What will ending overseas recruitment mean for adult social care?

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According to provider bodies, it risks creating “extreme workforce shortages” and consequent harm to older and disabled people (the Homecare Association), and was a “short-sighted” decision (National Care Forum), dealing a “crushing blow to an already fragile sector” (Care England).

On behalf of council leaders, the Association of Directors of Adult Social Services (ADASS) warned that the policy risked a “triple whammy” of greater reliance on more costly agency staff, greater levels of unmet need for care and more people giving up work to look after loved-ones.

From a staff perspective, UNISON said that it was only through the recruitment of staff from overseas over the past few years that the system has been prevented from “falling over”.

Why government is ending overseas recruitment

The government’s argument is that adult social care’s reliance on overseas staff was the result of poor pay and conditions that deterred UK workers from joining the sector.

Furthermore, it says that the sector fair pay agreement, which it is legislating for through its Employment Rights Bill, will attract UK staff into the sector and move the country away from a dependence on overseas workers to meet its care needs.

Few would argue with the pressing need to raise pay and improve conditions in adult social care, where the median pay of independent sector care workers in England as of March 2024 was £11 an hour, 58p above the then national living wage (source: Skills for Care).

Building domestic workforce ‘will not happen overnight’

However, though the fair pay agreement – under which an Adult Social Care Negotiating Body will set pay for sector workers, with ministerial sign-off –  is designed to improve terms and conditions, its implementation is years away.

What, sector bodies ask, should they do in the meantime?

“Building a skilled, better-paid domestic workforce in social care is vital, as is a proper career structure,” said UNISON’s head of social care, Gavin Edwards. “But none of this will happen overnight. Until it does, the sector will be stuck in a doom-loop of staffing shortages.”

But what difference will the removal of providers’ ability to recruit staff from abroad via the health and care worker visa really make?

Vacancies at all-time high

It is not hard to find evidence of the vital role overseas staff have played in shoring up the sector over recent years.

Rewind to April 2022 and, as the wider economy recovered from the Covid-19 pandemic, adult social care vacancies in England hit a record high of 164,000, up 52% (56,000) on the year before and equivalent to just over one in ten of all posts.

The figures came after the then government had relaxed its post-Brexit immigration arrangements to allow providers to recruit care workers and senior care workers from abroad through the health and care visa.

Ministers decided that overseas staff were key to addressing the sector’s workforce crisis, setting up a taskforce on boosting the number of international recruits in summer 2022, to help social care make it through a “challenging winter”. Then, in 2023-24, they provided councils with £15m to resource the recruitment of care staff from abroad.

Huge impact of overseas recruitment

The results were dramatic. The number of international staff recruited into direct roles in England’s independent care sector quadrupled from 20,000 in 2021-22 to 80,000 in 2022-23, rising further to 105,000 in 2023-24 (source: Skills for Care).

Over that time, the number of staff from outside the EU working in the sector almost doubled, from 140,000 to 300,000, while the number of British staff fell by 70,000, from 1.26 million to 1.19 million. As such, overseas recruits almost single-handedly drove a reduction in vacancy numbers, from 164,000 to 131,000, and an increase in the number of filled posts, from 1.615 million to 1.705 million, from 2022-24.

And international workers did far more than make up the numbers. According to Skills for Care data, while international recruits took an average of 2.5 days’ sickness absence during 2023-24 domestic recruits took nine days. And though 55% of international recruits had completed the care certificate standards, which set basic expectations of care workers, by March 2024, this was true of 37% of British recruits.

Exploitation of international staff

However, there was also a much darker side to the international recruitment of care workers.

In 2023, Brian Bell, chair of the Migration Advisory Committee, which advises the government on immigration, warned that some workers were being charged fees of up to £10,000 by “middlemen” in their home countries to come to the UK. Then, on arrival, some staff faced exploitation by “a tail of very bad employers”.

Many workers reported being forced to work excessive hours with the threat that their sponsorship would be cancelled, according to watchdog the Gangmasters & Labour Abuse Authority (GLAA).

Others were forced to pay off debts resulting from excessive fees charged to secure work, or reported not being properly paid, living in unsuitable conditions while being charged high accommodation fees and, in some cases, being offered no work at all, said the GLAA.

