of course that all this is to accommodate EU workers from next year, as commonwealth workers on visa's are already paying this and and accepting that it is value for money.

As a bit of an aside, I think one has to have lived in a non-EU country to completely appreciate the value and service that the NHS offers, as much as people in the UK complain about it. Many are used to paying as much for medical aids/insurance as they do for their monthly housing costs, this on top of high taxes.

So by your reckoning then everyone that comes of age should be made to pay the surcharge then? There's absolutely no difference. Turn 18 just starting work: new joiner, pay the surcharge for 5 or 10 years. Come to the country to work and pay taxes - just like our fictional 18year old: new joiner, pay a surcharge. Only difference being those people coming to work in the NHS already trained - will earn more than the 18yo and pay more taxes from the off. Not only have they come to work in Britain, but in the NHS itself. Ironic isn't it that they could be asked to pay an extra tax for the privilege Health cover while at the same time saving the NHS a shed load of training costs... But there you go suggesting just that. Next you'll be trying to suggest that the NHS should make a profit. Keep your cones and your frustrums - They're pyramids anyway - the whole social contract is a pyramid scheme - and would continue to function if money wasn't being constantly syphoned off.

I didn't suggest anything of the sort. In simple terms, we leave school/college/university (these days = 18-23 YOA..) get jobs, start earning, pay income tax and NI (ie start supporting the system) and yup, not everyone follows this route but the significant majority do.
I suppose the lower/est paid (lets say untrained/unskilled and probably unqualified) foreign health worker could arrive at 18 yoa and start off on a contribution par with our home grown 18 yoa youth - except our youth has a line of forebears that have already contributed/paid into the pot, supported the infrastructure etc. - and that's a tangible difference in the theory.
The same logic applies should we compare more skilled/qualified better remunerated young adults from within and outwith the system (there is little difference in the age at which they reach this status), and, if any of these hypothetical examples has need of the NHS they all are treated the same.
Surcharging (or compulsory personal health insurance) for a foreign worker arriving here specifically to work in the NHS is emotive but as I stated previously, like any other job, our foreign worker arrives having accepted the T&C's of their offer; evidently many found the offer attractive - even more attractive now it appears they may avoid the surchage altogether (crass decisions....)

Perhaps they could be a little more efficient in how they spend our money.

No surcharge required then.

Brave comment.
The waste in the NHS is colossal and there is much scope to improve. Whistleblowers get suppressed, and there are no serious active incentives to reduce waste. The NHS pays out billions in damages due to botched operations and substandard care. Plenty of scope for improvement but in practice this is difficult to achieve.

Sadly, as a nation and society, we can't have a rational discussion about the future of the NHS without someone screaming privatisation. Until we can it's not going to improve anytime soon.

Similar is occurring on the continent I see.

It's not always just a case of there being no incentive to reduce waste. One recent example I know of comes from a plumber who has done a lot of work for me - in March he took a job in the nearest hospital as he'd been told there was a shortage of plumbers, especially for fitting out additional new facilities for all the additional hygiene control. This included putting in shower units, which he said were built at 1200mm wide as per specification - however the shower trays ordered were delayed. When they finally arrived, they were all something like 1250mm wide, i.e. too big for the newly-built stalls (tbh I can't remember if those were the exact measurements, but I remember thinking that the ones delivered were a very unusual size). They were possibly ones which had been held over in stock due to a manufacturing error. But the supplier obviously felt they could get away with offloading them to the hospital at this time in particular, as the hospital wouldn't have the time to waste returning them and waiting for replacement stock to arrive. And he was right - it was decided that it would be quicker to dismantle all the previously built shower enclosures and replace them with ones that would fit these trays, as this could be done in a matter of days rather than returning the wrongly sized ones and potentially waiting weeks for their replacements. The work of three plumbers for four days, together with most of the materials used for building the stalls, was wasted, just like that.

I've mentioned before that my other half is a school principal, and while I can't say with certainty how it works in the health service I imagine the procurement and tendering processes are similar. Years ago, the Department of Education contracted out all school IT systems to one supplier of a particular system. Now there are a lot good reasons for having one shared IT system across all schools, but anybody with experience of working in schools knows how unwieldy, bug-infested and user-unfriendly this system is. If the school IT goes down, she can't simply call up a local person to come and sort it out that day or the next day - she has to log an issue with the supplier's call centre, wait to find out whether they can fix it remotely, and/or wait for the technician to come out. This can leave her without centralised IT for 2 or 3 days at a time, and this is not unusual - it can be pretty much guaranteed to happen at least 10 times in a school year, sometimes even more. Even something as simple as changing one child's log-in details can take half a day!

Same principle applies to the school fire alarms, intruder alarms, CCTV, heating and electrical systems - there is one supplier for all schools in a particular area and she is not supposed to use any others. Now it's true that centralising purchasing power within the department can drive costs down and that can be perceived as getting value for taxpayers' money (please note my choice of words there). But the knock-on effect almost invariably seems to be a deterioration in the delivery of the services being paid for, and often - as with the IT system - no means of addressing poor service once the tender for supplying those services has been awarded. As always, cheapest does not necessarily mean best, and whether it's the NHS, schools, roads, rail or any other state infrastructure, it is almost always supplied by the lowest bidder in such a way as to maximise their return for minimum delivery.

It's wandering off the original subject - but how true.
The NHS has become an enormous, bloated money pit with no direction or incentive to become nor operate 'efficient'. The front-end medical bit is in many ways world class but the administration/support/supply management is turgid, unwieldy and highly unaccountable ghosting along within a complex organisation. A huge employer (biggest single 'business' in the UK?) with leadership/vision it could become a lean provider but prefers/continues to blot-up cash and amble along whistling it's own tune.
All attempts at kick's in the backside get deflected with cries of privatisation/we're sacred so nowt/little changes - other than we need even more dosh(only a little of which will be justified)!!
When all the dust dies down over Covid-19 I wouldn't be surprised to learn that the initial crisis over PPE shortages was down to the NHS distribution regime/process rather than national strategic procurement/availability of stock - we shall see.

Stevie, no I wasn't. The "no free meals" I thought explained it. If I went and worked in another country I find out what the health service arrangements are. If that country decides I should pay some premium up as a contribution to the system I am happy to do that. I accept my responsibility for my health, I don't expect something for nothing. And in the case originally stated the health workers are being paid as are the agricultural workers and others who are working in the uk etcetc. Hence "no free meals" Chris.S.