The UK Government has published its long-awaited Immigration White Paper, outlining a series of reforms designed to tighten the rules that govern the UK's work-based migration system. The primary objective is to reduce the number of foreign workers and encourage employers to draw staff from the domestic labour market. The White Paper makes it clear this will be achieved via stricter eligibility criteria for visas, longer routes to settlement and increased administrative and financial barriers.
Given the health and social care sector's heavy reliance on international recruitment and deepening staffing crisis, these proposals have raised significant concerns within the sector.
Below, we explore the most impactful changes and their implications.
The most consequential proposal for the health and social care sector is a ban on recruiting care workers and senior care workers from overseas via the Skilled Worker route. Sponsorship will remain possible for those already in the UK under existing visa routes until 2028, but this policy will be under ‘continual review,' leaving the door open for further changes.
The sector has already faced major changes over the last few years. In March 2024, care workers and senior care workers were barred from bringing dependants to the UK. Then, in April 2025, a new requirement was introduced for employers to engage with regional partnerships to hire from the existing UK-based labour pool before they can recruit from overseas. The White Paper proposals add another layer of difficulty and uncertainty around long-term workforce planning.
International recruitment has long been a lifeline for the care sector, filling critical workforce gaps. While upskilling domestic workers is a worthy goal, it remains unclear whether initiatives like the proposed Fair Pay Agreement will deliver the required numbers.
Another major reform is the proposed increase in the skill level required for sponsorship - from RQF Level 3 (A-Level) to RQF Level 6 (degree level). This will sharply reduce the number of eligible occupation codes to 180 and significantly raise salary thresholds for visa applicants.
While the White Paper doesn't specify whether health and social care worker visa roles will be exempt, some concessions are likely. However, non-clinical roles - such as those in IT, HR, or finance - may no longer qualify, potentially leading to the loss of overseas talent to other sectors.
The most controversial measure in the White Paper is Government plans to double the qualifying period for settlement under the Skilled Worker route, from five to 10 years. While some exemptions are expected for individuals who have ‘contributed to the UK economy and society', it's unclear whether the change will apply retroactively.
This uncertainty has already unsettled many workers in the health and social care sector, who have voiced concerns that their long-term future may not be secure in the UK. This could lead them, and potential future recruits, to consider relocating to countries with shorter settlement pathways. Employers, in turn, will face increased administrative burdens and rising visa-related costs as they manage more frequent visa renewals.
The White Paper proposes raising the required English language level for skilled worker visa applicants from B1 to B2 (A-Level standard) of the Common European Framework of Reference. More controversially, dependant partners will now also face language requirements which are more lenient - initially A1, increasing to A2 for visa extensions.
While some clinical staff may not be affected as they can establish their language proficiency via professional qualifications, the tighter rules could reduce the number of eligible workers in certain health and social care occupations. Requiring language proficiency from dependants may further deter applicants from moving to the UK whose families cannot meet the new standards.
In addition to the April 2025 immigration fee increases, the Government plans a 32% rise in the Immigration Skills Charge, currently £1,000 per year for large sponsors. Combined with the extended settlement period, this will substantially raise the cost of hiring overseas workers.
Given the sector's already constrained budgets and ongoing funding challenges, employers will need to plan carefully, both financially and operationally.
Conclusion
International recruitment is growing increasingly complex and costly.
The targeted restrictions on worker visas, increased skill and salary thresholds, and rising administrative and financial demands could exacerbate existing staffing and funding pressures. While these reforms will affect many industries, the health and social care sector stands to feel a considerable impact unless balanced by robust domestic recruitment and meaningful support.
