Revenue from Britain’s immigration health surcharge fell by more than £100 million between the 2024–25 and 2025–26 financial years as migration declined, according to analysis by the health policy think tank the Nuffield Trust.
The findings, reported on Tuesday, 20 October, highlight how a charge paid by many visa holders has become an increasingly important, but potentially unstable, source of National Health Service funding. Read the Nuffield Trust briefing.
How Much Revenue Has Been Lost?
According to the Nuffield Trust, surcharge income peaked at approximately £2.42 billion in 2024–25 before declining to around £2.32 billion in 2025–26. At its peak, the charge accounted for roughly 1% of the NHS budget.
The difference is a fall in annual revenue, not proof that the NHS has already cut services by the same amount. The think tank warned that further declines in visa numbers could reduce future receipts.
Who Pays the Health Surcharge?
Most people applying for UK work or study visas must pay the immigration health surcharge in addition to visa fees. The standard annual rate is £1,035, although some categories pay a reduced rate or qualify for exemptions.
The fee was introduced in 2015 at £200 a year. It is generally collected upfront for the length of a visa, meaning income can fluctuate sharply as the number and duration of new visas change.
Importantly, paying the surcharge does not mean migrants receive preferential treatment. The charge contributes towards NHS access during the visa period, while many migrants also contribute through taxation.
Do Migrants Cost More Than They Contribute?
The Nuffield Trust estimated that, for the group paying the surcharge, contributions through the fee and taxation were at least 60% higher than the government’s estimated cost of their NHS care in 2023–24.
That estimate depends on modelling assumptions and does not mean every migrant makes the same financial contribution. Income, visa category, dependants, and healthcare use vary considerably.
Why Could This Complicate Immigration Policy?
The funding issue arises because the NHS receives surcharge revenue when visas are issued, even though the holder may remain eligible for care for several years. Lower new visa issuance can therefore reduce income before healthcare obligations to existing residents end.
The Department of Health and Social Care has defended the surcharge as a way for migrants to contribute to the potential cost of NHS treatment. The Nuffield Trust, however, argues that policymakers should examine whether relying on immigration-linked revenue is sustainable.
Trivane has separately reported on changes to UK visa rules and on the contribution of Nigerian nationals to the NHS workforce in England.
The new figures show why migration policy also has implications beyond border control: changes in visa numbers can affect public finances, workforce planning, and healthcare funding at the same time.
The surcharge is normally collected for the full visa duration in advance. The Nuffield Trust argues that the practice of transferring and spending that revenue in the year of arrival creates a mismatch: income can fall immediately when visa numbers decline, although people who paid in earlier years remain eligible for NHS services throughout their permission to stay.
The think tank estimates that the surcharge accounted for roughly 1% of the NHS budget at its 2024–25 peak. That is a meaningful sum, but it does not follow that a £100 million reduction automatically creates a £100 million hole in a specific hospital’s operating budget. Funding arrangements and government spending decisions also matter.
The analysis raises a separate question about fairness. Many visa holders pay the health charge while also contributing through income tax and other taxes. Nuffield Trust modelling suggests the combined contribution of surcharge-paying migrants in 2023–24 was at least 60% higher than the government’s estimated healthcare costs for that cohort. The estimate is model-based and should not be generalised to every migrant or every NHS service.
The government, meanwhile, defends the charge on the grounds that people coming to live in the UK for more than six months should contribute towards possible treatment costs. Its position reflects a different policy objective from the Nuffield Trust’s concern about fiscal stability.
For prospective migrants, the distinction between a surcharge and an NHS workforce contribution is important. Trivane previously documented that 40,575 Nigerian nationals worked in NHS hospital and community services in England in June 2025, based on official nationality data. That is a workforce figure, not a count of health-surcharge payers, and the groups must not be conflated.
The report therefore identifies a policy trade-off rather than a simple verdict on immigration controls: fewer visas may reduce upfront surcharge receipts, while changes to migration can also affect the demand for services, tax receipts and NHS staffing. Those effects require separate evidence.
