Social care providers will no longer be able to recruit staff from abroad via the health and care worker visa as part of the Labour government’s reform of immigration outlined in the white paper published 12 May.
Instead, social care providers will have to use domestic staff, people on other immigration visas or the pool of overseas staff who had been left without a job after losing visa sponsorship. The government said the measure would reduce immigration by 7,000 a year.
The paper also revealed changes to the time required to gain indefinite leave to remain (ILR), increasing it from five years to ten years.
The news has alarmed social care organisations, who said international recruitment had been a “lifeline” for the sector in recent years and that the decision risked “extreme workforce shortages” and harm to disabled and older people.
Professor Martin Green OBE, Chief Executive of Care England, described the plans as “a crushing blow to an already fragile sector. The Government is kicking us while we’re already down.”
Adding that “for years, the sector has been propping itself up with dwindling resources, rising costs, and mounting vacancies. International recruitment wasn’t a silver bullet, but it was a lifeline. Taking it away now, with no warning, no funding, and no alternative, is not just short-sighted – it’s cruel.”
Other provider bodies echoed his dismay on the changes, with the Homecare Association warning that the changes will “deepen social care workforce shortages, risking harm to older and disabled people across the UK.”
Unison, the UK’s biggest union representing health and care workers, also criticised the decision and called for urgent clarity on what the changes meant for those already working in the UK.
Christina McAnea, Unison’s general secretary, said:
“The NHS and the care sector would have collapsed long ago without the thousands of workers who’ve come to the UK from overseas.”
“Migrant health and care staff already here will now be understandably anxious about what’s to happen to them. The government must reassure these overseas workers they’ll be allowed to stay and continue with their indispensable work.”
The changes may be aimed at the social care sector, but the inevitable knock-on effect on the NHS, has alarmed other professional bodies. Professor Nicola Ranger, RCN General Secretary and Chief Executive, said in her keynote speech at the recent RCN Congress in Liverpool that the proposed immigration measures could “accelerate an exodus of migrant staff”.
Why is the government ending overseas recruitment
According to the Government, adult social care’s reliance on international recruitment is due to poor pay and conditions, which has deterred UK workers from joining the sector. It argues that the changes planned within its Employment Rights Bill will improve sector pay through a fair pay agreement. As a result this will attract UK staff into the sector and move the country away from a dependence on immigration.
The bill, published in October 2024 and currently going through parliament, includes the creation of an Adult Social Care Negotiating Body. This body will make agreements about the pay, terms and conditions of adult social care workers in England. The bill also tackles exploitative zero hours contracts.
There are however, big question marks over how the measures will be funded, bearing in mind that most services are funded by councils, which are struggling to provide services already due to a lack of funds.
Why does the social care sector recruit from abroad?
For decades little or nothing has been done to encourage good rates of pay, training opportunities, and good working conditions in the social care sector. As a result, it’s difficult to attract and retain domestic staff, who can get better pay and conditions in retail and hospitality.
In April 2022, adult social care vacancies in England hit a record high of 164,000, up 52% (56,000) on the year before and equivalent to just over one in ten of all posts. The Conservative government saw international recruitment as the quickest way to address the crisis.
Ministers set up a taskforce on boosting the number of international recruits in summer 2022. Then, in 2023-24, they provided councils with £15m to resource the recruitment of care staff from abroad.
As a result, the number of international staff recruited into direct roles in England’s independent care sector rose from 20,000 in 2021/22 to 80,000 in 2022/23, then rising further to 105,000 in 2023-24, according to Skills for Care, the charity that monitors the social care sector.
International recruitment was the primary reason for a reduction in vacancy numbers, from 164,000 in 2021/22 to 131,000 in 2023/24, and an increase in the number of filled posts, from 1.615 million to 1.705 million, from 2022 to 2024. The number of posts taken by non-EU international recruits rose from 140,000 in 2021/22 to 300,000 in 2023/24.
The changes in the White paper will reduce immigration, but according to the latest Home Office asylum and visa figures applications for the health and care visa have already tumbled since changes were made by the previous government in March 2024 and the present government in April 2025.
According to Home Office data, 27,174 health and care worker visas were granted in 2024, an 81% decrease compared to the previous year. The most recent data for 2025 shows a lower level than in 2024, at just 7,000 in the first four months of 2025, and significantly lower than in 2023 (145,823). Not all of these visas will be for care workers.
In March 2024 the Conservative made changes to the visa rules that prohibited care workers and home carers and senior care workers’ from bringing family members with them to the UK under the dependant visa route. Then in April 2025, care providers in England seeking to recruit workers from overseas, or those switching from another visa route, must first provide proof that they have attempted to recruit a worker resident in England through working with regional partnerships before they can hire from overseas.
It is not just these changes that have put off applications from abroad, but also the hostile environment created by the previous government as UNISON general secretary Christina McAnea, has noted:
“Hostile words and actions from the previous government, notably the ban on dependants, undoubtedly put off many overseas care staff from coming to work in the UK. Instead they’ll have chosen countries with warmer welcomes. Other care workers will have been deterred by the many horror stories of the abuse and exploitation of migrants at the hands of cowboy care operators.”
