The Lead Untangles: The crisis in care

It is not just welfare reform that risks leaving some of the most vulnerable in our society exposed.

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Jul 18, 2025

Stephen Kinnock, Minister of State at the Department of Health and Social Care. Credit: 美國之音/鄭樂捷

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At a glance facts

Keir Starmer’s much-maligned anti-immigration speech in June highlighted the crisis in adult social care. In an attempt to crack down on immigration, the Prime Minister announced a plan to entirely phase out overseas recruitment in care.

In a white paper entitled “Restoring control over the immigration system,” the Government proposed that care workers on sponsored visas would need to remain in the UK for 10 years before gaining the right to live and work here indefinitely - double the current requirement of five years. The Government cited abuse and exploitation of migrant care workers as part of their reasoning, as well as an overreliance on migrant labour.

The overall response was not just fury, but worry.

The Care Workers’ Charity said: “We fully recognise the urgent need to address modern slavery and exploitation—no worker should be at risk of abuse.

“However, the solution is not to remove Health and Care Worker Visas. Tackling systemic issues requires strong regulation, robust safeguarding, and fair recruitment practices, not restrictions that will damage an already overstretched sector.”

Context

The UK’s adult social care sector has been in crisis for at least a decade – and then the pandemic served to highlight and further compound the issues that already existed.

Since 2001, the share of state-funded adult social care has fallen from 42 per cent to 9 per cent, and, despite an ageing population, the number of older people receiving state-funded care in England has dropped by 10 per cent since 2014–15.

The main issues facing the sector are high costs – in 2023/24, the total expenditure on adult social care by local authorities was £32 billion – and, crucially, a severe understaffing crisis.

Last year, there were around 131,000 vacancies in social care in England, with one in ten care worker roles vacant. The turnover rate was higher than that of the NHS, with a quarter of care workers leaving their role.

According to this year’s adult social care worker survey, the main reason for this is pay. The average hourly rate for care workers is the same as minimum wage. The benefits of working in care are pitiful. The hours are long and unsociable, and three in ten care workers are on zero-hours contracts, nine times the average for the economy as a whole; and few care workers receive more than the legal minimum in terms of sick pay or pensions. The job is emotionally taxing. And the understaffing crisis is self-sustaining: existing care workers are often faced with high patient-to-caregiver ratios and extended hours, leading to even more turnover.

Migrant care workers make up a huge proportion of the existing adult care workforce. In 2023, nearly half of all new starters were migrants, and one fifth of the overall workforce is non-British.

But even foreign visas are dwindling. According to Home Office statistics, the number of entry visa grants for care workers and senior care workers in January to March 2024 was 84 per cent lower than the previous quarter and 87 per cent lower than a year prior.

What does the care workers' visa actually do?

The Health and Care Work visa allows medical professionals to come to or stay in the UK to do an eligible job with the NHS, an NHS supplier or in adult social care.

Under current conditions, the visa lasts for five years, and there are no limits on extensions. After five years, workers may be able to apply to settle permanently in the UK (also known as ‘indefinite leave to remain’).

Under the new plans, coming into effect on 22 July, the UK government is ending the ability for overseas workers to come to the UK on Health and Care Worker visas for roles in adult social care. Those already in the UK on a Health and Care Worker visa will be able to switch to other visa routes or extend their stay until July 2028.

What are politicians saying?

Kaukab Stewart, Equalities Minister for the SNP, said: “The UK Government’s plans on migration stand in stark contrast to our values and they do not reflect Scotland’s distinct population needs.

“Scotland needs talented and committed people from across the world to live, work and study here without excessive barriers.

“A one-size fits all approach to immigration fails to meet the needs of Scotland and much of the UK. In particular, any plans to end international recruitment of care workers will be devastating for the care sector in Scotland and across the UK.”

Labour MP Nadia Whittome said: “Migrants are being scapegoated for problems they did not cause.

“To be truthful, these arbitrary measures will not fix those problems, but they will harm migrants, people who need social care, our economy and anyone who fears racial abuse, which the rhetoric surrounding this issue emboldens.

“Why are we trying to ape Reform, when that will do nothing to improve our constituents’ lives and will just stoke more division?”

Labour MP Paula Hamilton – also the head of the Health and Social Care Committee – said: "I am concerned that if the visa restrictions are imposed immediately, social care could tip over the edge.”

What are stakeholders saying?

Martin Green, chief executive of Care England said: “International recruitment wasn’t a silver bullet, but it was a lifeline. Taking it away now, with no warning, no funding, and no alternative, is not just short-sighted – it’s cruel.”

UNISON general secretary Christina McAnea said: “The NHS and the care sector would have collapsed long ago without the thousands of workers who’ve come to the UK from overseas.

“Migrant health and care staff already here will now be understandably anxious about what’s to happen to them. The government must reassure these overseas workers they’ll be allowed to stay and continue with their indispensable work.”

Nadra Ahmed, of the National Care Association, said: "Understandably, many of those [workers] who are displaced have a preference of which part of the sector they work in or are qualified to do so, based on the promises made to them.

"Our preference would always be to recruit from within our domestic options but sadly we are not able to generate enough interest in social care when the funding remains a barrier to ensure that pay adequately rewards the skills and expertise of our workforce."

What happens next?

As of now, solutions are long-term. Labour has committed to a fair pay agreement, and commissioned an independent review into the adult social care sector, chaired by Baroness Louise Casey. Its first phase is expected to report next year, while phase 2 will finish in 2028.

According to the Government, once care worker visas are revoked, roles will be filled by the 40,000 displaced care workers who were found to have been exploited. However, a recent report by the Work Rights Centre found that the government scheme intended to help these workers find jobs is failing, with less than 4 per cent finding new work.

The Care Workers’ Charity called on the Government to ensure immigration policy does not compromise adult social care any further.

“Policies must prioritise safe recruitment, fair treatment, and long-term workforce investment,” it said.

“Without migrant care workers, the care sector would face collapse—acknowledging their value is not just right, it’s essential.”