Written evidence submitted by Nigerian Doctors in the UK (RTS4070)

This statement responds to the Call for Evidence on ILR Routes to Settlement by the UK Parliament and is submitted on behalf of Nigerian Doctors in the UK (NDUK). NDUK represents over 11,000 doctors and dentists of Nigerian origin who live and work in the UK or intend to do so, and is a non-profit organisation dedicated to professional development, social support, and the wellbeing of its members and their families. NDUK members make substantial and ongoing contributions to the NHS, the wider health and social care system, and the UK economy.

1. Evidence on pathways to settlement and their impacts

The existing five-year route to settlement provides a clear, time-bound pathway that supports long-term planning, integration, and workforce stability for migrant doctors and their families. Lengthening routes and tightening requirements risk creating prolonged precarity, discouraging investment in careers, housing, and education, and making the UK less attractive compared to countries offering faster and more predictable settlement. For the NHS, this would likely exacerbate workforce shortages, reduce retention of highly skilled clinicians, and weaken service capacity, particularly in underserved areas.

2. Economic and workforce impact of longer routes

Most medical training and non-training posts are offered on one-year contracts requiring annual renewal, which interact negatively with a prolonged pathway to ILR. Repeated visa applications, biometric appointments, and potential relocations impose substantial cumulative costs over ten years or more, limiting doctors’ ability to buy homes, start businesses, or pursue further training. Longer routes also reduce career mobility and bargaining power, as immigration status is tied to continued sponsorship; this suppresses progression and, indirectly, tax contributions that would otherwise accrue to the UK. At a time when comparator countries such as Canada, Australia, and New Zealand offer shorter and more stable routes to settlement for health professionals, extending the UK route risks accelerating onward migration and further harming NHS resilience.

For many doctors, the estimated basic immigration costs over a ten-year Skilled Worker journey under the proposed earned settlement model will exceed £16,000 for a single applicant and over £60,000 for a family of four, excluding priority and sponsor-related fees and future increases. Framing a longer qualifying period as “earned settlement” in this context is perceived as punitive rather than rewarding long-term service, particularly for those who have already invested heavily in the UK through taxes, professional work, and community participation. This undermines the policy objective of attracting and retaining high-skilled workers and risks creating the impression that settlement is an exclusive privilege rather than a realistic outcome for committed contributors.

3. Employer-tied visas and risk of exploitation

Tying sponsorship to individual employers, rather than sectors, already creates vulnerability where loss of employment can rapidly lead to loss of lawful status. Extending the journey to ILR to 10-15 years magnifies this risk over a much longer period, leaving workers perpetually dependent and less able to challenge unfair treatment. Cases where individuals lose employment shortly before becoming eligible for ILR illustrate how devastating this can be under a five-year model; under a ten or fifteen-year model, a similar event in the ninth or fourteenth year would be significantly more damaging, both financially and psychologically. Prolonged employer-controlled status is likely to increase the risk of exploitation and undermine ethical recruitment principles.

It is also common for doctors to begin in non-licence-restricting or lower-paid roles before progressing into substantive medical roles within the NHS. Under current rules, five years on a Health and Care Skilled Worker visa can count towards ILR regardless of role progression within that period. Proposals that differentiate pathways by income thresholds or role categories introduce uncertainty about how such career trajectories would be treated and risk unfairly penalising doctors who have made sustained and substantial contributions to the NHS over time.

4. Impact on families, dependants, and children

The proposed framework appears to treat dependants less favourably than principal applicants, particularly in Health and Social Care. Many doctors work at least 48 hours per week, while their partners combine paid work with primary childcare and other domestic responsibilities that enable the doctor to maintain demanding shift patterns that are required to sustain delivery of care and service within the NHS. A strict individual minimum earnings or tax-contribution threshold for dependants does not recognise this joint contribution to household functioning and the sustainability of NHS services. As a result, partners who undertake essential unpaid, part-time, or low-paid work may never qualify for ILR, creating permanent immigration status asymmetry within households.

Requiring dependants to meet English language and minimum tax contribution thresholds without adequate flexibility for caring responsibilities creates major barriers for families with young children. Scenarios in which a principal applicant qualifies for ILR but the partner does not would lock families into a state where one adult remains indefinitely on a dependant visa, with reduced security and rights. Children born outside the UK who migrate with their parents may also face complex and prolonged routes to settlement if both parents are not able to qualify simultaneously. Uncertainty over the continuation of existing long-residence provisions for children creates fracture lines in the family unit along immigration lines and intensifies insecurity for families making educational and life plans.

If the qualifying period for ILR is extended to ten years, many children entering the UK at age eight or older would reach university age without ILR and therefore be ineligible for home-fee status or most student finance. They would face international fees despite long-term residence and schooling in the UK, leading to reduced access to higher education and deepening educational inequalities. Aligning eligibility for home-fee status with years of residence in the UK, rather than ILR alone, would better reflect these children’s genuine ties to the country.

