We cannot afford to stay and save the NHS: Nurse and family have to find £7000 to stay in the UK

The escalating cost of applying to work in Britain is risking an exodus of medical staff from overseas and threatening to sabotage efforts to ease a crippling staffing crisis in NHS Scotland, experts fear.

Nurses and care workers, some ­earning minimum wage, must pay thousands of pounds in Home Office fees to remain here. Some are moving from the UK to other countries despite experts identifying the need for the NHS to recruit and retain experienced staff as a priority as the health service attempts to rebuild after the pandemic.

The £2,404 fees are the cost of Indefinite Leave To Remain (ILR), which overseas NHS workers apply for after five years in the UK.

NHS nurse Mictin Ponmala, from India, said: “Overseas health workers must apply for a Leave To Remain visa five years after arriving in the UK, if they want to continue living and working here.

“Nurses and other health care ­workers feel this is cripplingly expensive on the average UK salary, which nurses earn. Many care homes in Glasgow and other cities are currently recruiting care assistants from overseas on £9.50 hourly minimum wages to meet their staffing needs. They also have to pay this exorbitant fee to remain and look after residents.

“Some colleagues have gone to Australia and America because they ­cannot afford to pay the fees to remain working in the UK.

“When I asked the Home Office if they could reduce the cost, they replied that they charge the fee to meet wider expenses of Home Office.”

Many health boards are looking to recruit nurses and other care staff from overseas – Grampian NHS announced 30 nurses from Nigeria were in the process of joining – but the fees being demanded to remain mean many may not stay in the medium-term.

ILR fees were introduced in 2003 at £155 but now, because of the rising fees, experts are warning of huge shortages in NHS staff.

The Royal College of Nursing (RCN) recently revealed there were 6,700 nursing and midwifery vacancies within the NHS in Scotland and said the health service needed nurses from overseas to function.

Colin Poolman, director of RCN Scotland, said: “The costs that international nurses have to pay to work in the UK are significant. More must be done to recognise the important contribution of overseas nursing staff and to reduce barriers in the immigration system and the costs that are payable.

“Given there are almost 6,700 ­nursing and midwifery vacancies within the NHS in Scotland and considerable workforce challenges in social care, support for overseas nursing staff must be part of wider improvements to workforce ­planning, recruitment and retention. This includes ensuring nursing is an attractive and well-rewarded career to grow the domestic supply and retain existing experienced staff.”

The RCN also cites inflexibility of ­management to nurses, refusing them part-time contracts to cope with caring for family members. This forces some to retire in their 50s, leaving posts unfilled and covered by full-time colleagues as ­additional workload. The RCN adds that 60% are considering leaving current roles. “The pressures of the job, poor staffing levels and low pay are all factors being reported,” it said. “Nursing staff must be allowed to work flexibly while maintaining good terms and conditions if we are to prevent many experienced staff from leaving the profession early.”

Health service analysts believe a ­shortage of experienced staff across all areas will fundamentally undermine any effort to cut waiting lists built up during the pandemic. Ministers have been accused of failing to ensure enough medical staff are trained, and not doing enough to retain those who have been.

Research last week suggested 33% of family doctors were likely to quit in the next five years with Manchester University researchers finding almost half of GPs unhappy in their jobs, citing stress and overwork as the main reason.

Dr David Shackles, joint ­chairman of the Royal College of General Practitioners (RCGP) in Scotland said: “The pressures in general practice are extremely acute as we emerge from the pandemic. GPs, along with colleagues across health and care, rose to the challenge of Covid but it cannot be sustainable to work every day as if it is an emergency.”

RCGP Scotland surveyed members and found 73% of GPs admitted to being worried their workloads would negatively affect their ability to provide care for their patients in the coming months.

“A total of 70% of GPs reported working longer than they are contracted and 28% feel so stressed they can’t cope at least once or twice a week,” it said. “Staff are exhausted and under-strain. That is why retaining our GP workforce is our biggest priority right now. Our survey has also shown 38% of GP respondents think they will likely leave the profession over the next five years. We cannot afford to lose more GPs.”

The Home Office said: “We introduced the Health and Care visa to make it quicker, easier and significantly cheaper for eligible people working in health and social care to come to the UK with their families.

“We recognise the significant contribution of overseas health and care workers, but must be fair to all who use the immigration system. Those who directly benefit from the system should contribute to its funding.

“All income generated above the ­estimated unit cost is used to fund the wider Migration and Borders system. Income from fees charged for immigration and nationality applications plays a vital role in the Home Office’s ability to run a sustainable immigration and nationality system.”

The Scottish Government said more resources were being put in place to support the wellbeing and mental health of NHS staff while efforts to bolster numbers were continuing: “NHS Scotland staffing is at a record high with overall staffing up by over 22% since 2007.

“Our National Workforce Strategy for Health and Social Care in Scotland commits to increasing the NHS workforce even further, with 1,800 additional full-time posts on top of projected workforce growth requirements.”

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Nurse: We are being asked for the impossible. What do we do?

A Nigerian nurse recruited to ease crippling shortages in NHS Scotland has been told how she will need to find £7,000 to continue working here.

Angela, not her real name, and her husband, a care worker, says finding the money may be impossible and the couple fear for their future in Britain as the NHS struggles to recruit and retain experienced staff.

She is one of around 200,000 overseas workers helping to staff the NHS and began working here four years after being recruited by an employment agency. Now, after obtaining the qualifications to register with the Nursing and Midwifery Council she works in a large teaching hospital.

She said: “I am a band five nurse and earn £26,104 while my husband is a care worker on the minimum wage. Everything we earn goes to pay bills and care for our two young children. We are proud to work in the health and care sector and now need to apply for Indefinite Leave to Remain to stay here.

“We both worked through Covid contributing to the NHS at its busiest and most vulnerable time. Now we have to find £4,800 in Home Office fees and more money to apply for passports for our children, born here.

“I honestly don’t know where we are going to find the money except by borrowing it or living even more frugally than we already do.

“That may be impossible because of the huge rises in energy bills, food, council tax and all the everyday expenses young couples have to meet.”

They rent their home and see no prospect of buying one of their own because their salaries are limited. Travel home to see family is impossible as the couple have no income for savings.

She adds: “The employment agencies paint a rosy picture of the lifestyle you will lead if you come to the UK. However, the reality is that you work hard to stand still and then pay out four-figure sums to remain working. We have earned our place to work in the NHS and care sector and our children have been born here. They desperately wanted to recruit us.

“We feel that if you work and contribute to the NHS, and pay taxes, you should be given an incentive to remain doing so.

“We are being asked for the impossible and it is just not fair.”

Angela and her husband must pay £2,404 each for their passports while the cost for each of their two children is £1,300. There are additional administration and solicitor fees which add another £2,500 to the cost.