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.”

Social care leaders have sounded the alarm over a planned 120% hike in the fees they must pay to sponsor overseas staff to work for them on skilled worker visas.

The government has tabled legislation to raise the certificate of sponsorship fee from £239 to £525, though it has not confirmed the implementation date.

Employers must obtain the certificates to enable people from abroad to apply for a health and care visa, enabling them to work in the sector. The fee also applies to overseas workers already in the UK, on any visa, applying to work in the care sector.

Providers face costs hike from tax and wage increases

The development comes in the wake of the planned rise to employers’ national insurance contributions due to come into force in April 2025.

This is due to cost providers £940m in 2025-26, according to think-tank the Nuffield Trust, with organisations also facing a £1.85bn bill next year from the 6.7% rise in the national living wage (NLW).

While councils fund 70% of care in the independent sector, local government leaders have warned that they have not been sufficiently resourced to cover their share of the bill.

‘Yet another blow to care providers’

Representative body Care England estimated that independent adult social care providers would have faced an additional bill of £10.3m in 2024-25 had the proposed certificate of sponsorship fee been in place. This is based on an estimate that providers will have recruited 36,000 overseas staff during the year – based on Skills for Care figures showing 18,000 were taken on in the first six months – and multiplying this by the £286 increase in fees.

“These proposed fee increases represent yet another blow to social care providers, compounding what is already a devastating situation for the sector,” said Care England’s chief executive, Martin Green.

He also raised concerns about the impact of the measure on international recruitment, which was significantly responsible for the fall in sector vacancy numbers, from 164,000 to 131,000, from March 2022 to March 24.

Since last March, the number of international recruits has plummeted on the back of a ban on overseas staff bringing dependants with them when taking up roles in the social care sector.

The 18,000 international staff independent providers recruited from April to September 2024 compare with 105,000 in the year to March 2024, a fall of roughly two-thirds in the quarterly average.

Government urged to reverse policy

Green added: “Targeting international recruitment with these fee increases is an attack at the very heart of the sector’s ability to function. Care providers are already fighting to sustain services, and these additional costs will push many to breaking point. The government must reconsider its position immediately.”

The Association of Directors of Adult Social Services also raised concern about the fee increase, with president Mel Williams saying: “Care workers recruited from overseas have played an essential role in supporting thousands of people and their families, filling many vacant posts across the sector over the last few years.

“Given the financial challenges they face, we know some care companies will be questioning the financial viability of continuing to provide care and support.”

Overseas recruitment has driven a second consecutive annual increase in the size of the adult social care workforce, Skills for Care has reported.

The number of filled posts in the sector grew by 70,000, from 1.635m to 1.705m, while the number of vacancies fell from 153,000 (9.9%) to 131,000 (8.3%), in the year to March 2024, according to latest figures from the workforce development body.

Vacancy levels hit an all-time high of 164,000 (10.6%) in March 2022, following a year in which the size of the workforce fell for the first time since records began.

The growth over the subsequent two years has been driven by the previous government’s decision to enable providers to recruit care staff from abroad on skilled worker visas from February 2022.

Growth in number of overseas staff

Skills for Care reported that independent sector providers recruited 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.

Over that time, the number of 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.

The figures do not take account of the outgoing government’s decision to bar overseas care workers on health and care visa from bringing family dependants with them, which came into force on 11 March this year.

However, Skills for Care said the announcement of these changes, in December 2023, appeared to have resulted in a sharp drop in the number of health and care visas issued, from an average of 26,000 per quarter in 2023 to 3,300 in the first quarter of 2024.

‘Challenging’ for sector to grow given international recruitment fall

“Early evidence suggests that changes to immigration rules in March 2024 will result in much lower levels of international recruitment in 2024-25 in the adult social care sector.

“Given this possibility, and the ongoing difficulties with domestic recruitment, it will be challenging for the sector to continue to grow in-line with demand in 2024-25.”

Skills for Care issued the figures on the day that it launched its 15-year strategy for the future of the adult social care workforce, developed with leaders from across the sector.

