The government has curbed the recruitment of care staff from overseas with adults’ providers in England instead required to prioritise hiring international workers already in the country.

Ministers said the measure, which comes into force on 9 April 2025, was designed to provide work for care staff who had come to England and then been exploited, leaving them without a job.

However, provider leaders warned that the move, along with an accompanying rise in the minimum wage paid to care staff on health and care worker visas, would exacerbate the sector’s recruitment challenges.

This in the context of there having been a sharp fall in the number of staff recruited from abroad following a ban on care workers on these visas bringing dependants with them, which was introduced last year .

Sector’s increasing reliance on overseas staff

That had followed a two-year period in which providers had become increasingly reliant on overseas staff to tackle high vacancy levels, after being permitted to recruit care workers from abroad.

Independent sector providers hired 105,000 people from overseas into direct care roles in 2023-24, up from 80,000 in 2022-23 and just 20,000 in 2021-22, according to Skills for Care figures.

Over that time, the number of overseas staff from outside the EU working in the sector almost doubled, from 140,000 to 300,000, while the number of British staff fell by 70,000, from 1.26m to 1.19m.

Increasing exploitation concerns

However, the growth in the number of overseas care staff was accompanied by widespread reports of workers being exploited, either by employers or agencies recruiting workers from abroad.

The Gangmasters & Labour Abuse Authority (GLAA), which investigates worker exploitation, said last year that 61% of all concerns it received from April to June 2024 concerned abuses within the UK care sector.

Many workers reported being forced to work excessive hours with the threat that their sponsorship, obtained by their employer to enable them to work in the UK, would be cancelled, said the GLAA.

Others were forced to pay off debts resulting from excessive fees charged by exploiters to secure work, or reported not being properly paid, living in unsuitable conditions while being charged high accommodation fees and, in some cases, being offered no work at all.

Prioritising recruitment of staff who have lost sponsorship

Between July 2022 and December 2024, the government revoked more than 470 sponsor licences from care sector employers because of abuses, preventing them from recruiting from abroad. However, this has left many sponsored staff without a job.

Last year, the then Conservative government announced a £16m fund, allocated to regional partnerships of councils and providers, to help find care roles for these staff and offer them pastoral support.

The government has now gone further by barring providers from hiring care workers or senior care workers from abroad on health and care worker visas unless they have first tried to recruit from among the pool of workers already in England who have lost sponsorship.

Under changes to immigration rules, employers seeking to sponsor a care worker from abroad must provide confirmation to the Home Office from their regional partnership that they have fulfilled this requirement.

Employers will still be able to obtain sponsorship for staff who came to the UK via a different immigration route to the health and care visa, so long as they have already been working for them for three months.

Care workers ‘subjected to appalling exploitation’

At the same time, the government is raising the minimum wage employers must pay staff on a health and care visa from £11.90 to £12.82 per hour. This is above the £12.21 national living wage (NLW) that also comes into force next month.

In a statement announcing the changes, migration and citizenship minister Seema Malhotra said that “too many providers [had] recruited care workers to the UK and failed to provide them with the work they were promised, or have subjected them to appalling exploitation”.

“We have a duty to protect people against destitution, exploitation and modern slavery, and the best way to do so is through secure, properly paid work and employment conditions,” she added.

Requirements ‘will exacerbate recruitment challenges’

However, the Homecare Association said the requirements would “further exacerbate recruitment challenges for home care providers already struggling with an unsustainable commissioning system”.

This is a reference to the gap between the fees paid to providers by NHS and local authority commissioners and the minimum price the association has calculated is needed to meet costs and make an appropriate profit or surplus.

Last year, it identified a £1bn shortfall in commissioner fees and its minimum price in England, which it calculated as being £28.53 per hour in 2024-25.

However, the association’s minimum price has risen sharply for 2025-26, to £32.14 per hour, due to a 6.7% rise in the NLW, an increase in the rate of employer national insurance contributions (NIC) and a lowering of the salary threshold at which companies start paying NICs.

