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.”

The number of overseas recruits to the social care sector has plummeted as a report highlights how reliant the sector has become on international staff.

From April to June this year, an estimated 8,000 international recruits joined the adult social care workforce in England, down from a quarterly average of 26,000 in 2023-24, according to data from Skills for Care.

The sharp drop started in the month after a ban came into place on overseas care staff bringing dependants with them when taking jobs on health and care worker visas.

How overseas care staff have improved workforce indicators

Skills for Care shared the figures today as its annual State of the Adult Social Care Sector and Workforce in England report for 2023-24 demonstrated that overseas staff had been largely responsible for reducing vacancy rates and cutting turnover to its lowest level in almost a decade.

In addition, international care staff were more likely to have achieved the entry level care certificate standards than domestic recruits, while they had also helped increase the proportion of men – a target group for recruitment – in the workforce.

However, despite the contribution of overseas staff, the adult social care vacancy rate (8.3%) was almost three times the economy-wide average, while just two in five care workers (41%) had a relevant qualification at level 2, a figure that has been stuck since 2020-21.

Average pay rises but social care still lags other sectors

Following a real-terms fall in average pay for staff in 2022-23 – as a result of high rates of inflation – median pay for independent sector care workers grew from £10.11 to £11.00 per hour as of March 2024, a rise worth 8.8% in cash terms and 5.7% in real terms. This was driven by a 9.7% cash increase in the national living wage (NLW), from £9.50 to £10.42 per hour, in April 2023.

However, the sector continued to lag behind most parts of the economy, with 80% of workers in the UK earning at least £11.54 as of November 2023, according to Office for National Statistics (ONS) figures.

The news came as the government unveiled its Employment Rights Bill, which includes provisions to set up an adult social care negotiating body to determine pay and conditions in the sector, with a view to raising salaries.

A growing and more stable workforce with fewer vacancies

The number of filled adult social care posts, which fell for the first time in 2021-22, grew for the second consecutive year, from 1.635m in 2022-23 to 1.705m in 2023-24, a rise of 70,000 (4.2%).

This was driven by growing numbers of home care (42,000) and NHS roles (8,200), though there was a fall of 7,200 in the number of personal assistants, who are employed by direct payment recipients.

At the same time, the vacancy rate, which hit a peak of 10.6% in 2021-22 before falling to 9.9% in 2022-23, dipped again to 8.3% in 2023-24, equivalent to 131,000 roles.

As in previous years, the rate was considerably higher in domiciliary care (11.5%) and for direct payment recipients (11%), than in community care (6.2%), residential care (5.2%) or day care (4.9%).

The vacancy rate fell across all roles, with the highest percentage point fall being among care workers, where it dropped from 11.8% to 9.9%.

The workforce was also more stable, with the turnover rate across the independent and local authority sectors – who collectively employ 86% of the workforce – dropping from 29.1% in 2022-23 to 24.8% in 2023-24, the lowest level since 2014-15.

Positive trends driven by overseas staff 

Skills for Care said that these trends had largely been driven by overseas staff, on the back of the Conservative government’s decision to allow employers to recruit care workers from abroad via the health and care visa from February 2022.

From 2021-22 to 2023-24, the number of posts filled by staff who were from outside the EU rose by 160,000 (from 140,000 to 300,000), meaning their share of the workforce increased from 9% to 19%. Over the same period, the number of posts held by British nationals fell by 70,000, from 1,260,000 (84% of the workforce) to 1,190,000 (75%).

Employers who employed at least one non-British worker who arrived in the UK from April 2022 to March 2024 saw their turnover rate fall by 8.1 percentage points (from 41.5% to 33.4%) from 2021-22 to 2023-24. While employers who did not recruit internationally had a lower turnover rate to start with – 31.6% in 2021-22 – this only fell by 2.9 percentage points over the period (to 28.7%).

Similarly, employers who recruited internationally saw their vacancy rate fall from 12.8% to 8.5% over the two-year period – a drop of 4.3 percentage points – while the rate for other employers fell by only 1.2 percentage points, from 8.1% to 6.9%.

Qualifications and sickness absence gaps

Skills for Care also found significant gaps between international and British staff recruited in 2023-24 in relation to qualifications and levels of sickness absence.

While international recruits took an average of 2.5 days’ sickness absence during the year, domestic recruits took 9 days. Also, while 55% of those international recruits had completed the care certificate standards, which set basic expectations of care workers, by March 2024, this was true of 37% of British recruits.

International recruits also drove the rise in the proportion of men in the workforce, from 19% in 2022-23 to 21% in 2023-24, the highest level yet recorded. Men made up 29% of international recruits in 2023-24, but just 15% of domestic recruits.

Warning over ‘rapid’ decline in number of international recruits

Skills for Care chief executive Oonagh Smyth (photo from Skills for Care)

“On the face of it, the headline statistics paint a positive picture,” said Skills for Care chief executive Oonagh Smyth. “The workforce grew for the second consecutive year and we’ve seen the lowest turnover in a decade.”

“[But] the improvements in this year’s report are largely driven by international recruitment…and there is early evidence that the number of international recruits is rapidly falling.

“And it’s clear that social care is struggling to compete for staff in local labour markets so longstanding domestic recruitment and retention challenges exist.”

She added: “So we need to stem the tide of British care workers who are leaving their jobs and we can only do that by improving the quality of care roles so the sector can be more competitive in local job markets.”

Adult social care workforce strategy

In the summer, Skills for Care published a 15-year strategy for the workforce, designed to improve recruitment and retention in order to fill current gaps and meet the sector’s future needs, in the context of an ageing population.

The strategy, conceived by sector leaders, urged action to boost pay and qualification levels in the sector, along with measures to attract currently underrepresented groups, such as men and young people, into the workforce.

Skills for Care has set up an implementation unit to support adoption of the strategy’s recommendations. However, half of the recommendations are for government, either alone or in partnership with others.

No funding plan for pay improvements

While the Employment Rights Bill is designed to boost pay and conditions for adult social care staff, the government has not set out how it will fund local authority and NHS commissioners to pass on the required increases in fees to enable providers to deliver on these improvements.

This is the context of providers already warning that they are significantly under-resourced to deliver services. For example, the Homecare Association has calculated that there there is a £1bn gap between the home care fees paid by commissioners and the amount required by providers in England to pay staff the NLW.

Meanwhile, in relation to training and qualifications, the Labour administration has cut funding levels for 2024-25 by £115m relative to its Conservative predecessor’s plans.

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.”