This projected that the sector would need an additional 540,000 posts from 2023 to 2040, a growth of 29%, because of the increase in the number of older people over that time, but that England needed to become less reliant on overseas staff because of global competition for care workers.

Vacancy rate remains high

While the sector’s vacancy rate has come down, it remains, at 8.3%, three times of the average for the wider economy (2.8%) and significantly higher than for competitor sectors, such as retail (2.4%), accommodation and food (4%) and the NHS (6.9%), said Skills for Care.

Vacancy rates fell across all parts of adult social care in 2023-24, but they remained much higher in domiciliary care (11.9%) than in nursing or residential homes (5%).

However, independent domiciliary care providers accounted for the majority of the growth in filled posts (43,000 of 70,000), an increase of 7.9%. This compares with growth of 5.3% in independent nursing homes (15,000 roles), 3% in local authorities (3,500) and 2.4% in residential homes (7,000).

The one area in which employment contracted was for personal assistants, whose number fell by 7,000 (5%), reflecting the year-on-year drop in the number of people receiving direct payments, from 230,000 in 2020 to 211,000 in 2023.

State of pay in adult social care

The report followed the new Labour government’s announcement last week that it would legislate to introduce a “fair pay agreement” for adult social care staff, designed to improve pay and conditions in the sector.

In the same week, think-tanks the Health Foundation and Nuffield Trust produced a report on options to raise pay in the sector. This set out that, in 2023, in the independent sector:

• The median hourly rate was £11 for care workers and £11.78 for senior care workers,12 compared with £15.88 for all UK workers.
• Care workers with five or more years’ experience were paid just 8p per hour more than those with less than a year’s experience.
• The median hourly pay for the top 10% of earners was just £1.74 more than that for the bottom 10% of earners.

Impact of pay on employment

Skills for Care’s strategy, meanwhile, indicated that a significant boost to pay, for example would be needed to meet adult social care’s recruitment needs over the coming years.

It said a 5% rise in real wages in the sector could increase employment levels by 9-11%, according to research published this year from the University of Kent and the London School of Economics and Political Science.

In the strategy, Skills for Care set out options for raising pay, ranging from simply enforcing the national living wage (NLW) more tightly to setting a sector minimum wage above the NLW and tying social care pay to the higher levels of remuneration for NHS staff performing similar roles.

Costs and benefits of pay rises

With the exception of the tighter enforcement of the NLW, the measures would significantly increase public spending on social care.

For example, setting a sector minimum that was £1 hour above the NLW, while also ensuring that those with three years’ experience received an additional £2 an hour, would cost the state £2bn a year or £30.9bn over 15 years.

However, according to Skills for Care’s analysis, the measure would mean 264,000 more staff would be recruited and 435,000 more retained over 15 years, generating £4.2bn in savings on recruitment for providers.

In addition, the NHS would save £3.9bn over the period from not having to support people who would be having their needs met by adult social care, while there would also be £29.5bn in “wellbeing benefits” for the people receiving care as a result of the expansion in the workforce.

Government plans ‘to properly reward hard work’

Labour is yet to set out how much it will invest in its fair pay agreement plan.

In a response to the Skills for Care strategy, a Department of Health and Social Care spokesperson said: “We are determined to tackle head-on the significant challenges social care faces.

“Social care workers make an enormous contribution to society and that’s why we have committed to establishing a fair pay agreement to properly reward their hard work and attract more people to the sector.”

Responding to the latest workforce data, Simon Bottery, senior fellow at think-tank The King’s Fund, said: “International recruitment has provided the only real relief to this situation but with the tightening of regulations there are real concerns that this source of workers will now dry up, leaving a huge problem for providers and – most importantly – the hundreds of thousands of people who rely on and request social care services.

“Government plans to mandate higher pay for social care staff…will help make care worker roles more attractive. Wider action will still be needed, both to shore up social care with additional funding, and to develop a comprehensive, longer-term approach to the care workforce that focuses on recruitment and retention. The new Skills for Care workforce strategy will be a first step towards this.”

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.”

Over four in ten adult social care providers closed parts of their organisation or handed back contracts last year because of cost pressures, driven in particular by staffing shortages, a survey has found.

