Migrant nurses exploited by care employers, RCN report finds

A new report from the Royal College of Nursing (RCN) has exposed how some employers are exploiting migrant nursing staff in social care by taking advantage of their vulnerable visa status. The news comes just a week after prime minister Andy Burnham announced plans for a National Care Service and praised the migrant workers who cared for his father.

International nursing staff make up a large percentage of the social care workforce. While social care policy is devolved, immigration rules apply UK-wide. The RCN is calling on the UK government to change its immigration rules to help stabilise the sector in all four nations. This includes ending employers’ control over visa sponsorship, stopping them from using immigration status as leverage.

In the report, From Recruitment to Reality: Exploitation of Internationally Educated Nursing Staff in Social Care, the union has analysed almost 400 cases of health and care staff in adult social care who sought RCN support as victims of exploitation and extortion between 2023 and 2025. The union says this is likely to be only a small fraction of the true numbers, given low union membership among migrant workers and widespread fear of speaking up.

Most of those represented by the RCN in these cases are registered nurses, while the remainder are nursing support staff.

According to the union, employees’ precarious immigration status gave some employers a way to demand huge repayments, underpay staff, rewrite contracts to alter pay and conditions and ignore dangerous, substandard working practices.

The RCN believes the issue stems from a huge “power imbalance” in the visa system, which ties international nursing staff’s ability to live and work in the UK to their specific employer. As a result, some employers have been able to ignore concerns or exploit staff, often under threat of removal of their visa sponsorship and potential deportation, the union claims.

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.”

Key findings from the report include:

• More than half of all those seeking support from the RCN involved employers using repayment clauses to recover costs from staff wishing to leave employment before the end of their contract. Most of these cases involved demands from employers above the maximum £3,000 recommended by NHS Employers, with one case as high as £25,000.

• One in five of the cases analysed raised issues of pay. The most common complaint was being paid less than the agreed contractual hourly wage.

• More than half of respondents reported rampant substandard workplace practices, with a third of these cases involving severe bullying and harassment, including some cases of discrimination based on race.

The RCN’s report calls for stronger protections, effective enforcement and systemic reform to safeguard migrant nursing staff and raise standards in the sector, including:

• Visas to be administered by an umbrella organisation or industry body, so staff can move more easily between employers without facing threats of deportation.

• The new Fair Work Agency to properly monitor employment practices, go after unethical employers and deliver on the government's promised investigation into the sector.

• An extension to the time staff have to find a new employer, from 60 to 180 days, to eliminate the risk of deportation when moving jobs.

“Migrant workers are routinely intimidated and left fearful of speaking out. The prime minister has spoken movingly about the contribution of migrant nursing staff – now they need his full backing,” Ranger said.