Indefinite Leave to Remain: Healthcare Workers

Monday 18th November 2024 Westminster Hall

16:30

[Tony Vaughan (Folkestone and Hythe) (Lab)]

I beg to move,

That this House has considered e-petition 631412 relating to indefinite leave to remain for healthcare workers.

It is always a pleasure to serve under your chairship, Sir Edward. The petition we are debating today was created by Thomas Thulani Mthetho, and this is what it says:

“Healthcare workers are meant to have lived in the UK for at least five years before they can apply for indefinite leave to remain. With the work they do and the demand for their skills worldwide, they deserve to get residency status much quicker. Most healthcare workers are working under extreme pressure in the UK.

Many countries offer immediate residency status for occupations that are in high demand or extremely short. The UK has been a destination for most foreign nurses and doctors, and it is time for the Government to show they care and also appreciate the workers by making some of the restrictions in terms of residency more favourable. This could also reduce the number of care workers leaving the country for other countries that offer better conditions.”

The petition has attracted 52,962 signatures nationally. Before the election, the Petitions Committee decided that Thomas’s petition would be debated, which has led to the debate taking place today. I am leading the debate as a member of the new Petitions Committee. Before I get into the issues raised by Thomas’s petition, I want to tell Members a little bit about his experiences and what led him to make the petition. I have changed a few aspects of his story.

Thomas is a qualified nurse. While living in South Africa, Thomas approached a recruitment agency seeking healthcare staff in the UK. He had to sit English exams and, if he passed them, he would be able to enter the UK to work in the private healthcare sector. The contract was for three years. If he left before that, he would have to pay back the exam fees and the flight to the UK, which he understood would have been about £1,500. Thomas passed his exams and came to the UK on the health and care worker visa to work in a private nursing home. He worked mainly as a carer, and his contractual hours were 38 hours a week on minimum wage. He was sending money back to his family in South Africa, who depended on that money.

After starting work, he found that his employer required him to work 20 hours over his contractual hours, and regularly worked 60 hours a week. He would work five 12-hour shifts, five days in a row. He asked his employer if he could work less, but it refused. He approached the Royal College of Nursing, which told him that he had the right to refuse to do extra hours, but he felt that he was in an impossible situation. If he insisted that he do fewer hours, he was jeopardising his job, and so he did not feel able to seek legal advice about his situation.

After 11 months, he decided to leave, but his employer told him that he could not, and that if he did, he would be reported to the Nursing and Midwifery Council. It also said that he would have to pay £6,000, even though according to the original agreement, it was only £1,500 if he left before three years. He said he would not pay, it said it did not care, and that he would pay anyway. When he eventually left, it managed to deduct the £6,000 from his new wage packet.

Thomas knows of scores of people who have had an experience like his. All of them accepted breaches of their contract and employment rights for fear of jeopardising their job. Some had allegations fabricated against them by their employer to justify an abusive dismissal when they refused to accept breaches of their rights. Thomas believes that employers all over the country are abusing the Home Office system for sponsoring workers and are subjecting their employees to modern slavery, and doing so with impunity.

Thomas’s petition is about the qualifying period for indefinite leave to remain. He believes that if a qualifying period for healthcare workers was two years instead of five, the window in which the employee is locked in with their employer, and in which the potential for abuse is the highest, would be reduced. Thomas’s solution to the problem of which he has been the victim deserves careful thought, and I ask the Government first to review the qualifying period for those in his position. Thomas’s awful experiences show that there are gaping holes in the enforcement of employment rights standards in this country, especially in sectors such as healthcare. In a report published this month, the Work Rights Centre found that migrants working in adult social care, who constitute as much as 32% of care workers in the UK, face unsustainable working hours, low levels of pay and persistent breaches of employment rights. They fear that if they report their employers to the authorities, they risk having their visa curtailed, as some employers use the threat of curtailment to silence grievances. The report also found that non-compliance by visa sponsors—employers—is widespread. The most common employment rights breach is unfair dismissal, followed by unauthorised deduction from wages and discrimination, so it is clear that proper enforcement of labour standards is needed urgently.

I was encouraged to see that part 5 of the Employment Rights Bill, which the new Labour Government recently laid before Parliament, deals with the enforcement of labour market legislation. Under the Government’s plans, an agency will be set up to enforce employment rights, including on the national minimum wage, holiday pay, gangmasters licensing and modern slavery. The agency will consolidate enforcement bodies, such as His Majesty’s Revenue and Customs minimum wage enforcement team, into a single agency with greater powers, including powers to require that information be given, and powers to enter employers’ premises and require undertakings backed by criminal penalties. The Government hope that the agency will be a recognisable single brand so that individuals know where to go for help, as that would lead to a more effective use of resources.

It will be critical for the agency to take a preventive approach and address workers’ rights violations before they deteriorate to the level of slavery. Workers need to be able to trust it and come forward, so secure reporting needs to be embedded into it. It makes complete sense for employment rights to be enforced across the board, including alongside modern slavery, so my second question is: will the Government confirm that the new agency will police employment standards for those subject to immigration control, including those working in the UK health system under the UK health and care worker visa?

