How work visa design is driving exploitation of migrant care workers

Last year, our advisers started raising the alarm:

"My client is unable to take action about issues at work due to her immigration status. She has been crying, stressed, and unable to sleep due to the problems she faces at work. Any action she may want to take - although legal for an employee - could result in her being dismissed and therefore losing her right to stay in the UK."

-  Adviser, West Midlands

They were seeing a growing number of people who had been recruited from abroad to work as carers in the UK, but on arrival found themselves in extremely difficult situations that they couldn’t get out of. 

People like Ishaan*, a homecare worker who was promised a full-time salaried job, but in reality is only being paid for client contact hours. He works 14 hours per day, driving from client to client, but only earns £60 because he’s not paid for travel time or his full fuel costs. Ishaan can barely afford to eat - he’d gone 2 days without food before first being referred for help. He’s desperately trying to find a new job with a licensed sponsor, but it’s not easy. He can’t just quit and go home either - he owes £18,000 to the agency that helped recruit him.

People like Divya and Lakshmi, who came to us because they and their migrant colleagues hadn’t been paid for 2 months, while their British co-workers were paid as normal. They’re falling behind on bills and are worried they’ll end up homeless if they can’t pay rent. Divya has contacted their employer, but has had no response. She’s afraid to complain too much as the employer could dismiss her and her colleagues, leaving them with only 60 days to either find another sponsor or leave the UK. Divya told our adviser: “I feel like we’re being treated as slaves”.

And people like Angela, a senior carer who provides live-in care. She was threatened with dismissal and the subsequent loss of her visa when she complained about her working hours. Her employer requires her to work 7 days a week and be on call 24 hours per day. She once went nearly 4 months without a single day off. She’s afraid to act against her employer for fear of being fired and having to leave the UK. 

One of the things our advisers find most frustrating about these cases is that while they can usually help with the immediate symptoms - through a food bank referral or other crisis support - there’s very little they can do to address the root of the problem. Why? Because it stems from the type of visa these clients are on.

Restrictive visas - a recipe for exploitation

The migrant care workers coming to us for help are on the Health and Care Worker visa. This is a restrictive visa - it ties the visa holder’s right to live and work in the UK to a specific job and sponsor, and limits their access to welfare support. This creates a power-imbalance between employer and employee that seriously reduces a person’s ability to enforce their rights at work or even leave an exploitative job. 

Restrictive work visas are not new and aren’t necessarily problematic if the work pays well and has good terms and conditions. However, in recent years, to ease growing labour shortages, restrictive visas have been expanded on a large scale. They’re now increasingly used for jobs with low pay and poor terms and conditions. 

Workers in these jobs already lack bargaining power and poor treatment is often rife. Restrictive visas make this worse by giving employers high levels of power over migrant workers, who tend to experience the most extreme and disgraceful practices. 

The social care sector - known for its low pay and poor terms and conditions - has especially high staff vacancy and turnover rates. Since January 2021, several types of care jobs have been made eligible for the Health and Care Worker visa. Social care has since become the single largest sector relying on restrictive work visas.

The combination of a highly restrictive work visa and a sector where workers regularly face poor treatment has led to almost weekly news reports of migrant care workers being exploited. It’s become an issue that our local advisers are seeing increasingly often but can do frustratingly little to solve because the ingredients for exploitation are baked into the visa itself. 

Why restrictive visas make it easy to exploit people

Normally, if you’re treated badly at work, you have some options to resolve the issue or enforce your employment rights. You can raise the issue directly with your employer and, if that doesn’t work, you can either make a complaint to an employment tribunal or, if the issue falls within their remit, to one of the Government enforcement agencies. If your employer fires you or you decide to quit, you can freely look for another job in any sector. While you’re unemployed, or if you’re struggling financially, you can usually get support through the welfare system.

From our data we can see that for migrant care workers on the Health and Care Worker visa, all these avenues are blocked or come with such serious consequences that they aren’t viable options. 

We reviewed 150 cases where migrant care workers had come to us for help, and this is what we found.

1. People are scared of being dismissed and losing their visa

As a migrant care worker your employer can dismiss you at any time  and withdraw your Certificate of Sponsorship. You may be able to appeal the dismissal, but you will lose your sponsorship regardless of whether the dismissal is fair, unfair, wrongful, or constructive.[1] Unless you find a new job and sponsor within 60 days, and apply for a new visa, you’ll have to leave the country.

