Immigration Skills Charge a Threat to NHS Frontline Services

As the British Medical Association (BMA) and Royal College of Nursing (RCN) calls for an exemption from the Immigration Skills Charge for all health and social care staff, Helen Jackson, Managing Director for Bush & Company highlights for Lawyer Monthly the threats which are exacerbating the NHS’s skills shortage.

The Immigration Skills Charge (ISC) was one of the key reforms within the Immigration Act 2016, designed to reduce Britain’s reliance on migrant workers. Controversially, the charge will apply to medics working for the NHS and Health Education England, potentially diverting millions of pounds of funding away from frontline health services and the training of future health professionals.

Data from the BMA shows that £3.5 million would have been taken out of the NHS budget if the ISC had been applied to the doctors recruited between August 2014 to August 2015. Health Education England, the sponsor for all doctors in training in England, would have had to pay £1.6 million to cover sponsorship costs for their trainees for 2015-2016.

Whilst nursing has already been granted an exemption and remains on the shortage occupation list (SOL), the cost of recruiting other essential medical professionals from overseas will have an impact on frontline services, affecting nursing budgets, reducing staffing levels and training. Without an exemption, millions of pounds of taxpayers’ money intended for the NHS will in fact be redirected to support broad skills training initiatives that support a wide range of businesses across the UK.

It’s yet another pressure on a public service facing a severe skills shortage.

The NHS currently has four pools for recruitment, British trainees, existing NHS staff, EU Nationals and professionals from outside the EEA. All these pools are shrinking.

Without an exemption, the ISC will reduce the number of medical and healthcare professionals recruited from outside the EEA. With Article 50 triggering the Brexit process on 29 April, there could be further drops in applications from EU nationals. Staff already working for the NHS are being driven out by increasing work pressures, while many of the 57,000 staff from other European nations who are working here, are considering leaving due to the government’s reluctance to provide them with any security about their future. Finally, there are fewer nursing trainees, following the government’s decision to charge tuition fees to nursing students and axe the bursaries that used to help them cover their living costs. The talent pool is being drained from all sides.

There’s no shortage of statistics. One in ten nursing posts is unfilled. A survey by Nursing Standard last week revealed that more than half of nurses (52%) are considering quitting the NHS citing work pressures, and one in three nurses is due to retire in the next 10 years according to the RCN. Freedom of information responses showed that only 96 nurses joined the NHS from other European nations in December 2016 – a drop from 1,304 in July, while the number of EU nationals leaving the NHS rose by 68% from 1600 in 2014 to 2700 in 2016.

It’s clear that the NHS is simply not ready to rely on home-grown talent alone. At Bush & Company we employ highly trained health professionals to deliver high quality case management and expert witness services so we value the excellence of the training and their diverse experience. It is these skills and experiences of highly complex catastrophic injury cases which our consultants have gained through their work for the NHS, that our legal clients rely upon in the most important, demanding and emotive of cases.

We not only understand the importance of these skills, but also recognise and appreciate the lengthy training involved. It is a career that involves continuous learning and can include many specialities. It’s because of this lengthy training pipeline that the NHS could continue to be reliant on clinicians and nurses from overseas for quite a few years to come.

While the ICS alone may not be the straw that breaks the back of the NHS, we hope it does not prove to be a short-sighted policy that places an unsustainable burden on a cherished institution.

  1. J Zidane says

    Dear Richard,

    In your article you quote that Nursing applicants are exempt of the Immigration Skills Charge ; I have found no evidence of this on the Home Office website ; is that a confirmed information ?

    Many thanks for your answer on this.


    1. Richard Rossington says

      Hi, Helen Jackson, Managing Director for Bush & Company authored this piece. You can contact her at to confirm your query.
      regards, Richard

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