When I spoke to Thomas before this debate, he said that one of the things about the health and care worker visa he was most concerned about was being locked in with his employer because, putting the fees issue aside, his visa would be at risk if he left. At the moment, somebody in Thomas’s position who leaves their employment has a 60-day grace period to find a new employer. After that, they are illegally present in the UK. There appears to be no published policy that says that if somebody has faced exploitation or fraud by their sponsor, they are given a longer period to find a new job. Other countries have a bridging arrangement. For example, Australia has a migrant worker justice visa, so if somebody finds themselves in a position of exploitation or fraud, the Government can support them to leave it. In the UK, if somebody does not find a new employer after 60 days and becomes illegally present, there is no way back into the immigration system. That, in turn, creates pressure to go into the already overloaded national referral mechanism where that may not be necessary.

There is another barrier to leaving an exploitative healthcare workplace. If the worker leaves their main sponsoring employer or is unfairly dismissed, they are not allowed to work in a temporary job while they look for a new sponsor. There is a right to work for up to 20 hours a week in supplementary employment, but not if somebody leaves the main sponsor employer or is dismissed. The right to work up to 20 hours may apply where the employer loses their licence, but that is not enough to pay bills in the meantime while a new sponsor is found. A migrant justice visa that dropped the requirement to work only for the sponsoring employer in an exploitation situation would remove that barrier to leaving the exploitive situation, so my third question to the Government is: can any consideration be given to providing greater clarity and flexibility on the bridging arrangements when a worker on the health and care worker visa finds themselves in an exploitive situation?

We want all workers to be treated fairly, with rights and protections, so everybody can contribute fully to society without extra hurdles and financial pressures. We want people to be able to contribute in the long term. It goes without saying that all workers should be free from fear of exploitation. Thomas’s petition proposes one way in which those objectives might be addressed, and I have asked the Minister about others. There are many other sides to this debate and there is much more to be said, but I have set the scene and look forward to hearing other Members’ contributions.

16:39

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is a pleasure to serve under your chairmanship, Sir Edward. I rise to speak for a slightly different reason, which is that I have the honour to be the Chair of the current Petitions Committee and this is its first debate. I thank the hon. Member for Folkestone and Hythe (Tony Vaughan) for an excellent contribution. He described a worrying, if not harrowing, situation. I also place on the record my thanks, at this early stage in the life of the Committee, to the Members who have joined it. Their enthusiasm is most encouraging. I cannot continue without saying that we have been hugely impressed by the work put in by the Clerks and all the team who give us the presentations and so on. I will keep my remarks very short, because we want to hear the proper detail about this particularly harrowing issue, but I want to end by saying that to my mind the work of the Petitions Committee is very important, and it has a very high hit rate from members of the public who watch the proceedings and go into Hansard to see what we said. It strikes me that that is an important part of the way we do democracy in this country. I will conclude my remarks with that.

[Sir Edward Leigh (in the Chair)]

If Members wish to speak, they have to rise in their place.

16:41

[Sojan Joseph (Ashford) (Lab)]

It is a pleasure to see you in the Chair, Sir Edward. I congratulate my hon. Friend and constituency neighbour the Member for Folkestone and Hythe (Tony Vaughan) on his excellent speech introducing this important debate.

Members will know that before being elected to represent my home constituency of Ashford in July, I had spent the previous 22 years working in the national health service. As someone who also made the journey to work in the NHS from a foreign country, I will draw on my knowledge and set out in my short contribution why I support the e-petition and would back reducing from five years to two the time a foreign healthcare worker has to wait before qualifying for indefinite leave to remain. I would make the point that since I came to the UK in 2001, the rules have changed and people who have the same aspirations as I did now risk finding themselves excluded.

As we all know, the NHS is reliant on overseas workers. In the NHS workforce survey in June of this year, just under 30% of NHS staff in England reported having a non-British nationality. However, without proper incentives to both recruit and retain those workers, the employment deficit is likely to worsen. For example, in the years to June 2022 and June 2023, more nurses from the European Union and the European economic area left the NHS than joined. The picture is similar for healthcare workers from the rest of the world. In the year to June 2022, 4,702 healthcare workers left the UK, and for 2023 it was 6,610. In the year to June 2024, 7,957 workers left the UK.

The cost of recruiting and training an overseas nurse is anywhere between £50,000 and £70,000, while for a doctor it can be roughly £250,000—only for them to be tempted away by other countries with more attractive recruitment and retention policies, such as Australia and Canada. As the cost of living crisis has worsened over the past decade and a half across the country, especially in the south-east, where my Ashford constituency sits, stagnating wages and rising costs have not been a good incentive to keep staff in the NHS workforce.

This issue is also impacting patient care. Losing experienced staff is a big loss for the NHS. It takes 12 to 18 months for managers and matrons to train a newly joined staff member, so losing them in two to three years’ time is a big loss for the hospitals. Given those factors, we must rethink our retention strategy as a whole. Keeping in the United Kingdom skilled workers, especially those who have been the subject of large Government investment, is a vital step towards keeping our NHS alive and making it fit for the future. Therefore, granting healthcare workers indefinite leave to remain after two years rather than five is a necessary measure to solve the retention crisis identified by Lord Darzi in his recent independent report into our NHS.

