Pressure is mounting on the government from doctors, nurses and carers to scrap the surcharge that many migrant healthcare workers must pay to access the NHS, in recognition of the many risking their lives on the coronavirus frontline. Overseas staff recruited to work in healthcare jobs have expressed anger at the rising cost of the NHS surcharge, set to increase to £625 per year later this year, which they must pay for themselves and each family member alongside the cost of their UK visas. With international healthcare workers disproportionately represented in frontline healthcare roles, and also disproportionately the victims of Covid-19, the sense of injustice has heightened. Carl Perez, 27, a nurse who was recruited two years ago from the Philippines, became ill with Covid-19 at the end of last month while working at a care home in the West Midlands where several residents have died from the illness. He is currently in isolation at home. “It feels unfair that we are risking out lives on the frontline, and we are being penalised by having to pay this large sum out of our own pockets. We’re already paying for the NHS through our national insurance and tax,” he said. “It doesn’t leave much left for accommodation and living costs.” He said friends and colleagues felt similarly outraged, particularly given that many were still paying off debts relating to tuition and medical qualifications. The cost of the surcharge has risen three times in four years. “It is not fair for us migrants to shoulder the burden of the extra funding for the NHS. It’s a lot of money, especially to someone like me who doesn’t use the NHS much because I’m fit, active and healthy,” Perez said. The surcharge was introduced in 2015 as part of “hostile environment” legislation meant to discourage illegal migration, and to combat health tourism. The Home Office said the charges raised about £900m for the NHS between 2015 and 2018-19. The government has announced a number of one-year visa extensions for those working in healthcare, including a one-year exemption from the surcharge, for NHS doctors, nurses and paramedics due to renew a visa before October, so they do not need to renew their visas for the duration of the pandemic – but these exemptions are not comprehensive. Most frontline carers working in social care are not eligible, and workers like Perez, for example, whose visa comes up for renewal next year, will not benefit. The home secretary, Priti Patel, said last week the government was “reviewing” the charge but gave no further details. Dr Zakiuddin Mohammed, who moved from India six years ago to work as a doctor and is treating Covid-19 patients daily, said: “Much more than the monetary burden, it makes me feel as though the government doesn’t value our contribution. It is extremely unfair because we’re paying taxes and national insurance, and being told: if you’re to access the services of this wonderful organisation that you’re contributing so much to, you will have to pay a surcharge. It feels very ungrateful to us.” Labour’s shadow immigration minister, Holly Lynch, welcomed the extension of visas for some frontline workers, but added: “The government also needs to think again about whether the NHS surcharge paid by migrants to the UK, and working in the NHS, and other essential sectors, is fair.” Kimesha from Jamacia, a domiciliary carer for older people who asked to withhold her full name to avoid complications with her employer, said she found the surcharge hard to afford on her hourly rate of £9, which is 18p above the minimum wage. She has taken a second job in the evenings as a waitress, in order to pay the cost of renewing visas and paying the surcharge for herself and her three children. She has had to buy masks and gloves on eBay because the protective equipment provided by her employers has run out. “It is very stressful because it keeps going up. It is a struggle for people like me who aren’t earning enough to pay rent, council tax and bills. It should be abolished for everyone,” she said. Dr Chandra Kanneganti, the national chair of the British International Doctors’ Association, said: “We know BAME doctors are disproportionately getting ill. To have to pay for the same service that they are putting their lives at risk for doesn’t seem fair. This charge needs to be scrapped completely for NHS overseas workers.” A Home Office spokesperson said the government “fully recognises the contribution international health and care professionals make to the UK”, and described the visa extensions as “an exceptional offer to show our gratitude”, but added: “It is in the public interest for migrants to be financially independent and not burden UK taxpayers. Those who benefit from the state should be contributing to it.” Dr Chaand Nagpaul, the council chair of the British Medical Association, said: “The BMA has consistently said that all healthcare workers should be exempt from paying the immigration health surcharge – and this is more important now than ever. At a time when our skilled international colleagues are in many cases putting their lives on the line to fight Covid-19 on the frontline, it beggars belief that they are still being charged to use the very service they are working for.” Campaigners point out that many of those paying the surcharge are also on conditional work visas, that say they have “no recourse to public funds”, meaning they are not eligible for universal credit if they lose their jobs, and risk losing their visas if they become unemployed. This makes them less willing than UK residents to complain about working with poor protective equipment, and may help explain the disproportionately high fatality rate among BAME workers. “Migrants are made more vulnerable to exploitation by the immigration system. The NHS disproportionately relies on the labour of migrants who have already paid twice to keep it running, but who are denied access to public funds if they lose their job and face having to leave the country. It is no surprise if they feel huge pressure to stay, uncomplaining, on the frontlines of the fight against Covid, even if they feel unsafe, because they cannot risk speaking out,” said Chai Patel, the legal policy director at the Joint Council for the Welfare of Immigrants. Susan Cueva, a trustee of Kanlungan Filipino Consortium, which campaigns for migrant rights, said many international healthcare workers were afraid of losing their jobs and being sent back home. “So they keep on working, knowing they are risking their lives.”