Complaining or trying to enforce your rights therefore comes at a high risk - you could lose not only your job, but also your right to stay and work in the UK. If you live in employer-provided accommodation - a common feature of some care jobs - you also risk losing the roof above your head.

Many migrant workers are scared to rock the boat in any way, let alone stand up for their rights. 1 in 4 of the people we helped explicitly said they were scared to complain for fear of being dismissed. And often for good reason - 1 in 6 had experienced threats and intimidation, while 1 in 10 had experienced retaliation for complaining or trying to change jobs.

"My client and her friends feel they were promised much better terms and conditions when they were recruited. They are now forced to work over 14 hours per day, 6 days a week. They feel they cannot complain or switch companies for fear of losing their visa and being deported."

-  Adviser, South East England

2. Losing their job and visa is a risk many simply can’t afford to take

Many migrant care workers will have paid significant sums to secure their job and relocate to the UK, including for visa fees, travel, training, documentation, and accommodation. Recruitment fees are also common, despite being illegal in the UK and against the visa sponsorship rules. In a quarter of the cases we reviewed, the people we helped had been charged an upfront recruitment fee - on average more than £10,000. People regularly have to sell assets and take out loans to afford these costs. They simply can’t afford to risk having to leave the UK and losing the investment they’ve made.

"My client paid £20,000 to [care company - name redacted] to come to the UK for a job as a homecare worker and to have his visa arranged. He’s now not being offered the hours of work he was promised. He’s short of money and needing to resort to using a food bank. He feels he cannot complain about his treatment by this company as his visa is sponsored by them and will be cancelled if he loses his job."

-  Adviser, South East England

In addition to upfront recruitment fees, we also saw multiple cases where recruitment and sponsorship costs were passed onto workers once they were in the UK, through deductions and clawback clauses. Clawback clauses are written into people’s contracts to say they must pay their employer a fee if they leave their job, and sometimes even if they’re made redundant or dismissed.[2] The worst case we saw was Ola’s - his contract said he had to pay his employer more than £11,000 if he left his job at any point within the 5-year term of his visa. But he’s not the only one - nearly 1 in 10 people we helped had a clawback clause in their contract.

3. Visa rules mean finding a new job and sponsor is not easy

If you are dismissed or you’re being treated poorly and decide to leave your job, there’s no guarantee that you’ll find a new sponsor. You only have 60 days, and you can’t apply for just any job - it has to be one that qualifies for the visa. Your new employer has to have, or be willing to apply for, a sponsorship licence, which takes time and costs money. It can be hard to find an employer willing to take on these costs. To minimise the risk of having to leave the UK, some of the people we’ve helped have stayed in exploitative situations while they looked for a new sponsor.

"My client is in debt and can barely feed himself on the wages he is earning. If he can’t find another employer that’s willing to pay to sponsor him, he’ll have to return home to his debts. Meanwhile he’s in a stressful limbo searching for another job before the Home Office revokes his dodgy employer's licence. He’s being exploited by his employer as he has no other choice because of visa restrictions. There are many jobs in the social care sector, but not many employers willing to become sponsors."

-  Adviser, North West England

If you do find a new job and sponsor, you have to pay for a new visa. You’ll be several hundred pounds out of pocket, but with no guarantee that you’ll be treated any better.

4. There’s no safety net if you’re struggling or lose your job

Despite paying income tax and national insurance contributions, migrant care workers can’t access most public funds. This means that if you’re not given enough hours at work, if you’re dismissed, or if you leave your job without another lined up, you’re likely to struggle financially. 

Half the migrant care workers we helped were experiencing financial hardship - they were struggling or unable to buy food, pay their bills, or afford their rent, with some at clear risk of homelessness. Lack of access to a financial safety net can make people even more reliant on their employer, and more likely to accept poor treatment at work.

"My client came from [West Africa] on the Health and Care Worker visa. She was expecting - and has a contract for - 39 hours of work per week. Her actual hours are always short of the contracted hours, and her income is insufficient to pay rent and live. She is now reliant on food vouchers as she is not eligible to make a benefit claim due to no recourse to public funds condition on her visa. She is experiencing financial hardship, hunger, and general disillusionment."

