Impacts of the changes to the UK immigration policy
On 4 December 2023, the UK government announced changes to the immigration system that have taken effect from March and April 2024. In response, we have pulled together the information we have so far on how this will impact international recruits across NHS trusts.
The latest announcement can be found on the GOV.UK website.
Key points
- From 11 March 2024, care workers and senior care workers are unable to bring dependents when they migrate to the UK, and only CQC-registered providers in England will be able to sponsor Health and Care Visa applicants. All other occupation codes can continue to bring dependents as normal.
- From 4 April 2024, Certificates of Sponsorship issued for applications to the Health and Care Visa route for those occupations paid by NHS bands will need to meet the national pay scale for their role or the new minimum salary threshold of £23,200 (whichever is higher). This is an increase from £20,960.
- Roles that are not on a national pay scale will need to meet a general salary threshold of £29,000. This will apply to both new applications and to extensions to existing visas.
- All Health and Care Visa holders will continue to be exempt from paying the Immigrational Health Surcharge (IHS).
- From 4 April 2024, Certificates of Sponsorship issued for overseas workers requiring a general Skilled Worker Visa (such as data analysts, IT and finance professionals, etc) but sponsored by an NHS organisation will need to meet the new salary threshold of £38,700. This will not be increased in stages.
- Those already on a Skilled Worker Visa before the immigration rules change should be exempt from the new salary thresholds when they change occupation or sponsor, or settle (but their pay should progress in line with resident workers).
- From 4 April 2024, the Immigration Salary List (ISL) will replace the Shortage Occupation List (SOL). Occupations on the ISL can be recruited to on a salary below the general salary threshold. These occupations will still need to meet a threshold of either £23,200 (for Health and Care Visas), £30,960 (for general Skilled Worker visas), or their occupation-specific threshold, whichever is higher.
- As of 6 February 2024, the Immigration Health Surcharge increased to £1,035 per person per year.
- The minimum income requirement for family visas will rise in stages, starting at £29,000 from 11 April 2024 and will be incrementally increased to £34,500 and to £38,700 by early 2025. Only dependents that can be supported financially will be allowed into the UK.
Below is a description of how these changes will impact various international staff across the NHS and social care. All scenarios are based on current Agenda for Change pay scales (as of 21 March 2024), which are subject to annual review.
Health and Care Visa
- Applies to those on a Health and Care Visa (such as nurses, doctors, allied health professionals, etc). A list of applicable roles can be found on GOV.UK.
- The Health and Care Visa is a sub-type of the Skilled Worker Visa. During the application process, candidates will be asked if they are applying for a Health and Care Visa and will need to select yes.
- Only CQC-registered providers in England will be able to sponsor care workers or senior care workers.
- Salary threshold – national pay scale roles: the minimum salary threshold will increase to £23,200 for occupations on national pay scales where applicable. This will apply to both new applications and to extensions to existing visas.
- Salary threshold – not on national pay scale roles: the general salary threshold will increase to £29,000 for occupation not on national pay scales. This will apply to both new applications and to extensions to existing visas.
- Immigration Salary List: for Health and Care Visa occupations on the ISL (laboratory technicians, pharmaceutical technicians, care workers and home carers, and senior care workers), the salary threshold is set at either £23,200 or their occupation-specific threshold, whichever is higher.
- Immigration Health Surcharge: current and future visa holders will continue to be exempt from the IHS.
- Dependents: Health and Care Visa holders can still bring dependents to the UK as part of their visa (except care workers or senior care workers see below on Social Care). Dependents have a generic right to work meaning that they can be employed by the NHS, in another sector or not work.
Example – current Health and Care Visa holder (nurse):
Mohammed is a nurse from India. He moved to the UK with a three-year Health and Care Visa in December 2022 and works in an NHS trust as a Band 5 registered nurse. His wife, Fatima, and child, Aashvi, joined him in the UK in March 2023. Fatima works as a programme manager in the private sector.