Support to help displaced workers

Between July 2022 and December 2024, the government revoked more than 470 sponsor licences from care sector employers, as a result of such abuses and other breaches of the visa system.

To tackle such abuses, the then Conservative government announced plans, in 2023, to restrict visa sponsorship licences to Care Quality Commission-regulated providers.

Then, in 2024, it provided £16m for regional partnerships of councils to help find work for overseas staff displaced from their jobs by employer immigration abuses.

However, in the face of a sharp rise in immigration generally, it also barred overseas social care staff from bringing dependants with them to the UK, from March 2024 onwards, triggering a sharp fall in international recruitment.

Sharp fall in overseas recruitment

According to Home Office figures, there were 23,200 applications from main applicants for health and care worker visas from April 2024 to January 2025, an 81% fall on the number made in the same 10-month period from 2023-24. These figures include staff coming to the UK to work in the NHS, as well as social care.

In relation to social care alone, about 11,000 people from overseas took up posts in English independent care providers in each quarter of 2024-25, down from 26,000 per quarter the previous year, according to provisional Skills for Care data. This includes staff on health and care worker visas and those who have come through other immigration routes.

Official figures for sector vacancies for 2025 are not yet available. However, further provisional data from Skills for Care, provided by some independent sector providers, shows vacancy rates have actually declined during 2024-25, from 7.6% in April 2024 to 6.8% in March 2025. The March 2024 figure for all independent providers was 8.1%.

This suggests that the sector – while still struggling with significant workforce shortages – has survived the turning off of much of the supply of international recruits it had previously relied upon.

Tougher restrictions

Since April 2025, providers in England have faced even tougher restrictions, with the government barring them from recruiting from abroad without first trying to hire staff from the pool of overseas staff displaced from the roles they had come to the UK to fill.

To support this, the Labour government has renewed its predecessor’s fund to help regional council partnerships find work for this group of staff, which ministers claim number over 10,000.

As a result of this measure, plus the already reduced level of overseas recruitment into adult social care, the impact of banning providers from recruiting from abroad outright may not be substantial. The Home Office estimates it will reduce migration by about 7,000 a year.

The government will also allow providers to extend the visas of staff already in post and to hire people who have come to the UK through other immigration routes on health and care worker visas. They will also still be encouraged to recruit from the pool if displaced staff.

However, that will not prevent many providers from finding it significantly more difficult to fill jobs when the ban comes into force, at a time when the whole sector is under substantially increased pressure from the rise in employer national insurance contributions.

An uncertain future

And the permission to recruit from migrants already in the country and extend visas is due to end in 2028. So what then?

The answer appears to be the fair pay agreement for adult social care, assuming it is in force by then.

But there are severe doubts across the sector that the agreement will deliver real change.

While eight out of ten adult social care staff in England work in the independent sector, 71% of the care that sector provides is funded by councils.

So any package of improvements to pay and conditions proposed by the Adult Social Care Negotiating Body, which will comprise council, provider and union representatives, will need to be backed by significant public money.

Tight spending settlement expected

Next month, ministers will announce the results of its spending review, setting public expenditure levels from 2026-29.

According to the independent Office for Budget Responsibility, this settlement is likely to be exceptionally tight for services other than the NHS and defence, including local government; these services are likely to, collectively, face real-terms cuts in resource, though there will be winners or losers.

As a result, ministers may not sign off on any significant increase in adult social care pay and conditions put forward by the negotiating body.

Or they might agree a deal, but not sufficiently resource councils – and therefore providers – to implement it, a scenario that risks driving more services out of the sector and increasing unmet need.

Impact of Casey Commission

A possible saviour for the sector is the Independent Commission into Adult Social Care, led by Baroness (Louise) Casey, which is due to produce a 10-year plan for developing a ‘national care service’ – Labour’s as yet undefined ambition for the sector – in 2026 and an even longer-term reform strategy by 2028.

The most optimistic social care watchers will hope that the commission delivers a compelling argument that results in a generous funding settlement for local government and adult social care for 2029 onwards, laying the ground for a significant boost in pay and conditions.

However, this government’s record on adult social care so far – cancelling the planned cap on care costs and more generous care charging system, significantly cutting planned investment in training, not compensating providers for the rise in national insurance contributions and now cutting off overseas recruitment – does not provide much cause for such hope.