The ban on care workers’ family members: what will be the impact?

by Madeleine Sumption and Ben Brindle

Since becoming eligible for the Skilled Worker route in February 2022, the number of overseas care workers coming to the UK has increased sharply.

The care route has brought significant challenges. In particular, 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.

Care visas have also been one of the reasons for unusually high migration in the UK in 2022-2023. By 2023, around half of visas granted to workers under the Skilled Worker route went to care or senior care workers. The Home Office estimates that around 120,000 family members of care workers received visas in 2023, joining the roughly 100,000 main applicants on the scheme.

What is changing?

In December 2023, the Prime Minister announced a package of measures designed to reduce UK migration. One major change is that migrant care workers are no longer able to bring their partners or children with them to the UK, from 11 March 2024.

While the main aim of the policy was to reduce net migration, it also has wider ramifications, for care sector recruitment, the well-being of care workers, and public finances. This commentary examines some of the main impacts we can expect.

Will the ban on dependants affect employers’ ability to recruit?

Removing visa options for care workers’ partners and children will almost certainly make the UK a less attractive destination to care workers with family members. However, it’s unclear how it will affect recruitment overall. This is because it depends how workers and employers respond.

First, employers may shift to recruiting different people: fewer workers with families and more single people. Many prospective migrants around the world are willing to come to the UK to work in low-paid roles with less advantageous conditions than the current care visa even after the restrictions on family. The seasonal workers’ scheme, for example, provides six months’ work and no path to settlement.

Second, couples who would previously have come as a main applicant and a dependant may now decide both to get care work visas as main applicants. Anecdotally, some partners on dependant visas also work in the care sector – sometimes for the same employer as the main applicant.

Third, some care workers with children may leave their children behind (with grandparents, for example). This is a common phenomenon in global migration.

Even if employers can still recruit the number of care workers they would like to, their recruitment options will likely narrow. Many care providers currently hire qualified nurses from overseas to do care work, for example. Those more qualified applicants have a greater range of options. As a result, they may be less likely to migrate to the UK now if the country is perceived as a less attractive destination following the ban.

It is also possible that not being able to bring family will affect employers’ ability to retain overseas care workers. This is because some may prefer to migrate temporarily if they have left their children at home. There is also some evidence that people who come to the UK with family members are more likely to stay permanently.

Will care work migration fall?

If the number of care workers coming to the UK does start to fall, it will be difficult to pinpoint the role of the new restrictions. Visa grants to care workers were already falling towards the end of 2023 before the policy was introduced (Figure 1). This decline coincides with a Home Office move to scrutinise applications more, including checking that the employer actually had contracts in place to deliver care services. It is also possible that some of the ‘pent-up’ demand for workers in the care sector had already been satisfied.

Figure 1

The Home Office has also introduced a new requirement for care sponsors to be registered with the Care Quality Commission (CQC). CQC registration is required to provide regulated personal care services, but not to provide unregulated services such as helping with shopping or household tasks. Home Office analysis suggested that around one-fifth of employers licensed to sponsor care workers in England could not be matched to a CQC registration, indicating they may not be registered. The registration requirement is thus likely to affect sponsorship numbers at the same time as the dependants ban.

In summary, the impact of the dependants ban on future care worker recruitment and on overall UK migration remains highly uncertain. It is reasonable to assume that the number of Health and Care visas will fall because family members themselves will no longer receive visas. It is possible that care worker recruitment will also fall, although it might have fallen anyway—even without the restriction on family members.

How will the new rules affect care workers themselves?

The inability to bring partners or children will affect workers in different ways.

First, it may affect risks of exploitation. As noted above, there is now widespread qualitative evidence that exploitation of people on care visas has become a significant problem. This is in part because the care sector is already a high-risk sector for exploitation, and also because being on a work visa can put workers at further disadvantage. Workers often arrive with debt (sometimes having paid illegal recruitment fees), making it difficult to leave the employer who has sponsored them. One of the risk factors for exploitation is being isolated. Without partners in the UK, care workers may be more isolated and thus find it more difficult to leave exploitative situations. They may also become more financially dependent on their employers without the safety net of a partner’s wages, potentially limiting their ability to change sponsors in practice.