When Mohammed comes to renew his visa, he will need to continue to be paid at the appropriate banding for his role (and at least £23,200).
Fatima will retain her right to work in the UK and will continue to be able to live in the UK with her family.
Mohammed, and his dependents, will continue to be exempt from the IHS.
Example – current Health and Care Visa holder (Band 3 healthcare assistant):
Maria is from Spain and is sponsored by an NHS trust as a Band 3 healthcare assistant. She has been in post since May 2021 and her visa is up for renewal in May 2024.
When Maria first came to the UK, she was on the first pay point of Band 3. Since she has been in post for over two years, she has progressed to the second pay point (£24,336).
At the time of renewal, she will have to meet the salary threshold of at least £23,200. Since she is now on the second pay point, she meets this salary threshold.
Maria will continue to be exempt from the IHS and is able to bring dependants with her.
Example – future Health and Care Visa holder (Band 3 healthcare assistant):
Hanna is from Sweden. She will be looking to apply for a Band 3 healthcare assistant role (SOC 6131) in the NHS in August 2024, after the new visa rules come into effect.
Since this role will be on a national pay scale but is not included on the ISL, her salary will need to be at least £23,200 and be paid at the appropriate banding for her role (whichever is higher). Hanna will therefore be able to work as a healthcare assistant in any area with a London weighting added to her salary (i.e. entry level Band 3 in fringe areas, £23,957). However, locations outside of the London area will not be able to meet the salary threshold (i.e. entry level Band 3, £22,816), unless employers recognise previous equivalent work outside of the NHS (NHS terms and conditions of service handbook, Annex 23 Point 11 relates to starting salary. However, Annex 23 Point 17 and Section 12.2 states that: "employers have the discretion to take into account any period or periods of employment outside the NHS, where these are judged to be relevant to NHS employment").
Hanna will be exempt from the IHS.
Her wife, Julia, will be able to join her as part of her application. Julia will be given a general right to work as Hanna’s dependant and will also be exempt from the IHS.
Skilled Worker Visa
- Applies to those roles not eligible for a Health and Care Visa (general Skilled Worker Visa) but sponsored by an NHS trust (such as IT and finance professionals, administrative staff, etc).
- Salary threshold: From 4 April 2024, new applications will need to meet the increased general salary threshold of £38,700. This will not be increased in stages.
- Those already in the Skilled Worker route before the immigration rules changes should be exempt from the new median salary levels when they change occupation, change sponsor, or settle. The Home Office would, however, expect their pay to progress at the same rate as resident workers in the same role; therefore, they would be subject to the updated 25th percentiles using the latest pay data when they next make an application to change employment, extend their stay, or settle. This is in-line with normal practice.
- Immigration Salary List: for occupations on the ISL, a threshold of either £30,960 or their occupation-specific threshold, whichever is higher.
- Immigration Health Surcharge: they will need to pay the increased immigration health surcharge (IHS) of £1,035 per year per applicant.
- Dependants: they can still bring dependants to the UK as part of their visa. Dependents have a generic right to work meaning that they can be employed by the NHS, in another sector or not work.
Example – current Skilled Worker Visa holder (financial advisor):
Francesca is a Band 7 financial advisor from Italy. She has worked at an NHS trust for two years and is due to extend her visa in 2025. Her husband, Anthony, moved to the UK with her as part of her visa and works in construction.
Francesca is wanting to continue with her current role (which is not on the ISL). She will therefore be exempt from meeting the new salary threshold. However, her employer will need to ensure that she is paid according to her banding and progress in line with resident workers and updated with the 25th percentiles using the latest pay data.
Francesca will need to pay the increased IHS of £1,035 per year for herself, and again for Anthony.
Anthony will continue to maintain his right to work as Francesca's dependant and can continue to live in the UK.
Example – future Skilled Worker Visa holder:
George is a Band 6 graphic designer from France. He has been offered a role at an NHS trust for £35,392 starting in June 2024.
