The Royal College of Nursing has called on the UK Government to overhaul immigration rules after a new report revealed widespread exploitation of migrant nursing staff working in adult social care.
The findings come just days after plans for a National Care Service were announced, placing renewed focus on the vital role international nurses play in delivering care across the UK.
According to the report, From Recruitment to Reality, some employers are using visa sponsorship arrangements to exert excessive control over migrant workers, creating what the RCN describes as a significant power imbalance. Because many international nurses rely on a single employer to maintain their right to live and work in the UK, some have reportedly faced threats, financial penalties and poor working conditions when attempting to raise concerns or change jobs.
The RCN analysed almost 400 cases involving health and care workers in adult social care who sought union support between 2023 and 2025 after experiencing exploitation, extortion or unfair treatment. While the cases represent only a proportion of those affected, the organisation warns that fear of speaking out and low union membership among migrant workers mean the true scale of the problem is likely much higher.
Most of those represented in the cases were registered nurses, with the remainder comprising nursing support workers and other nursing staff.
The report highlights how some employers allegedly used workers’ immigration status as leverage, demanding large repayment fees, altering contracts, reducing agreed pay rates and failing to address unsafe workplace practices.
Among the most concerning findings identified by the RCN:
- More than half of the cases involved employers using repayment clauses when staff tried to leave before the end of their contract.
- Many repayment demands exceeded the £3,000 maximum recommended by NHS Employers, with one case involving a demand for £25,000.
- One in five cases raised issues relating to pay, with underpayment of contracted hourly rates being the most common complaint.
- More than half of respondents reported poor workplace practices.
- Around a third of those cases involved severe bullying and harassment, including allegations of racial discrimination.
The RCN believes many of these issues stem from a visa sponsorship model that ties workers to a specific employer, limiting their ability to seek alternative employment without risking their immigration status.
Professor Nicola Ranger, RCN Chief Executive and General Secretary, said:
“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.
“One of the major causes is a visa sponsorship system which creates a dangerous power imbalance, allowing some 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.”
To improve protections for migrant nursing staff and raise standards across social care, the RCN is calling for:
- Visa sponsorship to be managed by an umbrella organisation or industry body rather than individual employers.
- Greater oversight and enforcement powers for the new Fair Work Agency to investigate unethical employment practices.
- A government-led investigation into exploitation within the adult social care sector.
- The extension of the current 60-day period for workers to find a new employer to 180 days, reducing the risk of deportation when changing jobs.
The report concludes that meaningful reform is essential if the UK is to build a sustainable social care workforce and deliver the ambitions of a future National Care Service.
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