By making a special case for healthcare workers and allowing them to make this country their permanent home after two years, we would show the importance of their roles in the NHS and our gratitude, as a nation, for their decision to come to the UK to train, learn and work in our healthcare sector.

[Sir Edward Leigh (in the Chair)]

Order. I should say that it is against the rules to work on a laptop while attending these debates.

16:45

[Satvir Kaur (Southampton Test) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Folkestone and Hythe (Tony Vaughan) for securing this important debate, following a petition on this issue to which my constituents in Southampton Test contributed the most signatures.

The fact that more than 500 signatures came from Southampton does not surprise me. We are home to the largest hospital in the region and have a number of care homes, pharmacies, and GP practices, which local individuals and families rely on every day and which would not exist were it not for the incredible hard work of healthcare workers from around the world who keep our NHS going. For me, supporting healthcare workers from overseas is not only the right thing to do, but the most practical way to ensure that we have an NHS that is fit for purpose once more.

Southampton has welcomed people from around the world for centuries. It has made us the great place we are—we are talented, skilled, resourceful, diverse and so much more. Healthcare workers play an invaluable role not only in ensuring that we get the care we need, but within our local communities, with many spending their spare time volunteering in our neighbourhoods. It is heartbreaking to see the statistic from the RCN that two thirds of overseas workers are considering leaving because they are struggling and cannot access support.

Too many, especially those working at Southampton General Hospital, are sadly victims of hate crimes, too—something I have personally witnessed with horror. They are the ones in the most pressurised circumstances, playing their part to save thousands every single day, nursing our most vulnerable and caring for our loved ones when there is no one else to do it. Those who choose to come to us and keep our NHS—our most treasured asset—alive, and who give all they have to care for and help others in our local communities, should be valued. They should be able to put down roots and find a sense of belonging. At the very least, they should be able to call this great country, to which they give so much—including their taxes—their home.

On a more practical level, we all know that our NHS is on its knees. I am proud of the clear, much-needed investment that this Labour Government have made in the NHS through the Budget, but more must be done. Recruitment and retention is the biggest problem facing our local hospital and other health providers, and that means reform. The plan, rightly, to improve opportunities and access for home-grown talent through the Government’s new NHS workforce plan is welcome, but it would be a mistake to take for granted the huge contribution that overseas health workers make to our NHS right now and will make in future. We are losing health workers at an unprecedented rate, with those in the sector warning of a mass exodus that will cripple our NHS. We are failing to keep that talent, and we are losing out to other countries that make much more attractive offers.

If we want to keep our NHS alive and ensure it can thrive once more, staff—whoever they are and wherever they are from—must be valued and supported. I am grateful to every NHS worker. You do incredible work, sometimes in the most challenging circumstances. You are already playing your part for our country, and you deserve to be able to call this place your home sooner. Although I understand the Government’s position, I hope more can be done to support my residents on whom this issue has an impact, and to support healthcare workers more widely.

16:49

[Tom Hayes (Bournemouth East) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Southampton Test (Satvir Kaur), whom I am delighted to follow. She is always a keen champion for Southampton and the NHS. I also thank my hon. Friend the Member for Folkestone and Hythe (Tony Vaughan) for introducing the debate.

In this petition, we have a proposal to bring eligibility for indefinite leave to remain for migrant carers down from five to two years. Only a few months into being an MP, I am always delighted to see solutions and proposals rather than a regurgitation of problems. For me, it comes down to identifying the problems that the proposal intends to solve.

Behind the petition lies a concern that we lose migrant carers once they are here; that we lose out on them to other English-speaking countries; and that without the migrant carers in our country and those who may come to our shores, the NHS—as we all know, it faces its worst crisis in a generation—will fall over. The NHS is perhaps in the worst situation it has ever known, partly as a consequence of the vacancies that it carries, although there are many other reasons, too. To put it on a firmer footing, we need to fill those vacancies more urgently than the timescales for recruiting and training new NHS staff allow, so migrant workers will be part of the temporary solution to our workforce problems.

In that spirit, I commend the NHS carers who support patients in my constituency of Bournemouth East, particularly at the Royal Bournemouth hospital. A full 24% of the workforce at that hospital are from the global majority—a far higher percentage than is reflected across Dorset. Some 477 are Indian, 530 are African, 273 are Filipino, 72 are Pakistani, 29 are Nepalese and 31 are Sri Lankan. As I saw when I was at the hospital recently, that really is reflected in the spirit of care given to patients. I commend everybody who contributes to our NHS, wherever they come from. It is great to see the Indian population in Bournemouth growing—I have been to some of their recent celebrations. They are so proud to serve in our NHS, and I commend their work.

