CCSTP steering group member, Clifford Longley, updates his research, after government policy changes, into the injustices experienced by migrant domiciliary care-workers.
The Government has now begun its review of the domiciliary social care system in Britain and of working conditions in the industry. It is clear, in the name of the dignity of work, that there are really serious problems here.
The issue is compounded by the way it has become mixed with other agendas, such as the desire of the Home Office to revise the rules regarding the settlement of workers who came to Britain to work in the social care system with work visas. They were recruited from overseas when Brexit led to the drying up of recruits from Europe.
This avenue to recruitment has now been closed with the ending of the care-worker visa scheme, but the great majority of those who came to Britain are still here.
‘The most exploited group of workers in the country’
Without such workers the system would collapse. Yet they are among the most exploited group of workers in the country. Most are female. Most are Black. The word "slavery" is regularly used to describe their conditions, which is a cruel irony considering that many of them came from those parts of West Africa which gave the North Atlantic slave trade its eastern hub.
The social care sector 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 evidence is overwhelming. "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.”
New rules and ‘moving goalposts’ for care workers
These comments predate the announcement of a new set of rules governing how care workers with work visas can gain the right to live in Britain permanently. They came to Britain to fill vacancies that existed in the care system because recruitment into the sector was falling short.
They were promised that once they had stayed for five years they would become eligible for Indefinite Leave to Remain (ILR), and after that eventually for full naturalisation – the process whereby people of foreign nationality living in Britain can qualify for full British citizenship. The Government has announced proposals to extend that interval before qualifying for ILR, to 15 years. It is rare to see such a blatant case of "moving the goalposts".
Andrea Egan, general secretary of Unison, described this as "nothing less than a full-frontal attack on migrant workers and a wrecking ball for public services from a government that should be standing up for both. We already have a visa system that ties care workers to their employers, leaving them vulnerable to abuse and exploitation. Months without pay. Working without days off for weeks on end. Grafting for 16 hours and only getting paid for two of them."
At a very minimum, new rules about qualifying for ILR should apply only those who came to Britain after the change, honouring the implicit promise contained in the previous arrangement.
A shortage of workers
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.
The Conservative Government 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.
The present Labour Government has now closed this route, mainly because of concern over overall immigration numbers rather than because of exploitation. Logically, however, there is no connection between the flow of migrant care workers into Britain on care-worker visas, and any alleged "pull" factors driving up illegal immigration numbers. Migrant care workers did not arrive in rubber boats.
Meanwhile those who came to Britain under the visa scheme are still here, still working in the sector and still being exploited. They number about a hundred thousand, mainly female and mainly from west and central Africa.
It is worth noting that many of them come from cultures which have a high level of respect for elderly people, regarding them as precious members of the community rather than redundant and a burden because their useful lives are over.
Problems facing migrant care workers
These lovely people face a host of 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 a vocation, traditionally understood – the application of "tender loving care" to vulnerable patients who need it, by dedicated and trained professionals.
Very little research has been done into the actual conditions under which they work. But among migrant care workers who are Black, the majority, the experience of racism is commonplace. Some elderly clients are overtly hostile or at least unhelpful.
Anecdotally, these carers are sometimes forbidden the use of such domestic facilities as toilets or bathrooms. If they bring food with them which needs heating, they are not allowed the use of microwaves in the household kitchen. Care workers walking alone to get to their next job sometimes experience casual racial abuse from passers-by.
Failing to meet minimum standards for dignified work
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.
There are numerous ways the scheme fails to meet minimal standards to be regarded as offering "dignified work."
The sponsorship system and exploitation of workers
Before the migrant worker visa route was closed, an agency recruiting and employing care workers had to be licensed by the Home Office to sponsor those it recruits. Many bogus schemes sprung up, and it has to be admitted that this particular form of exploitation was sometimes organised in the country of origin.
The Home Office has worked strenuously to close down such schemes, which were bringing care workers recruited in their home country into Britain with no care work opportunities arranged or available, as a route simply to defeat immigration controls. Many recruits duped into taking part in such schemes arrived in Britain and then found themselves stranded.
Only workers sponsored in this way could then claim a migrant worker visa permitting them entry to the UK with the right to work. Agencies routinely required the workers they sponsored to pay them a fee in return, and some of the fees demanded could be outrageously high.
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.
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. Care workers report that if they complain, many agency managers use tight visa restrictions as an excuse for bad practice, or even use the argument "if you don't like it you can always go home" – though they would still be expected to pay off any outstanding fees or loans.
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. And 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 clicking, a migrant care worker looking for a new position is at a grossly unfair disadvantage when negotiating terms and conditions.
Training, development, trade union membership and unfair pay
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. Some trade unions, Unison in particular, have worked tirelessly to improve conditions of work, but migrant care work is largely within the gig-economy where union recruitment and organising is difficult.
Credit must also be given to the Work Rights Centre, a charity set up by migrant workers themselves to campaign for improved conditions. It offers a free advice service through its webpage.
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. Needless to say, agencies compete on price for such contracts, with little regard for other conditions such as the welfare of those the local authority will be indirectly employing.
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. Some agencies pay bus and train fares, some do not. 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.
The pressures facing 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 home, 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.
Poor accomodation and insecurity
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 is 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 or eliminated 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 exploited?
* https://www.unison.org.uk/our-campaigns/migrant-care-workers/
* https://www.workrightscentre.org/publications/2024/the-forgotten-third-migrant-workers-views-on-improving-conditions-in-englands-adult-social-care-sector/
* https://migrationobservatory.ox.ac.uk/resources/commentaries/the-ban-on-care-workers-family-members-what-will-be-the-impact/ ----
This report was compiled with input from migrant care workers including from Cameroon, Ghana, Nigeria, Uganda and India. Written by Clifford Longley 25/04/25, revised 28/02/26.