Care homes in England are warning they may have to close, as the sector’s longstanding staffing crisis faces further trouble due to changes in immigration policy.

The latest official migration statistics show the number of health and care worker visas granted to people to come work in the UK has dropped 25% between June 2023 and June 2024. There was an even more dramatic fall between April and June 2024 when the number of visas granted dropped by 81%, to 6,564. During the same period in 2023, 35,470 visas were granted.

The decline is undoubtedly linked to the previous government’s decision in late 2023 to stop allowing migrant care workers to bring family members with them. This was part of the Conservatives’ plan to deliver the “biggest ever reduction in net migration” (the difference between immigration and emigration).

The effect has been dire for the social care sector, which relies heavily on recruitment from overseas. In England, 19% of the adult social care workforce is non-British. Scotland and Northern Ireland, which both raised pay for care workers in recent years, are less reliant on migration.

Demand for social care is increasing throughout the UK, as it is elsewhere. People are living for longer, with major illnesses and disabilities as they grow older. To meet increasing demand, projections suggest that an extra 480,000 jobs will be needed in the sector by 2035 – a 32% increase above the 1.52 million currently filled posts.

Recruiting from abroad

The UK has long looked overseas to meet demand for health and care workers, with source countries changing according to the UK’s global relationships and migration policies. The enlargement of the European Union in the 2000s to include central and eastern European countries marked a turning point in recruitment patterns.

Before then, most migrant care workers came from the UK’s former colonies. After that, the majority came from EU member states, under freedom of movement rights.

Brexit and the end of freedom of movement led to a sharp fall in the number of care workers coming from EU countries. Categorised as “unskilled” work, care workers were initially excluded from the Conservative government’s new global points-based immigration system, introduced in January 2021.

Just 13 months later, though, workforce shortages forced the government to open up the skilled worker visa route to care workers. The most common source countries became again former colonies, such as India, Nigeria and Zimbabwe.

Since then, the large number of visas granted in a short period of time has exposed care workers to widespread exploitation by recruitment agencies or private care companies. Along with the restrictions on bringing family members, the previous government announced it would require care providers sponsoring visas to be regulated by a care quality commission.

Recruiting from within UK

Today, the care sector is struggling to recruit and retain the workers it needs to meet current care needs, let alone future demand.

Workplace conditions and the societal undervaluing of care work mean the social care sector struggles to attract British workers. In recent years it has only been as a result of international recruitment that the sector has been able to keep its head above water.

In October 2023 – before the recent collapse in the number of visas granted but the latest data available – there were 152,000 vacant posts in adult social care in England. The vacancy rate at 9.9%, was higher than the 8% for the National Health Service, and significantly higher than the 3.4% for the economy as a whole. Recruitment challenges are especially acute in rural areas.

Staff turnover – the rate at which workers left their jobs in the last 12 months – is also high at 28.3% in October 2023.

Research shows there are a number of reasons the sector struggles to recruit and retain workers, including:

  • low rates of pay (often at minimum wage level or below);

  • the prevalence of zero hours contracts (22% in October 2023 were on zero hours contracts);

  • limited opportunities for training and career progression; and

  • the low status of care work, linked to its longstanding association with women (81% of the current workforce in England) and racialised minorities (26% of the current workforce).

Improving sector

There is little sign that the new Labour government will address the urgency and scale of the challenges facing social care as a result of the collapse in the numbers now migrating for care work. The home secretary, Yvette Cooper, recently set out the government’s support for the rule changes introduced by the previous government, including those that prevent migrant care workers bringing their family members.

This is part of Labour’s wider policy to reduce net migration by ensuring “immigration is not used as an alternative to training or tackling workforce problems here at home”.

Labour’s manifesto commitment to implement a £12 per hour minimum wage for care workers is welcome. But, wider and longer term changes are needed, including most fundamentally around the funding of social care, to make sure that the sector can retain these key workers, regardless of where they come from.

Majella Kilkey is Professor of Social Policy, University of Sheffield.

This article was first published on The Conversation.