On the whole, however, we should recognise that migrant working will be a temporary solution. We must urgently start the longer-term and more sustainable solution of training, recruiting and retaining a domestic workforce. The NHS is the largest recruiting employer in Dorset. However, accounting for 6% of all vacancies in 2023, the NHS and the care sector face significant skill shortages and recruitment difficulties. The long-term workforce plan predicted that the workforce would need to grow by 2.6% to 2.9% a year, with 71,000 to 76,000 allied health professionals, which is an enormous target to meet. The plan identified shortfalls in the number of allied health professionals, namely paramedics, occupational therapists, diagnostic radiographers, podiatrists and speech and language therapists. There is clearly a gap in a wide range of professions. The shortfall is due to the education and training pipeline not keeping pace with the demand that we all knew was coming, and that, my hon. Friends, is a casualty of 14 years of Conservative Government.

We need to increase the number of local people employed in health and care careers. I commend the Dorset integrated care system’s people plan, which outlines that as a priority. We must also open young people’s minds to the idea of roles in health and social care before they make their career choices, and we must make apprenticeships an attractive career pathway for a wide range of people, including those who would normally choose higher education. Indeed, the long-term workforce plan identifies that more than a third of AHPs could train through apprenticeships. I commend Health Sciences University, Bournemouth and Poole college, and Bournemouth University, which are excellent education providers. With more support from Government in the form of funding and frameworks, they could do so much more to train the carers of the future from within our communities.

We all know that a larger domestic workforce is the future, and that investing in education and training is key. Because we have not done so, we have an urgent workforce gap to fill. Migrant workers can be part of the solution to fill that gap and avoid significant vacancies in the future, but it begs the question of what policy levers need to be pulled, and whether we lose migrant carers once they are here because they choose to leave—because of the cost of living crisis, or for other reasons—or because they choose not to come here in the first place and go to other English-speaking countries.

By requiring migrant healthcare workers to qualify for indefinite leave to remain after five years rather than two, and by making no immediate changes to existing policy, the Government are taking a view about whether they need to encourage migrant carers to come to or stay in the UK. The Government had at least three other options in relation to the petition and the urgent need to fill the gaps in our workforce. First, they could have agreed with the petition in its full scope. Secondly, they could have done something about eligibility for indefinite leave to remain, but not delivered the full scope of the petition; they could have reduced eligibility from five years to something more than two years. Thirdly, they could have done nothing with eligibility, but they could have done something else to further encourage migrant carers to fill the gaps in health and social care.

Whether the Government create new policy levers over time and pull them to encourage migrant workers to serve in our NHS, we must bear in mind one key thing. We must make sure that all future planning around workforce is effective and happens at place-based level. We need our integrated care systems to map projected vacancies and understand where carers will come from, whether it is through apprenticeships and training or from overseas. We must plan the healthcare, education, housing, transport and other infrastructure necessary to support any increase in the population at a local level. I think that is particularly important, because when I was knocking on doors in the months before the general election, it was clear that behind every single door there was a feeling of hopelessness—a feeling that nothing improves, nothing gets better, the problems are too big to fix and nobody has done anything for so long.

If we do not put in place the right frameworks and funding, and if we do not fill the gaps in our healthcare workforce and put in place a longer-term, sustainable trajectory to a full workforce, we will store up yet more problems and create yet more hopelessness. I therefore encourage the Government to do all they can to support the NHS—now on life support—by filling those gaps in the workforce, and to do all they can to support colleges and universities in my area and elsewhere to make sure that we have the workers of the future.

16:56

[Mrs Sarah Russell (Congleton) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Folkestone and Hythe (Tony Vaughan) for securing this debate.

There is a significant and ageing population in my constituency. There has been a 25% increase in the number over-65s since 2011 and, accordingly, a huge increase in the need for care. Prior to coming here, I was a solicitor specialising in employment rights. I worked in a law centre and saw at first hand how the issue plays out when it goes wrong—and it does go wrong. Typically, we would be approached by a care worker who was very concerned that they were being treated horrifically at work, in ways that were clearly unlawful. Unfortunately, once we gave them advice, they would not go forward with any form of complaint. They were too frightened that they would lose their visa status and their employer would create untrue allegations about them in order to have them thrown out of the country, rather than dealing with the underlying problems in the care sector.

The Gangmasters and Labour Abuse Authority reports that 61% of all reports made to it in the first quarter of 2024 concerned labour abuse in the care sector. Many, many people work in the care sector in my constituency and many, many more spend their life savings on care. They would all be rightly horrified to experience or receive care from people who work in the circumstances that I saw at first hand in practice.

The Gangmasters and Labour Abuse Authority website lists common signs that indicate the exploitation of care workers. It asks that if someone is visiting a loved one or a loved one is receiving care at home and they spot the signs, they contact the authority. The common signs listed are scavenging for food or eating leftovers, working excessively long hours, not being dressed adequately for the role—having insufficiently warm clothing or not having personal protective equipment—being in fear of the authorities, showing signs that their movements are being controlled, or having injuries. That is the reality of working in care in this country. That is what we all accept day to day in order to have our older people or people with disabilities looked after. Any of us would find that idea completely abhorrent. While we continue to do nothing, that is what we perpetuate in our society and all around us.

