From the outside, Royal Star & Garter’s care homes look tailor-made for deep England. Nestled on quiet streets in prosperous suburbs — High Wycombe, Surbiton, Solihull — they evoke a world familiar to our grandparents. Yet, step inside and the atmosphere is startlingly contemporary. Nearly 40 nationalities work side-by-side across Royal Star & Garter’s three properties, from South African healthcare assistants to nurses with Caribbean heritage. This cultural mosaic reflects a growing reliance upon international labour, as domestic staff shortages continue to plague the sector.
Nor is Royal Star & Garter unique. In care homes up and down the land, the staff represent a multicultural kaleidoscope. In theory, this conveyor belt of low-paid overseas workers provides a vital lifeline for Britain’s ageing society. But these workers often do not come alone, bringing with them a set of dependents who add to the state’s future care burden. That, in turn, creates a self-perpetuating dependence on immigration, one where sector-wide profit taking and governmental inefficiencies have built up a veritable human Ponzi scheme. And if the cycle now can’t be stopped without fear of collapse, it follows that Britain requires fundamental socioeconomic reform — if we want to leave a welfare state to our grandchildren.
Over the past two years, care providers in England recruited 185,000 international workers, easing vacancy rates in adult social care to around 7% by early 2025. This marks a significant improvement from the double-digit rates seen in previous years, especially as the sector has lost over 70,000 British care staff since Brexit. All told, foreign-born workers now make up roughly a third of the care home workforce, up from a quarter before the pandemic.
On the surface, then, this global recruitment drive has provided a vital lifeline. But this quick fix comes at a cost. Britain’s population isn’t just growing: it’s ageing. Net migration now accounts for roughly 73% of the country’s population growth. The number of people over 85 is on track to nearly double over the next 25 years, naturally ensuring continuing demand for future care. Against this backdrop, the sector’s staffing progress is minuscule. Even with recent hiring spurts, Britain faces a shortfall of carers and will need almost half a million additional workers over the next decade just to keep pace. The country is facing the lethal combination of a population that is both growing and greying, piling pressure on services.
To meet this demand, the UK has increasingly leaned on non-EU migrants, mostly from poorer countries. India alone accounted for close to a third of new care workers via the health and care worker visa. Zimbabwe, another country facing a drain in its healthcare sector, accounted for 15% of all visas granted. In theory, that offers care operators trained staff willing to work at minimum wage, while also saving on training local workers. No wonder the retail and service sectors have poached domestic care workers, promising better working conditions for similar pay. That’s helped turn international recruitment from a mere stop-gap to the bedrock of Britain’s social care system, with ministers desperately needing to fill a hole that just keeps getting wider.
In truth, though, the crux of the problem lies in what happens after these migrant carers arrive — or rather with whom. Until recently, Britain’s immigration rules allowed care workers to bring their immediate families. Between 2022 and 2023, around 100,000 migrant carers brought with them some 120,000 dependents, adding not just themselves but often a spouse or children to Britain’s population. Those family members will likely live in the UK permanently, and why wouldn’t they, given how much higher our wages and living standards often are? Naturally, these people use public services, and will inevitably need social care themselves.
This self-reinforcing loop has all the hallmarks of a Ponzi or pyramid scheme. Instead of cash, the care sector’s Ponzi is built on people. To keep the system stable, Britain must continuously import new carers, growing the base of dependents, and eventually adding to the ranks of old people who need care. When that future arrives, even more (presumably international) carers will be needed, perpetuating the cycle. The risk is that the system grows ever larger and more costly until it eventually collapses under its own weight.
“This self-reinforcing loop has all the hallmarks of a Ponzi or pyramid scheme.”
This looming disaster is the result of an approach that merely treats the symptom of empty jobs rather than the disease of why they’re so hard to fill domestically. To do the latter requires us to acknowledge a number of uncomfortable truths. Migrant labour is often painted as a virtuous act of mutually beneficial exchange. An international worker is able to enjoy a higher standard of living than in their home country, and Britain benefits from filling the gaps in our domestic workforce. There is, of course, something to this sketch. Yet, within the care sector particularly, the fact is that Britain’s workforce boom has largely been built on poverty-wage labour and dubious recruiting practices.
Overseas carers are often drawn from countries with their own critical health-worker shortage — allowing Britain to relieve its own shortfall by depriving poorer nations of much-needed caregivers. The Government has policies to discourage active recruitment from such countries, places like Nigeria and Ghana. Yet, enforcement is patchy at best, with regulators and care home owners both preferring blissful ignorance.