Almost one in five said they were providing care to fewer people, while a similar proportion said they made redundancies in 2023, due to cost constraints, found the annual Pulse Check survey commissioned by learning disability provider Hft and representative body Care England.

Also, just under four in five reported that local authority fee increases were insufficient to cover last year’s 9.7% increase in the national living wage (NLW), amid widespread concerns that the same will be true of the 9.8% rise in the salary floor due in April 2024.

Increased funding for adult social care

The research was a test of the impact on providers of a 10% real-terms budgeted increase in adult social care spending by councils in 2023-24, on the back of significant extra government funding.

Several chunks of this funding, either in whole or in part, were focused on increasing the fees councils pay providers, including:

• The £562m market sustainability and improvement fund (MSIF), £162m of which was designed to help councils pay providers ‘a fair cost of care’ with the remainder earmarked for fee increases, bolstering workforce capacity or cutting waiting lists for care or assessments.
• The £365m market sustainability and improvement fund – workforce fund, which is for the same purpose as the MSIF but is particularly designed to bolster the workforce.

‘No impact’ from government cash boosts

However, most respondents (84%) reported that recent government funding rises, such as the MSIF workforce fund, had had no impact on their financial sustainability, with two-thirds saying the same about the fair cost of care work.

Providers reported that they struggled to meet funding conditions that differed between authorities and also said that, in some areas, domiciliary care was prioritised over residential services for resourcing.

The Pulse Check report also criticised the “short-term, sporadic nature of these government funding measures”, which only delivered “temporary relief”, rather than helping providers address financial challenges “root and branch”.

Service closures

As a result of these pressures, 43% either closed parts of their organisation or handed back contracts to commissioners, 18% provided care to fewer people and 19% made redundancies.

Workforce-related costs were, by far, the largest pressure on providers (cited by 81% of respondents) followed by utility bills (59%) and unrealistic expectations from commissioners, such as unfunded service costs (38%).

The most significant staffing pressure, reported by 87% of providers, was the need to increase pay in line with rises in the statutory national living wage (NLW) or the voluntary real living wage or London living wage.

The NLW rose from £9.50 to £10.42 per hour last year, a 9.7% rise that was the highest percentage increase in the salary floor since its introduction in 2016. However, 79% of respondents to the Pulse Check said increases in council fees were not sufficient to cover the rise.

Providers struggling to offer competitive pay

The report said this appeared to have had an impact on providers’ ability to offer competitive pay, with gap between the average wage respondents offered care workers (excluding senior care workers) and the NLW having narrowed from £1.02 per hour in 2022 to 77p in 2023.

Correspondingly, 86% of providers cited pay as their biggest recruitment and retention challenge, up from 75% in the 2022 study.

The NLW is due to go up by an even greater amount next year – by 9.8%, from £10.42 to £11.44 an hour – and council leaders have warned that the government has not funded them to deliver this increase.

“Unfortunately, as pay for care workers shifts closer to the NLW it is likely that recruitment will become ever more challenging as potential staff chose careers offering a more attractive salary,” the Pulse Check report warned.

Reliance on international recruitment

National data showed a small overall reduction in adult social care vacancies from 2022-23, from 164,000 to 152,000, driven by the government relaxing immigration rules to enable more recruitment from abroad.

However, while most respondents to the Pulse Check reported an increase in international recruitment (57%) in the previous 12 months, this was not true for domestic recruitment. For this, 43% of providers saw an increase in activity, but almost as many (36%) saw a reduction.

The study also found international recruitment was not viable for some organisations, with a quarter saying it was “not applicable” to them. It also warned that the government’s impending ban on allowing overseas care workers to bring family members over when taking up jobs in the UK would make the recruitment situation worse for providers.

Recommendations

On the back of the research, Hft and Care England called on the government to make international recruitment more accessible by measures including reducing visa fees and providing more support to guide providers through the process.

Other recommendations from the report included introducing national standards for commissioning – backed by statutory guidance – to reduce costs and complexity for providers and improve consistency, including in how councils allocated the funding they received.

They also called for changes to VAT rules to reduce providers’ tax liabilities.