There are two things that we could do. Irrespective of the subject of today’s petition—even if there was a two-year wait for rights—we need to look at the relationship between employment rights and visa status in the intervening period, because people in those first two years would still be subject to widespread abuse. The other thing that we could look at is the Gangmasters and Labour Abuse Authority licensing scheme, which does not currently extend to the care sector. That is a significant omission that we could review.

I thank Members for listening to me today. Finally, I want to pick up on the point made by my hon. Friend the Member for Southampton Test (Satvir Kaur) about hate crime against NHS workers. When I visited Congleton War Memorial hospital recently, the chief executive made the point to me that his staff are habitually and regularly subjected to racial hatred. In raising that issue again with the House, I echo my hon. Friend, and I thank all NHS workers and all our care staff—it is appalling and we need to do something about it.

17:00

[Lisa Smart (Hazel Grove) (LD)]

I am grateful to the Petitions Committee and to the hon. Member for Folkestone and Hythe (Tony Vaughan) for this debate, and it is a pleasure to serve with you in the Chair, Sir Edward. It is an honour to speak on a matter that is deeply important, not just to those who signed the petition, but to every single one of us who relies on the dedication and compassion of healthcare workers.

We should be clear about the immense contribution that healthcare workers make to the UK. Those individuals form the backbone of our communities, tirelessly offering their time, skills and empathy to ensure the wellbeing of those in need. Every single day, they save lives and, in doing so, can risk their own. They also face mounting pressure, whether from record waiting times in the NHS or from staffing shortages in care homes. Other Members have mentioned hate crimes in their constituencies, and over the weekend I had an horrific incident of exactly that in my constituency. I completely agree with the comments made in that regard.

What do healthcare workers get in return? They get a system that makes them jump through hoops and that can leave them vulnerable to exploitation, as we heard clearly in Thomas’s story—about how the power sits with the sponsoring employer, rather than with the healthcare worker. Those workers deserve better. They deserve a system that recognises their sacrifices, their contributions and their humanity.

The Liberal Democrats have long championed better support for healthcare workers from around the world, because if we want to continue benefiting from their dedication, we must treat them with respect—not as mere cogs in a machine, but as valued members of our society. To us, the first step to ensuring that healthcare workers have the resources, support and respect they deserve to continue their essential work, is reversing the utterly cruel decision made by the last Government to ban those on the health and care worker visa from bringing their dependants with them. That policy places undue burden on workers who are already sacrificing so much to support our healthcare system, and it sends a clear message that our Government do not value them. By overturning that decision, we could take a vital step towards returning compassion.

I urge the Government to exempt NHS staff, and care staff too, from the £1,000 a year immigration skills charge. That fee, imposed on employers who recruit workers overseas, places an unnecessary financial strain on our already stretched healthcare system. At a time when the NHS and care sectors face significant workforce shortages and mounting demand, charges such as those are unproductive.

We must also address the exploitation of migrant workers, a problem particularly acute in the social care sector. Many of those workers face long hours, low pay and isolation from their families, a situation only worsened by the decision to ban dependants. The Liberal Democrats are committed to tackling that head on. We are calling for a single enforcement body to crack down on modern slavery and worker exploitation. That was promised by the previous Government, but unfortunately did not materialise.

Reforming policies for immigrants working in healthcare is essential, but the long-term solution surely lies in a robust workforce plan that invests in training and retaining our own talent. That was mentioned by the hon. Member for Bournemouth East (Tom Hayes). Had the previous Government paid care workers properly and valued them as skilled professionals, they would not have needed to bring in tens of thousands of care workers from abroad.

The Liberal Democrats urge the Government to produce a long-term workforce strategy to focus on addressing those skill gaps that exist within the UK through increased training and education opportunities, and for relevant Departments to work with employers in each sector to address their specific needs. We have also called for a carers’ minimum wage to make it easier to recruit British workers to those vital services on which our country relies. The previous Government did not implement those proposals, but I urge this Government to revisit them.

There is a central point to be made here: the UK’s visa system is broken. It is not fair or fit for purpose. Our economy and, with it, our public services and—most importantly—our people, suffer for it. The Liberal Democrats are committed to building a system that is fair, practical and humane—one that recognises economic realities, values families and enables our workforce to meet the needs of this country. We need a flexible, merit-based visa system that reflects the actual needs of our economy—one that considers skills, qualifications and demand for expertise, not an arbitrary figure that is forced to fit across all industries and sectors. A key part of that flexibility should be moving work visa policy out of the Home Office, which has repeatedly shown that it does not understand the needs of employers. That policy should be placed under the responsibility of Departments better equipped to address workforce challenges. By doing so, we can ensure that policies are designed with a deeper understanding of sector-specific challenges and a focus on supporting economic growth and service delivery.

The UK’s immigration system is not working for too many people. It fails healthcare workers, it is failing employers and it fails all of us who rely on vital services. The Liberal Democrats have a plan to fix it by treating healthcare workers with the respect they deserve, cracking down on worker exploitation and building a visa system built on merit and real workforce need. We urge the Government to start delivering a system that actually works for healthcare workers, for the NHS and for the entire country.

