Immigration Rule Changes Set to Reduce Care Sector Workforce by Tens of Thousands
A comprehensive impact assessment on immigration rule changes, belatedly published in December 2025, has revealed the scale of workforce reductions facing the health and social care sectors over the coming years.
The assessment, which accompanied the Statement of Changes in Immigration Rules (HC 997), was initially laid before Parliament in July 2025 without the crucial supporting documentation. The delay in publishing the full impact assessment drew sharp criticism from the parliamentary committee responsible for scrutinising such instruments, which noted that proper parliamentary oversight had been impossible without the complete information.
The committee had expressed particular concern about the absence of the impact assessment throughout the autumn, eventually inviting the Minister for Migration and Citizenship, Mike Tapp MP, to provide oral evidence in October. The assessment was finally published on 9 December 2025, more than five months after the initial Statement.
Substantial Financial and Workforce Implications
The delayed documentation revealed significant financial implications, with an estimated direct monetised cost of £5.4 billion over five years on a central estimate. The assessment provides a range between £2.2 billion and £10.8 billion, with costs primarily arising from reduced tax receipts and lower income from immigration fees and the immigration health surcharge. These figures account for public sector savings from reduced spending on public services.
However, the government’s rationale centres on unquantifiable benefits, particularly incentives for employers to upskill domestic workers. The assessment suggests that if more than 44% of the reduction in migrant jobs were filled by currently inactive workers, the changes would have an overall positive financial impact, with potential longer-term productivity gains from upskilling initiatives.
Care Sector to Face Steepest Decline
The combined reforms are expected to reduce visas issued to those currently overseas by approximately 27,000 annually, with around 7,000 of these affecting social care workers. However, the most significant impact stems from a measure whose full implications only became clear with the publication of the impact assessment: the removal of the ability for those already in the UK on other visas to switch to health and social care visas.
This restriction, taking effect in July 2028, is projected to reduce “in country” visa grants by around 42,000 per year once fully implemented, including 6,000 dependents. Of these, approximately 21,000 would have been social care workers, with a further 6,000 in health and care roles, including 2,000 dependents.
The anticipated annual drop in new joiners to health and social care following the introduction of in-country visa restrictions represents about 4% of the sector’s total workforce. As these annual reductions are cumulative, by 2029/30 the health and care and adult social care sectors are expected to have 66,000 fewer migrant workers than would otherwise have been the case.
Other sectors facing significant impacts relative to their existing workforce include accommodation and food services, covering hotels and hospitality businesses, as well as agriculture, forestry and fishing.
Proposed Mitigating Measures
The impact assessment acknowledges that the changes “may have an impact on users of care services” but points to several mitigating factors that could reduce the sector’s dependence on migrant workers.
These include the development and expansion of the Care Workforce Pathway, described as the first universal career structure for the adult social care workforce, alongside the introduction of a Digital Care Workforce Pathway to support frontline care workers and their managers.
The government also highlights the first ever fair pay agreement in adult social care, designed to encourage UK nationals and unrestricted migrants to join the sector. Additionally, the assessment notes the potential for redeployment of care sector workers previously affected by the revocation of their employer’s sponsorship licence, estimating the current size of this available pool at 16,000 workers.
The extent to which these measures will successfully offset the substantial reduction in migrant workers remains to be seen as the changes are progressively implemented through to 2028 and beyond.