Extra funding ‘not cutting through’

“For years, adult social care providers have absorbed increased costs and inflationary pressures without corresponding funding,” said Care England chief executive Martin Green.

“When money is made available it simply isn’t cutting through. Recent changes to immigration rules and an insufficient local government finance settlement this year further suggest a government that is heading in the wrong direction.”

The Association of Directors of Adult Social Services (ADASS), which welcomed the Pulse Check’s “practical recommendations to ease pressure on the sector”, issued a similar message on funding.

Investment ‘not keeping pace with need’

“The government has invested more, but it’s not keeping pace with increased levels and complexity of need, inflationary pressures including wages, and broader pressures on local government budgets,” said ADASS joint chief executive Anna Hemmings.

“We welcomed the increase in the living wage announced last autumn, but with no new money to pay care workers that increase, there can only be one result: fewer jobs and cuts in care.”

In response to the report, a Department of Health and Social Care spokesperson said: “To address the issues facing the care sector, we’re investing up to £8.1bn* to put the adult social care system on a stronger footing, enabling local authorities to buy more care packages, help people leave hospital on time, and reduce waiting times.”

Breakdown of extra government cash

Not all of the £8.1bn, allocated for 2023-25, will be spent on adult social care, with some destined for children’s services and another chunk dependent on council tax increases. It consists of:

• £3.2bn extra through the existing social care grant, with 60% expected to be spent on adults’ services and 40% on children’s services.
• £1.6bn to tackle delayed discharges, with the funding split between councils and NHS integrated care boards.
• £1.6bn through increasing the adult social care council tax precept by 2% and raising standard council tax by 3% in each year.
• £1.08bn through the market sustainability and improvement fund, designed to help councils increase provider fees, tackle waiting lists and boost recruitment and retention.
• £570m through a separate market sustainability and improvement fund – workforce fund, which has the same objectives but is particularly focused on tackling staff shortages.

New career pathway

With the Pulse Check having identified poor perceptions of social care as a career as providers’ second biggest recruitment and retention challenge, behind pay, the DHSC spokesperson also cited its announcement last week of funding for a new qualification, alongside the establishment of a career pathway, for care staff.

“Last week, we also announced a major boost to the care workforce through the creation of a new accredited qualification meaning for the first time, there will be a national care career structure, giving the profession the recognition it deserves,” they said.

However, sector bodies have warned that the pathway would not succeed without extra investment to enable providers to reward progression with additional pay.

Government plans to prevent overseas care staff from bringing family members with them to the UK risks worsening the sector’s already significant staff shortages.

That was the message from sector bodies yesterday after home secretary James Cleverly announced a raft of policies designed to cut annual net migration from a high of 745,000 in 2022.

This included a bar on care workers who take up jobs using the health and care visa bringing dependants with them, as they are currently permitted to do.

It will also prevent providers who are not Care Quality Commission-registered from sponsoring workers, in response to significant concerns about workers being exploited by recruiters running fake care agencies. The changes will come into force next spring.

The government said that, in the year to September 2023, it issued visas to 101,000 care workers and senior care workers, and to 120,000 dependants accompanying them, about a quarter of whom were in work.

Overseas care staff instrumental in cutting vacancy levels

Overseas staff were instrumental in a slight reduction in adult social care vacancies – from 164,000 to 152,000 – and increase in filled posts, from 1.615m to 1.635m, between March 2022 and March 2023.

During that time, 70,000 overseas staff were recruited into direct care roles by independent providers in England through the health and care visa, many more than the 20,000 year-on-year increase in filled posts across the sector as a whole.

Cleverly told the House of Commons yesterday that he did not envisage that the measures would have a negative impact on the social care workforce.

International recruitment ‘displacing British care staff’

He claimed overseas staff were displacing British workers, as the number of people coming in on visas was less than the overall increase in the workforce last year.

James Cleverly

He also said the government suspected that there was “significant surplus demand” from overseas staff to work in the UK care sector.

This would mean that anyone dissuaded by the restrictions on bringing in dependants would likely be replaced by someone without family commitments, he added.