-  Adviser, East of England

5. Enforcement of employment rights and visa rules isn’t working for people on restrictive visas

Migrant care workers technically have more rights at work than UK care workers - they are protected by the same employment laws as everyone else, but their visa grants them further rights, like a higher minimum salary. If treated poorly, they could theoretically turn to either the labour market enforcement system or, if the treatment is against sponsorship rules, to the Home Office. But, in practice, both systems fail them.

The key issue is that migrant care workers who stand up for their rights at work risk being dismissed and having their sponsorship withdrawn. This has happened to several of our clients, including Kathleen, who was dismissed a week after trying to talk to her manager about her workload. She was working up to 64 hours per week and was expected to do her manager’s duties in addition to her own. She felt stressed and like she was being taken advantage of due to her nationality. After dismissing her, Kathleen’s employer withheld her last month’s pay, saying she owed them for sponsorship costs. Kathleen was left struggling financially and scrambling to find a new job and sponsor.

To enforce their rights without risking their visa, migrant care workers first have to find a new job and sponsor. But even then, major barriers remain.

The UK’s labour market enforcement system is complicated and confusing and in dire need of reform. Government agencies can only enforce a limited set of rights, leaving workers to pursue their employer themselves through a backlogged tribunal system. Timeframes for making tribunal claims are short - usually 3 months minus 1 day from the date the problem at work happened - which is especially problematic if you have to delay your claim until you’ve secured a new job and sponsor. 

Cost is also a barrier - each party must pay for their own legal costs, and legal aid is only available for discrimination cases. Even then it doesn’t cover representation at tribunal, only advice. If you’ve had to leave the UK, you may not be able to access the employment tribunal system at all - only some countries allow evidence to be given from within their borders.

Trying to enforce your rights through the Home Office is arguably even more challenging. Almost all the sponsorship guidance is aimed at employers, and there’s no direct reference point for workers to complain about breaches of the sponsorship rules. If you do manage to report an issue and an investigation is launched, your employer’s licence to sponsor workers could be revoked, leading to you and all your colleagues losing your sponsorship and therefore your jobs.

This is what happened to Hari - he reported his employer to the police because they were charging people £10,000 for a homecare job, dismissing half of those recruited and then overworking the other half. He’s since received a letter saying his employer’s sponsorship licence may be revoked, but has seen no action to support his rights or wellbeing. He’s now desperately trying to find a new job and sponsor. Arjun and his 50 or so colleagues are in a similar situation - the Home Office has revoked their employer’s licence and now they all need new jobs.

There’s very little incentive for migrant workers to approach or engage with the Home Office if their employer is breaking the sponsorship rules. They risk losing their job and sponsorship, and stand to gain nothing in return. Cases like the one below show how badly both the immigration and labour market enforcement systems are failing migrant care workers.

"My client was brought to the UK by a care company under false pretences to do a job she had not agreed to. She was charged high fees by the company for sponsoring her visa, training, and accommodation. She was made to work long hours in unsafe conditions, but was only paid for a maximum of 36 hours per week. She was left with little money and is in debt due to charges made by the company and expenses from travelling to multiple work locations. My client found a new job and sponsor, and reported the company to the Home Office. In response, the Home Office informed her of her right to seek employment elsewhere under her visa, but did not take any action on the company and failed to advise her on who else she could report them to. She came to us because she wants to report the company for its exploitation of foreign workers, but is worried about what might happen to fellow overseas workers at the company if she does so."

-  Adviser, South East England

6. The consequences of restrictive visas are dire

The consequences of a visa that seems almost designed to enable exploitation, and an enforcement system that fails to protect workers, is predictable. In the 150 cases we reviewed, we’ve seen countless examples of poor treatment and serious exploitation, as well as violations of visa conditions. We’ve summarised some of the key issues below, but you can read more about the problems people have been coming to us about here.

Violations of sponsorship rules

Violations of employment rights

The visa conditions also mean that our advisers find themselves in a place where they can’t advise, at least not in the way they’d like to. They may need to put their client’s interest in keeping their job and sponsorship ahead of tackling multiple breaches of employment rights and other forms of exploitation. Otherwise they risk creating new, worse problems for the person they’re trying to help.

