CCSTP steering group member, Clifford Longley, presents research into the injustices experienced by migrant domiciliary care-workers.
A major overhaul of the social care sector has become urgent to ensure that widespread exploitation of those who work in the sector, especially those from abroad on work visas, is brought to an end as soon as possible. It cannot fulfil its duty to care for those who, because of age, disability or illness, need help to look after themselves at home, if it neglects those who actually provide such crucial and necessary support.
The State recognised its responsibility to those needing care through the 2014 Care Act, which was an update to previous legislation. But because of poor pay and conditions, there is a huge shortfall of recruits to the industry from the indigenous British population. Governments have therefore encouraged the overseas recruitment of domiciliary care workers, often from less developed economies. Pre-Brexit, many home care-worker roles were filled by recruits from elsewhere in Europe.
But the change has produced a host of new problems, in the light of which it becomes obvious why recruitment into this industry has proved so difficult. It is not enough to note that overseas workers are prepared to do jobs that the British themselves do not want to do, without asking why. Pay is by no means the only issue. Nor is the nature of the work, which can be very rewarding. Though it is not legally recognised as such, this is "nursing" as traditionally understood – the application of "tender loving care" to vulnerable patients who need it, by dedicated and trained professionals.
Post-Brexit visa scheme fuels exploitation and abuse
"A post-Brexit visa scheme to fill vacancies in social care was badly designed and enabled 'horrific' abuse of migrant workers, the UK's anti-slavery watchdog has said. Commissioner Eleanor Lyons said the care worker visa route introduced by the Conservatives in February 2022 had caused avoidable harm and 'some really severe' exploitation."
The Migration Observatory at Oxford University states: “The care industry is a high-risk industry for exploitation. Widespread qualitative evidence suggests that many care workers are not receiving the pay or working conditions they were promised, while others have experienced severe forms of exploitation and modern slavery.”
After three years of the scheme the nature and extent of the exploitation is becoming clearer. Some of it is down to poor and abusive employment practices in a thinly regulated sector of the labour market. Some is structural, that is to say even good employers have to operate within financial constraints that are imposed on them, and care workers are subject to official rules, such is visa restrictions, that are the detailed consequence of this "badly designed" scheme.
Failing to meet the standards for dignified work
It is time this situation was given the attention it deserves, so that the Government comes to appreciate the urgency of the crisis affecting many migrant workers in this sector. There are multiple ways the scheme fails to meet minimal standards to be regarded as offering "dignified work."
Apart from the anti-slavery commission, other organisations have been blowing a whistle on this social injustice, such as the Work Rights Centre, the trade union Unison, and the Migration Observatory at Oxford University. All three have produced excellent reports after extensive research.*
To operate as a recruiter and employer of care workers, an agency has to be licensed by the Home Office to sponsor those it recruits. Only workers sponsored in this way can then claim a migrant worker visa permitting them entry to the UK with the right to work. Agencies routinely require the workers they sponsor to pay them a fee in return, and some of the fees demanded can be outrageously high.
The Government has reacted to the more egregious examples of abuse, such as "rogue" agencies that recruit care workers abroad without sufficient work being available to make the jobs viable. Some rogue agencies were never more than fraudulent scams. Some were just very poor at what they did, as their priority was to make money rather than provide a service.
Care workers left stranded and isolated
The Government has begun to withdraw recognition from such agencies, and more than 580 had by the end of March 2025 been deregistered and hence were likely to have to close. In many cases, however, that leaves the care workers they sponsored isolated and stranded in the UK without a job. They are then very vulnerable to exploitation and abuse.
Realising that this problem follows directly from official action by the Home Office, the Government has recently set up a network of regional partnerships of local authorities, which can connect unemployed care workers with agencies seeking to recruit. Agencies are obliged to look to the existing pool of care workers available for hire, before they recruit overseas.
It is too soon to say how well this scheme is working, or how well known it is in the industry. This scheme is not designed for care workers who may become unemployed because their sponsoring agency has shut down for some other reason, or care workers who may wish to change jobs for instance because of tensions with their employer, or because they have not been given sufficient work to make a decent living.
Threat of dismissal is threat of deportation
Visa conditions for migrant care workers specify that their visa, and hence permission to remain in the UK and to work here, will automatically expire if they are unemployed for more than 60 days (starting from the time they have been notified by the Home Office that their agency has lost its licence.)
This gives employers almost unbridled power over the care workers they employ, as the threat of dismissal automatically contains a threat of deportation if the visa requirements can no longer be fulfilled. Meanwhile fees may still be outstanding. It is this aspect above all which makes the migrant care worker system intrinsically abusive and why it has been likened to slavery.
There is a strong case for overhauling the sponsorship system itself, however, for instance by having one national body responsible for sponsoring care workers rather than leaving it to individual agencies. This would remove the competition between agencies regarding sponsorship terms, but that competition has not served the interests of the workers themselves. It would ensure that fees for sponsorship were reasonable and transparent.
