Last Updated on August 18, 2026

A new Royal College of Nursing (RCN) report has issued a call to end the 'grotesque' exploitation of migrant registered nurses. This comes a week after the Prime Minister set out his plans for a National Care Service in England, paying tribute to the migrant staff caring for his dad.

The new report from the RCN reveals the extent to which employers are using the precarious visa position of staff as leverage to demand huge repayments, underpay, re-write contracts to alter their pay and conditions, as well as fail to address substandard working practices.

The RCN puts the issue down to a huge 'power imbalance' in the visa system, which ties health and care staff's ability to live and work in the UK to their specific employer. As a result, employers have been able to ignore concerns or exploit staff, often under threat of removal of their visa sponsorship and potential deportation.

In From Recruitment to Reality: Exploitation of internationally educated nursing staff in social care, the nursing union analysed 383 cases of health and care staff in adult social care who sought support from the RCN having become victims of exploitation and extortion by their employer between 2023 and 2025. The majority of those represented by the RCN in the cases are registered nurses, with the rest made up of nursing staff including nursing support workers.

The report found that over half (197) 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 clauses are used as threats to prevent staff leaving, or face paying sometimes tens of thousands of pounds. Over half of the RCN's repayment clause 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 (79) of the cases analysed raised issues of pay, with the most common complaint being that they were being paid less than their agreed contractual hourly wage. The RCN also found serious issues with contracts, including dozens (35) of cases where they had been altered after employment started, often to reduce pay or change terms and conditions to force longer working hours.

Meanwhile, over half (203) reported substandard workplace practices, with a third (68) of these cases involving severe bullying and harassment, including some cases of discrimination based on race.

The RCN's report highlights that the adult social care sector is reliant on the work of migrant health and care staff, with nearly 30% of all jobs in adult social care being held by a non-British national. The numbers of migrant nursing staff coming to the UK increased significantly from 2022, however the Home Office did not adequately increase the number of compliance officers responsible for scrutinising employers' use of visa sponsorships.

The RCN says a change to immigration rules is crucial to stabilising the sector by ending the control of employers over visa sponsorship, stopping them from using immigration status as leverage.

Its calls in the report include:

• Visas should be administered by an umbrella organisation or industry body so staff can move more easily between employers without facing threats, including of deportation.
• The new Fair Work Agency should properly monitor employment practices, go after unethical employers who exploit their employees and deliver on the promised investigation by Government into the sector two years ago.
• An extension to the time period in which staff have to find a new employer from 60 to 180 days to eliminate the risk of deportation when needing to move jobs.

All of the measures are crucial to stabilising the nursing workforce, which is crucial to delivering a sustainable adult social care system in line with the Prime Minister's vision, the RCN says.

Reports suggest migrant health and care staff working in adult social care will be exempted from reforms to extend the period to secure Indefinite Leave to Remain. However, the RCN claims that would still leave migrant nursing staff waiting five years, essentially condemning them to the status quo visa system in which this exploitation is already widespread.

Commenting on the launch of the new report, RCN General Secretary and Chief Executive Professor, Nicola Ranger, said, 'Just a week after the Prime Minister laid out his plans for social care in England, 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. Fixing social care and changing the system that allows this exploitation, bullying and discrimination must come hand in hand.

'One of the major causes is a visa sponsorship system which creates a dangerous power imbalance, allowing 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.

'For years, our members have bravely spoken out and sought support against these appalling practices, but we know these cases are just the tip of the iceberg. 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.'

Dr Jane Townson OBE, Chief Executive at 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.'

To read From Recruitment to Reality: Exploitation of internationally educated nursing staff in social care, visit the RCN website.

In other news, The National Care Forum (NCF) has launched a new employment practice programme to support not-for-profit care and support providers.