The health and social care visa route was introduced in August 2020 to address labour shortages exacerbated by Brexit and the COVID pandemic. However, an independent report from the chief inspector of borders and immigration has revealed that the Home Office’s “limited understanding of the sector” has left care workers vulnerable to exploitation.
Published in March, the report criticises the Home Office for its mishandling of the visa system. It highlights serious flaws, including instances where social care providers were granted sponsorships for workers, despite not existing, with one case involving 275 certificates of sponsorship issued to a non-existent care home.
In response, the Home Office clarified that this situation involved a licence being issued in the name of a legitimate care home without their knowledge, obtained using false information. They have accepted the chief inspector’s recommendations for reform, with many improvements already underway.
The report also underscores the strain the Home Office system has faced due to an unexpected surge in demand for visas. The number of registered sponsors has skyrocketed from 30,730 in 2019 to 94,704 by November 2023, intensifying pressure on officials to ensure compliance with UK employment laws and prevent illegal working. These issues are especially prevalent in the care sector, where low pay and poor working conditions contribute to the challenges.
The inspector’s report highlights that these weaknesses have resulted in a situation where a significant number of care workers are vulnerable to exploitation. Additionally, the restrictive nature of visas—where workers’ legal immigration status is tied to their employment with a specific employer—creates a deterrent for care workers, discouraging them from speaking out about issues related to pay and working conditions for fear of jeopardising their status.
Exploitation in the Care Sector
Exploitation within the care sector, including forced labour, a form of modern slavery, has been a long-standing concern. The Joseph Rowntree Foundation raised these issues in a report over a decade ago. However, recent years have seen a sharp rise in such cases, according to the charity Unseen, which operates the UK’s modern slavery helpline.
In 2022, the year the health and care visa was added to the UK’s shortage occupation list, Unseen recorded a staggering 606% increase in cases reported by care workers. Calls from potential modern slavery victims in the care sector rose from 708 in 2022 to 918 in 2023.
My own research indicates that exploitation in the care sector typically falls into four main areas: debt bondage, recruitment practices, pay, and substandard working conditions. Live-in care workers are especially vulnerable, often attracted to the role due to the inclusion of accommodation.
Migrant workers may find themselves indebted to a recruitment agency, loan sharks, or even family members in order to secure a visa, only to realise that repaying this debt is almost impossible on their wages. Deceptive sponsoring organisations may also charge exorbitant visa fees, with reports of illegal recruitment costs ranging from £2,000 to £18,000. In some cases, the job they were promised fails to materialise once they arrive in the UK. At least one local authority has identified instances of organised immigration crime within the sector.
Reports have also surfaced of “clawback clauses” in care workers’ contracts, which stipulate that workers must forfeit their final month’s salary and repay training and immigration costs to their employer. While repayment clauses are legal when they are proportionate, there is a lack of clear guidance on the exact amounts that can be reclaimed. Some cases have seen exit penalties ranging from £1,300 to as much as £11,500.
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Transparency in Supply Chains
The Modern Slavery Act mandates large commercial organisations to disclose how they are preventing exploitation within their supply chains. However, this requirement currently does not apply to the majority of smaller providers or the local authorities that commission social care services. Despite a promise made by the government in 2019 to extend the duty of transparency in supply chains to public authorities, no significant progress has been made.
While a growing number of local authorities have voluntarily participated in this initiative, adding their statements to a repository managed by the Local Government Association, the government must do more to enforce transparency across the sector, particularly given the ongoing exploitation concerns. Introducing sanctions for organisations that fail to publish annual transparency reports could encourage compliance and, as seen in other countries, provide valuable compensation funds for survivors of exploitation.
At Nottingham University’s Rights Lab, I have collaborated with three English local authorities and the Local Government Association to create a set of guidelines for social care commissioners. These guidelines, based on the Organisation for Economic Co-operation and Development’s Responsible Business Conduct framework, aim to bolster worker protection within social care contracts.
While the UK continues to rely on social care workers and their visas, even with upcoming changes to sponsorship rules, the risk of exploitation in the sector remains a significant issue.
