Rt Hon Seema Malhotra MP 
Parliamentary Under Secretary of State (Minister for Migration and Citizenship)
Home Office
Direct Communications Unit
2 Marsham Street
SW1P 4DF

By email:  privateoffice.external@homeoffice.gov.uk

23 July 2025

Dear Minister,

I am writing following our meeting on the 19th of July to formally raise a pressing concern affecting internationally recruited health and care staff. I am deeply concerned by the impact of the increased minimum salary threshold on internationally recruited nursing staff and wider health and care services. The RCN raised this concern in a letter to the Home Secretary earlier this year, and we are also writing to the Home Affairs Committee to raise this concern.

As you may be aware, the Royal College of Nursing (RCN) is the UK’s largest nursing trade union and professional body. We represent more than half a million members including many internationally recruited nursing staff.  In recent weeks the RCN has been contacted by several members in nursing support worker roles who have been left in a precarious situation following increases to the immigration salary threshold.

As of April 9th, the immigration salary threshold for health and care worker visas increased from £23,200 to £25,000. This closes band 3 roles to international recruitment in England (excluding London) and Northern Ireland. I am concerned that this decision has been taken without an assessment of the impact on health and care services which are reliant on internationally recruited staff. In the care sector RCN members report that some employers have refused to renew visas due to the new threshold.

In the NHS, staff employed in England on the first salary point of Band 3 are just £63 short of the new salary threshold. In Northern Ireland a pay agreement for 2025-26 has not yet been reached and currently all band 3 staff fall below the threshold. As a result, impacted staff are unable to renew their visas, change employers, or change their visa type. In your letter to the RCN dated 16th June you state that: 

“On the issue of salary thresholds, it is our firm belief that most Band 3 staff currently on a Health and Care Worker visa will be unaffected by the changes introduced on 9 April. Those changes could only affect them at the time they came to renew their Health and Care  Worker visa, by which time they should have accrued enough experience to move to the top of Band 3, which is already above the new minimum salary threshold. Nevertheless, we will keep this issue under careful review.”

I very much welcome your commitment to keep this issue under review. Unfortunately, there is no standard time for which a visa will be issued, and staff on one-year visas will continue to fall through this gap. Employers in the NHS have been instructing current employees that their sponsorships will not be renewed due to the new salary threshold. The RCN has been contacted by several affected members including those on one-year visas who are at risk of being unable to renew their visas and therefore losing their jobs. 

Band 3 staff are an essential part of the workforce and are critical to the delivery of safe and effective care. These staff have made life-changing decisions to come to the UK, and it is deeply unjust that many of them will be forced to return home because they are just £63 short of the threshold. As a result of the insufficient pay increase for Band 3 staff, they have been made vulnerable to losing regular status. Those who are unable to switch employers will also be put at greater risk of exploitation.

I urge you to please investigate this further and ask that the Home Office implements an exemption for staff already employed in the NHS before the 9th April 2025. I would also welcome the opportunity to discuss this issue further with you.

Yours sincerely, 

Bejoy Sebastian 
RCN President