17:07

[Alicia Kearns (Rutland and Stamford) (Con)]

It is a pleasure to serve under your chairmanship, Sir Edward. It is always a privilege to debate issues brought to us directly through petitions. I join the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) in thanking the Petitions Committee for all the work it does, particularly the Clerks. They are currently fortunate to have Rahul Sindwani within their team, who was my Speaker’s intern for a year. He is very much missed, but I am delighted that he has gone on to find another role within Parliament.

In today’s debate, it has been good to hear about the wide range of work that health and social care workers do on a daily basis. They are integral to our communities, supporting our loved ones during times of crisis, and our beloved older ones. I am deeply grateful for the work they do. The issue brought to us today highlights the broad and interconnected nature of immigration, a policy area with influences far beyond the remit of the Home Office. Few areas feel its effects more acutely than our health workforce, and that workforce is a vitally important matter.

The previous Government understood the importance of developing a strategy for the NHS workforce that extended beyond parliamentary cycles, taking into account its long-term impact. Our proposals aimed to reduce reliance on international recruitment agency staff. Our report stated that in 15 years’ time, we expect just 9% to 10.5% of our workforce to be recruited from overseas, compared with nearly a quarter now. That shift towards a home-grown health workforce is contingent on implementing education and training expansions as set out in our plans. I would be grateful if the Minister could confirm that that target remains and what steps the Government are taking to achieve it.

In Government, the Conservatives created the health and social care visa to facilitate the entry of top global health professionals into the NHS, aligning with the needs of both the institution and the country. Within its first three years, over 61,000 people had taken it up. I would like to clarify that health and social care workers are exempt from the immigration health surcharge, so that would not be a new proposal from other parties— it is the current existing policy.

We should discuss the basis for achieving indefinite leave to remain and why it matters. The standard requirement of five years is designed to allow applicants to build ties and demonstrate an ongoing commitment to the UK. In sponsored work routes, settlement relies on applicants having worked in their sponsored role for five years. Other requirements include demonstrating an adequate level of English. That is essential so that individuals can properly integrate into our communities. Integration is a crucial element of settlement. Delving into the definition of integration is complex, and I would not want to test the patience of the room on that matter. However, the data available is clear that migrants’ English language skills and labour market outcomes improve over time, giving them more opportunities to shape their own futures. That also benefits society as a whole.

While there are some limited circumstances in which individuals can apply for accelerated settlement, most routes leading to permanent residency require an individual to have done those five years. To me, and I am sure to many others, that represents an appropriate timeframe for people to build ties to the UK and their local communities. I am not convinced by the arguments that having two years instead of five somehow reduces the risk of abuse, and indeed slave labour, within the system. We must ensure that work standards are appropriate, and there are many routes for victims of slave labour to receive protections, such as the national referral mechanism, but it is quite fair that if someone cannot find another role within the UK, their visa would no longer be valid.

We did a lot of work when we were in Government to crack down on fraudulent social care companies, which are using this visa route to bring vast numbers of people to this country without social care jobs for them to go to. We have to recognise that, while the majority of people who apply to come and work in this country using the health and care worker visa are coming here for the right reasons, many companies have abused that route. That is why we have had to put in additional restrictions around that.

It is important to note that the rate of settlement in this country is managed thoughtfully, ensuring that those who successfully integrate have the opportunity to remain here indefinitely. Contrary to what was said in the opening speech, individuals can undertake additional paid work on a health and social care worker visa, as long as they continue in their sponsored role. They can also engage in unpaid voluntary work. That, again, helps them to identify alternative routes to employment, should they be unhappy with their sponsor.

As many Members will be aware, grants of settlement have generally increased since 2016, although they remain below the level seen in the early 2010s. While there was a slight decrease in 2023, it was still the second highest year for grants since 2013, with 119,000 granted. Could the Minister kindly set out whether the Government have considered the level of settlement grants they anticipate in the coming years, and how they plan to ensure that those remain sustainable?

All of us here appreciate the work of healthcare professionals, but, in our view, five years is a reasonable timeline to achieve indefinite leave to remain. It ensures that those who come to make permanent homes here have the time to lay down roots, to fully integrate with their neighbours and local community, and to demonstrate commitment to our country. As with all areas of visa policy, it is vital that we find a balance between ensuring robust protections against misuse, ensuring trust in its fairness from UK residents and citizens, and the rights and prospects of those coming here to make new lives and contribute.

The current timeframe for indefinite leave to remain is the correct one, and should not be shortened. Is that also the Government’s view? Are there plans to either review or change the eligibility criteria for indefinite leave to remain? Ultimately, we welcome the ongoing discussion around this issue; indefinite leave to remain is a serious status, and the five-year timeframe reflects the seriousness of that and the opportunities that being in this country offer to those with indefinite leave to remain.

17:12

[The Parliamentary Under-Secretary of State for the Home Department (Seema Malhotra)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank and congratulate my hon. Friend the Member for Folkestone and Hythe (Tony Vaughan), for securing this important and informative debate, and indeed for the work that he and colleagues across the House are now doing in the Petitions Committee. I am grateful to him and to colleagues for taking part today.

