As Boris Johnson left hospital after a week of treatment for Covid-19, he lauded the care he had received, in particular from two nurses – Jenny McGee from New Zealand, and Luis Pitarma from Portugal.

In a lengthy statement about how the NHS saved his life, the prime minister praised the ward sister and senior staff nurse at St Thomas’ hospital in London as being typical of their profession. But it is a profession that has suffered badly as a result of government policy in recent years.

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Since the Conservatives came to power in 2010, the average salary for a nurse has fallen by 8% based on the consumer prices index (CPI) – or by £2,646 in real terms, according to the Royal College of Nurses (RCN).

Rehana Azam, GMB national secretary, said that health workers “continue to be punished by austerity pay policies”, adding: “The government’s new NHS salary arrangements fail to account for this grotesque loss which has consigned NHS workers to real-terms pay cuts. We need pay justice for the NHS workers, who are currently putting their safety at risk to save lives.”

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Migrant nurses – as both McGee, 35, and Pitarma, 29, are – may face other difficulties too. During last year’s election campaign, Johnson announced plans to increase the yearly surcharge for all non-EU migrant workers by more than 50% from £400 to £625 and to extend it to all EU citizens who migrate to the UK after Brexit.

The fee is payable for each member of a family migrating, meaning nurses who come to Britain with a spouse and two children would have to pay the government £2,500 a year for the privilege of working in the NHS.

Announcing the change in November last year, the health secretary, Matt Hancock, tweeted: “It’s the National Health Service not the International Health Service. Everyone should make a fair contribution towards our NHS.”

Matt Hancock (@MattHancock) It’s the National Health Service not the International Health Service.



Everyone should make a fair contribution towards our NHS - so after Brexit we’ll extend the NHS surcharge to all non-UK residents. https://t.co/hYeBprtvrG

Figures obtained by the Liberal Democrats last year showed that almost 5,000 nurses who were EU nationals had left the health service since the Brexit vote in 2016. Additionally, figures from the Nursing and Midwifery Council showed that the number of nurses arriving from the EU dropped hugely, from 6,382 in 2016-17 to 805 in 2017-18.

Until 2018, a cap on skilled workers led to thousands of foreign nurses from outside the EU being denied visas. The rules were relaxed to make nurses exempt, amid a staffing crisis in hospitals. Nevertheless, according to the RCN, vacancies for nurses in England alone are running at about 40,000 currently.

Donna Kinnair, RCN chief executive and general secretary, said: “International staff are expected to pay twice for the very services they keep running – the government should remove this immoral immigration health surcharge for nursing staff without delay.

“Across the UK, health and care services were already missing tens of thousands of nurses before this began – making this unprecedented challenge even more difficult to face.

“When this pandemic is over and pay negotiations begin, ministers must remember the dedication and sacrifice that was on display – properly rewarding staff will begin to address the long-term shortages in the nursing workforce.”

A cap on pay rises for NHS workers was lifted in 2018. The previous year, both Johnson and Hancock had voted against ending the cap. Sara Gorton, Unison’s head of health, said pay freezes and caps had “caused much financial hardship and fuelled staffing shortages”.

Munira Wilson, the Lib Dems’ health spokeswoman, said: “Now more than ever, it is obvious to us all how much we value each and every healthcare worker – and just how many of them are from overseas yet risking their lives for our country.”

McGee’s mother, Caroline, said on Monday that her daughter had described the experience of treating the prime minister as “surreal”.

She told broadcaster TVNZ that her daughter, from Invercargill in New Zealand, was “very professional” and waited until Johnson, 55, was out of intensive care to let her parents know that the prime minister was one of her patients.

She said her daughter told them “she had just had a most surreal time in her life, something she will never forget, and that she had been taking care of Boris”. The prime minister of New Zealand, Jacinda Ardern, said the country was “very proud” of McGee.

For his part, Pitarma, a senior staff nurse, was thanked by the Portuguese president, Marcelo Rebelo de Sousa. His cousin, Ivo, a firefighter who lives in Aveiro, Portugal, said: “I’m obviously very proud. I knew of course that Luis was a nurse in London but had no idea he had been looking after Boris Johnson so this has come as a real surprise for me.”

A government spokesperson said: “Doctors, nurses, paramedics and health professionals from all over the world continue to play a leading role in our country’s healthcare … as part of the national effort to combat coronavirus, frontline NHS workers will automatically have their visas extended free of charge, as outlined by the government in early April.”