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Care homes in England are warning they may have , as the sector's faces further trouble due to changes in immigration policy.

The 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 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 in net migration" (the difference between immigration and emigration).

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

Demand for social care is increasing throughout the UK, as it is . People are , with major illnesses and disabilities as they . To meet increasing demand, 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 the demand for health and care workers, with changing according to the UK's global relationships and migration policies. The enlargement of the European Union (EU) 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. Categorized 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 . The most common source countries again became 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 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.

Why can't the sector recruit from within the 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 .

In October 2023—before the recent collapse in the number of visas granted but the latest data available—there were in adult social care in England. The vacancy rate at , was higher than the for the NHS, and significantly higher than the for the economy as a whole. Recruitment challenges are especially acute in .

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

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 ( 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 ( of the current workforce in England) and racialized minorities ( of the current workforce).

Improving the sector

There is little sign that the new Labor 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, 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 Labor'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."

Labor's manifesto commitment to implement a is welcome. But, wider and longer term changes are needed, including most fundamentally around the , to make sure that the sector can retain these key workers, regardless of where they come from.

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