I want to start by saying that I totally agree with the sentiment underlying so many of the contributions—that everyone should be able to work free from fear and exploitation, and that there should be absolutely no place for hate crime or sentiments from anybody, anywhere in the country. I am sure that all hon. Members across this House take those issues extremely seriously.

I will address several of the issues raised—including tackling the exploitation that we see regarding this route, taking a preventive approach, ensuring trust, making sure that there are escape routes for people if they feel locked in with their employers, and many others—in my remarks this afternoon. I thank my hon. Friends the Members for Ashford (Sojan Joseph), for Southampton Test (Satvir Kaur), for Bournemouth East (Tom Hayes) and for Congleton (Mrs Russell), as well as the Liberal Democrat spokesperson, the hon. Member for Hazel Grove (Lisa Smart), and the Conservative shadow Minister, the hon. Member for Rutland and Stamford (Alicia Kearns), for their contributions today.

The Government do recognise the vital contribution that health and care professionals from overseas make to our NHS and in social care, and indeed to the wider health and wellbeing of the United Kingdom. Indeed, my hon. Friend the Member for Ashford speaks with great personal experience, having worked as a nurse. I know that he, like me, will want to congratulate our mutual friend, Bejoy Sebastian, a critical care nurse, who was recently elected as president of the Royal College of Nursing. Bejoy is a true example of the incredibly important contribution that is made to our wider health sector.

Hon. Members will be aware that in 2020 the previous Government introduced the health and care worker visa, which recognises the crucial contribution that international healthcare workers make, and this Government have kept that offer. The health and care worker visa provides significantly reduced visa fees, as well as a dedicated Home Office team to process applications. Most applicants can expect a decision within three weeks of enrolling biometrics. Applicants are also exempt from having to pay the immigration health surcharge. Those benefits apply to not only the main applicants but their dependants, which I hope is a sign of how much we value the role that those coming here play in our health and care services.

The United Kingdom’s offer to health and care professionals continues to be strong, competing with those of other countries in attracting health and care professionals who may want to work overseas. However, as several hon. Members have said, it is important in that context that we look at net migration overall. Under the previous Government, net migration trebled in five years, driven by a big increase in overseas recruitment.

Our Government are clear that net migration must come down, and we are committed to tackling skills shortages and labour market failures here in the UK to support that effort. That is why the Government’s approach is to link migration policy and visa controls to skills and labour market policies, so that immigration is not used as an alternative to training or tackling workforce problems in the UK. That will be important in ensuring that people have opportunities to gain new skills and access these important jobs, as part of enabling the Government’s broader agenda.

Although I appreciate the arguments about granting health and care workers settlement after two years, the system must be fair to all users. That is why it would not be right to allow health and care workers to qualify after two years, when skilled workers, including those in other much-needed sectors with global demand, would need to wait until they had completed five years on a work route before they were eligible to apply for settlement.

Settlement in the UK is a privilege and not an automatic entitlement. In determining the qualifying period, the Government have to balance what is fair to all applicants with ensuring that individual applicants are able to continue the skilled work they have been issued a visa for, which often aligns so much with their passions and, in this case, with the deep compassion that so many will bring. We must ensure that the period is of a reasonable length, while also recognising the potential impact on public funds of granting settlement sooner.

On balance, the Government consider that five years is the right length of time for people to demonstrate a reasonable contribution to their sector, as well as their commitment to the UK. That is why we have no plans to reduce the length of time that health and care workers, or other skilled workers, need to complete in the UK in order to apply for settlement.

In terms of examples elsewhere, France offered frontline workers fast-track citizenship in 2020 during the covid-19 pandemic, and other countries have offered short-term visas for roles in high-demand sectors. The French offer appeared to go wider than those just in health and social care, but the scheme appears no longer to be operating. So there are examples where there can be short-term changes, but those changes may also come to an end.

However, it is right that we tackle the issues underlying the sentiment behind the petition, which my hon. Friend the Member for Folkestone and Hythe powerfully outlined. In my remaining remarks, I want to tackle some of those issues, and particularly those related to displaced workers and exploitation.

I was asked what the Government are doing to more effectively tackle some of the exploitation we have seen, and it is worth laying out some of the protections that are now in place. In March 2024, there was rightly a change to sponsor guidance so that sponsors would need to be carrying out regulated activity and be registered with the Care Quality Commission. The Home Office has continued to act against unscrupulous sponsors and has highlighted bad practices to the sector. It continues to share concerns and intelligence related to bad practice, and since July 2022 has revoked 452 sponsor licences in the care sector, for reasons including underpayment of salary and failing to provide workers with enough hours to maintain salary levels.