Second, some couples will choose both to come to the UK as main applicants on care visas, whereas previously one would have come as a dependant. This may increase costs for the family if both members of the couple incur (illegal) recruitment fees to secure their job. It would also limit the couple’s mobility. Currently, partners who join Health and Care worker visa holders as dependants can legally work for any employer – unlike the main applicant, who can only work full-time for their visa sponsor. If both partners arrive as main applicants, both of their right to work would be tied to their sponsor.

At the same time, preventing care workers from migrating to the UK with children is likely to reduce the risks of UK-based child poverty in families that hold work visas. Care visa holders have no recourse to public funds (NRPF). Their earnings (£20,960 per year until April 2024) 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 (Table 1).

Table 1

Care worker earnings compared to poverty thresholds

Household scenario
	Gross earnings	Disposable income (after housing costs)	Absolute poverty threshold	Relative poverty threshold	Minimum Income Standard
Single, no children	£21,200	£15,300	£8,100	£9,000	£14,900
Couple (both care workers), no children	£42,400	£33,300	£14,000	£15,600	£24,700
Single, one child (aged 5)	£21,200	£9,800	£11,000	£12,200	£26,200
Couple (both care workers), two children (aged 5 and 14)	£42,400	£31,000	£22,700	£25,300	£39,000
Couple (both care workers), three children (aged 2, 5 and 14)	£42,400	£31,000	£25,600	£28,400	£51,400

Source: Migration Observatory analysis of Home Office Immigration Statistics, Freedom of Information request 78407; ONS Private Rental Market Summary Statistics in England, April 2022 to March 2023; DWP Income sources and values HBAI 2021-22, table 2_4ts; and Minimum Income Standard 2022, Centre for Research in Social Policy, Loughborough University.

Notes: Absolute poverty is defined as 60% of median income in 2010/11; relative poverty is 60% of the median income in 2021/22; and Minimum Income Standard is the income required for an acceptable standard of living in 2022, based on deliberations by members of the public. After Housing Costs refers to income after tax deductions and spending on rent, water and service charges. Care worker earnings are based on the median care worker salary in the year ending June 2023. Each scenario assumes the number of bedrooms required is equal to the number of distinct age groups (i.e. adults, 14-year-olds, ages 5 and below), and that the median rental price in England is paid. In scenarios with couples, both adults are assumed to be care workers.

In other words, the combination of NRPF, low wages, and the ability to bring children is likely to have contributed to UK-based child poverty.

Note: if families no longer migrate at all or if children are left behind in someone else’s care, those families will not necessarily be better off without the option to bring children to the UK. That said, preventing children from coming as care route dependants should largely prevent a specific safeguarding problem identified by the Home Office, where children were included in applications of care workers who were not their parents.

What next?

Two major issues in the care sector remain unresolved.

First, migration has been used to fill vacancies in care, but the underlying causes of shortages have not been addressed. That is, poor pay and working conditions due to limited funding, which restricts salary levels.

Restricting family members will likely reduce the care route’s contribution to overall migration levels. This is due primarily to the fact that family members will no longer migrate, but could also result from lower migration of main applicants or more people choosing not to remain permanently.

However, it is possible that care migration will remain relatively high unless the government addresses the sector’s difficulty recruiting domestically. Early data suggested that in Scotland, where care work pays more than competing occupations, care employers have been less likely to use the visa route.

Moreover, if pay and conditions remain poor, retention of both British and non-UK care workers is likely to be more difficult in the longer term.

Of course, improving pay and conditions in the care sector would come at a cost and compete with other spending priorities—even if it is the more sustainable solution to recruitment problems in the care sector in the long term.

Second, the government continues to face a huge task enforcing care workers’ rights. The scale of the administrative challenge was outlined in a recent report from the Independent Chief Inspector of Borders and Immigration (ICIBI), which found that monitoring and compliance had failed to keep up with the rapid increase in the care route. The dependants ban does not address these issues either.    

Thanks to Olivia Vicol, Adis Sehic and Kate Roberts for comments on an earlier draft.