RCN Calls for End to ‘Grotesque’ Exploitation of Migrant Nursing Staff

An RCN report has exposed how some employers are exploiting migrant nursing staff in social care by taking advantage of their vulnerable visa status. It comes a week after Prime Minister Andy Burnham announced plans for a National Care Service and praised the migrant workers who cared for his father.

International nursing staff make up a large percentage of the social care workforce. While social care policy is devolved, immigration rules apply UK-wide. We’re therefore calling on the UK government to change its immigration rules to help to stabilise the sector in all four nations. This includes ending the control of employers over visa sponsorship, stopping them from using immigration status as leverage.

In the report, we’ve analysed almost 400 cases of health and care staff in adult social care who sought RCN support as victims of exploitation and extortion between 2023 and 2025. This is likely to be only a small fraction of the numbers facing exploitation due to low union membership among migrant workers and widespread fear of speaking up.

Most of those represented by the RCN in these cases are registered nurses, while the remainder are nursing staff, including nursing support workers.

Employees’ precarious immigration status was a way for some employers to demand huge repayments, underpay, rewrite contracts to alter their pay and conditions, as well as fail to address dangerous substandard working practices.

We believe the issue is down to a huge “power imbalance” in the visa system, which ties international nursing staff’s ability to live and work in the UK to their specific employer. As a result, some employers have been able to ignore concerns or exploit staff, often under threat of removal of their visa sponsorship and potential deportation.

Professor Nicola Ranger, RCN Chief Executive and General Secretary, said: “This report exposes the scale of grotesque exploitation taking place in the sector. A National Care Service meeting the needs of an ageing population with complex conditions will need to be registered nurse-led. We’re the ones with the skill and expertise to make it work, but that cannot happen while so many of our migrant colleagues are being exploited.

“One of the major causes is a visa sponsorship system which creates a dangerous power imbalance, allowing some unscrupulous employers to use withdrawal of sponsorship as leverage to extort money, alter contracts, reduce pay or bully and harass with impunity. It’s a shocking scenario which hands individual employers all the power. It has no place in a National Care Service.”

Key findings include.

• More than half of all those seeking support from the RCN involved employers using repayment clauses to recover costs from staff wishing to leave employment before the end of their contract. The majority of these cases involved demands from employers above the maximum £3,000 recommended by NHS Employers, with one case as high as £25,000.
• One in five of the cases analysed raised issues of pay. The most common complaint was that they were being paid less than their agreed contractual hourly wage.
• More than half of respondents reported rampant substandard workplace practices, with a third of these cases involving severe bullying and harassment, including some cases of discrimination based on race.

The report calls for stronger protections, effective enforcement, and systemic reform to safeguard migrant nursing staff and raise standards in the sector, including:

• visas to be administered by an umbrella organisation or industry body so staff can move more easily between employers without facing threats of deportation
• for the new Fair Work Agency to properly monitor employment practices, go after unethical employers and deliver on the promised investigation by government into the sector
• an extension to the time staff have to find a new employer from 60 to 180 days, to eliminate the risk of deportation when needing to move jobs.

“Migrant workers are routinely intimidated and left fearful of speaking out. The prime minister has spoken movingly about the contribution of migrant nursing staff, now they need his full backing,” Nicola added.

Dr Jane Townson OBE, Chief Executive of the Homecare Association, said: “Exploitation of social care nurses and care workers is indefensible, in any form. The practices this report describes, including unlawful fees, excessive repayment clauses, coercion and harassment, have no place in homecare or anywhere else. Every provider is accountable for the way it treats its workers, and system pressures are never an excuse for mistreating people.

“Many providers operate responsibly and support their staff well. A minority do not, and they betray both their workers and a sector that millions of people rely on. We support firm and effective enforcement to remove exploitative operators, and we back reform of a visa system that hands too much power to a single employer.“Enforcement alone, however, will not build a fair system. We need improvements in commissioning and market shaping, a fair price for care through a national contract, fair pay and secure income for workers, and fair regulation that roots out exploitation. “The Prime Minister’s vision for a National Care Service is the moment to get this right. Immigration policy, employment rights, regulation and the way care is commissioned and purchased must be aligned, with the person receiving care and the people who provide it at the centre.”