An Uncertain Environment: What is the Impact of Proposed Changes to Settlement on the Health and Social Care Workforce?

An Uncertain Environment: What is the Impact of Proposed Changes to Settlement on the Health and Social Care Workforce?

Visa policy changes that reversed the trends of the previous administration’s visa liberalisation have seen rapid reductions in people applying for health and care worker visas, but the rules on Indefinite Leave to Remain (ILR) are also significant determinants in the health and social sector, as recruitment is arguably unsuccessful without retention.

We know the challenges around recruitment in the health and social care sector are ongoing, and no sustainable solution to domestic supply has addressed this focus of the current government. However, we also know that retaining staff once recruited is crucial to creating organisational stability, through positive impacts on workforce culture, financial sustainability, and, of course, the continuity of care and support for service users. Long-term workforce stability (retention and progression) affects every measure of success for service providers.

The current Indefinite Leave to Remain (Settlement) system allows many workers, including those with health and care worker visas, to qualify for ILR after five years. The government’s 2025 Immigration White Paper proposed a major overhaul called “earned settlement”. Suggested changes include shifting requirements to between 10-15 years to qualify to apply for ILR, and conditional requirements around income contribution, English language proficiency, ‘integration’ (a strengthened Life in the UK Test, and community contribution are some of the suggestions around this requirement) and compliance with visa requirements, such as no overstays.

For those looking to take the huge step of migrating to the UK, careful consideration of the long-term sustainability of work is the key factor informing such a life-shaping action. Mitigating the risk of immigrating, including costs and family impact, is offset by long-term outcomes, with the goal being to create a lifestyle of some security and quality. The uncertainty of facing a possible 15-year wait to apply for settlement and begin building a life is discouraging.

For those already working in our sector, awaiting government reforms to the current system, the stress is inescapable because for all those who have not yet gained settled status, changes will be substantively retrospective, if not legal. Proposals have been made to uphold current standards for those whose visas have already been issued, but the wait for certainty is difficult.

Concurrently, sector colleagues are weathering the ongoing system pressures that are causing rising demand for services, increasing complexity of needs amongst service users and work insecurity as employers are squeezed by operating costs. High rates of stress and burnout in the health and social care sector are well-evidenced.

Published in February 2025, Unison’s ‘Caring at Cost’ surveys only those with temporary work visas and paints an intersectional, pressured picture of life, characterised by marginalisation and inequality. Confined by their immigration status to lower-paid roles, avoiding homelessness by sharing beds, and acquiring debt to facilitate moving to the UK to work, participants felt unsafe to share concerns or uphold their rights at work for fear of losing their job and therefore their visa.

Remaining tied to sponsoring employees through an extended ILR qualifying period increases the risk of exploitation. Combined with consistently increasing cost of living circumstances and a social climate charged with prejudice against migrants, the wellbeing of our colleagues at this time must be acknowledged through our actions in actively supporting, guiding and advocating for staff.

For organisations like SIG, a collaborative approach to addressing the inequity faced by colleagues without settlement is vital. Acknowledgement by commissioners of the issues facing the frontline of our sector, along with appropriate support, is essential. For other providers and us, providing guidance and clarity to employees about vias and settlement changes as they are announced, as well as reassurance that we wish to support, not exploit, is not to be underestimated.

In our sector, working to the social model of disability for service users upholds person-centred support. The principles of this model apply to those with protected characteristics in a broad context, including employment, because structures and policies can be insurmountable barriers without clear information, advice and guidance to know what legal protections exist and what accessible support is available, both at work and externally for employees.

The responsibilities of employers towards those facing challenges because of their employment status seem obvious when written plainly; the connection is rather obvious, yet there has been a prevalent view for many years that by providing work, an organisation has fulfilled its obligations. In our sector, we would be hypocritical to take this approach, because the whole-person, deinstitutionalised, and dynamic support that empowers our service users is equally applicable to the workforce required to deliver it.

At SIG, CEO Mark Milton has taken a steer towards workforce culture, development and support. Working out the methods to action this in what is a unique and diverse organisation will require a long-term approach that addresses the needs and aspirations of our workforce. Because it is this workforce that has shaped our Inclusivity Charter, demonstrating our ability to understand and manage complexity with efficiency and inclusivity, I am confident that we can work together as active participants and agents of change.

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