The IHS is unhealthy for everyone: the hostile environment as a threat to wellbeing in Higher Education and beyond

by Gwyneth Lonergan (Lancaster University) and Samuel Solomon (University of Sussex)

As a result of the COVID-19 pandemic, the International Health Surcharge (IHS) has gotten a lot of media attention as the government agreed, after much public pressure, to waive the surcharge for migrant NHS staff and care workers. The surcharge is a levy applied to work, spousal, and student visas, and was introduced following the 2014 Immigration Act, ostensibly to defray the ‘cost’ of migrants on these visas to the NHS.  Initially set at £200/year [£150 for students], it was increased to £400/year in 2018, and will rise to £624 in October.   A person applying for a three- year Tier 2 (General) work visa will therefore pay £1,872 for the health surcharge alone.  Non-EU migrants therefore pay a very literal price to work and study in the UK.  A Tier 2 (General) visa costs a minimum of around £450/year, in addition to the health surcharge, and applying for “Indefinite Leave to Remain” costs a minimum of £2,389.

We at Unis Resist Border controls (URBC) welcome the news that the IHS will be waived for NHS staff and care workers, although we wonder how this will be implemented in practice (at the time of writing, it seems the answer is: unevenly at best).  Will an international student who gets a part-time job in their local hospital canteen get a partial refund on their IHS?  What about a person on a spousal visa who works in a care home? More importantly, though, we strongly believe that the system of visa fees and surcharges is grossly exploitative to migrants, and that the IHS should be eliminated completely. 

Unis Resist Border Controls (URBC) has long sought to understand how the Home Office’s “hostile environment” policies are implemented in higher education and how these policies shape other aspects of university life for migrant staff and students.  As part of this, we conducted an online survey in late 2018 asking staff and students at UK Universities about hostile environment policies at their institution. Our research illuminates how the visa fees system exploits migrants, and why piecemeal gestures by the government or employers to reduce the fees for certain groups of migrants are bound to fail.   

One of our survey questions asked respondents “Does your university compensate international staff members for fees/expenses?” We received answers from home and international (both EU and non-EU) students and staff, including both academic and non-academic staff members.  Strikingly, a significant number of respondents (57 total, or 36%) did not know the answer. That is, they did not know if their university covered international staff costs (visa fees and immigrant health surcharge). Of the 110 who did know, more than half (52%) said that their universities did not offer any help with costs at all, whilst just over a third (34%) said that their employer helped with some but not all costs. These numbers do not necessarily correspond to the percentages of universities that help with costs, but they tell us a lot about what information staff and students have, and they provide us with an insight into what we believe are widespread perceptions. Perhaps unsurprisingly, UK nationals tend to be entirely unaware of the costs that migrants to the UK, including Tier 2 “skilled” workers, face in visa and NHS fees. Moreover, for those who have not had to pay such fees themselves, the question of whether or not employers cover these costs doesn’t seem to occur. A logical consequence of this uneven distribution of the “need to know” is that non-EU staff and students often find themselves met with disbelief, if not disinterest, when they ask for solidarity from UK and EU nationals.

We saw this kind of ignorance and disbelief at work in the media debates around whether NHS workers should be expected to pay the IHS.  Shock was repeatedly expressed that NHS workers had to pay the IHS; but the fact is migrant NHS and care workers have been paying these fees since they were first introduced in 2015. Most people in the UK, including, it would seem, in the UK media, only became aware of these fees because of the global pandemic, and because the government decided to draw attention to the existence of the IHS by announcing the increase.  Furthermore, while we are pleased when any migrant is granted a reprieve from these fees, selecting a ‘special’ group of migrants to exempt suggests a broader lack of understanding of, or indifference to, how extortionate immigration-related fees promote severe inequality.  We know from our own research that visas fees cast a pall over the lives of university staff and students, constraining their opportunities and choices. One of our survey respondents, a lecturer employed at a wealthy Scottish research university, noted: “Some people save for a flat, I save for immigration.” Staff and students who support non-EU dependants are charged additional visa and health fees; many end up in significant debt as a result, or must make heart-wrenching decisions around whether to leave their partners and/or children behind in their countries of origin. No one, regardless of what sector they work in, should be forced into such situations.

The economic hardship created by extortionate visa fees is especially critical during the current global pandemic. It has been widely reported that BAME people have been disproportionately impacted by Covid-19 in the UK; Black men are more than 4.6 times more likely to die from Covid than white men. This is due to health inequalities caused by structural racism. Many BAME people in the UK are citizens here, and therefore may not be affected by the visa fee system (unless, of course, they have family and friends who are migrants). But for BAME migrants, high visa fees create an additional level of economic hardship while they are already struggling with the dire health consequences of structural racism. Moreover, the very existence of high visa fees, and the general indifference to their impact, is a product of the well-documented racism of the UK immigration system.

Both in, and outside, of Higher Education, we need non-migrants to see this picture clearly and then to stand alongside their migrant neighbours, colleagues, and students — but not only out of altruism. The IHS can be understood as a government strategy to further monetize migration even as, under austerity, the wealthy are paying less tax, and the state is disinvesting from public services. Given the prevalence of anti-migrant feeling and policies in the UK, migrants are particularly vulnerable to this. However, UK citizens would be well advised to consider whether they might be next. As Jackie Wang describes in her book Carceral Capitalism, “government bodies… have the power to generate revenue not only through taxation, but through the police power and court system as well.” UK and EU nationals may well find that they are increasingly hit with service fees, including to use the NHS, as the government seeks to balance the books without requiring wealthy Tory donors to pay their taxes – after all, the UK remains one of the few countries where companies that evade taxes can still apply for financial assistance to deal with the fall-out from COVID-19.

The overall picture here is of a harmful financial landscape for migrants in the UK, one that can have deleterious effects on their health and general wellbeing.   It is not enough to abolish the IHS for migrants seen as ‘skilled’ or valuable, whether they work in the NHS, or in higher education. As Unis Resist Border Controls, we call on all HE institutions, as well as the UCU and other unions active in HE, to lobby the government to end the hostile environment and the debt, distress, and illness that it causes so many of those who live, work, and study in the UK. It is not enough to ask for special dispensation for university academics: we join our comrades in Docs Not Cops in fighting to end the IHS and all upfront charges for healthcare in the NHS. 

Note: One of the authors’ employers (the University of Sussex) did cover his Tier 2 visa costs, IHS, and the cost of an application for Indefinite Leave to Remain. This somewhat unusual outcome was based on policy at School level, while there is as of yet no policy across the university to guarantee that this is applied equitably for all staff regardless of School or department finance levels.


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