Unison is currently running a campaign to ensure migrant care workers get respect, dignity and fair pay in the workplace, as a result of considerable evidence collected by the union over recent years that international recruits in social care have been subjected to unacceptable treatment including fraud, underpayment of wages, bullying, racism and many other forms of exploitation and mistreatment.
What will be the consequences of the changes
Social care continues to have high vacancy levels, despite the influx of international recruits in 2023, without further international recruitment, providers will find it very difficult to provide adequate services.
Lack of staff in social care has wide scale consequences: elderly and vulnerable people do not get the care they need increasing the pressure on the NHS, hospitals can not discharge patients safely as care packages take longer to develop or are simply not available, with the knock-on effect on A&E and elective surgery as bed space is taken up. There is also a major cost for councils trying to fulfil their statutory duties with expensive agency workers, and in the wider economy, as people (usually women) have to give up work to care for relatives.
Jess McGregor, president of the Association of Directors of Adult Social Services (Adass) noted: “A shortage of care workers leads to a triple whammy of more reliance on agency staff who the person drawing on care won’t know and who the provider will need to pay much more for, more people – especially women – giving up paid work to care for their loved ones, and many people potentially missing out on care altogether.”
Much of the discussion around the white paper for social care has focused on the ending of the care worker visa route. However, the change to the time taken to gain settled status, an increase from five years to ten years, also has implications, as does the whole tone of the white paper, which is widely seen to be hostile to immigrants.
Professor Nicola Ranger, RCN General Secretary and Chief Executive, noted that closing the care worker visa route and making migrant nursing staff wait longer to access vital benefits will create a “hostile environment on steroids”.
“They pay tax and work in our vital services, they deserve the same rights. Sadly, this government is intent on pushing people into poverty, away from the country, and with no credible plan to grow the domestic workforce in sight.”
The RCN has recently published the report – Unreciprocated Care: why internationally educated nursing staff are leaving the UK – now sent to the Home Office and the Department of Health and Social Care, in which the views of more than 3,000 IENs working in the UK were reported. Of these 42% said they are planning to leave the country. Of those who planned to leave, 70% said a better salary would influence their decision to stay in the UK, and 40% said immigration policy would be another important factor.
The report also details shockingly normalised levels of discrimination faced by migrant nursing staff. Overall, two-thirds (64%) of respondents said they had experienced discrimination since moving to the UK.
Growing a domestic workforce
Despite the spike in international recruitment through 2023, the social care sector continues to see a high vacancy rate, with an estimated 131,000 vacancies and employers continuing to struggle to recruit with turnover levels high, according to Skills for Care. The visa changes already enacted have driven down international recruitment, but domestic recruitment has failed to compensate as the issues of low pay, lack of career progression and poor working conditions still prevail in the sector.
The sector welcomes the changes promised in the Employment Rights Bill; however, the sector’s issue is what to do in the interim period.
Growth of a domestic workforce will only be possible if pay and conditions are improved and these changes are years away, meanwhile the sector has a recruitment problem that can no longer be addressed by international recruitment. Professor Martin Green of Care England noted:
“We’re told to wait for the Employment Rights Bill and a Fair Pay Agreement, but those reforms are years away and come with no significant funding attached. In the meantime, we’ve lost 70,000 domestic workers over the last two years, vacancies still remain sky-high, and many providers are on the brink of collapse. Who do Ministers think is going to care for people tomorrow, next week, or next month?”
UNISON general secretary Christina McAnea also noted that a fair pay agreement must become a reality and social care be funded properly as “long as care wages stay barely above the legal minimum, employers will never be able to recruit the staff needed to deliver a national care service of which we can all be proud.”
She added that politicians should also stop describing care jobs as “low-skilled” pointing out that “the work is tough, requires a high level of skills and huge amounts of empathy, as any family whose relative is receiving care support knows only too well.”
Growing a domestic workforce requires government help, but since this government came to power it has shown little sign of wanting to help the adult care sector. In July 2024 it cancelled the planned cap on care costs, and in September 2024 it made a significant cut to planned investment in training. The government has also not compensated providers for the national insurance rise.
In addition, it seems unlikely that any additional funding will be available to help social care in the coming years to grow its workforce. In June, the government’s spending review will be announced, setting public expenditure levels from 2026-29. According to the independent Office for Budget Responsibility, this settlement is likely to be exceptionally tight, with local government possibly facing real-terms cuts in resources. Even if the proposed negotiating body for social care pay, to be put in place by the Employment Rights Bill, agrees a significant increase in pay and change of conditions for adult social care, it may not be signed off by ministers or if signed off, it may just not be funded, leaving already cash-strapped councils to try and implement it.
In the long-term, the Independent Commission into Adult Social Care, led by Baroness Casey, is due to produce a 10-year plan for developing a ‘national care service’ in 2026 and an even longer-term reform strategy by 2028. It is possible that the plan results in a generous funding settlement for local government and adult social care for 2029 onwards, laying the ground for a significant boost in pay and conditions, then again it might not.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
