Britain's care system runs on immigrant labour - whom politicians now threaten
Hostile immigration policies target the workers who keep vulnerable people alive
Within months of recruiting personal assistants in the early 2000s, the pattern became unmistakable. Of the first ten applicants, only three were British - all arrived with the standard agency mentality, patronising and unwilling to learn from disabled clients about their own needs. The remaining seven, from Poland, the Czech Republic, Hungary, and Zimbabwe, were superior in every way: pragmatic, eager, genuinely willing to listen.
Petra came from the Czech Republic with a permanently anxious expression and a willingness to work that British applicants couldn't match. She bathed, dressed, and enabled independence whilst holding down cleaning jobs on the side. As trust developed, she disclosed what she'd been hiding: criminal abuse by an employer, threats she dared not report. Report it and risk everything - deportation, loss of the life she'd built, return to prospects far worse than exploitation in Britain.
Twenty-five years later, this pattern isn't an anecdote. It's the foundation of Britain's entire care system. And politicians are proposing to dismantle it.
A system built on other people's desperation
Nearly one in five NHS staff in England are not British. In adult social care, the proportion is identical: 19%. That's 265,000 people in the NHS alone, performing surgery, staffing A&E departments, keeping intensive care units running. In social care, it's immigrant workers bathing Britain's elderly, feeding disabled people, enabling independence for those who cannot manage alone.
The Nuffield Trust calculated something remarkable: half of all health and social care workforce growth over the past decade came from people born abroad. Between 2009 and 2019, the sector added 446,000 staff. Immigrant workers accounted for 221,000 of them. This isn't supplementation. It's dependency.
During the pandemic workforce crisis, the government added care workers to the shortage occupation list. Visa grants exploded from 113 in 2021-22 to over 40,000 the following year. An additional 58,000 overseas staff flooded into social care in twelve months, providing temporary relief for vacancy rates that had hit 10.6%. The Migration Observatory documented almost 100,000 overseas health and care workers entering Britain in the year to March 2023 - the majority of all skilled worker visas granted.
Even with 70,000 new overseas recruits, adult social care vacancy rates remained at 9.9%, compared to 3.4% across the wider economy. The message was clear: when other jobs exist, British workers choose them. Every time.
The price of vulnerability
The workers who answered Britain's call discovered exploitation wasn't incidental. It was structural.
Research by the Rights Lab at Nottingham University found migrant live-in care workers face significant modern slavery risks. The conditions creating these risks are deliberate: workers isolated in clients' homes, dependent on agencies with minimal oversight, holding precarious immigration status that gives employers absolute power. Complain and lose everything.
Unseen, the charity running the UK Modern Slavery Helpline, reported a 30% increase in potential victims in 2023. The care sector featured prominently. Their analysis revealed the mechanism: recruitment agencies charging workers up to £20,000 in fees, trapping them in debt bondage from day one. Workers arrived to find threats, racial abuse, sexual violence. Employers wielded deportation like a weapon. Silence or leave.
UNISON surveys documented the scale. Workers reported paying £14,000-£15,000 to change jobs - illegal fees that agencies demanded with impunity. One single mother sold everything she owned and borrowed from relatives to pay £5,000 to an agency. She arrived in Britain to find no work existed. A care worker from Nigeria told researchers that employers treat sponsored workers like modern-day slaves, threatening to remove their visas constantly.
The system concentrates power intentionally. Care visas attach to employers, not workers. Lose your job, lose your right to stay. The Gangmasters and Labour Abuse Authority identified care as high-risk for labour exploitation and conducted raids across care homes. But prosecutions remain rare. The exploitation continues because it's profitable and the victims cannot easily resist.
This isn't a bug. It's how Britain has chosen to run its care system.
What British workers know
The answer to why British workers avoid care jobs isn't complicated. The work pays poverty wages for backbreaking, emotionally exhausting labour.
