The health surcharge

The Health Surcharge is an often forgotten part of the ‘Hostile Environment’.

It is the extra contribution that migrant workers and their families have to make to the NHS, in addition to paying their taxes. The surcharge was introduced in 2015 at £200 a year for each person. In 2018 it was doubled to £400.

Our concerns

It’s unfair

The government claims it ensures that migrant workers and their families are making a ‘fair contribution’, but what it really means is they are paying extra. NHS workers who pay the surcharge essentially make a triple contribution to our healthcare services. Many UNISON members are providing key healthcare services  while being charged extra to do that. Because they are still paying for the NHS through their tax and national insurance, just like all their colleagues.

It’s unaffordable

If someone comes to work in the UK on a three-year-visa, with a partner and two children, they will have to find an extra £4,800 (£400 x four people for three years) on top of their visa fees. One nurse recently told UNISON that she is already trying to save £150 every month, by working more overtime, to pay the NHS surcharge before her visa renewal in 2020. She calculates that it would cost her almost £2,000 altogether.

It contributes to staff shortages

Workers from other countries play an important role in helping to deliver healthcare in the UK. NHS staff shortages are a real problem and international recruitment remains vital to achieving the overall staffing numbers needed. It’s now harder to recruit staff from abroad for many reasons, including the immigration health surcharge.

What you can do

UNISON branches/reps

There are several things branches could be doing to help UNISON campaign to end the immigration health surcharge:

  • find out how many of your members are affected by the immigration health surcharge
  • meet your employer and ask them to pay the surcharge for the staff they employ
  • ask your members to speak to UNISON about how paying the surcharge has affected them. They can email us, in confidence, at

Help for UNISON members

We work with the Joint Council for the Welfare of Immigrants (JCWI) to provide immigration advice to members who have come to work in the UK. If you would like to get some advice please call us on 0800 0 857 857 and we’ll arrange an appointment for you.