Migrant nurses being ‘exploited’ in social care, RCN warns

Migrant nursing staff working in England’s social care sector are facing exploitation including underpayment, excessive repayment demands and threats linked to their immigration status, according to new evidence from the Royal College of Nursing (RCN).

The nursing union has warned that the current visa sponsorship system can leave internationally recruited workers heavily dependent on individual employers, creating what it says is a significant imbalance of power.

The RCN examined almost 400 cases involving health and care staff in adult social care who sought support over alleged exploitation and extortion between 2023 and 2025.

Most of those involved were registered nurses, while others worked in nursing support roles.

The union believes the cases may represent only part of the problem, with some migrant workers potentially reluctant to raise concerns because of fears about their employment and immigration status.

Workers faced large repayment demands

More than half of the cases examined by the RCN involved repayment clauses requiring workers to pay money to their employer if they left their job before the end of an agreed period.

The RCN said most of the repayment demands were above the £3,000 maximum recommended by NHS Employers.

In one case, a worker was reportedly asked to repay £25,000.

Pay was another concern, with around one in five cases involving pay-related issues. The most common involved workers reportedly receiving less than the hourly rate stated in their employment contract.

Other cases included allegations of excessive working hours, poor or overcrowded accommodation, work-finding fees and changes to pay and employment conditions after workers had arrived in the UK.

More than half of the cases also involved concerns about workplace practices, according to the RCN. Around a third of these included reports of severe bullying and harassment, while some workers reported racial discrimination.

Immigration status being used as leverage

The RCN is particularly concerned about the power employers can hold when they are also responsible for sponsoring a worker’s visa.

Its report found more than 100 cases since 2023 in which employers were alleged to have used threats concerning visa sponsorship to keep workers in exploitative employment.

Professor Nicola Ranger, Chief Executive and General Secretary of the RCN, described the situation as “grotesque exploitation” and warned that migrant nursing staff can be left at the mercy of employers who control their immigration status.

The RCN argues that tying a worker’s immigration status so closely to an individual employer can make it considerably harder for staff to challenge poor treatment or leave an exploitative workplace.

Concerns about exploitation within international social care recruitment have also prompted government intervention.

The government previously revealed that more than 470 care providers had their licences to sponsor international workers revoked between July 2022 and December 2024 as part of action against abuse and exploitation in the sector.

Government figures have also indicated that tens of thousands of workers were associated with affected sponsors.

RCN calls for changes to visa system

The RCN is calling for reforms that would reduce the control individual employers have over migrant nursing staff.

It wants the government to explore alternative sponsorship arrangements, including the possibility of visas being administered through an umbrella organisation or sector body rather than being tied directly to individual employers.

The union has also called for the period available to find a new sponsoring employer to be increased from 60 days to 180 days.

It says this would give workers more opportunity to escape exploitative employment without immediately facing the prospect of having to leave the UK.

The RCN also wants the Fair Work Agency to proactively monitor employment practices and take action against employers engaging in unethical behaviour.

The warning comes as the government pursues wider reform of both immigration and adult social care.

Overseas recruitment for new care worker and senior care worker applicants was closed in July 2025, following concerns about abuse within the sponsorship system. Workers already in the UK can continue to access the route during a transition period where eligibility requirements are met.

The government has previously acknowledged cases where internationally recruited care workers arrived in the UK carrying significant debts, were treated unfairly or discovered that jobs they had been promised did not exist.

For the RCN, however, changing overseas recruitment rules does not resolve the position of migrant nursing staff already working within the sector.

It argues that reforming sponsorship and strengthening employment protections will be essential if England is to build a social care workforce in which internationally recruited staff can challenge poor treatment without fearing that doing so could also jeopardise their immigration status.

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