5. Fairness, psychological impact, and retroactivity

Many migrant families have structured their careers, finances, and family life around the current five-year route to ILR. Retrospectively extending this route to ten years or more for those already in the UK would undermine the principle of legal certainty, damage trust in public institutions, and conflict with widely held notions of fairness. Frequent, substantial rule changes and anti-immigrant rhetoric contribute to heightened anxiety and a sense of not being wanted, even among those who are filling critical shortages in the NHS and paying substantial taxes.

A model in which families contribute for a decade or more without access to long-term security risks creating a stratified system where only those with the greatest financial resources can realistically achieve settlement. This would shift ILR from a marker of contribution and integration to a test of affordability, entrenching inequality and diminishing the UK’s attractiveness to globally mobile, highly skilled professionals.

6. Integration and social cohesion

Pathways to settlement are central to integration because they signal whether long-term residence, work, and community participation will ultimately be recognised with secure status. Clear, achievable routes support language acquisition, civic engagement, and local participation, whereas prolonged insecurity can inhibit these behaviours. If settlement is perceived as arbitrarily delayed or dependent on high financial thresholds, migrants may be less inclined to invest in community life, which could undermine social cohesion and the policy goal of promoting integration.

International experience suggests that jurisdictions which provide predictable and inclusive routes to permanent residence tend to achieve better labour market outcomes, higher rates of naturalisation, and stronger social integration among migrants. By contrast, highly restrictive, extended routes can correlate with increased irregularity, labour exploitation, and parallel communities, none of which support stable integration outcomes.

7. “Earned settlement” and defining contribution

A contribution-based system must define “long-term contribution” in a way that recognises both fiscal and non-fiscal elements. In the context of migrant doctors and health professionals, key dimensions include:

- Fiscal and economic contributions: income tax and National Insurance payments; sustained employment in shortage occupations; participation in out-of-hours and emergency services; and contributions to training, supervision, and service improvement.

- Social and community contributions: service in underserved or rural areas; involvement in community health initiatives; engagement with professional bodies, teaching, and mentoring; and participation in local civic or voluntary activities.

These elements could be quantified over time, but they should be weighted in a way that acknowledges that contributions are often made at household level. A household income or household contribution approach, complemented by recognition of unpaid care and community work, would provide a more accurate picture of total contribution than a narrow focus on individual earnings.

8. Exemptions and safeguards

Within any earned settlement system, there should be clear exemptions and safeguards for:

- Key public service workers, including doctors, nurses, and other health and social care professionals, to ensure their routes remain viable and competitive internationally.

- Dependants with primary caring responsibilities, who should not be disadvantaged because their unpaid labour underpins the principal applicant’s ability to meet workforce needs.

- Children and young people who have completed a substantial part of their education in the UK, whose integration and prospects should not be constrained by a prolonged parental route.

There should also be transitional protections to prevent retroactive application of extended qualifying periods to individuals who have already embarked on a five-year route in good faith. Such protections are essential to maintaining trust and avoiding sudden, life-altering detriment.

9. International practice on contribution-based systems

Other countries that apply contribution-based or points-based approaches often combine time-based residence requirements with clear criteria linked to employment, language, and civic integration. However, they frequently provide:

- Shorter or accelerated routes for priority occupations such as healthcare.

- Greater portability of status across employers to reduce dependency and exploitation.

- Stronger consideration of family unity in settlement decisions, recognising the role of dependants in supporting labour market participation and integration.

In designing the UK’s earned settlement model, it will be important to ensure that any contribution-based criteria do not inadvertently exclude those in key public services or those whose contributions are not easily captured in salary thresholds alone.

10. Recommendations

In light of the above, NDUK submits the following recommendations:

a. Reclassify doctors and healthcare professionals as “Global Talent” or equivalent, with access to settlement timelines and dependant provisions comparable to the existing Global Talent route, including accelerated pathways where appropriate.

b. Maintain a five-year qualifying period for ILR for doctors and health professionals already in the UK, and ensure any move to a ten-year qualifying period if effected, is not applied retroactively to this cohort.

c. Align the ILR pathways of dependants of doctors and healthcare workers with those of principal applicants, so that families can settle together after the same qualifying period.

d. Exempt dependants from rigid individual minimum work or tax-contribution thresholds and instead assess total household income and contributions, explicitly recognising unpaid care and support that enable NHS service delivery.

e. Ensure that time spent in different but lawful health service roles within the NHS counts towards ILR, provided the individual has met continuous residence and compliance requirements.

f. Take steps to avoid and reduce educational inequalities by allowing long-term resident children to access home-fee university status after a defined period of residence as is obtainable in Scotland, regardless of ILR timing.

10. Conclusion

Medical professionals and their families are integral to the functioning of the NHS and to the UK’s broader economic and social fabric. Any reform of ILR routes should safeguard the UK’s ability to recruit and retain such staff, uphold fairness and family unity, and recognise the full spectrum of contributions that migrant doctors and their households make to the United Kingdom.

Dec 2025