Original Coverage & Source Attribution: www.nursinginpractice.com
The NHS has become increasingly reliant on revenue from the Immigration Health Surcharge (HIS) which generated almost £2.5bn in 2024/25, according to the Nuffield Trust.
The think tank warned a decline in immigration and less income from the surcharge – paid by most visa holders for their use of the NHS – could leave the NHS facing further financial pressures.
Revenue from the surcharge has increased tenfold as a share of the NHS budget over the past decade, rising from 0.1% in 2015/16 to more than 1% in 2024/25.
The Nuffield Trust said IHS income fell by more than £100m as immigration declined in 2025/26 and warned that further falls in migration could negatively affect NHS finances.
Nuffield Trust fellow Stelios Vassiliou said: ‘Whether by accident, by design, or a combination of the two, the Immigration Health Surcharge has grown to a prominence that cannot be ignored.’
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The HIS, which is not applicable to health and care workers who are eligible for a Health and Care Worker visa, has risen from an annual charge of £200 to £1,035, or £776 for students and child dependants.
The analysis found that people paying the surcharge contributed at least 60% more to the NHS budget in 2023/24, when their normal tax contributions were included, than the Department of Health and Social Care (DHSC) estimated their healthcare cost.
Mr Vassiliou said: ‘If the level of income from the charge was to fall back to that seen at its inception in 2015/16, the NHS would be left facing a shortfall in the billions, as it has grown reliant on immigrants in this group contributing substantially more to the NHS than they take out.’
The Nuffield Trust also questioned the evidence used to estimate IHS payers’ healthcare costs and set the surcharge rate, suggesting the charge may be too high.
In addition, the analysis raised concerns about how surcharge income is paid and allocated.
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Migrants are required to pay the IHS upfront for the full duration of their visa, typically three years, but the money is transferred to and spent by the NHS in the first year.
The researchers warned that transferring the entire payment in one year made the stability of NHS finances vulnerable to future falls in migration.
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Earlier this year, government statistics published in the NHS Pay Review Body annual report showed the number of Health and Care Worker visas granted for nurses in the first quarter of 2025 was 76% lower than in the same quarter in 2024.
In addition, NHS Employers and Unison recently warned that government plans for immigration reform could cost the NHS at least £169m and put the future of 12,000 healthcare workers in jeopardy.
Mr Vassiliou said: ‘With around a fifth of the NHS workforce hailing from overseas, it’s well understood that immigration affects NHS staffing.
‘This analysis shines a light on migrant contributions to our health service that receive far less attention.’
Mr Vassiliou added that the analysis should give politicians ‘pause for thought’ about unforeseen and ‘possibly overlooked’ consequences of changes to visa rules.
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He said: ‘The government needs to think carefully about what it’s trying to achieve with the surcharge.
‘We need clarity on whether this policy is about migrants paying their fair share, topping up NHS funding, or discouraging migration in the first place.’
A DHSC spokesperson said: ‘The Immigration Health Surcharge is an entirely fair system that means migrants who apply to enter or remain in the UK for more than six months pay the costs upfront for any NHS treatment they may end up needing while they are here.’