“So, we don’t envisage there being a significant reduction in demand because of the changes that we’ve made, but it will mean that we have the care workers that we need but not the estimated 120,000 other people who have, in the most recent year, come in,” said Cleverly.

However, his confidence was not shared by sector bodies.

Government ‘severing lifeline’ for sector

The Care Provider Alliance (CPA), a coalition of 11 representative bodies across all provider sectors, said the government was “severing the lifeline of international recruitment”.

“This is currently the only option we have to maintain and increase workforce numbers, as recruitment in the UK remains challenging,” said CPA chair Jane Townson.

“If care workforce numbers fall and providers cease to operate, unmet need will escalate. Not only will this lead to individual and family suffering, but it will increase pressure on council and NHS services and further extend waiting lists.”

The Care and Support Alliance (CSA), which represents over 60 charities for older people, disabled people and carers, issued a similar message.

‘Action needed to make care roles attractive to UK staff’

“Too many people in need struggle to access good care as it is, and the risk is that today’s announcement will make the situation worse,” said CSA co-chair Caroline Abrahams, who is also charity director of Age UK.

“It is facile for any policymaker to suggest that there are ample numbers of people already based here to fill the gaps in the social care workforce, without also agreeing to the action needed to make these roles more attractive domestically in terms of pay and conditions.”

In his autumn statement last month, chancellor Jeremy Hunt announced a 9.8% rise in the national living wage, from £10.42 to £11.44 an hour, next April, a move which will benefit many thousands of care staff.

However, Townson warned that, without extra funding, councils and NHS commissioners would not be able to pay providers sufficiently to cover the rise.

Latest call for more investment into sector

Both the CPA and CSA urged the government to significantly increase adult social care funding to reduce the sector’s reliance on migration.

The government’s response to the many such calls it has heard over recent months is to point to £8.1bn it has made available to councils to invest in social care from 2023-25.

However, £1.6bn of this is reliant on authorities raising council tax by the maximum permitted amount and about £1.3bn is expected to be spent on children’s services.

Social care was spared further restrictions on immigration that will apply to other sectors. People with a health and care visa will be exempt from a sharp increase in the minimum salary required of skilled migrants from next spring, from £26,200 to £38,700.

Currently, care workers and senior care workers are allowed to come in on a reduced salary – £20,960 – on the grounds that they are on the government’s shortage occupation list (SOL).

As part of his announcement yesterday, Cleverly announced a review of the SOL to reduce the number of occupations it covered.

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.”

The social care workforce has been boosted by 58,000 overseas staff over the past year, revealed government immigration figures published today.

But while care homes have made a dent in record vacancy levels experienced in 2022, staffing gaps have remained stubbornly high in domiciliary care, according to separate data issued by Skills for Care.

The rise in overseas staff joining the workforce came on the back of the government’s decision to add ‘care workers’ and ‘home carers’ to its shortage occupation list for skilled workers in February 2022, enabling providers to directly recruit from abroad to these roles for the first time.

Immigration figures

This resulted in a rise from 113 to 40,416 in the number of these staff issued with health and care visas from 2021-22 to 2022-23. Over the same period, the number of senior care workers recruited in the same way rose from 6,763 to 17,250, meaning 50,790 more staff joined the workforce through the health and care visa in 2022-23 than 2021-22.

Social care staff accounted for 57% of health and care visas in 2022-23, up from 19% in 2021-22. Over half of health and care visas were granted to staff from India (29,726), Nigeria (17,596) or Zimbabwe (17,421), with all three nations seeing rapid growth in the number of their citizens moving to the UK to work in health and social care.

Photo: Zerbor/Adobe Stock

The rise in the overseas workforce follows a 52% rise in adult social care vacancies in 2021-22, attributed to factors including a loss of competitiveness in pay to retail and hospitality, a drop in the number of migrant staff from Europe due to Brexit and post-Covid burnout among the workforce.