Skills for Care data shows median hourly pay of £10.90 - barely above minimum wage. Experienced workers earn seven pence more per hour than newcomers. Seven pence. For years of accumulated skill and emotional resilience. Staff turnover runs at 28.3% because workers consistently flee to retail, hospitality, anywhere offering similar pay without the burden of intimate care work.
Nearly a quarter of care workers are on zero-hours contracts. For home care workers, the proportion hits 47%. They don't get paid for travel time between appointments, crushing their effective hourly rate further. The Resolution Foundation found care workers' pay premium over other low-paid sectors - retail, hospitality, cleaning - fell from 5% to 1% between 2011 and 2021. The sector stopped competing.
When pandemic lockdowns forced restaurants and shops to close, care recruitment briefly improved. British workers took care jobs because nothing else existed. The moment the wider economy reopened, they left. The pattern has held for decades: given any alternative, British workers choose it.
Could higher pay change this? Almost certainly. But increasing wages requires increased government funding, which local authorities cannot provide after years of cuts. Adult social care consumes 40% of council budgets whilst facing a £3.5 billion shortfall. Without fundamental funding reform, pay cannot rise enough to compete.
Immigrant workers become the solution not because they're willing to work harder, but because they're willing to accept worse. The conditions British workers reject, immigrants from countries with far bleaker prospects will tolerate. Britain hasn't accidentally created dependency on immigrant labour. It's deliberately maintained a care system that only desperate people will staff.
The deportation programme
In September 2025, Reform UK announced that if elected, it would abolish indefinite leave to remain. Anyone currently holding permanent residency would need to reapply for visas every five years, meeting higher salary and English language thresholds each time. Fail and face deportation.
The policy targets precisely the workers Britain cannot function without. Nigel Farage told reporters that migrants who came during the "Boriswave" would not receive indefinite leave to remain. He means the consultants performing life-saving surgery. The care workers enabling disabled people to live independently. The construction workers installing dropped kerbs for wheelchair access. The people keeping Britain's most vulnerable alive would lose the security they believed years of legal work had earned them.
The contradiction runs deeper. Between April and June 2024, health and care worker visa grants collapsed by 81% compared to the same period in 2023 - from 35,470 to 6,564. The previous government stopped allowing care workers to bring families in December 2023. Labour maintained the restriction. International recruitment into care, which temporarily stabilised workforce numbers in 2022-23, has virtually ceased.
Care England warned in January 2025 that international recruits entering the sector fell to 8,000 per quarter, nearly 70% below the previous year. Tens of thousands of British workers have left the sector. Vacancies are climbing. As visa numbers collapse, nothing fills the gap.
Politicians celebrate this. Home Secretary James Cleverly claimed overseas staff were displacing British workers, predicting "significant surplus demand" would ensure anyone deterred by family restrictions would be replaced by workers without dependants. The theory sounded plausible. The reality has been catastrophic workforce decline.
Reform UK claims its immigration reforms would save £234 billion over several decades. Independent experts dismissed the figures as fantasy. What the policy would certainly create is mass deportations on a scale unseen in British history, targeting essential workers who came legally, paid taxes, and kept vital services running.
YouGov polling revealed public discomfort with the extremity. Whilst ending new grants of indefinite leave to remain divided opinion (44% support, 43% oppose), removing it from current holders proved unpopular - just 29% in favour, 58% opposed. Even amongst Reform voters, support varied dramatically depending on which groups would lose status. Research by UK in a Changing Europe found 84% of respondents thought migrants working and paying taxes should access the same welfare benefits as citizens after five years maximum. Only 3% supported permanent exclusion.
The public don't support what politicians are proposing. But the policies advance regardless.
The breaking point
The consequences are already visible. The 81% visa collapse means recruitment that temporarily stabilised workforce numbers has ceased. Local authorities report struggling to meet statutory care obligations. Disabled people who employ personal assistants face growing difficulty finding workers, forcing some to surrender independence for residential care. Families caring for elderly relatives without formal support face burnout and their own health crises.
