On 4 December 2023, the UK government announced changes to the immigration system that will take effect in March and April 2024. In response, we have pulled together the information we have so far on how this will impact international recruits across NHS trusts.

Details of the changes to the immigration system can be found on the GOV.UK website.

The latest announcement can be found on the GOV.UK website.

The changes being made to the Health and Care Visa route will only affect care workers and senior care workers. From 11 March 2024, care workers (SOC 6145) and senior care workers (SOC 6146) will be unable to bring dependents when they migrate to the UK, and only CQC-registered providers in England will be able to sponsor Health and Care Visa applicants. These changes do not affect those employed on a Health and Care visa on other occupation codes (SOCs).

Other changes, such as the increase in salary thresholds, do not apply to the Health and Care Visa route. Health and Care Visa holders will continue to be exempt from paying the Immigrational Health Surcharge (IHS).

These exemptions only cover those on a Health and Care Visa. Overseas workers requiring a general Skilled Worker Visa (such as data analysts, IT and finance professionals, etc) but sponsored by an NHS organisation would be subject to these changes. The new salary threshold of £38,700 will come into force on 4 April 2024. Those already in the Skilled Worker route before the immigration rules change should be exempt from the new median salary levels when they change sponsor, extend, or settle, providing they aren’t moving to different occupations (but their pay should progress in line with resident workers). For those who are not exempt from paying the Immigration Health Surcharge, from 6 February 2024, this will increase to £1,035.

The new immigration rules from 14 March will include the removal of the 20 per cent going rate discount for occupations on the Shortage Occupation List (SOL), which will be replaced with a new Immigration Salary List from early April.

The minimum income requirement for family visas will rise in stages, starting at £29,000 from 11 April and will be incrementally increased to £34,500 and to £38,700 by early 2025. Only dependants that can be supported financially will be allowed into the UK.

Below is a description of how these changes will impact various international staff across the NHS and social care.

Health and Care Visa

Applies to those on a Health and Care Visa (such as nurses, doctors, allied health professionals, etc). A list of applicable roles can be found on GOV.UK.
The Health and Care Visa is a sub-type of the Skilled Worker Visa. During the application process, candidates will be asked if they are applying for a Health and Care Visa and will need to select yes.
The increased salary threshold does not apply. Recruitment to these roles can continue as normal (i.e. at least £20,960 or the national pay scale for the role).
They will continue to be exempt from the IHS.
They can still bring dependants to the UK as part of their visa. Dependents have a generic right to work meaning that they can be employed by the NHS, in another sector or not work. Only CQC-registered providers in England will be able to sponsor Health and Care Visa applicants, of which trusts are already registered.
Skilled Worker Visa

Applies to those roles not eligible for a Health and Care Visa (general Skilled Worker Visa) but sponsored by an NHS trust (such as IT and finance professionals, administrative staff, etc).
From 4 April 2024, new applications will need to meet the increased salary threshold of £38,700.
Those already in the Skilled Worker route before the Immigration Rules changes should be exempt from the new median salary levels when they change sponsor, extend, or settle, providing they aren’t moving to different occupations. The Home Office would, however, expect their pay to progress at the same rate as resident workers; therefore, they would be subject to the updated 25th percentiles using the latest pay data when they next make an application to change employment, extend their stay, or settle. This is in line with normal practice.
They will need to pay the increased immigration health surcharge (IHS) of £1,035 per year.
They can still bring dependants to the UK as part of their visa. Dependents have a generic right to work meaning that they can be employed by the NHS, in another sector or not work.

Skilled Worker Visa

Applies to those roles not eligible for a Health and Care Visa (general Skilled Worker Visa) but sponsored by an NHS trust (such as IT and finance professionals, administrative staff, etc).

From 4 April 2024, new applications will need to meet the increased salary threshold of £38,700.

Those already in the Skilled Worker route before the Immigration Rules changes should be exempt from the new median salary levels when they change sponsor, extend, or settle, providing they aren’t moving to different occupations. The Home Office would, however, expect their pay to progress at the same rate as resident workers; therefore, they would be subject to the updated 25th percentiles using the latest pay data when they next make an application to change employment, extend their stay, or settle. This is in line with normal practice.

They will need to pay the increased immigration health surcharge (IHS) of £1,035 per year.

They can still bring dependants to the UK as part of their visa. Dependents have a generic right to work meaning that they can be employed by the NHS, in another sector or not work.

Social Care

Applications for care workers (SOC 6145) and senior care workers (SOC 6146) received after 11 March 2024 will no longer be able to bring dependants to the UK as part of their visa.

Care workers and senior care workers already in the route will be able to remain with their dependants, including extending, changing employer (within these SOC codes) and settlement.

Where a care worker or senior care worker is in the route before the Immigration Rules change, but has not yet brought dependants, they will be allowed to bring dependants during their sponsorship (on this visa).

Individuals who are in the UK on any other route, including where that route permits dependants, who switch into the care visa as a care worker or senior care worker after this date, will not be able to stay with (or bring over) dependants.

The increased salary threshold does not apply. Recruitment to these roles can continue as normal (ie at least £20,960 or at least £10.75 per hour).

They will continue to be exempt from the IHS.

Only CQC-registered providers in England will be able to sponsor Health and Care Visa applicants.

Care providers who were sponsoring workers in exclusively non-regulated activities (and therefore not required to be registered with the CQC) before the rules change should be able to continue to sponsor these workers, including for extensions to their visa on those terms, but not hire new ones.

Dependants

Dependants of those on a Health and Care Visa can be employed by a trust at any role regardless of skill level or salary threshold, as long as the main visa holder meets the appropriate pay scale (as is the current case).

Dependants of those on a Skilled Worker Visa can be employed by a trust at any role regardless of skill level or salary threshold, as long as the main visa holder meets the £29,000 threshold when it comes into force on 11 April 2024. By early 2025 this will increase to £38,700.
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