2. Getting here: visas and the sponsorship system
risk – commonly unpaid for travel time and lacking proper contracts. Many remain in exploitative roles due to fear that speaking out will lead to potential deportation.
Examples of abuse
• One care provider with only four declared staff received 1,234 Certificates of Sponsorship.
• Another provider, linked to a non-existent care home, received 275 certificates.
• A Nigerian care worker paid £ 10,000 to an agent and arrived in the UK to find no job existed, leaving her reliant on food banks.
• Four Indian nurses each paid up to £ 25,000 to a recruitment agency for Health and Care Worker visas. Once in the UK, they were left jobless despite holding contracts.
Lack of regulation
Although the Labour government placed some new obligations on care sponsors from July 2025( see box on page 12), oversight of the current system is minimal. In 2023, over 94,000 employers held sponsor licences, yet there was just one Home Office compliance officer for every 1,600 employers. Now there are even fewer. Most sponsors have never received a visit. Local authorities are not always informed when licences of their contracted service providers are revoked, putting both workers and vulnerable patients at risk.
The Employment Agency Standards Inspectorate, the government agency tasked with regulating and enforcing the rights of agency workers, is similarly underresourced, with only 29 staff in 2021( compared to 400 staff for minimum wage enforcement at HMRC). Furthermore, workers who report employment abuse to the agency, may open themselves to investigation by immigration enforcement, deterring them from speaking out. Meanwhile, employers rarely face consequences for bad practice.
One key safeguard which is supposed to prevent this type of abuse is the Code of Practice for the International Recruitment of Health and Social Care Personnel in England. This code sets out principles and benchmarks for ethical recruitment, including a ban on charging recruitment fees to workers and the use of countryspecific red lists to limit active recruitment from vulnerable health systems. Employers are expected to follow the code, and NHS Employers publishes guidance to support its implementation. However, there is no formal mechanism to ensure its enforced. Agencies and employers can appear on the NHS Ethical Recruiters List without undergoing consistent or robust checks. As a result, reports found that adherence to the Code is patchy, with many employers failing to follow it despite being expected to do so.
LRD • Supporting migrant workers 13