Fighting an unfair fee

Nurse Eva Omondi’s crusade to challenge the immigration health surcharge began at RCN Congress in 2018. She explains how support for her mission grew, resulting in a government promise to scrap the charge for health care workers

For Eva Omondi, the fight to remove the immigration health surcharge (IHS) for health care workers from overseas was personal – in order to pay it, she was forced to work extra shifts, separate from her children, and take out loans that she is still paying off now. 

This May, under pressure from Eva’s campaigning, the RCN and others, the UK government finally promised to scrap the IHS for health care workers. 

The fee, which sees all migrants who come to the UK from non-EEA countries pay £400 a year for the NHS, whether they use its services or not, is due to increase to £624 a year from October.

Speaking out against unfair government policies is not an easy decision and many others in the same position feared what would happen if they raised their voices. However, Eva, an NHS nurse, who is originally from Kenya, was determined to fight for her family and other overseas nursing staff.

Unfair charge

In 2015, Eva paid the IHS fee when she applied for her work visa. After saving money to pay for visas for her family, she then discovered the IHS also had to be paid for every individual family member and paid upfront for the number of years each visa lasted. This meant £3,600 on top of their usual visa fees.

“It didn’t make sense,” Eva says. “The NHS has relied on overseas workers to sustain it. We come here as legal residents and we pay National Insurance and taxes.”

NHS Nurse and RCN member Eva Omondi who successfully campaigned against the immigration health surcharge

But it wasn’t simply a matter of paying the extra upfront fee. To afford it, Eva and others have had to borrow money. To pay the money back, they’ve had to work overtime. To work overtime shifts, they had to find childcare. Overseas workers have no recourse to public funds and therefore can’t access government-subsidised childcare and are unlikely to have extended family in the country who could help out for free, leaving Eva and others stuck in a vicious cycle.

“This was an issue that could make someone easily lose it,” says Eva. “Currently I am a theatre nurse, so you can be called at any time. The only option was to look for cheaper childcare, which meant taking my children back home to Kenya. That separated me from my little ones.”

Action at Congress

As an RCN steward and RCN Eastern region board member, Eva is used to standing up for the nursing profession, so she began to research and draft a resolution opposing the IHS, to be debated at the RCN’s national Congress in 2018.

Her resolution was accepted and, as Congress approached, it gained media attention. “It was on the radio and in newspapers,” Eva says. “I realised that this was important, and many other people identified with it.”

At Congress, other RCN members approached Eva with questions about the IHS, expressing disgust at the policy. “It was something that was silently sneaked into the system,” Eva says. “Unless it affects you, you wouldn’t know about it.”

Eva presented her resolution on the main stage and was encouraged to hear Janet Davies, RCN Chief Executive & General Secretary at the time, championing the cause: “The manner in which she read that motion and spoke with such passion about it was incredible.”

Congress delegates passed the resolution almost unanimously and the RCN took up the cause to end the IHS for health care workers.

Media attention

Media interest increased, and Eva was interviewed by ITV local news, the BBC, local radio and newspapers. Meanwhile, the RCN put pressure on the government to cancel the unfair charge.

There was an early setback when the government announced later that year that it was doubling the fee to £400 and it announced another planned increase in 2020. “That was like a slap,” Eva says. “The government was not considering how valuable we are.”

But throughout it all, Eva says: “The RCN has been alert to any opportunity to support the campaign to end the IHS. I cannot say how grateful I am for the support from RCN members and leadership.”

Pandemic pressure

When the COVID-19 pandemic took hold in the UK, health care workers such as Eva were put in the spotlight. “The pandemic has magnified how unfair the government has been. We’ve been putting our lives on the line when the country has been in need.”

The RCN increased pressure on the government, highlighting the invaluable work of overseas nursing staff. In May, the government finally pledged to exempt health care workers from the unfair charge.

“After this announcement, I cannot tell you how overjoyed I was,” Eva says. “I cannot thank the RCN enough. The members have been great, the whole community has been so supportive.”

In July, Eva received good news: the government finally confirmed that overseas registered nurses on a Tier 2 visa would be exempt from the IHS charge, along with their spouses and dependents.

However some people, including many nursing support workers, will still have to pay the upfront charge. The RCN is pushing for the government to extend the full exemption to them, and ensure the UK's immigration system meets the workforce needs of the health and social care sectors.

Future goals

Now Eva wants to continue campaigning to improve conditions for overseas health care workers. She is calling on the UK government to: scrap no recourse to public funds for healthcare workers; consider extending leave to remain to staff working throughout the COVID-19 pandemic; and pledge not to freeze NHS wages.

“The government needs to embrace us, the frontline workers,” Eva says. “We are still working, putting our lives on the line, and we are committed to the health of this nation. This is the time to recognise us.”

She also has a message for other RCN members: “We are the RCN. By speaking out, we highlight issues that affect us, and that is the only way the RCN will be able to identify the issues that they need to push for us.”

In the meantime, Eva is hoping to bring her children back to the UK soon: “Families will be reunited. Overseas workers can continue their important work and be in a better mental and physical state.”

Words by Rachael Healy. Pictures by Gareth Harmer

Did you know?

The RCN is calling on the Home Office to grant indefinite leave to remain to all international health and care staff who have worked in the UK during the COVID-19 pandemic. Find out more here.

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