Royal College of Nursing warns visa system is leaving migrant care workers vulnerable to exploitation

The Royal College of Nursing (RCN) last week published a report on the exploitation of internationally educated nursing staff in the UK's social care sector, finding widespread employment and immigration-related problems.

You can download the 30-page report here.

The RCN reviewed 383 cases reported by members working in adult social care between January 2023 and December 2025. The cases contained 1,280 separate incidents involving issues such as poor working conditions, repayment demands, contractual obligations, pay and threats relating to immigration status.

As the report notes, the Health and Care Worker visa ties workers' immigration status to an employer-issued Certificate of Sponsorship (CoS), which the RCN says reinforces power imbalances and increases the risk of exploitation.

Professor Nicola Ranger, RCN Chief Executive and General Secretary, explained: "This report exposes the scale of grotesque exploitation taking place in the sector. … 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."

Substandard working practices were the most frequently recorded issue, appearing in 203 cases. The RCN said 33% of these involved severe bullying or harassment, including verbal abuse, intimidation and discriminatory treatment.

Contractual issues were reported in 113 cases, with 38% involving contracts that were changed after employment began. The report says these changes often reduced pay or worsened employment conditions.

Repayment clauses were a major problem, being reported in 197 cases. These clauses can require workers to repay recruitment or other employment-related costs if they leave their job before a specified period. In more than half of these cases (53%), employers were seeking repayments of more than £3,000, which is above the maximum amount recommended by NHS Employers. The RCN said such demands could make it financially difficult for workers to leave an employer, even where they were experiencing poor treatment.

As the RCN highlights, care workers are being pushed to pay high fees in their home countries and the UK to secure work, leaving many financially vulnerable.

In one case, a member said they had paid more than £10,000 to a third party for recruitment, travel and immigration-related arrangements before coming to the UK. On arrival, they were presented with a contract containing repayment terms they said had not previously been disclosed. When they decided to leave the position due to excessive working hours and harassment, they were told they owed around £5,000 in fees.

Threats relating to immigration status were recorded in 90 cases, though the RCN highlights that this is likely to underrepresent the true scale of the problem, as immigration-related coercion is often implicit and may not always be explicitly recorded in member cases.

The report states: "The RCN's findings show that immigration dependency is not simply a background risk or incidental to the sponsored work system. Rather, some employers are actively using this dependency as a tool to exploit migrant workers, suppress complaints from those who feel their immigration status is at risk."

Calling for reform of the system, the report continues: "Fundamentally, a new, more balanced system would remove the duty of employers to be directly responsible, and shift this to a different umbrella organisation or industry body, allowing workers to switch between employers more easily. The RCN recommends that a full review of the sponsorship model should take place, with the view to implementing an alternative model that reduces migrants' dependency on employers. Ensuring that migrant care workers can exercise labour mobility without fear of immigration consequences is essential to reducing exploitation within the independent social care sector The RCN is calling for reforms including a review of the visa sponsorship system, consideration of alternatives to employer-based sponsorship, and an extension of the period Health and Care Worker visa holders have to find a new employer from 60 to 180 days."