The number of Health and Care worker visas issued to foreign health care professionals who take employment in an eligible job with the NHS, an NHS supplier or in adult social care remains on the increase. This immigration route was opened in August 2020 to address the shortage of skills within the sector. It made up nearly 60% of all work visas issued during the year up to June 2023, with the majority of visas being sponsored in adult social care, care worker and home carer roles.  Yet staff shortages are still a major concern for the sector.

In reality, care home staff from overseas continue to feel under pressure. Upcoming changes to the immigration system will restrict their ability to bring dependant family members to accompany them from 11 March 2024, yet more concerning challenges were recently exposed by BBC’s Panorama which  reported that care home staff feel “exploited and trapped” making them vulnerable and putting them at risk.  Anti-slavery charity Unseen, reported that the number of workers contacting their modern slavery and exploitation helpline significantly increased in the last year and the report highlighted that overseas workers do not always understand their rights in the UK, which leaves them vulnerable to abuse and exploitation. Home Office statistics released last year confirmed that Indian, Nigeria and Zimbabwean nationals make up the majority of the Health and Care worker visas issued to care workers last year.

There is no doubt the sector is susceptible to worker exploitation and modern slavery due to long-term issues of low pay and poor working conditions owing to persistent underfunding in social care. It is vital to highlight that when care workers are sponsored for employment under the immigration rules, they are tied to the employer for the duration of their sponsorship; that could be up to five years. If their employment should end prematurely, they would be required to return to their home country if they cannot secure employment with another sponsor within 60 days. There is the added complexity when employers include repayment clauses in contracts for visa fees incurred during the application process and in some cases contract clauses preventing employees from working for any competitor care homes. The Department of Health and Social Care (DHSC) Code of Conduct, makes it clear that staff should not have to pay these costs. This behaviour can be seen as a mechanism for unscrupulous employers to intimidate their staff. 

While it is imperative for the UK to tackle the shortage of skills in the sector, the Care Quality Commission and UK Visas and Immigration, Home Office must do more to safeguard staff where there are systematic failings of poor practice. The Home Office will revoke sponsor licences where there is abuse of the system, but employers in turn must ensure they are hiring staff with the required skills and experience to ensure the correct quality of care is provided. Employers also need to be conscious that all staff, irrespective of their race or nationality are treated fairly and equally.  Employers should follow the Home Office Code of Practice on preventing illegal working, to avoid unlawful discrimination while preventing illegal working.


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