Skills for Care projects the sector will need an additional 480,000 jobs by 2035 to meet demographic demand. Without international recruitment and with British workers continuing to avoid the sector, the gap becomes unbridgeable. The mathematics are simple and brutal.
Some politicians believe restricting immigration will force British workers into care jobs through necessity. The evidence suggests delusion. When EU freedom of movement ended in 2021, vacancies surged to records but British workers didn't materialise. Economic inactivity has risen since 2020. Those supposedly available workers are often students, family carers, long-term sick, or retired - many either providing informal care themselves or receiving care services. They're not a hidden workforce waiting to be activated. They don't exist.
Experienced providers report immigrant workers often arrive with nursing qualifications and allied health experience that Britain doesn't recognise, bringing capabilities exceeding formal care assistant requirements. They're not displacing British workers. They're filling positions British workers have refused for decades.
Reform's proposal would create a permanent underclass of temporary workers who can never belong despite decades of residence, tax contributions, and essential service. Legal experts warn retroactively removing settlement rights from 430,000 people who complied with rules and built stable lives would trigger extensive legal challenges. The administrative burden of processing repeated visa applications every five years would overwhelm the immigration system.
More revealing is what the proposal says about belonging. Contribution isn't enough. Working legally for years, paying taxes, performing essential services enabling British citizens to live with dignity - none of this earns permanent residence if political winds shift. Workers who answered Britain's pandemic call, who accepted exploitation and racism whilst keeping vulnerable people alive, would face deportation for political convenience.
Britain cannot simultaneously depend on immigrant workers to staff its care system and campaign to deport them. When immigrant workers stop coming because Britain makes their lives too precarious, and British workers continue refusing poverty-wage jobs with brutal conditions, something breaks. The most vulnerable - disabled, elderly, sick - will bear the cost.
Who bears the cost
Twenty-five years after Petra arrived from the Czech Republic with her anxious expression and willingness to work, the pattern has hardened into a trap. Britain engineered a care system that depends on immigrant workers willing to accept conditions British workers reject. Politicians attack these same workers for "taking British jobs" and "burdening services". The workers endure modern slavery conditions - £20,000 fees, deportation threats, racist abuse - because even exploitation here beats prospects at home. Now Reform UK proposes removing their right to permanent settlement.
The result would be either care system collapse or the deliberate creation of a permanent underclass of temporary workers with no stake in British society. A country that treats essential work as worthless, performed by people it treats as expendable, and expects the system to continue functioning.
The people living this reality understand what political rhetoric ignores. The care workers facing debt bondage know their labour props up a system that would collapse without them. The disabled people depending on immigrant personal assistants for independence know British applicants stopped coming long ago. The elderly in care homes staffed by workers from Zimbabwe, India, and the Philippines know who keeps them alive.
Politicians celebrating collapsed visa numbers whilst promising to protect the NHS and fix social care are engaged in fantasy bordering on fraud. The workforce mathematics don't bend to rhetoric. When immigrant workers stop coming because Britain makes their lives unbearable, and British workers continue refusing poverty-wage jobs with crushing conditions, the system breaks. The most vulnerable bear that cost.
Perhaps that's acceptable. Perhaps Britain has decided that disabled and elderly people don't deserve care enough to either pay workers properly or treat immigrant workers humanely. Perhaps creating a permanent underclass of exploited temporary workers is the price of maintaining the pretence that immigration can be reduced whilst services continue functioning. Perhaps the human cost of that pretence - measured in workers trapped by debt, vulnerable people losing independence, families broken by deportation - is simply what Britain has chosen.
The only certainty is that something gives. Care work exists whether politicians acknowledge it or not. Someone must perform it. If not British workers who reject the conditions, and not immigrant workers Britain deports or deters, then who? The question has no answer. The consequences of that absence are arriving regardless.
