Professional Comment

Critical Care: Recruiting International Workers in the UK Adult Care Sector

Angela Barnes, Head of Business Immigration at Napthens (, explains the key steps to take when hiring care home staff from abroad.

With almost 165,000 vacancies in the adult care sector unfulfilled, care homes and home care providers are turning to the international workforce to plug critical gaps within their organisations. However, gone are the days when care homes could rely on the steady arrival of skilled workers from the EU to fill these crucial roles.

Employers now face a myriad of specific immigration laws that make hiring from abroad more complex. In the face of these new challenges, there are important steps and hurdles that care homes need to be mindful of when recruiting from overseas.

Step one – Getting a licence
If you’re looking to hire skilled workers from overseas, you will first need approval from the Home Office, by way of a Skilled Worker Sponsor License (licence). Applying for a licence can be complex, so it is important that you have a dedicated legal expert guiding you throughout the process. Once you have secured a licence, you can then sponsor skilled workers to carry out the necessary work within the UK.

To secure a licence, you will need to submit a suite of corporate documents including, for example, your latest annual accounts, corporate bank statement, Employer’s Liability Insurance Certificate and VAT registration certificate, as well as your CQC registration.

Other pieces of evidence need to be disclosed, such as confirmation that the company has robust HR processes in place that will ensure compliance with the strict reporting and monitoring requirements placed on all sponsor licence holders. Care organisations also need to have appointed key personnel from within the business to manage the sponsorship system.

On top of all these requirements, a payment fee of £536 for small or charitable sponsors and £1,476 for medium to large sponsors is required.

Step two – Getting key talent in

It usually takes the Home Office around 8 weeks to process a licence, but can take longer depending on the capacity of the sponsor licence processing team at any particular time and complexity of the particular application. Whilst there is an option to ‘fast-track’ the application, it is subject to availability – and also costs an additional £500. When hiring more than one non-UK national, the costs can start to quickly add up.

Once a licence has been granted, potential new staff will need to meet several criteria to be able to work in the UK. This includes a minimum skill level, minimum salary level and they must meet an English language requirement. As background checks are likely to be required for care staff roles, they will need a criminal record certificate from their current country of residence and a tuberculosis test if they are from a listed country.

Typically, a skilled worker using this route will need to be paid a salary of £25,600 (rising to £26,200 on 12 April 2023) or the ‘going rate’ for the role, whichever is the higher. However, there are exceptions to this when an individual can be paid a lower salary. This would include, for example, if the job is on the Shortage Occupation List or if the individual qualifies as a ‘new entrant’ to the profession.

Getting over the line

The Government recognises the shortage in care home workers, which is why it launched the Health and Care Worker Visa in August 2020. This visa allow medical professionals to come to the UK to do an eligible job within the NHS, an NHS supplier, or a role in adult social care.

The programme fast tracks the visa process for those entering the UK, gives access to support from a dedicated Home Office team, and reduces visa fees, such as the exemption from the Immigration Health Surcharge. It’s key that when hiring any overseas employee, you are doing so through this visa programme.

As with other visas, applicants can stay in the UK on a Health and Care Visa for up to 5 years, after which they will be able to apply for indefinite leave to remain (ILR) or British citizenship thereafter, making the Health and Care Visa a pathway to settlement.

Retention is as important as recruitment. Making sure your existing overseas employees are applying for ILR or British citizenship is key to avoiding unexpected shortages and demand pressures.

From February 15th 2022, a number of other care sector roles, including care assistants and support workers, were added to the Shortage Occupation List, meaning that applicants are able to be paid a lower salary and still qualify for a Health and Care Visa.

The journey ahead
Whilst these reforms are unquestionably helpful to the care sector in providing short-term relief, we do not know for how long they will remain in place. The shortage facing the industry increases month-on-month, so there may be more relief plans put in place to help stem the problem. We’re seeing this already, in the form of an additional £15m from the Government to boost support for international recruitment within adult social care across this year and next.

The UK’s immigration rules are complex and the application process can be overwhelming. Speaking to a business immigration specialist before embarking on the process would be a wise step to ensure recruiting from abroad is a smoother process, and avoid mistakes that may lead to a swathe of unnecessary costs, fees and administrative burdens.

Care homes and providers are working tirelessly to deliver the best care service to the UK population. The Government must take further action to make foreign recruitment more accessible and cost-effective, so that the industry is able to focus on delivering the world-class care that our country is renowned for.