Strong criticism has been directed towards the 66% increase in the immigration health surcharge this week for anyone wishing to extend their visas or apply to enter the UK. On February 6, the annual standard rate increased to £1,035 and applicants were required to pay the whole amount up front in addition to their immigration fees. Student, under-18, and young adult visas on youth mobility programmes are all subject to a discounted rate; the fee will increase from £470 to £776. Although migrant health workers in the UK under the health and care visa are exempt from paying the surcharge, there are those who arrived here on other visas who have to pay the surcharge when renewing visas. Some may be able to get refunds but the process is slow and complex, and those who originally paid the surcharge before 13 March 2020 will only receive a partial refund. The rise will force a number of health workers who need to renew non-health and care visas into debt. Sky News has cited the case of a nursing assistant who has been legally working in the UK since 2009 being expected to find £2,587 to obtain access to NHS care for the duration of her visa, on top of around £1,048 in Home Office fees for processing her application. Depending on the visa and the job, there are methods for claiming some of the money back. Those who do not have a Tier 2 general visa – but hold, for example, a Tier 5 medical training initiative visa – can only apply for a refund six months at a time. And those on zero-hour contracts, as in the Sky News example, are likely not eligible. Nicola Ranger, chief nurse at the Royal College of Nursing, said it was “unacceptable” that those who are qualified for the refund “will have to wait six months before being eligible” for a refund. She said she is also concerned about the impact it could have on migrants accessing the NHS. “It could discourage migrant workers and their families from maintaining their visas, creating a risk that more patients are subject to the NHS charging system, and deterred from accessing the health care they need,” she said. An individual on the limited leave to remain scheme can pay on average about £4,000 every two and a half years to renew their visa, according to migrant charity Praxis, who are calling on the government to abolish the added healthcare fee. Emma Brooksbank, partner and business immigration law expert at law firm Freeths, said the surcharge was unfair. She said: “The government’s description of the surcharge as a contribution to the cost to the NHS has always been dubious. All applicants pay the charge regardless of their health needs, and many of them are contributing through tax and national insurance anyway. “Many employers cover immigration fees for their sponsored workers. This increase makes it harder and much more expensive for UK-based employers to meet labour shortages and to recruit skilled workers from overseas. “This includes public sector employers who rely on the immigration system to meet workforce requirements. This is the government robbing Peter to pay Paul.” Brooksbank added that the increase had been justified as required to meet the cost of public sector pay rises but the legality of using funds raised from the charge this way was questionable. A spokesperson for the Home Office said that while it recognised the migrant contribution to the country, it mandates “a financial contribution from those using public services”, which includes the NHS. They added: “The new rate reflects increases in healthcare expenditure and better reflects the NHS use by migrants, who are provided with near-comprehensive access to health services in return.” Last October Pat Cullen, RCN general secretary and chief executive, raised serious concerns to ministers about the impact of rising fees on “the ability of the UK to attract and retain desperately needed nursing staff”.