Rt Hon Chris Heaton-Harris was MP for Daventry 2010 -2024 and was in the Cabinets of three Prime Ministers he has since founded a public affairs company called Oak Insight
Gaurav Menon is a social care executive with more than two decades of experience operating in highly regulated sectors, including adult social care and environmental services.
This is part 3 of a mini-series Who Cares? You can read part 1 here and part 2 here. Based on ‘The Future of Adult Social Care in England: A Predictive Analysis’ by Gaurav Menon
When Brexit disrupted the pipeline of European care workers, the government’s response was the Health and Care Worker visa – a scheme that brought tens of thousands of overseas workers into a sector facing acute vacancy pressure. It solved a short-term crisis. It also created a medium-term dependency that is now unravelling in ways that neither policymakers nor providers were prepared for.
How the Sector Got Here
Brexit and the Domestic Workforce Gap
Before Brexit, freedom of movement provided relatively frictionless access to EEA workers willing to work in care at a time when domestic recruitment was already struggling. The post-Brexit immigration framework dismantled that pipeline with no equivalent replacement in place. The Health and Care Worker visa was the managed substitute: between 2021 and 2024, it brought an estimated 70,000–100,000 overseas workers into the sector, primarily from the Philippines, India, Nigeria, Ghana, and Zimbabwe. By 2023/24, approximately 19 per cent of the adult social care workforce were non-British nationals, with concentrations exceeding 40 per cent in London and the South East.
The visa filled a gap. It did not close one.
Domestic wages had not risen sufficiently to attract new entrants, and the structural conditions that had produced EEA dependency – low pay, high demand, poor public perception of care work – remained entirely unchanged. Skills for Care estimated approximately 152,000 vacant posts in 2023/24. Annual turnover remains above 28 per cent. The National Living Wage has compressed pay differentials in ways that make care work structurally uncompetitive: a care worker and a logistics operative may earn within pennies of each other per hour, yet the care worker faces CQC scrutiny, safeguarding obligations, complex clinical risk, and end-of-life care. The logistics operative does not.
The Visa Scheme: What Worked and What Did Not
A Sponsorship Architecture That Favoured the Large
The visa scheme tied workers to licensed sponsor employers, intended to create mutual dependency between worker and provider. In practice, it created a dynamic that systematically disadvantaged smaller providers. Under the Immigration Rules, a Skilled Worker may transfer to a new Certificate of Sponsorship with a different licensed sponsor without returning to their country of origin. Large corporate care providers and NHS trusts – all licensed sponsors with superior wage offers – were able to recruit workers already in the UK at lower marginal cost than the original sponsor who had funded the overseas recruitment, visa fees, and relocation.
The Recruitment and Employment Confederation estimated the full replacement cost of an internationally recruited care worker at £8,000–£15,000. Small independent providers absorb this cost without recovery mechanism, against fee rates that take no account of international recruitment economics. Large corporate providers amortise it across scale. The financial asymmetry between large and small providers was being systematically widened by the very workforce strategy supposed to stabilise the sector.
The Remittance Economy
The most significant factor absent from policy analysis of this workforce is the remittance economy underlying it. Workers recruited primarily from the Philippines, India, Nigeria, Ghana, and Zimbabwe are, in the overwhelming majority of cases, economic migrants whose financial objective is the transmission of earnings to households in their country of origin. The World Bank consistently identifies these nations among the highest remittance-receiving globally.
For the internationally recruited care worker, the UK is a staging post. The visa tenure is the horizon, not the beginning of a settled life.
A worker remitting 30–40 per cent of net income is transferring approximately £4,000–£7,000 per year out of the UK economy; capital that does not circulate in the local care economy and does not represent the economic integration that long-term workforce stability requires. Skills for Care data shows that visa-route workers leave the sector at significantly elevated rates after the two-year mark, once employer-tied repayment clauses have elapsed.
