Denise Osterwald, legal director for law firm Birketts, weighs up the debate on using international workers to support the struggling social care sector.

The UK media has been reporting for years that there is an acute labour shortage in the country’s health and care sector. According to the Skills for Care’s Workforce Intelligence Team (commissioned by the Department of Health and Social Care to collect data on adult social care providers and their workforce), there were around 152,000 vacancies for the year ending in March 2023.

While these numbers seem high, the vacancies actually dropped significantly from the previous year (164,000 in the year March 2021 to March 2022). It is a reasonable assumption to trace the reduction in vacancies back to a corresponding increase in visas issued to workers in this sector (in 2021/22 20,000 migrants entered the UK to take up health and care roles, in 2022/23 the number rose to 70,000).

This was mainly possible due to several changes the Home Office made to skilled worker visas over the last few years (specifically referred to as Health and Care Worker visa in the context of skilled worker sponsorship in the medical sector). After a general overhaul of the UK’s immigration system to take account of the end of free movement from the European Union, it was possible from 1 January 2021 to sponsor senior care workers, however, it was not possible to sponsor entry-level health and care workers because they were not considered to be sufficiently skilled enough to add value to the UK labour market. Senior care workers were also added to the UK’s Shortage Occupation List (SOL – a list containing all UK roles the Home Office considers to be suffering from a workforce shortage) the same month.

The Home Office changed its stance on the ability of junior care workers to obtain a UK work visa in February 2022, when they were also included on the SOL. This gave employers with a sponsor licence the ability to sponsor entry-level care worker roles via the Health and Care Worker visa for a reduced salary compared to the standard Skilled Worker visa and to apply for their visas by paying reduced government fees. These changes have meant that entry level care worker visas have overtaken all other Health and Care Worker visas in numbers.

The lower skills requirement for entry-level positions and reduced applications costs appear to have attracted a number of less scrupulous recruitment agencies, some of whom charge migrants excessive fees to obtain visas for them, while paying them the minimum wage once they arrive in the UK. These workers are then provided to the NHS or private care homes. There have been reports in the media that many do not receive adequate training and may also be working in poor conditions and excessive hours in a bid to pay off their visa debts to their employer.

After easing the visa restrictions on the Health and Care Worker visas in February 2022, the Home Office has recently decided to tighten them again to reduce the UK’s net migration figures and prevent the misuse of this visa category. However instead of reverting to permitting only senior carers to be sponsored, from 11 March 2024, new carers and senior carers requiring a visa can no longer bring family members with them to the UK, and only providers registered with the Care Quality Commission can sponsor Health and Care Worker visas. Other medical occupations (for example Doctors and Nurses) are not affected by these changes. The change in rules is therefore specifically intended to make coming to the UK as an international care worker less attractive.

On 4 April 2024 the UK authorities also raised the minimum salary requirement for the general Skilled Worker visa category significantly. While those already on Health and Care Worker visas are exempt, it is still expected that their salaries will be required to increase in line with those of the general UK employment market to ensure better parity and to avoid undercutting of resident workers.

It is vitally important for anyone using agency care staff to ensure that anyone entering their premises is checked for their right to work in the UK, current registrations with professional bodies in the UK, and their knowledge and ability to undertake the job they were sent to do.

It has become clear that shortages in the UK health and care sector cannot be remedied by relaxing visa rules alone. The UK authorities are trying to find a balance between allowing businesses to fill their vacancies, while keeping an eye on net migration and protecting workers from infringements of their rights. This will likely mean an unsettling period for end users relying on care workers in this visa category. Everyone involved in the health and care sector will need to watch this space carefully and be able to react to changes quickly.