How the care industry came to rely on migrant workers

Chronic staff shortages, low pay and demanding working conditions have long made it difficult to recruit care workers in Britain. For years, migrant workers have kept the sector afloat but now government immigration reforms could put further pressure on an already overstretched industry.

Social care providers will no longer be able to recruit staff from abroad on a Health and Care visa, under plans outlined in the government's immigration white paper. Instead, providers will have to employ domestic workers, immigrant care workers already here legally or immigrants on other visas. The government says these changes will reduce reliance on overseas workers, crack down on "rogue care providers" and cut immigration by 7,000 a year.

Care England, the body representing the adult social care sector, has described the plans as "a crushing blow to an already fragile sector."

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How much do we rely on migrant care workers?

Migrant workers hold 32% of adult care worker roles in England, according to a 2024 Skills for Care report, with 26% coming from outside the EU and another 6% from an EU member state. Most foreign-born workers were recruited from Nigeria, India, Zimbabwe, Romania and Ghana.

In 2022, the Conservative government added care workers to the Health and Care visa list to allow overseas recruitment, following the twin shocks of Brexit and the Covid-19 pandemic. By 2023, more Health and Care visas were being granted than any other skilled worker visa – over 336,000 in total – but, last year, numbers fell to 27,174, after successful applicants were no longer allowed to bring dependants with them and the government cracked down on abuse of the scheme.

How did it get this way?

The problems facing social care are "deep-rooted" said The Bureau of Investigative Journalism. Austerity-era cuts from 2010 slashed council budgets, limiting funding for social care. And the challenges of the job – "stressful and sometimes exploitative conditions, a lack of career progression and high turnover" – have been cited in reports "as far back as 2015".

Health think tank The Nuffield Trust has also cited Brexit as "adding fuel to the fire of severe challenges" facing social care. "Shutting off the 'relief valve' of EU migration has put additional pressure" on staffing shortages in a system that "has relied heavily" on recruitment abroad and lacks an effective training and retention plan for British workers.

Yet workforce shortages aren't a recent problem, said the Centre for Health and the Public Interest. The NHS and the wider economy "have been dependent on migrant labour to fill job shortages for decades", with the root causes of staff shortages "deeply embedded into how we have chosen to run and organise" our healthcare sector.

Why do we struggle to recruit British carers?

Between 2022 and 2024, the number of British care sector employees dropped by 70,000. Even with over 100,000 immigrants filling care worker roles during that time, the sector's vacancy rate of 8.3% is still nearly three times higher than that in the wider economy, according to the Skills For Care report.

According to research published in Frontiers in Public Health, the sector struggles to recruit and retain workers for several reasons, including low pay, the prevalence of zero-hours contracts, limited opportunities for training and care progression, and the low social status of the work itself.

What does the future look like for the sector?

It's not a pretty picture, unless the government can solve the domestic recruitment crisis. Given Britain's ageing population, the demand for carers will only increase. Skills For Care estimates an additional 540,000 care jobs will be needed by 2040. But without urgent reform, including better pay, training and working conditions, few believe these roles will be filled domestically.

"International recruitment wasn't a silver bullet but it was a lifeline," said Care England's CEO Martin Green. "Taking it away now, with no warning, no funding and no alternative, is not just short-sighted; it's cruel."