‘You cannot legislate for better conditions without funding’

“The government is imposing immigration restrictions without fixing the broken commissioning system that makes stable employment impossible,” said Homecare Association chief executive Jane Townson.

“You cannot legislate for better working conditions while simultaneously underfunding the services expected to provide them.”

The government has launched a £16m fund to tackle the exploitation of overseas adult social care staff.

The resource is an extension of the international recruitment fund for the adult social care sector, issued last year to help councils and providers increase the employment of overseas staff.

However, for 2024-25, the Department of Health and Social Care has switched the focus of the fund to preventing and responding to unethical employment practices concerning international recruits.

Growth in number of overseas care staff

Overseas staff played a vital role in cutting adult social care vacancy numbers from a record 164,000 in March 2022 to 152,000 a year later, on the back of the government allowing employers to recruit care workers from abroad through its health and care visa.

Approximately 70,000 international recruits started working in direct care roles in the independent sector from 2022-23, up from 20,000 the year before, with a further estimated 30,000-40,000 doing so from April to August last year (source: Skills for Care).

However, the growth in the number of overseas staff has been accompanied by concerns that many are being exploited.

Exploitation concerns

In her 2023-24 strategy, the government’s director of labour market enforcement, Margaret Beels, reported increased use of illegal recruitment fees, debt bondage – where people work for little or no money to pay off a debt – wage underpayment and other forms of labour exploitation within social care.

This has been echoed by the Gangmasters & Labour Abuse Authority (GLAA), whose role is to investigate worker exploitation.

“The GLAA has seen a significant increase in the information it has received relating to labour exploitation in the care sector over the last couple of years and has more than 30 ongoing investigations,” said national investigations lead Martin Plimmer in December of last year.

Abuses included charging for work-finding fees both in the UK and abroad, breaches of student visa schemes, placing staff in cramped and unsuitable accommodation and subjecting them to debt bondage, he added.

Also, the Care Quality Commission (CQC), in its annual state of care report for 2022-23, said it appeared that a “small number of providers” were exploiting staff, including by tying accommodation, transport or food to jobs, excessive sponsorship fees, long working hours and poor pay.

Supporting staff forced out of jobs

Such abuses can lead to the revocation of providers’ sponsorship licence, which enables them to recruit from abroad; however, this leaves sponsored staff without a job.

The DHSC said a key aim of its international recruitment fund in 2024-25 was to support staff in this position find “alternative, ethical employment”.

The funding will be allocated to regional partnerships of councils and care provider alliances – headed by a lead local authority – who will be expected to set up a mailbox for overseas care workers to contact should they lose their jobs. They should also provide staff with pastoral support, for example, through buddying schemes with other international workers, it added.

In addition, the department said partnerships should monitor data around licence suspensions and revocations among local providers and disseminate information to affected local authorities so they can tackle ensuing caps in workforce capacity.

It said they should also take steps to prevent care worker exploitation, including by supporting providers’ compliance with visa conditions.

The DHSC has set out indicative funding allocations for the partnerships, which have already been constituted. The lead local authority must submit an application for funding by 28 May 2024, with the DHSC agreeing funding as soon as possible after bids are received.

Concerns over fall in overseas recruitment

Alongside the funding, the government has also introduced a requirement for providers to be CQC registered to be able to sponsor overseas workers, to crack down on abuses of workers through the creation of fake care agencies.

This was part of wider reforms, announced in December 2023, to reduce levels of migration that included barring care workers who take up jobs using the health and care visa from bringing dependants with them.

Though these only came into force in April 2024, they have been linked to a fall in the number of people applying from abroad to work in adult social care and health. From December 2023 to March 2024, there were 16,600 applications from health and care visas, less than a third of the number who applied over the previous four months (55,400).

While these numbers are not broken down between health and adult social care, they likely represent a significant cut in overseas recruitment into the latter sector.