Better still would be to let migrant care workers make full use of the Government’s national Job Centre network, where a register of notified vacancies could be maintained.
The 60-day time-limit on the period when care workers must look for a new job with a sponsoring agency serves no useful purpose and is the cause of much abuse. With the clock ticking, a migrant care worker looking for a new position is at a grossly unfair disadvantage when negotiating terms and conditions.
Code of practice is voluntary and unenforced
There is a code of practice applicable to agencies when they recruit migrant care workers abroad. But it is voluntary and not enforced. In most respects the code ceases to apply once the care worker has reached the UK and begun work.
There is no guidance to care agencies as to how to maintain the best possible conditions of work, to protect and respect the dignity of the workers. Problems include a lack of career structure, insufficient access to skills training, and guidance to develop a culture of mutual support, respect and cooperation. Membership of a trade union should be recognised as a right, and collective bargaining where appropriate.
Workers are paid by the hour at a minimum wage level, but only when are actually present with a client. The nature of the work follows a Package of Care for each client, drawn up by the local authority under the 2014 Care Act. The authority places a contract with an agency of its choice, which is then largely left unsupervised.
Care workers could be assigned to visit as many as a dozen clients per day. They have to make their own way to each address, using public transport if necessary. If an appointment is cancelled, they are not paid for it.
They are not paid for time spent travelling, even though their duties require it. Hence their weekly wage is significantly below average for a normal working week. This is manifestly unfair. The agency has no choice as the fees they are paid by the local authority under each Package of Care are based on time actually spent with clients, regardless of travel times.
Workers subject to "immigration control" such as most migrant care workers are under a visa condition of "no recourse to public funds". The origin of this policy dates from a time when work visas were made available to specialist groups with professional expertise who had to be offered jobs considerably above average wage levels. These were assumed to be high enough to ensure an individual could stand on their own feet without the need to access such public funds as universal credit, housing benefit or job seekers' allowance.
Migrant care workers fall well below the levels of income for which the policy was designed. Yet they are still not allowed access to certain welfare benefits which count as "recourse to public funds." Such benefits exist to help people in need because of income or some other reason. Migrant care workers certainly come into this category. This is manifestly unfair and discriminatory.
Pressures on care workers with children
The financial plight of care workers with children – they were allowed to be joined by family members until March 2024, when the rules changed – has been examined in depth by Oxford University’s Migration Observatory. “Their earnings … were sufficiently low that most British workers with children would qualify for substantial in-work benefits to reduce their risk of poverty. Indeed, an adult on a single care-worker salary with children and no access to in-work benefits could easily be below the official poverty line“.
Many care workers are female, and may be married with children who, after the withdrawal of the scheme for permitting family members to join them, are still back home with aunts or grandparents. Many such care workers find themselves under pressure to send money to assist with the cost of raising those children, including school fees.
The separation from children also puts an emotional cost on both sides of the relationship. Furthermore separation from spouses may lead to feelings of isolation and depression. Being a migrant in a strange and unfamiliar culture can itself be a source of stress and mental illness.
Accommodation offered to migrant care workers is often inadequate, sub-standard, unhygienic and overcrowded. Because it is arranged by their sponsoring agency they can feel tied and unable to complain. It is sometimes far away from the area where they will work, increasing travel times and costs.
Although the Care Quality Commission has been given responsibility to oversee domiciliary care agencies, it has no duty of care towards their employees when they are off duty.
Migrant care workers are usually on zero hours contracts, so if they do not work, for whatever reason, they will not be paid. This insecurity increases their dependency on their sponsoring agency. They are not paid for rest days or when they are sick.
If they were employed by a local authority directly, for instance, instead of via an agency, they would have a full-time contract. Care agencies do not guarantee a minimum amount of work, so if enough work it not available care workers may fall short of a full working week. In some instances too many care workers are chasing after too few jobs. The opposite also happens.
A debt of gratitude
Migrant care workers make up about a third of the total social-care work force. Many are well qualified, dedicated to the work they do and to the needs of their clients.
Without migrant care workers the care sector would be even less able to support the NHS hospital sector by providing adequate alternative care for patients after discharge. This has knock-on effects and partly explains long waiting lists and trolley queues in A and E corridors, while patients wait for an available bed. The country owes an enormous debt of gratitude to its migrant care workers, and failing to look after them properly is inexcusable. It is a “structure of sin” if ever there was one.
But why have these blatant injustices been allowed to continue, or were not spotted and corrected at the outset? Is this because policy-making in official circles in Britain is still influenced by implicit racism?
And if the Government hopes the need to recruit care workers from overseas can be reduced by encouraging recruitment from the British population, how likely is it that such potential recruits will find the prospect attractive, given how poorly existing care workers have been treated?
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This report was compiled with input from migrant care workers including from Cameroon, Ghana, Nigeria and Uganda. Written by Clifford Longley 25/04/25 clifford.longley@btinternet.com
