Steep visa fall to trigger ‘skills catastrophe’ for health and social care

The huge fall in visa approvals for the health and social care sector, while expected, has caused added disquiet among medical professionals already concerned about staffing and wages. Adam McCulloch asks whether the new wage threshold and dependants ban are working only too well. 

Figures released by the Home Office this week (22 August 2024) showed that 89,085 visas for the health and care sector were granted in the year to June 2024 – more than 80% down on April to June of the year before.

One immigration lawyer told Personnel Today that the trend could cause a “skills catastrophe” for health services.

The figures are stark considering that according to Skills for Care’s Workforce Strategy earlier this year there are 131,000 social care vacancies on any given day, with a rate of 8.3% – three times the average for other sectors. The study also showed that the number of posts filled by people with a British nationality had fallen by 70,000 over the past two years.

In 2022/23, 70,000 posts were filled by overseas workers, compared with 20,000 in 2021/22 and 10,000 in 2020/21. Care workers were added to the shortage occupation list for visas in February 2022 – recognition that international recruitment could offer a partial solution to the sector’s staffing crisis.

Since 2022, however, the rules have changed in a bid to bring down net immigration.

From 11 March 2024, care workers who have applied to work in the UK on a health and care visa have not been able to apply for their partners/spouses to join them.

There has also been a rise in the minimum salary threshold for care roles: since April 2024 this has been set at £23,200 per year, or the national pay scale for the role, whichever is higher, an increase of £2,200 above the previous level. With care workers unable to bring dependents, the single salary of £23,200 is unlikely to go far in a country afflicted by a high cost of living.

That overseas recruitment was on the slide was obviously known to senior figures in the sector, but their response underlines the risk to services from the decline. Mike Padgham, chair of the Independent Care Group, said: “A fall in the number of overseas staff is the last thing social care needs at the moment, as we are struggling to fill shifts as it is.

“The last government’s brutal measures are working and the lifeline of overseas staff to help staff homecare and care and nursing homes has been cut.”

He added: “We desperately need to see the new government’s promised care workforce strategy and with it some funding measures that will help us to properly reward care workers and enable us to recruit at home, otherwise we will be in dire straits.”

Care England chief executive Professor Martin Green agreed that “without the proper measures in place to draw in domestic recruits, the gap left by international recruits will reach an untenable level” and warned the new government must “take ownership of their inherited situation”.

Bhavneeta Limbachia, immigration lawyer at Russell-Cooke, said the policy on dependants played a critical part in the decline of applicants. She said: “This policy risks undermining the UK’s ability to address critical staff shortages in the NHS and care sector, but also transmits a potentially damaging message about how we value those who devote their lives to our public health.”

Naomi Hanrahan-Soar, partner, at law firm Lewis Silkin, said that the rule on dependants may be having an even more dramatic effect on immigration than its chief architect – the then home secretary James Cleverly – had intended. She said: “Post local freedom of movement, we now have longer distance migration from the global south, with people who want to bring their families and start a new life in the UK more permanently.”

This was particularly the case for low paid employment such as in most health and care visa applicants who were also likely need the second salary to supplement their full-time income of £23,200 to afford to live in many parts of the UK. “Therefore,” she said, “taking away the ability to bring dependants is likely to have a bigger impact than the government believed when bringing in that change.”

The overall result, said Limbachia, could be a “skills catastrophe” in the NHS. “Ultimately the UK has become a less attractive destination for essential professionals and it would not be a surprise to see the government reconsider the policy in light of these recent figures, and in fear of a skills catastrophe in the NHS – not least as training settled workers, although important, is not a quick fix.”

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