Government has dealt another blow to care for older and disabled people. By systematically dismantling international recruitment routes without a viable alternative, ministers are damaging our ability to meet rising demand. Lack of availability of care risks harm to individuals, adds burdens to families and increases pressure and cost to the NHS.
Since 2020, we have lost 70,000 British care workers, whilst over 130,000 posts remain vacant nationwide. International recruitment became a lifeline, with 185,000 overseas workers joining adult social care between 2021 and 2024. These dedicated professionals brought vital skills and filled positions British workers would not or could not take.
On 12th May 2025, Government’s Immigration White Paper announced closure of the care visa route by 2028. Employers must prove they have trained domestic staff before accessing international talent. Introduction of the genuine vacancy test in 2023, followed by a ban on dependants and CQC registration requirements for sponsoring employers, had already slowed overseas recruitment to a trickle. International recruitment crashed from an average of 26,000 new workers per quarter to just 8,000 in the second quarter of 2024.
The irony is that everyone understands the root cause of recruitment and retention difficulties. The Migration Advisory Committee has repeatedly identified chronic underfunding by successive governments as the fundamental issue. Almost a third of local authorities offer fee rates for homecare that fail even to cover statutory employment costs at minimum wage. Is it any wonder British workers avoid our sector?
Government is introducing a Fair Pay Agreement for social care as part of the Employment Rights Bill. It has also initiated the Casey Review of adult social care reform. The outcomes of these, however, remain some years away, with no funding allocation or implementation timeline. Meanwhile, Skills for Care projects 540,000 additional care workers will be needed by 2040 to meet our ageing population’s needs. If we cannot hire in the UK or abroad, how will we manage?
Behind every statistic lies human suffering. Each unfilled post represents someone waiting hours for help, an exhausted daughter pushed beyond her limits caring for her mother with dementia or a stroke survivor trapped in hospital with no support at home. Without a plan, we risk repeating the chaos of 2021 – lack of care, longer hospital stays and extensive waiting lists. We need pragmatic interim measures whilst longer-term solutions develop. So, what can be done?
Government must ensure ethical commissioning and purchase of care services by local authorities and the NHS. We need a National Contract for Care Services, with mandatory minimum prices. Government budget cuts are causing unsafe, low-quality care and worker exploitation. Local authorities must organise care delivery in geographical patches to enable integrated neighbourhood working. Instead of buying homecare by the minute for contact time only at low rates, they must focus on quality, outcomes and workforce value. Good-quality ethical providers need enough hours in a zone to optimise routes and create efficient rotas.
Maximising client contact time and minimising travel allows payment of care workers for shifts. It also reduces fuel costs and contributes to Net Zero. Homecare can then become an integral part of multi-disciplinary neighbourhood health teams. This allows care workers and health professionals to collaborate in addressing increasingly complex needs. Care services are a vital part of our social infrastructure. Investing wisely in building our workforce is a moral and economic imperative. With our population ageing fast, time is running out. Care needs a parachute.
Dr Jane Townson OBE is Chief Executive Officer at the Homecare Association. Email:Â [email protected]Â Â X:Â @homecareassn