LONDON (Realist English). The UK government’s plans to tighten immigration rules have caused serious alarm in the social care sector, whose market, according to LaingBuisson, exceeded £15 billion a year and serves about 915,000 adults in England alone. The reform proposed in the Immigration White Paper could deprive the industry of access to the foreign workforce it relies on.
New rules: 15 years instead of five
The key change concerns so-called “earned settlement.” Under the proposals, the waiting period for obtaining indefinite leave to remain (ILR) for workers classified as “medium- and low-skilled” will be increased from five to 15 years. For the care sector, where the vast majority of positions fall into these categories, this means that foreign employees already building their lives in the country will face the prospect of waiting more than a decade.
In addition, since July 2025, a ban has been in place on recruiting new workers from abroad under the Health and Care Worker visa for social care roles. Transitional provisions allow those already in the country to change employers until 2028, but the path for new international recruits is closed.
Consequences: vacancies and “boiling point”
Data from the UNISON union show how sharp the decline has been: the number of new international staff hired into the care sector fell from 105,000 in 2023/24 to 30,000 in 2025/26. Care England reports that the number of visas issued to personal care workers has plummeted by 82% since December 2023 — from 107,772 to 1,397.
Vacancies in social care remain roughly three times higher than the economy-wide average. Industry organizations warn that further tightening of the rules will worsen the crisis. NHS Employers, which represents trusts, estimates that around 12,000 NHS staff (including care assistants) could be affected by the reforms, and additional visa costs will amount to at least £169 million.
“Morally unacceptable”
Unions and industry leaders criticize the retroactive nature of the changes. “Applying these changes retroactively to workers who are already here is morally unacceptable,” UNISON said. “It will accelerate the staffing crisis in social care and make employees more vulnerable to exploitation.” Maria, a nurse who came from Zimbabwe in 2022, says: “When the rules keep changing, it throws you off balance. It is getting harder and harder to stay and keep working.”
The reform reflects a fundamental choice: the government is trying to reduce net migration but is doing so at the expense of a sector that is already in crisis. The £15 billion social care sector is not just a business but infrastructure on which hundreds of thousands of elderly and disabled people depend.
If foreign workers start leaving or refuse to extend their stay, the consequences will be felt not only by patients but also by the NHS, whose beds are occupied by people waiting for social care. The question is whether the domestic labor market can fill the gap — or whether the reform will turn a managed staffing shortage into an uncontrollable one.