The February 2024 Dependant Visa Restriction
In February 2024, the government restricted the right of Health and Care Worker visa holders to bring dependants to the UK. The Homecare Association documented a 70 per cent decline in overseas care worker visa applications following the restriction, confirming that the pipeline is sensitive to policy signals in ways that make forward planning for providers unreliable. The restriction also directly damaged the UK’s competitive position: a Filipino carer who can bring their family to Canada but not to the UK will, rationally, choose Canada.
Why the Pipeline Is Narrowing — and Will Not Recover
Source Nations Are Changing
The Philippines, India, and West African source nations are each, at different rates, absorbing their own trained healthcare workforces as domestic demand grows. The WHO Health Workforce Support and Safeguards List already identifies several dominant source countries as critically undersupplied in health workers, with ethical recruitment guidelines recommending that high-income nations refrain from active recruitment from them. Geopolitical competition from Canada, Australia, Germany, and the Gulf states – all running parallel international recruitment programmes, many with superior settlement rights – is further reducing the UK’s relative attractiveness. The post-2024 dependant visa restriction accelerated that reorientation.
The international recruitment model bought the care sector approximately a decade of breathing space after Brexit. The workers already here will age through their visas, remit their savings, and in significant numbers return to their countries of origin or move on to third countries with better long-term settlement prospects. There is no equivalent cohort behind them.
What Needs to Happen
The care sector’s workforce crisis is not a recruitment problem. It is an economics problem. The pay, conditions, and public perception of care work have combined to make it structurally unattractive to domestic workers, and no recruitment campaign will overcome that while the underlying economics remain unchanged. A sustainable domestic workforce requires wages that genuinely differentiate care work from comparable alternatives – wages that reflect the clinical complexity, emotional intensity, and regulatory burden of what care workers actually do.
International recruitment has a role to play – but as a complement to domestic workforce development, not a substitute for it. The ethical dimensions of recruiting from health-worker-scarce countries, the remittance economics that prevent genuine workforce integration, and the visa architecture that produces transient rather than settled workers all point to the same conclusion: the model of the past five years cannot and should not be continued indefinitely.
The breathing space that international recruitment provided has not been used to build the domestic alternative. The window in which that alternative can be built is narrowing.
Rt Hon Chris Heaton-Harris was MP for Daventry 2010 -2024 and was in the Cabinets of three Prime Ministers he has since founded a public affairs company called Oak Insight
Gaurav Menon is a social care executive with more than two decades of experience operating in highly regulated sectors, including adult social care and environmental services.
This is part 3 of a mini-series Who Cares? You can read part 1 here and part 2 here. Based on ‘The Future of Adult Social Care in England: A Predictive Analysis’ by Gaurav Menon
When Brexit disrupted the pipeline of European care workers, the government’s response was the Health and Care Worker visa – a scheme that brought tens of thousands of overseas workers into a sector facing acute vacancy pressure. It solved a short-term crisis. It also created a medium-term dependency that is now unravelling in ways that neither policymakers nor providers were prepared for.
How the Sector Got Here
Brexit and the Domestic Workforce Gap
Before Brexit, freedom of movement provided relatively frictionless access to EEA workers willing to work in care at a time when domestic recruitment was already struggling. The post-Brexit immigration framework dismantled that pipeline with no equivalent replacement in place. The Health and Care Worker visa was the managed substitute: between 2021 and 2024, it brought an estimated 70,000–100,000 overseas workers into the sector, primarily from the Philippines, India, Nigeria, Ghana, and Zimbabwe. By 2023/24, approximately 19 per cent of the adult social care workforce were non-British nationals, with concentrations exceeding 40 per cent in London and the South East.
The visa filled a gap. It did not close one.
Domestic wages had not risen sufficiently to attract new entrants, and the structural conditions that had produced EEA dependency – low pay, high demand, poor public perception of care work – remained entirely unchanged. Skills for Care estimated approximately 152,000 vacant posts in 2023/24. Annual turnover remains above 28 per cent. The National Living Wage has compressed pay differentials in ways that make care work structurally uncompetitive: a care worker and a logistics operative may earn within pennies of each other per hour, yet the care worker faces CQC scrutiny, safeguarding obligations, complex clinical risk, and end-of-life care. The logistics operative does not.
