UK health and care sector employers have benefited from a boom in international recruitment at a time of significant staff shortages. But if high reliance on overseas workers persists long term it also brings vulnerabilities, including exposure to international competition for health workers and risks of exploitation in the care sector, a new analysis published by the Migration Observatory at the University of Oxford commissioned by ReWAGE has concluded.

In the year ending March 2023, almost 100,000 skilled workers received visas to work in health and care jobs in the UK, making up more than half of all Skilled Worker Route work visas. This number of overseas hires is unprecedented in the UK’s post-war history and accelerates an existing trend of growing reliance on migrant workers to staff the NHS and the care sector. The new briefing, Migration and the health and care workforce documents these trends - a summary document has also been published.

Among the key statistics:

By October 2022, just under half (47%) of fully qualified secondary-care doctors registered to practice in one of the four nations of the UK had received their primary qualification outside of the UK or Ireland.

By March 2023, 21% of people on the Nursing and Midwifery Council register were trained overseas, up from around 15% five years earlier.

In the year ending March 2023, 57,700 care and senior care workers received skilled work visas. The share of people in the residential care sector who worked for an employer that held a sponsor license increased from 10% to 39% from February 2022 to March 2023 – the first 13 months after care workers became eligible for skilled work visas.

The health and care sector has faced well-documented staff shortages in recent years, with unusually high vacancy rates. The report notes that while international recruitment is helpful for employers trying to recruit staff in the short run, it does not address the underlying challenges in hiring and retaining domestically trained workers, who still make up most of the workforce. If heavy reliance on international recruitment continues to persist, the UK could become more vulnerable to changes in employers’ ability to recruit from abroad—for example, due to competition from other countries such as the US. In future, retention challenges may affect internationally recruited workers too, especially after they receive Indefinite Leave to Remain and can work in other jobs more easily. Particularly in the care sector, heavy reliance on work visa holders can bring risks of exploitation. The Director of the UK Government’s Labour Market Enforcement has identified care as a high-risk industry for exploitation and past research suggests that being on a work visa can further exacerbate workers’ vulnerability by making it harder to switch employers. The rapid increase in the number of care workers on work visas from early 2022 onwards increases the scale of the monitoring challenge.

Dr Madeleine Sumption, Director of the Migration Observatory at the University of Oxford said:

“Health and care employers have benefited a lot from international recruitment, which has allowed the NHS to increase its workforce faster than if it was relying only on people completing domestic training. But relying this much on overseas recruits also brings risks. For example, care workers on temporary visas are vulnerable to exploitation and the rapid growth in overseas recruitments makes monitoring pay and conditions a real challenge.”

Politicians from both major parties have said that they would like to reduce the UK’s reliance on skilled workers from overseas. The report notes that the UK’s ability to ‘ramp down’ the current high levels of international recruitment and increase employment from within the UK would depend on a combination of factors, including funding for training and pay.

Dr Sumption added: “

Unlike areas of the labour market dominated by the private sector, the government has quite a lot of control over training, pay and conditions in health and care. If it wanted to reduce reliance on overseas recruitment, expanding the medical and nursing training pipeline and improving pay for care workers could well help to achieve this. It would also cost money, of course, and so will compete against other spending priorities.”

The Migration Advisory Committee recommended in early 2022 that care workers should be eligible for skilled work visas after concluding that the end of free movement after Brexit had exacerbated existing shortages that were primarily caused by poor pay and conditions in the sector.

Professor Chris Warhurst, co-chair of ReWAGE and Director of the Institute for Employment Research at the University of Warwick said:

“In the medium to long term, UK health and care employers’ ability to have sufficient staff is likely to depend primarily on policies to improve recruitment and retention among UK trained workers, who make up the majority of the workforce. Higher wages and improved career prospects would make the sector more attractive to UK workers and lead to a reduction in turnover, which would bring down recruitment costs.”

In 2022, 99% of care workers sponsored for work visas in the UK were from non-EU countries. The top countries of citizenship for care workers using Certificates of Sponsorship (CoS) in 2022 were India (33%), Zimbabwe (16%), Nigeria (15%) and the Philippines (11%). India was also the top country of nationality for newly recruited overseas doctors (20% of doctors) and nurses (46%).

Migration and the health and care workforce and the summary document are available to download.