Falling care home vacancies

Vacancies appear to have fallen – and employment increased – since then in the care home sector. Preliminary Skills for Care data showed that, from March 2022 to April 2023:

• There was a 3.8% rise in the number of filled care worker posts in residential and nursing homes from March 2022 to April 2023.
• The nursing home vacancy rate, for all roles, fell from 8.8% to 7.9%.
• The residential home vacancy rate dropped from 7.7% to 6.8%.

However, in domiciliary care, the vacancy rate for all roles fell only slightly over this time, from 13.2% to 13%, while the number of filled care worker posts fell by 1.2%.

Umbrella body the Homecare Association has cited the sharp rise in fuel costs during 2022 as among factors forcing staff to leave their roles.

The extent of the pressures on home care workforce were revealed in the results of Homecare Association research with providers carried out in January and February 2023.

This found that 66% of providers felt recruitment was harder, while 43% said that more care workers were leaving,  than six months previously.

Care England, which represents independent care providers, said the rise in the number of overseas staff could not address the chronic workforce pressures the sector faced, driven by low pay.

£15 minimum wage urged

“Whilst increases in net migration may help to fill vacancies within the sector, ultimately, the workforce crisis will never be truly addressed until the government provides the sector with the funding it needs to adequately reward the workforce with the pay and recognition they deserve,” said its chief executive, Martin Green.

Care England CEO Martin Green

As of last month, the national living wage (NLW) – the hourly pay floor for staff aged 23 and over – rose from £9.50 to £10.42, while the national minimum wage (NMW) for 21- and 22-year-olds increased from £9.18 to £10.18.

This will have boosted the pay of the many care workers who earn around the NLW or NMW.

However, Green added: “Care England has long called for a care wage that sits above the NLW and supports the Trade Union Congress’ call to implement a £15 minimum wage for individuals in care worker roles, fully funded by central government and ring-fenced for this purpose. This would not only improve the workforce crisis in adult social care, but give the English economy a much needed multi-billion pound boost.”

Councils in England are failing to protect children subject to immigration control, including by rarely recognising their poverty as a safeguarding issue, a study has found.

In many of the 26 serious case reviews (SCRs) analysed, practitioners did not understand the implications of families having no recourse to public funds (NRPF), offering them inappropriate advice or refusing support, it found.

The NRPF rule excludes most temporary migrants in the UK from access to benefits, homelessness assistance or social housing through their local authority.

The children in the SCRs studied were often malnourished, lacking access to healthcare, and living in inappropriate or insecure accommodation such as overcrowded housing.

Domestic abuse was present in several cases and was sometimes exacerbated by immigration status. For example, one woman was left financially dependent on the perpetrator after her student visa expired and she was left unable to work or claim benefits, while another was pressured to have a termination by her partner threatening to get her deported.

Despite families’ level of need, services sometimes closed cases before probing further or did not follow up after losing contact with a family.

The study attributed this to the English child protection system’s focus on parental harm, not harm caused by socio-economic factors, such as poverty, immigration status or race.

Prevalence of destitution

Destitution was a prevalent issue across the cases, with a number of reviews mentioning children going hungry. In one SCR, school staff reported children arriving poorly clothed and undernourished, referring them to the school nurse for concerns about their eating.

Many of the families had also experienced homelessness or insecure or inappropriate accommodation, with two reviews mentioning overcrowded housing.

The study said the destitution families faced arising from their NRPF status harmed children and undermined parents’ ability to care for them.

However, when there was no parental abuse or neglect present, destitution was regarded as low risk, it found, resulting in cases being closed following assessment, or assessments not being initiated or being left incomplete.

Some families were refused payments under section 17 of the Children Act 1989 – including on the erroneous ground that it was prohibited by NRPF status. Where these were given, they were sometimes extremely low, for example, £65 a week for a family of three. Accommodation provided under section 17 was also sometimes inappropriate, the study found.

Culture and language factors not addressed

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Language barriers often hampered agency responses, but the study found a lack of effort was made to address them.

In some cases, there was an absence of professional interpreters even where the parents did not speak English. Family members were commonly used instead, with implications for confidentiality. In one review, this had contributed to a mother being kept in an “isolated and potentially oppressed position”.  Other interpreting practices included using Google Translate, the paper found.

