What has happened to international recruitment in social care?

New data show that the government granted around 90% fewer work visas to adult social care staff in 2024 than in 2023. In the space of a few years, we have gone from reports that a former Conservative minister wanted international recruitment into the care sector on ‘a mass scale’ to rumours the current Prime Minister is eyeing new immigration restrictions. This blog looks at changes in immigration policy relating to social care in recent years and considers what lies ahead.

2020 to 2023: Brexit, a recruitment boost and a brewing storm

Since Brexit, a succession of policy changes have affected international recruitment into the social care sector (see Box 1). In 2021, social care experienced record vacancies as UK economic inactivity rose, competing sectors like hospitality and retail reopened after the height of the COVID-19 pandemic and international recruitment was affected by Brexit. In response, the government made care workers and home care workers eligible for its Health and Care visa. 

The new care worker visa route successfully enabled significantly more international recruitment and boosted staffing in social care. In 2023/24, 1 in 3 new starters in direct care roles in the independent care sector was recruited internationally. While the vacancy rate in social care remained significantly higher than the wider UK labour market, it dropped from 11% in 2021/22 to 8% in 2023/24. 

Although migrant workers were vital to improving staffing in social care, there were significant problems with the care worker visa route. Concerns arose within government almost as soon as the route was introduced. By summer 2023, the media was reporting widely on modern slavery and exploitation of care worker visas. Last year, a report from the Independent Chief Inspector of Borders and Immigration described how a fundamental lack of understanding of social care in the Home Office contributed to mistakes when implementing the new policy. It found instances of sponsorship certificates granted to care homes that did not exist and a rise in illegal recruitment fees, modern slavery and wage underpayment. 

The care sector also heavily recruited from countries with severe shortages in health and care workers. Nigeria and Zimbabwe were among the three most common countries of birth for migrant workers taking up direct care posts in 2022/23 – both countries on the World Health Organization’s red list from where health and care professionals should not be actively recruited. This appears to remain an issue: in the final quarter of 2024, 42% (815) of social care visas were granted to applicants from red list countries.

2023 to 2024: Delayed diligence, the dependants ban and a drop in international recruitment

In the latter half of 2023, the Home Office began to make changes to the care worker visa, strengthening processes for assessing visa and sponsorship applications. After this, there was a significant decrease in work visas granted to social care staff (see chart below). Then, in early 2024, the government banned care workers from bringing family to the UK and required providers who recruit internationally to register with CQC, aiming to reduce levels of both immigration and exploitation.

Overall, around 90% fewer care workers, home carers and senior care workers were granted Health and Care Worker visas in 2024 than in 2023. The latest data show that fewer than 2,000 care workers, home carers and senior care workers were granted Health and Care visas in the final quarter of 2024, compared with just over 20,000 for the same period in 2023. Stopping care workers, who are mostly women, from bringing their families with them was controversial and being isolated may put workers at higher risk of exploitation and financial insecurity. And, anecdotally, some dependants of main visa holders also ended up working in the care sector, so the ban may have unintended consequences on staffing. But moves to improve oversight of these visas were clearly necessary to help prevent exploitation.

So far, provisional data do not suggest that the fall in international recruitment has had a significant negative impact on the vacancy rate or even on the new starter rate in social care. Social care staff who arrived in 2022 and 2023 will often have been on multi-year visas, so many will still be working in the sector. But the staffing situation is precarious – we may start to see higher vacancies in social care again, affecting people who need care and support.

Lessons from the care worker visa route

The care worker visa route demonstrates the important role that migrant workers have long played in sustaining the UK’s health and care sector. But, given that social care vacancies and turnover remained higher than the rest of the labour market throughout this period, it shows the limits of turning to international recruitment alone to tackle workforce problems. Sadly, it also highlights exploitative employment practices in the sector and the consequences of central government’s limited understanding, oversight and funding of the care system.  

A recently published government survey of the care workforce found that low pay is the key driver for leaving the sector – perhaps unsurprising given that around 1 in 5 social care workers lives in poverty. The government must make good on its promise of fair pay in social care, following through on plans to introduce a new ‘adult social care negotiating body’. And, alongside pay reform, the forthcoming social care commission provides an opportunity to set out a comprehensive workforce plan, to ensure good-quality jobs in the sector and enough staff to care for our growing population.