High vacancy rates mean staff are unavailable for people who need care and support, affect the well-being of workers and the sustainability of some providers, and increase pressures on NHS services and workforce.  

In February 2022, changes were made to UK immigration policy to widen the eligibility for the Health and Care Worker visa. People from other countries can now apply for the visa to work as a care worker or home carer with a UK employer that has been approved by the Home Office. This new route for international recruitment is designed to meet the high levels of staffing shortages in adult social care in the UK.

Social care assistant taking blood pressure of elderly patient

Study aims

This study aims to provide independent and timely evidence on the impacts of the amendments to the UK immigration system for government policymakers in adult social care in England and wider care workforce stakeholders.

How the study will be carried out

A mixed-methods approach will be used to:

1) Explore the data on who is taking up this new recruitment opportunity and compare this to previous workforce data

2) Gather the views and experiences of key stakeholders including social care employers, internationally recruited social care staff, brokerage and employment agencies, local authorities and Integrated Care Systems, representatives of service users and carers, and sector skills experts.

The research team will interview the following stakeholders:   

  • social care employers to understand motivations to become sponsors, as well as reasons why employers do not pursue this route, including experiences of the processes involved in obtaining a sponsor license and perceived cost-effectiveness.
  • internationally recruited social care staff to explore motivations, ambitions, career pathways, qualifications/skills, induction and support, rotas, retention/job movement and any experiences of discrimination. The impact on dependants who may accompany or remain in their home countries of this new group of staff will also be explored.
  • brokerage and employment agencies to identify what models of assistance are available, at what cost to social care employers and to workers themselves, and how their expertise and support are experienced
  • local authorities and Integrated Care Systems to explore the extent of knowledge of this form of new international social care recruitment at a local level amongst local authorities and Integrated Care Systems, and any support or advice they may offer to improve or stimulate international recruitment
  • representatives of service users and carers
  • sector skills experts.

How service users and carers are involved in the study

The Unit’s patient and public involvement and engagement (PPIE) Advisory Group will be consulted at regular intervals throughout the study. The study was presented and discussed at the Group's last meeting in July 2022 and members have commented on the proposal and helped shape topic guides. The group is made up of diverse, independent and informed members who act as ‘critical friends’. The research team will also seek the views and experiences of service users and carers by interviewing individuals from a variety of organisations representing different groups and will seek the specific advice of members of the PPIE group for these interviews.

Potential benefits of the project

The project’s findings will inform policy developments on adult social care workforce and immigration systems. It will offer evidence about the impact of the new changes, the effectiveness of processes and perceptions, and equip policymakers with independent evidence of the impact on diverse stakeholders, in the event that further calls are made for system modification, or change relevant to social care. It will help inform possible questions about ethical recruitment, the place of immigration in any social care workforce strategy and where costs of the immigration system should be incurred.

The study is funded by the NIHR Policy Research Programme for the Policy Research Unit in Health and Social Care Workforce at King’s College London. It was adopted by NIHR ARC South London in September 2022 and will be completed by August 2023.

Read the ARC BITE summary of the project