The new health and care visa: an exercise in cosmetic rebranding?

Photo by Andrea Piacquadio from Pexels
Share this article

Last week, the Government published further details of its new ‘points-based’ immigration system, to be introduced from 1 January 2021, assuming no extensions to the Brexit transition period.

Under the new system, freedom of movement will be no more, and EU citizens wishing to come to live in the UK will be subject to the same rules as citizens from the rest of the world.

Make no mistake, this is the biggest shake-up of the UK’s immigration regime since 1992, when the Treaty of Maastricht established EU freedom of movement.

The proposed system is skills-based. In practice, this means that most people wishing to come to the UK to work long-term – under the so-called Skilled Worker route – will need a job offer for a middle-skilled or high-skilled job, and for that job’s salary to be £25,600 or higher.

For EU citizens, this will be a much more restrictive and expensive than freedom of movement. But for those citizens from the rest of the world, who can currently come to the UK to work only in high-skilled (i.e., graduate-level) jobs, with a salary of at least £30,000, the future policy reflects a substantial liberalisation.

Some occupations are exempted from the £25,600 salary threshold. Most notably, 24 ‘public service occupations’ in health and education, including nurses and teachers of the science, technology, engineering, and mathematics ‘STEM’ subjects, will be able to come to the UK on salaries as low as £20,480.

But what is so striking about the points-based system is that it offers no dedicated routes for people working in lower-paid jobs, or those which the Government deems to be low-skilled.

The very term ‘low-skilled’ is contentious: jobs the Government classes as low-skilled – such as those in retail or food production – are challenging, and will in fact require a range of skills. For some, it is no small irony that people working in many such ‘low-skilled’ jobs have during the pandemic been ‘reclassified’ as key workers.   

One occupation that has received special attention during the crisis is care, as exemplified by ‘Clap for Carers’; this is perhaps why the Government announced that its new immigration system would incorporate a special Health and Care visa.

This was formerly known as the NHS visa. Its rebranding, and especially the addition of the word ‘care’ has taken place amidst an outpouring of support for care workers during the Covid-19 crisis – and repeated warnings from the social care sector that the points-based system would lead to workforce shortages. As much is implied by the Government’s statement introducing the new route: “The events of recent months have illustrated just what a crucial role the care sector plays in UK society.”

The new visa, the Government announced, would make it “cheaper, quicker and easier for healthcare professionals from around the world to come to the UK”. Although it will cost less than the ordinary Skilled Worker Visa, how much cheaper has yet to be revealed. But of greater benefit is its exemption of eligible health workers and their dependants from the immigration health surcharge, which must be paid up-front when applying for a visa, for each year that the visa lasts. From October, the charge will be set at £624 per year. For a three year visa, this equals savings of £1,872.

Health and care professionals will be able to apply for the visa from August 2020. The key question, of course, is: which health and care professionals?

In its 130-page policy document, Annex E’s Table 31, which lists “Occupations not eligible for the Skilled Worker route” – of which the Health and Care visa is a part – includes “care workers and home carers”; these are the people who attend to the basic personal needs of the elderly or the disabled within their own homes or in care homes.

Thus, the people whom we typically think of as carers will not be eligible for the Health and Care visa. Instead, “qualified doctors, nurses and allied health professionals who have been trained to a recognised standard” are amongst a short-list of skilled professions that qualify, and the Government has said that senior care workers, who supervise carers, will qualify under the points system.

In response to criticism from the care industry, the Government has said that it wants employers to invest more in the recruitment, training, and development of care workers in this country, citing the opinion of the Migration Advisory Committee, its independent migration advisors, who have argued that immigration is not the sole answer to care-worker shortages.

Whether resident workers will take up care jobs at the rates of pay on offer remains to be seen. What seems altogether clearer is the Government’s commitment to a skills-based immigration system without carve-outs for specific sectors. Its Health and Care visa – closed to the majority of care workers – seems proof of that. It also provides compelling evidence for the opinion of its critics: that the Health and Care visa reflects no genuine recognition of the crucial role that carers have played in the crisis, but rather a cynical exercise in cosmetic rebranding.

Dr Peter William Walsh is a Researcher at the Migration Observatory, University of Oxford