The Visa Scheme: What Worked and What Did Not
A Sponsorship Architecture That Favoured the Large
The visa scheme tied workers to licensed sponsor employers, intended to create mutual dependency between worker and provider. In practice, it created a dynamic that systematically disadvantaged smaller providers. Under the Immigration Rules, a Skilled Worker may transfer to a new Certificate of Sponsorship with a different licensed sponsor without returning to their country of origin. Large corporate care providers and NHS trusts – all licensed sponsors with superior wage offers – were able to recruit workers already in the UK at lower marginal cost than the original sponsor who had funded the overseas recruitment, visa fees, and relocation.
The Recruitment and Employment Confederation estimated the full replacement cost of an internationally recruited care worker at £8,000–£15,000. Small independent providers absorb this cost without recovery mechanism, against fee rates that take no account of international recruitment economics. Large corporate providers amortise it across scale. The financial asymmetry between large and small providers was being systematically widened by the very workforce strategy supposed to stabilise the sector.
The Remittance Economy
The most significant factor absent from policy analysis of this workforce is the remittance economy underlying it. Workers recruited primarily from the Philippines, India, Nigeria, Ghana, and Zimbabwe are, in the overwhelming majority of cases, economic migrants whose financial objective is the transmission of earnings to households in their country of origin. The World Bank consistently identifies these nations among the highest remittance-receiving globally.
For the internationally recruited care worker, the UK is a staging post. The visa tenure is the horizon, not the beginning of a settled life.
A worker remitting 30–40 per cent of net income is transferring approximately £4,000–£7,000 per year out of the UK economy; capital that does not circulate in the local care economy and does not represent the economic integration that long-term workforce stability requires. Skills for Care data shows that visa-route workers leave the sector at significantly elevated rates after the two-year mark, once employer-tied repayment clauses have elapsed.
The February 2024 Dependant Visa Restriction
In February 2024, the government restricted the right of Health and Care Worker visa holders to bring dependants to the UK. The Homecare Association documented a 70 per cent decline in overseas care worker visa applications following the restriction, confirming that the pipeline is sensitive to policy signals in ways that make forward planning for providers unreliable. The restriction also directly damaged the UK’s competitive position: a Filipino carer who can bring their family to Canada but not to the UK will, rationally, choose Canada.
Why the Pipeline Is Narrowing — and Will Not Recover
Source Nations Are Changing
The Philippines, India, and West African source nations are each, at different rates, absorbing their own trained healthcare workforces as domestic demand grows. The WHO Health Workforce Support and Safeguards List already identifies several dominant source countries as critically undersupplied in health workers, with ethical recruitment guidelines recommending that high-income nations refrain from active recruitment from them. Geopolitical competition from Canada, Australia, Germany, and the Gulf states – all running parallel international recruitment programmes, many with superior settlement rights – is further reducing the UK’s relative attractiveness. The post-2024 dependant visa restriction accelerated that reorientation.
The international recruitment model bought the care sector approximately a decade of breathing space after Brexit. The workers already here will age through their visas, remit their savings, and in significant numbers return to their countries of origin or move on to third countries with better long-term settlement prospects. There is no equivalent cohort behind them.
What Needs to Happen
The care sector’s workforce crisis is not a recruitment problem. It is an economics problem. The pay, conditions, and public perception of care work have combined to make it structurally unattractive to domestic workers, and no recruitment campaign will overcome that while the underlying economics remain unchanged. A sustainable domestic workforce requires wages that genuinely differentiate care work from comparable alternatives – wages that reflect the clinical complexity, emotional intensity, and regulatory burden of what care workers actually do.
International recruitment has a role to play – but as a complement to domestic workforce development, not a substitute for it. The ethical dimensions of recruiting from health-worker-scarce countries, the remittance economics that prevent genuine workforce integration, and the visa architecture that produces transient rather than settled workers all point to the same conclusion: the model of the past five years cannot and should not be continued indefinitely.
The breathing space that international recruitment provided has not been used to build the domestic alternative. The window in which that alternative can be built is narrowing.