Reports by the Royal College of Nursing (RCN) and UNISON trade unions have exposed the brutal exploitation of migrant National Health Service (NHS) and social care workers in Britain. They reveal a system in which internationally recruited workers are brought in to prop up a collapsing care sector, and are then trapped by employer-tied visas, debt, low pay, racism and face the constant threat of deportation.
The RCN analysed 383 cases of internationally educated nursing staff in adult social care between 2023 and 2025. UNISON surveyed 3,306 migrant care workers between November 2024 and January 2025. Together, their findings indict a sector dependent on migrant labour while denying migrant workers elementary security.
The Health and Care Worker visa—introduced by the Conservative government in 2020 and maintained by the Starmer Labour government when it too office in 2024—ties a worker’s right to live and work in Britain to a single employer. It hands employers enormous power to alter contracts, withhold wages, demand inflated repayment fees, impose unsafe conditions and threaten workers who complain with dismissal, loss of sponsorship and removal from the UK.
The RCN found repayment clauses in more than half of its cases, often exceeding NHS Employers’ recommended £3,000 limit. One worker was asked to repay £25,000. In more than half the cases, staff reported poor workplace practices, bullying, harassment or discrimination; around one in five involved underpayment or detrimental contract changes. Among 29 percent, members reported unpaid hours, excessive hours or duties outside their contracted roles.
UNISON’s evidence is equally damning. Workers reported paying thousands of pounds to employers and agents before arriving in Britain, sometimes for jobs or hours that did not exist. Some had paid £20,000 or more before entering the UK. Over a quarter (27 percent) said they had been paid below the legal minimum wage; 46 percent reported racism; and 36 percent said they or a migrant colleague had been threatened with dismissal or redundancy after raising concerns. More than half (52 percent) were not paid for travel time between care visits.
Behind these figures are lives pushed to breaking point, with workers thrust into a cost-of-living crisis. One UNISON respondent said they skipped meals so groceries would last longer and bills could be paid. Another slept rough after working unpaid shadowing shifts until the local council provided emergency accommodation. The RCN recorded workers paying more than £10,000 for promised jobs, only to arrive and find contracts rewritten, hours cut or new repayment threats imposed. Such cases expose a labour regime built on fear with huge debts being incurred even before arrival in Britain, insecure work after arrival, and deportation threats whenever workers resist.
This is the outcome of a system that fuses immigration control with labour discipline. The Health and Care Worker visa means that the anti-migrant agenda of the Tories who implement it and the Starmer and Andy Burnham Labour governments who maintain it becomes a weapon allowing the ramping up of exploitation. When the right to remain depends on one boss, every demand for wages, every refusal of unsafe work and every complaint about racism carries the threat of destitution and deportation.
The Conservatives expanded migrant recruitment to mask the devastation of social care caused by cuts, privatization and low wages. Labour’s immigration policy, centred on the Immigration and Asylum Act of Starmer’s Home Secretary Shabana Mahmood—who was retained by Burnham—is the fifth major piece of legislation since 2022. It curtails the rights of migrants and asylum seekers, worsening the attacks carried out under successive Conservative governments
The same logic runs through the government’s proposed settlement reforms. Under the Orwellian slogan “A Fairer Pathway to Settlement”, Mahmood proposed replacing the current five-year route to Indefinite Leave to Remain with a 10-year baseline for most migrants. After a last-minute retreat when the plan was presented, NHS doctors, registered nurses and some other graduate-level health professionals were spared the 10 to 15-year route. But many lower-paid, frontline social care workers would still face that longer wait.
The message from Labour is that migrant workers can be recruited to keep hospitals, nursing and residential care homes and home-care services functioning, but they are to be denied economic security. The RCN and Unison reports provide evidence that migrant workers are welcomed as cheap labour for low-cost NHS providers—after jumping through many hoops—while being denounced as a burden when they demand citizenship, equality and a secure life.
Workers throughout the NHS and more broadly must oppose every move to scapegoat migrant workers. Skills for Care recorded 111,000 vacant posts in adult social care in England in 2024/25, a 7 percent vacancy rate—around three times the wider economy. International recruitment fell from 105,000 recruits in 2023/24 to 50,000 in 2024/25, while posts filled by British nationals fell by about 30,000. Migrant workers are not “taking jobs”. They are holding together a sector British capitalism has made intolerable for hundreds of thousands of workers.
Nor is this crisis temporary. Skills for Care projects that the sector will need around 470,000 additional posts by 2040 simply to keep pace with the ageing population. Age UK estimates that two million older people in England already have some unmet need for social care. The result is misery for workers and neglect for those who need care.
The health of the overall population is sacrificed under this regime. In February 2025, an average of around 13,700 hospital beds a day were occupied by patients ready for discharge; across 2024/25 the daily average was about 12,600.
The RCN and UNISON have documented the abuse, but as two of the main health sector trade unions they have not organised a unified struggle of health and social care workers in hospitals and the care sector against employer-tied visas, illegal fees, racism and intimidation. UNISON’s Fair Visa Campaign and its call for a five-year route to settlement, a sector-wide social care visa and a Fair Pay Agreement have gathered some support from migrant care workers. But the campaign remains politically confined to appeals to the same Labour government deepening the “hostile environment” against migrants and asylum seekers established by the Tories nearly 15 years ago.
Angela Rayner, former deputy prime minister under Keir Starmer, and now restored to the Cabinet by Burnham, is working closely with the trade union bureaucracy. Rayner addressed UNISON members in June 2026, as Andy Burnham backed the Immigration and Asylum Bill into law, voting for it as it passed its main second reading the following month. Appeals to right-wing politicians enforcing tougher migration controls cannot defend migrant workers. What is required is independent rank-and-file organisation linking migrant and domestic workers in a common struggle against low pay, privatisation, austerity and the visa regime.
Health and social care workers must demand an end to employer-tied visas, and oppose all deportation threats against those who speak out. Full citizenship rights must be granted to migrant workers, their pay raised, safe staffing levels reached as part of a fully funded public social care service run for need, not profit.
Workers hailed as “essential” throughout the pandemic must not be made disposable now. Their defence cannot be entrusted to Labour, the employers or unions who confine struggle to lobbying. It depends on the independent mobilisation of the working class against the capitalist system that turns care into a market and migrant labour into a disposable commodity.
This is the fight being led by NHS FightBack, part of the International Workers Alliance of Rank-and-File Committees. We urge migrant workers and workers throughout the NHS to get in touch.