In August 2020, the health and social care visa route was established in reaction to the COVID-19 epidemic and employment shortages following Brexit. The Home Office's "limited understanding of the sector" has now led the independent chief inspector of borders and immigration to conclude that care workers are vulnerable to exploitation.

An independent report, published in March, details the Home Office’s “shocking” mishandling of the visas. It highlights problems in the way that the system to give social care providers the ability to sponsor workers from abroad operates. In one case, “275 certificates of sponsorship [were] granted to a care home that did not exist”.

The Home Office responded that this incident involved “a licence granted in the name of a real care home without their knowledge … obtained using false information/evidence”. It has accepted the chief inspector’s recommendations to improve the system, and said that many of these improvements were already underway.

The report details how the Home Office system has buckled under unforeseen demand for visas. The number of registered sponsors tripled from 30,730 organisations in 2019 to 94,704 by the end of November 2023, putting considerable pressure on the officials responsible for checking compliance with UK employment law and preventing migrants from working illegally. These issues are particularly acute in the care sector due to low pay and poor working conditions.

According to the inspector’s report, these weaknesses have created a scenario that puts large numbers of care workers at risk of exploitation. And the nature of restrictive visas, where your legal immigration status is tied to your role at a specific employer, means that care workers are discouraged from raising concerns about pay and conditions out of fear of losing their status.

Exploitation in the care sector

Exploitation in the care sector, including forced labour (a type of modern slavery), has been a concern for years. The Joseph Rowntree Foundation highlighted these issues in a report more than a decade ago. But figures have spiked alarmingly in recent years, according to the charity Unseen, which runs the UK’s modern slavery helpline.

In 2022, the year that the new health and care visa was added to the UK’s shortage occupation list, Unseen recorded a year-on-year increase of 606% in cases reported by care workers. Calls from potential victims of modern slavery from the care sector rose from 708 potential victims in 2022 to 918 in 2023.

My own research shows that care worker exploitation usually falls into one of four areas: debt bondage, recruitment, pay and substandard working practices. Live-in care workers are particularly vulnerable. Migrants may seek out live-in care jobs because accommodation is included.

Workers may become indebted to a recruitment agency, loan shark or members of their own family to secure a visa, only to then find that this is almost impossible to pay off from their wages. They may be deceived by the sponsoring organisation into paying extortionate visa costs – illegal recruitment fees of between £2,000 and £18,000 have been reported. And when they arrive in the UK, some find the job they expected fails to materialise. At least one local authority has identified a small number of such cases of organised immigration crime.

There have also been reports of “clawback clauses” in care workers’ contracts. Some of these clauses require care workers to forego their final month’s salary and to pay back training and immigration costs to their employer. While proportionate repayments are legal, there is little guidance on the exact amounts that can be reclaimed. There have been reports of exit penalties amounting to between £1,300 and £11,500.

Transparency in supply chains

The Modern Slavery Act requires large commercial organisations to publish details of how they are preventing exploitation. But this does not currently apply to the majority of smaller providers or the local authorities who commission social care. The government has yet to make good on its 2019 promise to extend the transparency in supply chains duty to public authorities.

An encouraging number of local authorities have participated voluntarily, and have added their statements to a repository run by the Local Government Association.

But the government should be doing more to require transparency, given the level of exploitation still in the sector. The introduction of sanctions on all organisations who fail to publish annually could also encourage compliance and, as in other countries, provide valuable compensation funds for survivors.

At Nottingham University’s Rights Lab, I have worked with three English local authorities and the Local Government Association, to publish a set of guidelines for social care commissioners. These guidelines, which build on the Organisation for Economic Co-operation and Development’s Responsible Business Conduct framework, encourage local authorities to shore up worker protection in their social care contracts.

The UK needs social care workers, and visas for them, but even with planned changes to the sponsorship rules, it seems the risk of exploitation among care workers will remain.