"We’re seeing more clients like this one. The employer pays for the flights, work visa, DBS checks, etc. On arrival the employer gets them to sign an agreement that says they’ll pay all the money back if they’re dismissed or if they resign. The client in this case is being sexually abused in her [employer-provided] accommodation, but risks being dismissed if she complains. If she’s dismissed, she’ll have nothing. She’ll have nowhere to live, no money, no right to access public funds, no sponsored work visa, and will have her final months wages taken off her. She’ll have to return to her home country but is unlikely to have sufficient funds to pay for the flight. She can’t make an Employment Tribunal claim because of the minimum 2-year employment service for unfair dismissal claims, and the Tribunal is unlikely to accept jurisdiction for third party sexual harassment."

-  Adviser, South East England

Advisers’ hands are tied - but we’re not giving up

Our local advisers are there for anyone who comes to us for help, but when it comes to helping people on the Health and Care Worker visa, their hands are too often tied. They can get migrant care workers access to a foodbank, but because of no recourse to public funds they can’t get them more sustainable support. They can advise people on their rights, but they can’t remove the very real risk of retaliation for those who try to enforce them. Even reporting bad or fraudulent employers to the authorities isn’t straightforward - it could backfire on the people they’re trying to help. 

Despite these challenges, our advisers haven’t stood idly by. They’ve held outreach sessions for people on the Health and Care Worker visa, issued food and fuel bank vouchers, and helped people access other charitable support. They’ve even helped people find new, safe jobs and sponsors. 

They’ve also raised awareness of the issues they’re seeing - externally as well as internally within Citizens Advice. They’ve written to their local MPs and to the authorities commissioning social care services, and have submitted more than 150 evidence forms to our central database, providing the evidence base for this investigation.

Evidence forms are short, anonymised summaries of cases that advisers at local Citizens Advice offices are seeing. They’re used to highlight particularly powerful examples of unfair policy or practice, or issues advisers haven’t seen before. They can also be completed in response to a local or national call for evidence. These internal calls for evidence are issued to get a deeper understanding of a specific problem and its impact on the people we help, provide case studies to campaign for change, and gather evidence for research reports and consultation submissions.

Despite the challenges, advisers have continued to help people understand their rights under UK employment law, and how these rights interact with the conditions of the Health and Care Worker visa. Those workers in a position to do so have been supported to challenge poor treatment at work - some have even taken their case to an Employment Tribunal. 

Our Expert Advice team - a group of solicitors, barristers and subject matter experts that advise our advisers - has also been active. They’ve produced new guidances for advisers as well as for anyone on the Health and Care Worker visa experiencing problems at work. 

However, just from reading the guidance for workers, it’s clear that something has to be done to fix the problem at the root. It starts by saying: 

“You have the same rights at work as any other worker. However, if you have a Health and Care Worker visa it can be hard to complain about your rights because your visa is linked to your job. If you complain about your rights and your employer dismisses you, your visa will be cancelled.” 

It can't go on like this

It’s clear that something has to be done. We cannot keep failing people who come here in good faith to care for our parents, grandparents, and other loved ones. This is a problem that will keep growing unless something is done to address its true causes. As one of our advisers said, “I don’t think we’ve seen even the tip of the iceberg yet”. 

Ultimately, anyone who is treated poorly at work must be able to stand up for their rights or leave their job. This is the outcome we need to see. Its absence allows exploitation and is the barrier which, in too many cases, prevents our advisers from being able to help. Currently people on the Health and Care Worker visa are not able to do either without risking serious consequences, unless they’ve first secured a new job and visa sponsor.

Having reviewed more than 150 cases, spoken to our frontline advisers, consulted our Expert Advice team, and read what other organisations are calling for, it’s clear that there is no single, silver bullet solution. Instead there are many steps that can - and should - be taken, with varying impacts.

1. Steps to empower individuals to enforce their rights at work and/or leave exploitative jobs

There are a number of barriers that prevent people from enforcing their rights at work or leaving an exploitative job. Two of the key barriers are: 

• people’s fear of being dismissed and losing their right to stay and work in the UK; and

• people feeling financially tied to their employer. This may be due to money owed as a result of recruitment fees and clawback clauses; money they would need to pay to secure a new job and sponsor, or not having enough money to leave their job without risking destitution.

To address the first barrier, the most important step would be to remove - or at the very least weaken - the link between a person’s employer and their visa. Leaving or losing your job shouldn’t mean losing your right to remain in the UK. People should be able to come and work in social care without their visa being tied to a specific job. Restrictive visas simply give employers too much control, especially in sectors like social care where ill-treatment is already rife. 