The ethnicity of children was either missing or incomplete in some records. In one case where it was recorded, its impact on the family was given little consideration, while another SCR found race, culture and religion had not been taken into account.

Professionals felt uncomfortable inquiring about cultural background, resulting in assumptions that then informed assessments and plans, reported the study

Inadequate information sharing

Reviews expressed concerns about information sharing, especially when children were moved from area to area, with a lack of notification systems and families being left without details about support services in their new areas.

The report also identified a lack of communication between different agencies, finding that inadequate information sharing between GPs and health visiting services led to a missed opportunity to support a mother and daughter.

However, it also found that “the lack of information sharing for child welfare or safeguarding contrasted sharply with well-developed information-sharing processes for immigration control purposes”.

All but two of the local authorities in the SCRs were members of the NRPF Connect database, enabling them to automatically share information with the Home Office.

The paper concluded that families, at times, avoided professionals for fear of alerting the immigration authorities, adding: “The task of safeguarding and promoting the welfare of children is made more difficult when information sharing with immigration authorities takes precedence over communicating with children, their parents and other professionals.”

Lack of understanding of immigration status

Practitioners did not always understand different immigration statuses and the entitlements they entailed, leading to inappropriate advice and support, such as wrongful denial of section 17 payments to destitute families with NRPF.

This lack of knowledge also led to missed opportunities for support, while the report also found that NRPF status brought about suspicion and scepticism that further complicated accessing services.

“An assumption that families were not really destitute and were fraudulent sometimes took precedence over child welfare concerns,” it added.

Procedures ‘do not protect children’

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Co-author Dr Andrew Jolly attributed services’ poor practice to a lack of government guidance and the child protection system not fitting well with immigration control.

“There’s an assumption there’s a safety net, which doesn’t exist for these children,” he said “So even if local authorities and other agencies are meeting what’s required of them, there’s still going to be children who slipped through the net because there aren’t protective procedures to support them.”

One case review wrote that, “lawful and efficient responses are not always enough to compensate for the very particular vulnerabilities of the extremely marginalised group represented by those who have no recourse to public funds”.

Jolly added: “I think that is the absolute heart of the issue. Even when organisations are following procedures, the procedures themselves do not protect children in this group.”

The report said that, to effectively safeguard children in families with NRPF, professionals needed to take into account the impact of the poverty and other inequalities arising from their status.

Jolly added: “If a child hasn’t got enough to eat and it’s a result of a parent or caregiver, we know how to respond to that. But when a child doesn’t have enough to eat, and it’s a direct result of structural issues, we don’t know how to respond to it, and we don’t see it as neglectful. But actually, the experiences of that child are the same.”

A Department for Education spokesperson said local authorities have “clear responsibilities to support children in need and in cases where there are child protection concerns. This includes children in families who have no recourse to public funds.”

They added that the DfE’s legal guidance “clearly sets out a range of factors that should be considered when assessing a child’s needs”, including housing, income and employment status.

“We will be setting out ambitious plans to improve children’s social care, which will look at where having no recourse to public funds is a factor in these children’s lives,” they added.

This is a reference to its forthcoming response to three reports on reforming children’s social care, in particular, the Independent Review of Children’s Social Care’s final report. This found that families with no recourse to public funds faced “particular challenges in accessing support from children’s social care, with the proportion of referrals received for these families resulting in services being provided under section 17 varying widely”.

About the study

Pictured: co-author Dr Andrew Jolly, social work lecturer at University of Plymouth /
Photo credit: Andrew Jolly

The study, Children and families with no recourse to public funds: learning from case reviews, was carried out by Dr Andrew Jolly, lecturer in social work at the University of Plymouth, and Anna Gupta, professor of social work at Royal Holloway, University of London.

It identified 26 SCRs in England from the NSPCC national case review repository detailing the deaths or serious abuse of children in families with NRPF, dating from 2006, with 18 published from 2016-21.

When analysing them, the authors focused on the role of NRPF and how it interplayed with children’s other vulnerabilities.

The findings were grouped based on correlative issues detected, such as mental health or housing, and divided into two themes, ‘children’s and family experiences’ and ‘agency responses’.