Will the United Kingdom Struggle From Lack of Health Care Workers: What Has Changed in Health and Care Visa Requirements?

The UK has long relied on international recruitment to bolster its healthcare workforce, particularly in response to chronic shortages of skilled professionals due to Brexit and the COVID-19 pandemic. 

However, recent changes to the Health and Care Visa route have sparked concerns about the future supply of healthcare workers. These reforms, aimed at refining the immigration process, could inadvertently impact the UK’s ability to attract and retain essential healthcare staff.

What are the Changes to the Health and Care Visa Route, and Why is the Care Sector Concerned?

In December 2023, Former Home Secretary James Cleverly announced some measures to drive down unsustainable and unfair levels of migration into the UK, which took effect in March and April 2024. These changes affected some immigration routes, including the Skilled Worker, Graduate, Family, and Health and Care visas.

One of the first reforms in the health and care route was a ban on the dependents of migrants who are care workers or senior care workers. 

Home Office data showed that grants to dependents in the care and senior care workers category represented the most visas granted to dependents on the health and care route in 2023. As such, the Conservative government deemed it essential to eliminate additions to the migration figures from this route.  

However, many have condemned the ban on dependents of foreign care workers in the UK, deeming it harsh. Some have projected that care workers with families will move to other countries instead of coming to the UK. 

In a letter sent to the then Prime Minister, Rishi Sunak, the Cavendish Coalition, a group of UK health and social care organisations, stated that “the assumption that care workers would work in the UK without their dependants would be disastrous to both the care sector and the NHS and make the UK a less attractive place for much-needed social care staff.”

If care workers are not looking to come to the UK, that will put further pressure on an already strained care sector. Care England, which represents independent care providers, has already warned that there are 152,000 vacancies in the industry. 

Additionally, in 2023, Skills for Care, which collects data on the UK’s adult social care workforce, warned that by 2035, the country will need 440,000 people to meet the demand for care workers. 

In response, Vic Rayner, the Chief Executive of the National Care Forum in the UK, said, “It seems very unlikely that we will be able to do that without a significant migrant workforce.” He also said, “Every barrier that we put up makes us less attractive as a country for people to come and work in.”

Another major reform was an increase in the minimum income threshold for healthcare workers. The threshold for occupations on national pay scales rose to £23,200 annually, while roles outside the pay scales increased to £29,000 annually. 

Also, an Immigration Salary List (ISL) was introduced to replace the Shortage Occupation List (SOL). According to the health and care visa guidance, care roles on the ISL must meet a new minimum income threshold of at least £23,200. These income increases will impact both new applications and extensions of existing visas. 

The government has insisted that it aims to discourage employers from recruiting cheap labour from overseas at the expense of the British worker. It has also announced some measures to reform social care careers to increase the domestic workforce.

“Taken together, the measures we’ve introduced will radically reduce legal migration. 300,000 people who arrived in the UK last year would no longer be eligible to do so under these new rules,” said Secretary Cleverly.

Furthermore, there have been concerns about exploitation and abuse across the care system. In 2023, the Home Office granted at least 268 sponsor licences to care providers that the Home Office had not inspected. There were also cases of over 200 visas granted to non-existing care homes.

To address these concerns, the government instructed that only care providers registered by the Care Quality Commission in England can sponsor Health and Care Visa applicants. 

What is the Impact of the Changes So Far?

As soon as it was announced in December 2023, the new policy began impacting the number of applications from both dependents and main applicants. By January 2024, applications from health and care visa applicants fell to 4,700 from 6,400 in the previous month.

By April 2024, one month after the ban on care worker dependents became effective, dependent applications from the health and care route fell to 6,400, an almost 60% decrease from 15,100 recorded in April 2023.

The dependent ban may have affected applications from main visa applicants. In April 2024, there were only 2,200 applications, an 82% decrease from the 12,200 recorded in April 2023. 

The impact of the increase in the income threshold on NHS workers already in the UK will vary across the country. For instance, those in Scotland under pay scales may not be affected as all pay rates are already above £23,200. The rate in Wales is below the top pay point in band 3, and anyone earning below could be affected when extending their visas.

However, the increased threshold may significantly impact care homes in the UK. Research by Care England showed that 79% of publicly funded adult care homes do not have sufficient funds to cover the increased wage. 

Some care providers are considering exiting the market if local authority funding cannot cover workforce costs. This will mean fewer employers being able to hire foreign care workers and the care sector may struggle with staffing even more. 

However, the Conservative government was hopeful that its measure to invest funds to equip local talent would encourage more British workers to take up adult care roles. We will see how this plan will impact the UK care sector in the coming months.