Dr Kalpa Kharicha is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London. She led the Unit’s Visa Study, the report from which was published in October 2023. (679 words)

Internationally recruited care workers made the biggest contribution to reducing vacancies in frontline adult social care in England during 2022-3; 70,000 people came to the UK to work in a direct social care role. During this time the number of domestic recruits to care work fell. Vacancies in social care are currently at 152,000.

The increase in international care workers follows changes to government immigration policy in recent years. In particular, the addition of ‘Senior care workers’ and ‘Care workers’ to the shortage occupation list (on 27 January 2021 and 15 February 2022, respectively) allows people from other countries to apply for these jobs, with a licensed UK employer and if eligible for a Health and Care Visa.

Recent announcements on immigration policy mean that from early 2024 (exact date to be confirmed at time of writing), Health and Care Visa holders arriving in the UK after that time will no longer be able to bring their dependants with them Health and Care Visa holders who are already in the UK can bring dependants whilst on their current visa.

As part of our recent research to understand the impact of the Health and Care visa system on the adult social care workforce in England, we spoke to 29 internationally recruited care workers and dependants, as well as 22 social care providers, 8 brokerage agencies and 15 sector skills experts, who shared their views and experiences with us.

We found that:

• Almost all Health and Care Visa holders with partners and children (aged under 18 years of age) initially had come to the UK alone, with the plan to bring their dependants once they had settled and secured appropriate accommodation.
• Visa holders’ longer-term ambitions included to continue working in social care or the NHS, to remain in the UK, and to secure a better future for themselves and their families, both for their dependants in the UK and by sending money home in remittances.
• All adult dependants of Health and Care Visa holders who had already moved to the UK had paid or unpaid roles. In contrast to Health and Care Visa holders, dependant visa holders had flexibility in the choice of work and terms of contract available to them and in this respect represented what might be viewed as a valuable, hidden and flexible source of care and other labour.
• Dependants worked in care homes as care workers as well as auxiliary roles in kitchen and housekeeping. One ran a virtual diaspora group on a voluntary basis supporting individuals looking to move to the UK on the Health and Care Visa. Others worked in warehouses and food delivery. They described changing jobs as they needed or wanted to, for example, one dependant initially worked as an agency care worker, then as a care assistant employed by a care home and was due to start work as a healthcare assistant in an NHS hospital, all over the course of 9-10 months of being in the UK.
• The flexibility of terms and conditions associated with dependant visas was attractive to care providers. It allowed them to employ dependants in different part-time roles within social care and to be responsive to fluctuating demands for care and turnover of staff.
• Internationally recruited care workers were comparable to their domestically recruited peers in terms of gender but were younger (most were aged 25-39 years old). Their skill level (in terms of formal qualifications and experience) was high. Our sample included nurses and graduates, those with professional training in other subjects, and paid and unpaid experience of care work.
• Several care workers and dependants had already worked internationally in other countries. For those with children, the ability to bring their children to the UK as dependants made the UK an attractive option for longer-term settling.

Workforce priorities of recruitment and retention in health and care need to extend to both domestic and internationally recruited workers. Policies that deter people from moving and staying in the UK may put further pressures on workforce shortages and the availability of care to those with care and support needs.

Dr Kalpa Kharicha is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London.

The Visa Study project page at King’s

Visa Study report

Kharicha, K., Manthorpe, J., Kessler, I., & Moriarty, J. (2023) Understanding the impact of changes to the UK Health and Care Visa System on the adult social care workforce in England, Phase 1: The Visa Study. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London.

Our research was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR Policy Research Unit in Health and Social Care Workforce: Ref. PR-PRU-1217-21002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.