2. Getting here: visas and the sponsorship system
Following Brexit, the system changed significantly. From December 2020, the Tier 2 visa was replaced by the Skilled Worker visa as part of the Conservative government’ s new points-based immigration system that applied equally to EU and non-EU nationals. This ended free movement for EU citizens and made employer sponsorship a requirement for anyone without settled status coming to the UK to work. In 2021, in response to the huge staffing shortages in the NHS and adult social care sector after the Covid pandemic, the government introduced the Health and Care Worker visa. This sub-category of the Skilled Worker route offered reduced fees and exemption from the Immigration Health Surcharge( which allows visa holders to access NHS services similarly to UK residents) for eligible workers – and encouraged a huge wave of recruitment into low paid care roles.
In 2024, after widespread reports of abuse and failings in the system, the Conservative government attempted to‘ crackdown’ on the wave of immigration – that they had previously encouraged – with policies that targeted new migrant workers and their families. In March 2024, most care and senior care workers granted a visa to work in the UK lost the right to bring dependants with them and had to secure jobs with higher salaries which reduced the numbers able to work in the lowest paid care roles. Then, in July 2025, the Labour government controversially shut down overseas recruitment altogether for low paid care roles.
Whilst nursing assistants and auxiliaries can still be recruited from abroad under a new‘ medium-skilled route’, this can only be done by‘ regulated healthcare providers where nurses are also employed’ e. g the NHS, and they will not be allowed to bring dependents. Further, this rule will only apply until December 2026 in a‘ transitional phase of change’ that will last until 2028. The government claims the reforms will not affect social care staffing as up to 40,000 workers already in the UK via“ rogue” providers could be redeployed into any new vacancies while a longer-term workforce strategy to recruit UK workers is developed. Sponsors seeking to recruit care workers can now employ workers from the‘ displaced worker pool’, i. e. workers who are already in the UK( but are not obliged to do so). However, in another blow to these workers, the government also has plans to increase the number of years required for migrants to be able to apply for indefinite leave to remain to 10 years from the current five.
UNISON general secretary Christina McAnea called the changes“ hugely damaging” and warned it could push the sector to breaking point.“ The NHS and care sector would have collapsed long ago without the thousands of workers who’ ve come to the UK from overseas,” she said.“ Migrant health and care staff already here will now be understandably anxious. Politicians must stop describing care jobs as lowskilled – they require high levels of skill and huge amounts of empathy.” She urged the government to properly fund social care, deliver its promised fair pay agreement for the sector, and target unscrupulous employers, not workers.
10 LRD • Supporting migrant workers