Tory plan to double migrant worker surcharge will worsen NHS staffing crisis, says BMA

BMJ 2017; 357 doi: (Published 19 May 2017) Cite this as: BMJ 2017;357:j2453
  1. Matthew Limb
  1. London

The Conservative government’s pledge to double the charge that organisations pay to employ workers from outside the European Economic Area will exacerbate the NHS staffing crisis and “take around £7bn a year from the NHS frontline,” the BMA has said.

The Conservative Party’s manifesto promises that by the end of the next parliament the immigration skills charge, which was introduced in April and currently stands at £1000 (€1165; $1300) per year of a tier 2 visa (for immigrants working in skilled areas), would rise to £2000.

The BMA said that the government had ignored warnings that the immigration skills charge would worsen the NHS staffing crisis. Mark Porter, its chair of council, said, “As overseas staff can only be employed if recruitment from the UK and EU has been unsuccessful, it is completely unacceptable for the Conservatives to pledge what is in effect a penalty against trusts for trying to fill staff shortages and maintain safe patient care.”

He added, “Public health is the ticking time bomb facing the UK, yet there is no mention of preventive measures in this manifesto.”

The prime minister, Theresa May, launched her party’s manifesto on 18 May (, saying that she would give the NHS the resources it needs if the Conservatives were re-elected on 8 June. She pledged to increase spending on the NHS by a minimum of £8bn in real terms over the next five years, which would raise real terms funding per head of population for “every year of the parliament.”

But independent health economists have called for more clarity, warning of a £12bn funding gap and the NHS receiving a falling share of UK national income.

The Health Foundation said that the proposed figures exceeded current spending plans and that estimated healthcare spending in England would rise by around £800m next year (2018-19). Between now and 2020-21 spending would increase by an annual average of 1.2% a year, the analysis said. Anita Charlesworth, the foundation’s director of research and economics, said, “The Conservatives’ proposals would mean NHS spending per person would not fall in real terms in the next two years, as currently planned. But it would leave a funding gap for the NHS in England of £12bn by 2020-21.”

The health think tank the Nuffield Trust said thatmore clarity was needed about the extra funding: when it would start and whether pledged upgrades for buildings and IT would be backed by new spending. The trust’s chief executive, Nigel Edwards, said, “Even under a generous interpretation of what will happen to these other budgets, the share of Britain’s national income going to the NHS will continue to shrink, from 7.3% to 7%. The same is the case for the other parties’ proposals as well: we are on course for more than a decade of unprecedented austerity.”

The Conservatives’ manifesto has retained a commitment to reduce immigration to the tens of thousands, despite May’s failure to get close to the target for six years as David Cameron’s home secretary. It also pledged to introduce a new GP contract to help develop wider primary care services and to reform the contract for hospital consultants “to reflect the changed nature of hospital care over the past twenty years.”

The target for 95% of patients in hospital emergency departments to be seen within four hours would be retained, and up to 10 000 more mental health professionals would be recruited.

The 84 page manifesto laid out five “giant challenges” facing the UK over the next five years and beyond—achieving a strong economy, delivering Brexit, and tackling social divisions, an ageing society, and fast changing technology—but without any detailed costings of policy promises.

The Conservatives pledged to raise an extra £4bn for schools by 2022 but would stop free school lunches for all children in the first three years of primary school in England and instead fund breakfasts across the primary years.


  • News Liberal Democrat pledge to extend GP opening hours needs proper funding plan, say experts doi: 10.1136/bmj.j2428; Labour’s pledge to boost NHS funding by £30bn is “still not enough” doi:10.1136/bmj.j2404

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