When Stella Shaw left her job in the NHS in 2018 to set up a homecare agency, she found she had to advertise for months on end to hire staff locally in the north west of England.
Now, every member of her 45-strong team is an international recruit on a sponsored work visa, several of whom qualified as doctors, nurses, a physiotherapist, a pharmacologist and a sports scientist in their home country.
The government’s decision in 2022 to open an immigration route for entry level care workers has “changed the landscape” in the sector, where a quarter of workers are non-UK nationals. The visa fees she pays, on top of the required annual salary of £25,000, are well worth it, she says. “It’s actually more cost-effective, because they’re reliable.”
But care providers now face a brutal adjustment, following this week’s announcement that overseas recruitment in care will end within months, as part of a broader immigration crackdown.
Too many of the workers who had arrived since 2022 had been “subject to shameful levels of abuse and exploitation”, the government said, arriving to find themselves “saddled with debt, treated unfairly . . . or discover the jobs they were promised did not exist”.
Some economists say there are good reasons to close a visa route that left low-paid workers highly vulnerable to exploitation, but under no obligation to work in care in the long term.
“Work visas with a path to settlement do not work for jobs where the demand for migrants comes from poor pay and conditions,” said Alan Manning, an LSE professor and formed head of the government’s Migration Advisory Committee. “Those who came on a care worker visa and worked in social care for five years may have another 50 years in the UK.”
Care executives, however, say there is no immediate alternative to international recruitment given the long-standing funding pressures on the sector that prevent them raising wages.
Shaw says her local authority, in Chester, is relatively generous in the hourly rate it offers providers. But many councils auction out small packages of care to the lowest bidder in a way that leaves providers unable to plan ahead or to group clients sensibly within a small geographical area.
Staffing “was always the big concern” even before the Covid-19 pandemic, said Darren Stapelberg, chief executive of Grosvenor Health and Social Care Group, one of the UK’s biggest providers. After the pandemic, burnout led to a “massive shift” in the hours UK staff wanted to work, and a sharp drop in the number willing to use their own cars for client visits, he said.
About two-thirds of Grosvenor’s 6,000 staff were recruited in the UK, Stapelberg said, including many who were not British nationals but had moved to the country and settled. But among the 900 staff who had started within the last year, just 67 were local recruits. The opening of the visa route “maintained and stabilised our business”, he said.
Ministers argue that the route’s closure will not tip the sector into a fresh crisis, because up to 2028, employers will be able to hire from a pool of migrants already in the UK. This group includes students, recent graduates and about 40,000 displaced care workers previously hired by “rogue” employers who have been stripped of their licence to sponsor visas.
But both charities and care providers say that while many displaced workers are in need of support, helping them find new care jobs is not straightforward.
“We found a range of barriers the government has not been upfront about,” said Dora-Olivia Vicol, chief executive of the Work Rights Centre, which has interviewed many of the migrants affected, as well as regional hubs the government is funding to match workers to jobs.
Some people were couch-surfing and could not afford to relocate for a new job, she said. Some had fallen pregnant and given birth since arriving. Others had no UK driving licence and wanted to work in a care home, while most vacancies were in domiciliary care.
Meanwhile, the regional hubs were often offering no more than a “glorified jobs fair”, Vicol said, and care providers were “reticent” about hiring people whose previous employers had been abusive to the point of violence, seeing them as “damaged goods”.
Providers say the migrants still looking for work are often unsuited to care and that driving ability is a big barrier, given the logjams in the testing system. Zimbabweans have had an edge over other nationalities, because they drive on the same side of the road as the UK and their licences are valid.
“The people left in the pool . . . are not necessarily a good fit,” said Camille Leavold, chief executive of Abbots Care, a Hertfordshire-based provider.
About 100 of her 580 staff are international hires, including several who have switched from abusive employers, but she says: “It’s not just a job. You have to be genuinely wanting to care, very person focused, to see what needs doing and how to communicate with a client.”
Stapelberg says Grosvenor is receiving enquiries from about 600 displaced migrants each week, interviewing 100, and finding just seven with the requisite driving licence, communication skills and aptitude.
The longer-term aim is to drive up pay and standards in the sector through a new mechanism for collective bargaining, with no plan yet on how to boost the sector’s funding. But providers say it will not take long for strains on staffing to reappear.
“None of us believe we can sustain our operations without some form of immigration,” said Raina Summerson, chief executive of Agincare, a UK-wide provider.
“By the end of the summer, it will be horrendous,” said Leavold, who sees vacancies on the rise, and believes that by December, hospitals will yet again face bed blockages because they cannot safely discharge patients. “That’s the only time anyone cares about social care.”