In response to the numbers, independent provider representative body Care England’s chief executive, Martin Green, said the sector had been left to “pick up the pieces” from the government’s immigration reforms.

He added: “These figures only serve to renew the need for meaningful workforce reforms that make the sector an attractive destination for domestic staff if we are going to shut off the route for overseas recruitment.”

A “tail of very bad employers in the social care sector” are exploiting overseas staff brought to the UK to fill gaps caused by endemic low pay, a government adviser has warned.

Migration Advisory Committee chair Brian Bell has also castigated ministers for their failure to respond to an April 2022 MAC report they themselves commissioned, which called for increases to social care pay, rather than a reliance on immigration, to tackle the sector’s workforce problems.

Bell, professor of economics at King’s College London, made the comments in an interview with BBC Radio 4’s World at One yesterday (31 July).

They come on the back of a large increase in the number of migrant social care staff on the back of the government’s decision – based on MAC advice – to place care work on the so-called shortage occupation list from February 2022, enabling employers to recruit people from abroad as skilled workers, on health and care worker visas.

Call to improve social care pay

However, in its April 2022 report on adult social care and immigration, the MAC told ministers it would be “highly damaging for the sector in the long term if the necessarily limited and short-term relief brought by immigration policy were used as an ‘excuse’ not to
address the more fundamental problems the sector faces”.

These included “low pay rates with little pay progression, and poor terms and conditions compared to competing occupations”, prompting the MAC to call for the government to introduce “a fully funded minimum rate of pay for care workers in England that is above the national living wage, where care is being provided through public funds”, implemented immediately.

Such a policy is in place in Scotland and Wales, where care staff in state-funded roles receive a minimum rate of £10.90 an hour, above the current national living wage of £10.42.

However, not only have ministers not done this for staff in England but, 15 months on, they have not responded to the MAC’s paper, compared to a typical response time of two to three months to committee reports commissioned by the government, according to Bell.

Brian Bell, chair, Migration Advisory Committee (credit: HM Government)

In his BBC interview, he said that while immigration had resulted in social care services being provided that would not have been otherwise, overseas staff were enabling the government to get away with not funding social care properly, while some were also facing exploitation.

“There are lots of really great employers out there,” he said. [But] there are two main problems. One is that many are exploited in their home country in terms of middlemen asking for very large fees to so-called help them get a place in Britain and that can be £10,000.

‘Very bad’ employers exploiting staff

“And then there are the bad employers in Britain. It’s not just immigration, there’s a tail of bad very bad employers in the social care sector who exploit workers.”

Bell said this was “always a problem in low-wage labour markets” and that similar concerns had also been raised several times by Margaret Beels, the director of labour market enforcement, a government appointee whose role is to examine exploitation of staff by employers.

In her 2022-23 strategy, published in March this year, Beels said: “Workers on student visas have been found to be working substantially in excess of their permitted hours and being exploited with very low pay, poor accommodation and without the required qualifications.”

Meanwhile, last month UNISON voiced concerns about overseas staff being placed in sub-standard accommodation or not being paid on the grounds of employers recouping relocations costs they had incurred.

‘No one should feel exploited’ – DHSC

In response to Bell’s comments, a Department of Health and Social Care spokesperson said: “International recruitment has a valuable role to play in helping grow the adult social care workforce, while at home we are investing £250m to support staff to develop new skills, get better training and develop their careers.”

The £250m, spread over the next two years, will fund hundreds of thousands of training places to help staff progress along a career pathway, but it represents half of what the DHSC had originally pledged, from 2022-25, to develop the workforce, with pledges on resourcing wellbeing services ditched.

The DHSC spokesperson added: “No staff should feel exploited or harassed. Any concerns regarding potentially unethical and illegal employment practices should be reported to the Gangmaster and Labour Abuse Authority [which examines abuse of vulnerable workers] who will investigate fully. Staff should contact the Care Quality Commission if they witness or are a victim of malpractice.”