If the sponsorship system remains, then the government needs to increase the time people have to find a new job and sponsor if their Certificate of Sponsorship is withdrawn. The current 60 days is not long enough for people to feel like they can safely leave or complain if they’re treated poorly. More also needs to be done to make it easier for people to find new, safe jobs and sponsors. UNISON has called for the NHS, local authorities, and charities to track vacancies regionally among approved employers.

In addition, the government should provide victims of, and witnesses to, the violation of labour rights with protection against losing their visa, as has recently been done by the United States. This would support people to assert their rights, report violations, and cooperate in labour standards investigations, and ensure employers can’t use the threat of immigration-related retaliation to exploit people. Anyone who has already lost their visa through no fault of their own should also be protected - being undocumented is one of the greatest risk factors for labour exploitation. This could be done by allowing people to apply for a new visa without having to leave the UK, or by introducing a ‘bridging visa’, as Ireland has recently done.

To address the second barrier, action is needed on three fronts. First, government needs to ensure people do not end up financially tied to their employer due to debt from unlawful recruitment fees and clawback clauses that are unreasonable and breach visa rules. The Code of Practice for the international recruitment of health and social care personnel in England sets out guidance on both these issues, but needs to be made enforceable with proper monitoring of compliance. 

Second, government needs to remove the visa cost associated with securing a new job and sponsor - no one should have to pay to change their employer, and many people who have suffered exploitation will not have the hundreds of pounds that it costs to apply for a new visa. 

And third, government needs to ensure people have enough money - via adequate pay, sufficient hours, and access to public funds - to leave bad employers without risking destitution. Many of the migrant care workers we see are experiencing serious financial hardship. They’re not earning enough to live on, but would struggle even more if they left their job without another lined up.

2. Steps to prevent harm through better supervision and enforcement of existing rules

In addition to empowering individuals, the government must step up and actively prevent and address poor treatment of migrant care workers. It shouldn’t leave people to fend for themselves. 

Crucially, people’s rights at work need to be actively enforced. The current labour market enforcement system relies too heavily on individuals enforcing their own rights through a tribunal system, which is not accessible to those who are most likely to experience issues at work. Access to employment tribunals needs to be improved, by reducing the backlog of claims, extending timeframes for bringing claims, widening the scope of Legal Aid, and ensuring people are still able to give evidence even if they’ve had to leave the UK. 

But what’s really needed is a Single Enforcement Body for employment rights that is accessible to workers and has the resources and powers to seek redress on their behalf. This body needs to have secure reporting channels that separate the enforcement of labour rights from immigration enforcement, so that anyone who is worried about their immigration status, or has lost their visa, is still able to seek help.

More also needs to be done to ensure employers do not circumvent visa rules. Proper checks need to be carried out before sponsorship licences are granted - to prevent scams and ensure employers with a history of poor practice aren’t able to recruit workers from abroad - and after, to ensure compliance. There also needs to be a way for workers to report and receive redress for violations of the visa rules around pay, working hours, the clawback of training and immigration costs, and the charging of recruitment fees. Currently anyone reporting these violations to the Home Office are, at best, going to see little benefit and, at worst, will lose their job and visa as a result of enforcement action.

These are just some of the steps that the government needs to take to address the risk of exploitation created by the Health and Care Worker visa. It’s a complex issue, but there are many experts, from trade unions and workers’ rights organisations to academics and migrant community organisations, who can help the government get it right. They’ve been raising the alarm for years - it’s time to listen.

"Migrant care workers must have access to justice and be able to hold employers accountable."

-  Adviser, West Midlands

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Acknowledgements

This report was written by Meri Åhlberg, with invaluable input from David Mendes da Costa, Stephanie McKeon, Shaun Duffy, Asfah Kosir, and many others. Thank you to all the staff and volunteers at our local Citizens Advice offices who have helped make this report possible by sharing their knowledge, experiences, and what they're seeing on the ground.

Endnotes

*All names in the report have been changed to ensure anonymity.

[1] You can generally only claim unfair dismissal after 2 years of continuous employment.

[2] Charging workers fees and expenses can be lawful in some circumstances, but in the cases we’ve reviewed, people have been charged fees that breach the visa sponsorship rules, are hugely inflated, or are otherwise unacceptable, for example because they apply even if the person is dismissed shortly after starting work or because they don’t taper down over time.

[3] Migrant care workers must be paid a minimum of £20,960 per year, or £10.75 per hour, whichever is higher. The current National Living Wage is £10.42.