Low pay, staff shortages and a tough job no wonder Britain’s care homes are struggling to fill vacancies.

Now, industry leaders say that could get even harder due to Prime Minister Rishi Sunak’s plans to stop foreign workers being able to bring family members with them if they come on visa programmes to take up UK health and care jobs.

Seeking to address concerns about the impact of the measure on a sector heavily reliant on migrant workers, the government unveiled plans in January aimed at attracting more Britons to care jobs.

That could be vital as demand for care workers grows in tandem with an ageing population. The number of over-65s is set to reach 13.8 million by 2035, according to Skills For Care, a workforce and planning body for adult social care.

Here’s a look at how these factors will impact the country’s care sector and why it matters:

Why are there staff shortages?

More than half of nearly 2,000 care providers said they had difficulties hiring staff and a third said they had trouble retaining them, found a 2023 survey by the Care Quality Commission, an independent health and care regulator in England.

With median hourly pay of 10.11 pounds ($12.85), according to Skills For Care, social care jobs are among the lowest-paid in Britain, with workers earning less than shop assistants (10.12 pounds) though slightly more than cleaners (9.96 pounds).

There is also growing concern about increasing exploitation in the care sector.

In 2022, 106 cases of modern slavery involving carers were reported to a helpline operated by anti-slavery charity Unseen, equating to about 10% of all cases that year, the group said.

Doing gruelling work with little pay in a challenging environment makes adult social care an unattractive career for many Britons, said Simon Bottery, a senior fellow of social care at The King’s Fund health charity.

“Unless we do something about the underlying problem with the underfunding of the system, which in turn leads to too low pay, then we’re not going to fix the problem,” he told Context.

How many foreign care workers

About 19% of the care workforce is foreign, with most coming from Nigeria, India, Romania, Poland, the Philippines and Zimbabwe, according to 2023 data from Skills For Care.

Demand for jobs intensified in 2022 after Britain opened up a new visa route for overseas workers to help fill more than 160,000 vacancies in the care sector following the Covid-19 pandemic and Britain’s departure from the European Union.

In the year ending September 2023, skilled visas granted to health and care workers jumped to nearly 144,000 from 61,274 the year before, the biggest of all sectors according to official immigration data.

Low wages are one of the reasons the sector is heavily dependent on migrant workers from countries where average salaries are much lower than in the UK.

An overseas carer in Britain earns a minimum 20,960 pounds a year – a low wage given the high cost of living, but more than 10 times what many teachers in Zimbabwe earn.

Why is the care industry worried?

With migration high on the political agenda ahead of a 2024 election, Home Secretary James Cleverly announced plans in December aimed at slashing the number of migrants arriving in the UK by legal routes including care and health workers.

While they were exempted from a higher minimum salary requirement for other people on skilled work visas, he outlined other measures that could deter them.

They included the ban on bringing family members and a hike on the surcharge that migrants have to pay to use the health service by 66%.

Care providers are concerned that without the ability to bring over dependents, among other barriers, many foreign carers will instead go to places like Australia, the United States, the Middle East and Canada, which also need more care workers.

“Every barrier that we put up and makes us less attractive as a country for people to come and work in,” said Vic Rayner, chief executive of the National Care Forum, which represents nonprofit care providers across Britain.

With the global population ageing at an “unprecedented pace”, the over-60 age group reaching 2.1 billion by 2050, according to the United Nations World Health Organization, worldwide demand for health and care workers is set to soar.

In its 2023 report, Skills For Care estimated that a further 440,000 carer jobs will arise as the British population ages.

“It seems very unlikely that we will be able to do that without a significant migrant workforce,” Rayner said.

This article first appeared on Context, powered by the Thomson Reuters Foundation.