When the health and care visa was unveiled as a temporary pandemic measure in 2020, the Department of Health and Social Care predicted perhaps 6,000 people would use it annually. Yet by 2023, the reality was staggering: 349,000 people arrived via this route, 58 times higher than projected. This represents one of the most dramatic policy failures in recent British immigration history, a failure not merely of prediction but of governance, as ministers systematically permitted what was meant to be a stopgap solution to expand into a permanent backdoor migration route that serves neither patients, workers, nor taxpayers.
One might reasonably ask how a scheme designed as temporary pandemic relief transformed so rapidly into what amounts to an industrial-scale importation system. The answer, as with many policy disasters, lies in the most alluring political temptation: short-term fixes over structural reform.
For every care worker admitted in 2023 we welcomed an average of almost two dependent family members, a ratio two times higher than on the skilled worker route. This creates a costly cycle that Britain is now trapped in: we import care workers who bring multiple dependents, these families eventually gain indefinite leave to remain and perhaps even citizenship, accessing education, healthcare, housing support and other public services. As David Miles of the OBR soberly observes, “New immigrants, particularly if they come on work visas, may generate a favourable balance of extra tax revenue relative to extra public spending for some years. But immigrants who stay grow older and have children, so the favourable tax to spending balance does not persist.” Put plainly, today’s care visa holders become tomorrow’s care recipients, requiring yet more imported workers. The wheel turns, ever faster, with each rotation more costly than the last.
With extensions for existing foreign healthcare staff permitted until 2028, this policy could easily be softened or reversed
The Government’s decision to end overseas recruitment for social care visas acknowledges what the Centre for Policy Studies highlighted in “Taking Back Control” — Britain has created a destructive cycle of dependency, one that grows exponentially with each iteration.
The economic consequences are severe. This visa route has effectively trapped the sector in a permanent low-wage environment. According to recent data from The King’s Fund, median care worker pay in March 2024 was just £11.00 an hour — barely above the National Living Wage and lower than what entry-level supermarket or warehouse staff earn. With care worker pay rising at essentially the same rate as the minimum wage over the past eight years, employers have little incentive to improve conditions when they can simply import more workers willing to accept rock-bottom wages. Why invest in better pay and conditions when an endless supply of overseas labour will accept the bare minimum?
What’s rarely acknowledged in this debate is that eight out of ten workers in social care are already UK nationals. The problem isn’t a lack of potential domestic workers, but unattractive wages and conditions that drive them to seek employment elsewhere. The Migration Advisory Committee concluded with admirable clarity that “the underlying cause of these workforce difficulties is the underfunding of the social care sector.” A modest wage increase of 40p per hour would cost around £950 million — roughly 3 per cent of the social care budget — far less than the long-term public expense of continued mass migration.
Government data on earnings reveals how poor the financial return is for taxpayers. According to the latest data, main applicants (excluding their dependents) on Health and Care Worker visas earn a median salary of £30,900 annually and contribute just £3,500 each in income tax. Despite making up 16 per cent of all sponsored visa holders, they generate only 11 per cent of the total tax paid by migrant workers. For Nigerians, one of the largest groups of care visa holders, the figures are even lower: median earnings of £27,400, barely above minimum wage. Factor in that each care worker brings nearly two dependents who access education, healthcare, and housing, and the fiscal equation becomes even more unbalanced. We are, in essence, subsidising a system that perpetuates its own problems.
Britain’s growing dependence on imported care workers is a relatively recent phenomenon, not an inevitable feature of our social care system. According to Skills for Care data, 19 per cent of the adult social care workforce in England now consists of international staff, with this figure reaching a staggering 38 per cent in London. In 2022/23 alone, 70,000 people started work in direct care roles, having arrived in the UK that year, triple the previous year’s figure. The curve is not merely rising; it’s approaching vertical.
The government’s decision to end overseas recruitment for social care visas marks a potential break from years of taking the easy way out. But with extensions for existing foreign healthcare staff permitted until 2028, this policy could easily be softened or reversed when the political winds shift or the changes needed prove costly initially. Fixing care will be politically uncomfortable — it means paying higher wages and improving dire working conditions, steps that will cost money upfront but save far more in the long term.
Without this political courage, we’ll inevitably slide back into importing an ever-growing army of low-paid workers, each bringing multiple dependents who themselves will eventually need care. Sometimes the only way out is through, and addressing the fundamental issues in our care system requires precisely the sort of political fortitude that has been conspicuously absent from this debate for far too long.