You might say the same of Whitehall civil servants. In 2022, the health and care worker visa was expanded, allowing entry-level carers access to the dedicated immigration route for overseas medical professionals. But despite warnings from the charity sector, including Citizens Advice, the new migration path was quickly exploited by criminals and unscrupulous brokers. Capitalising on the vast demand for these roles, they started charging steep service fees for UK jobs, flouting British labour laws in the process. A major survey by Unison found that nearly a quarter of migrant care staff had paid money to a care provider or broker to secure a job in Britain. In extreme cases, criminals have demanded £20,000 from their foreign charges, with workers selling property or taking out loans in their home countries.
In one shocking incident, a single mother sold all of her belongings and paid £5,000 to a broker after being promised a care role. Yet upon reaching the UK, the job proved to be nonexistent, and the broker vanished. Even for those who do secure real jobs, life in Britain can be grim. There have been widespread reports of wage theft and abuse by rogue care homes, effectively trapping workers in bondage. Between unpaid hours, arbitrary deductions and recruiter fee repayments, over one in four migrant workers claim to be being paid below the legal minimum.
Nor are things necessarily better once migrant workers clock off. Many are housed in accommodation provided by their employers: another form of wage extraction, even as many carers often pay through the nose for squalid conditions. An recent investigation by UNISON found nine migrant workers crammed into a three-bedroom house, forcing them to sleep on the floor or share makeshift beds. Food was also restricted, with some carers obliged to eat the leftovers of their care residents. At the same time, the scale of the Ponzi scheme makes change tough. Though the authorities have stripped over 470 care firms of their sponsorship licences, there are 12,000 such outfits nationwide.
Taken together, it’s little wonder the UK’s Anti-Slavery Commissioner has described the situation as “horrific”. But despite these miseries, workers feel they can’t complain. Visa status is bound to a single sponsoring employer, and any dispute can jeopardise their ability to remain in the UK. Rogue operators have been known to wield this power as a method of subjugation, with some going so far as seizing workers’ passports. That’s shadowed by “exit fees” — whereby a worker owes thousands of pounds if they try to leave before an arbitrary period. The rising demand for care workers has allowed this form of forced labour to continue unabated, with the sector becoming increasingly reliant on worker exploitation.
The public’s renewed focus on record immigration figures — and the corresponding strain on national services — has seen Labour abruptly try to break the imported worker cycle. This effectively involves turning off the tap of overseas recruitment in social care just three years after it was opened by the previous government.
Once again, however, there hasn’t been any attempt to address the root causes of domestic worker shortages: exactly the thing that sparked our reliance on overseas alternatives to start with. The Home Secretary has said that care employers should draw on the roughly 40,000 migrant carers who are already in the UK and whose sponsor firms have collapsed. In theory, that could reduce immigration without impacting the care sector. Yet this is an extremely short-term solution to a foundational issue. A combination of gruelling conditions and long unsociable hours has been continually met with low wages at best — and thoroughgoing exploitation at worst.
A recent Government survey showed that a better-paying opportunity outside of social care was the primary driver behind people leaving the industry. That’s hardly surprising: Ipsos reports that almost two thirds of Britons think care workers are underpaid. With the hourly wage in social care the same as the legal minimum, these entry-level roles compete directly with retail and hospitality jobs. In the first place, then, social care must pay. The Trades Union Congress previously advocated for a minimum £15 per hour wage for the care sector, believing that this would address the domestic recruitment shortfall. But raising the minimum wage through legislation isn’t the only option here. Rather, the unlimited pool of international labour currently available to care homes must urgently be drained.
That also requires a fundamental rethink of how social care recruitment is done. These roles are often considered low-wage, low-skill jobs, where workers are expected to work long hours and are treated as interchangeable drones. Making the profession more desirable therefore requires improved working conditions, better oversight to prevent worker exploitation, and renewed opportunities for role development. Training and the ability to access career-long qualifications would also go some way to challenging poor public perceptions.
Of course, completely ending reliance on foreign carers is neither realistic nor desirable in a globalised world. Migrants will remain an important part of Britain’s care workforce as the population continues to age and the demand for new workers accelerates. If the sector continues to rely on international labour, then an increase in the state’s future care burden is inevitable. The only real solution, then, is to increase the domestic workforce supply. And if that obliges the Government to improve conditions — among other things, it must assail care home operators who try and ignore the minimum wage — it’s also clear that who the Home Office lets in must be far more selective in future. Fail and we risk even greater problems than understaffed care homes.