For those individuals whose employer’s licence has been revoked, the Home Office has established a joint venture with the Department of Health and Social Care and with directors of social care operating in regional hubs in England, whereby the Department has funded a process allowing the hubs to find alternative employment for those in that position. Further information can be found on the Government website. The scheme has been implemented on an exceptional basis because of the exploitative practices that have been identified in the sector, and to provide protections to victims of those practices. Concerns regarding potentially unethical and illegal employment practices should be reported to the Gangmasters and Labour Abuse Authority, which will investigate fully. Information on reporting those issues can also be found on the GLAA website.

Colleagues on both sides of the House raised the important issue of having a single enforcement body. In their plan to make work pay, the Government set out a significant and ambitious agenda to ensure that workplace rights are fit for a modern economy, that they empower working people and that they deliver economicgrowth. The Government also introduced the Employment Rights Bill on 10 October 2024. It is important that we talk about this issue in the context of improving rights and protections for all workers.

It is also important to recognise that workers may want to change employer because of exploitation, even though their sponsor may not have lost its sponsor licence. Any worker on the health and care worker visa is able to seek alternative employment, provided they have a job offer from a Home Office-approved sponsor, and to make a new application. They are free to do that at any time, and they do not need their employer’s permission to move jobs. We strongly encourage health and care worker visa holders who think they are being exploited—whether they have concerns about pay, working rights or working hours—to come forward and report those concerns to us using the pay and work rights complaints section on the Government website. First and foremost, any worker who believes that they may be in danger should also contact the police.

If a migrant working in care has left their job because of exploitation, they should contact their regional support officer, so that they can help them try to find alternative employment. That includes people who have yet to have their visa cancelled.

In the context of some of the protections we have in place and the ability to move employer, the Government have no plans to extend the period allowed to workers who have lost their jobs, as that could leave them unable to work and support themselves for longer, increasing the risk of destitution or of becoming trapped in illegal working situations.

It is also important to recognise the point raised by my hon. Friends the Members for Congleton and for Bournemouth East, among others, that staff retention in the care sector remains a long-standing issue that the sector needs to address. That is why we are committed to ending long-term reliance on overseas recruitment by linking our migration, skills and labour market policies, as I mentioned. That includes improving working conditions and bringing in workforce and training plans for sectors such as health and care. That is why it is important that we have introduced the Employment Rights Bill and are looking at the fair work agency becoming a single enforcement body. However, I recognise that there is still much more to do.

The Government will continue to monitor care worker access to the immigration system and act to stop exploitation in the care sector. We do not plan to make any changes to the immigration system at this time, but we will act if needed.

In closing, I thank my hon. Friend the Member for Folkestone and Hythe for securing this valuable debate, and all those who have spoken. There is no doubt about the important role that health and care staff, and the sector in which they work, play in all our constituencies in supporting communities. This is a matter about which Members on both sides of the House care passionately, as has been demonstrated today. I assure Members that we will reflect carefully on this debate and on the points that have been raised. We will continue to do all we can to support those in our health and care sector and to ensure their safety.

17:26

[Tony Vaughan]

The debate has underlined that the UK desperately needs care workers from abroad. As I said earlier, about 33% of our care workers come from abroad, yet they are leaving in their thousands, as other hon. Members have pointed out. They are also being exploited because the system does not currently enforce labour rights. All the while, there is a recruitment crisis in health and social care.

I would like to declare an interest: my mother worked as a care worker for decades before she retired two years ago. She came from the Philippines in the 1970s and worked as a carer in the NHS and in nursing homes, and I know from her experiences that the work was hard. I also know that that is not the chosen career for many younger people, and I thank and congratulate everybody who works in the care sector to provide that vital public service.

I completely agree with other Members about the need to encourage apprenticeships, improve conditions and not treat immigration as an alternative to training. The reality at the moment is that we need the 33% of care workers who come from abroad, and a lot of work needs to be done to make sure that the care profession is seen as attractive to those not already working in it.

I welcome the acknowledgment from the Government of the need to prioritise tackling exploitation. I also welcome the actions to enforce labour standards that the Minister outlined, but I wonder whether there is another way of doing that. Ongoing contact between the Home Office and employers would ensure that employer non-compliance was addressed before breaches become so serious that revoking the sponsor licence is the only option. It would avoid other employees being left out in the cold and losing their jobs. I would hope that the fair work agency will provide the powers, resourcing and enforcement officers to ensure that there is ongoing contact, so that the extreme step of revoking sponsor licences is not the only tool in the box.

I note the point made by the Opposition spokesman, the hon. Member for Rutland and Stamford (Alicia Kearns), about the 20-hour period. My understanding is that if someone is in a situation of exploitation and they lose their job, either by termination or resignation, the immigration rules are clear that they are not allowed to work at all in the 20-hour period. That barrier to leaving an exploitative situation is very real.

I finish by thanking everyone for their contributions to the debate. I also give particular thanks to Thomas for putting himself out there and starting this petition. The number of signatories shows that this is an issue of concern for many people, and I hope this debate has given Thomas some reassurance that our system has considered it carefully. I encourage everyone to continue to use the petitions system, which is a great way of participating in our democracy.

Question put and agreed to.

Resolved,

That this House has considered e-petition 631412 relating to indefinite leave to remain for healthcare workers.

17:30

Sitting adjourned.