The Prime Minister’s ambitions to reform social care will be a success if they also include plans to end the ‘grotesque’ exploitation and extortion of migrant registered nurses working in the sector, a new report from the Royal College of Nursing (RCN) says.  

 

It 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.  

 

But today, nursing leader Professor Nicola Ranger tells the Prime Minister that his vision for a service delivering high-quality person centred care must also include decisive action to end the exploitation of staff in the sector. 

 

Ranger says: “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.” 

 

The damning 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 dangerous 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. This is likely to be only a small fraction of the numbers facing exploitation due to low union membership among migrants and widespread fear of speaking up. 

 

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

 

The adult social care sector is deeply 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 failed to 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. Their calls in the report include:  

 

• Visas should instead 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 to 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.  

• For 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 College 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, 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.  

 

Speaking on the day the report is published, 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." 

 

Within the report, there is devastating testimony from RCN members who have sought the nursing union’s support.

 

One RCN member reported that despite paying over £10,000 to accept a job in the UK, on arrival their contract had been re-written to include new financial provisions and were pressured into signing. After being subjected to shocking working conditions including excessive working hours, verbal harassment and being denied annual leave, the employer tried to charge them around £5,000 to leave their job.  

 

Another RCN member contacted the RCN after experiencing difficulties securing continued sponsorship despite repeatedly raising it with their employer. When they were offered a new contract by their employer, it had a substantial repayment clause of £25,000 if they left the organisation early. This is despite the member paying for all their own costs, with them feeling they had no choice but to sign the agreement.  

 

Another was required to pay their employer more than £3,000 at the start of their employment and were given no clarification on what the fees were for. They also reported their probation period being extended multiple times despite no concerns being raised about performance. After raising concerns about their manager's behaviour, they were fired with immediate effect for allegedly failing to follow workplace procedures.  

 

Ends

 

Notes to editors

 

In the report, the RCN has called for stronger protections, effective enforcement, and systemic reform to safeguard migrant care workers and raise standards in the sector, including:  

 

• The Code of Practice for the international recruitment of health and social care personnel to be placed on statutory footing to ensure compliance. 

• Clearer and more accessible reporting mechanisms for workers to safely raise concerns about employers.  

• Standardised repayment clauses including exemptions for workers who experience serious mistreatment, to prevent financial exploitation.  

• An extended visa curtailment period from 60 to 180 days to reduce hardship and improve job mobility.  

• Comprehensive review of the visa sponsorship system with the purpose of exploring alternative models that reduce employer dependency and provide greater protection for migrant workers.  

• For the UK Government to deliver on their promise and use the Fair Work Agency to perform a full investigation of the sector.