The role is included on the ISL, which has a salary threshold of £30,960. Therefore, George meets the salary threshold for this role.
He will be able to bring his partner, Margaret, and child, Belle, as part of his visa application. George and his dependents will be required to pay the increased IHS of £1,035 per year per person and will be given the right to work.
Social Care
- Only CQC-registered providers in England will be able to sponsor care workers and senior care workers.
- Care providers who were sponsoring workers in exclusively non-regulated activities (and therefore not required to be registered with the CQC) before the rules change should be able to continue to sponsor these workers, including for extensions to their visa on those terms, but not hire new ones.
- Salary threshold: the general salary threshold for health and care worker occupations not on a national pay scale will increase to £29,000. This will apply to both new applications and to extensions to existing visas.
- Immigration Salary List: for Health and Care Visa occupations on the ISL (currently including care workers and senior care workers), the salary threshold will be set at either £23,200 or their occupation-specific threshold, whichever is higher.
- Immigration Health Surcharge: they will continue to be exempt from the IHS.
- Dependants: Health and Care Visa applications for care workers and senior care workers received after 11 March 2024 will no longer be able to bring dependants to the UK as part of their visa.
- Care workers and senior care workers already in the route will be able to remain with their dependants, including extending, changing employer (within their SOC code) and settlement.
- Where a care worker or senior care worker is in the route before the immigration rules change, but has not yet brought dependants, they will be allowed to bring dependants during their sponsorship (on this visa).
- Individuals who are in the UK on any other route, including where that route permits dependants, who switch into the care visa as a care worker or senior care worker after 11 March 2024, will not be able to stay with (or bring over) dependants.
Example – current Health and Care Visa holder (care worker):
Jose is from Spain and is currently working as a care worker at a private nursing home that is CQC registered in Essex. Jose currently earns £24,000 a year. He lives in the UK with his partner, Matilda, and two daughters, Mia and Jessica. Matilda works as a shop assistant in a local supermarket.
When applying to extend his visa he will need to make at least £23,200, which he does on his current salary.
His partner and daughters will be able to continue to stay in the UK and Matilda will retain her right to work. They will also continue to be exempt from the IHS.
Example – future Health and Care Visa holder (senior care worker):
Sara is a senior care worker from the Philippines. She has secured a role at a care home in Newcastle.
Her role is on the ISL, which means there is a salary threshold of £23,200. Sara’s salary offer is £24,000 which allows her to come to work and live in the UK.
Sara will not be able to bring dependants to travel with her. She will be exempt from paying the IHS.
Dependents
- Dependents of those on a Health and Care Visa and Skilled Worker Visa can be employed by an NHS trust at any role regardless of skill level or salary threshold, as long as the main visa holder meets the appropriate general salary threshold.
- The minimum income requirement for family visas (i.e. British citizens bringing dependents to the UK) will rise in stages, starting at £29,000 from 11 April and increase to £38,700 by early 2025.
- From 11 March 2024, care workers and senior care workers under the Health and Care Visa will not be able to bring dependents as part of their visa application.
- Care workers and senior care workers already in the route will be able to remain with their dependents, including extending, changing employer (within their SOC code) and settlement.
- Where a care worker or senior care worker is in the route before 11 March 2024 but has not yet brought dependents, they will be allowed to bring dependents during their sponsorship (on this visa).
- Individuals who are in the UK on any other route, including where that route permits dependents, who switch into the Health and Care Visa as a care worker or senior care worker after 11 March 2024, will not be able to stay with (or bring over) dependents.
Example – current dependents of those on a Health and Care Visa (senior care worker):
Robert is married to Anita, who is from Spain and works as a senior care worker at a private care home in Lincolnshire. They moved to the UK four years ago. Robert has the right to work in the UK and is employed as a chef.
When Anita comes to renew her visa in 2025, she will be expected to meet the salary threshold of £23,200.
Robert will keep his right to work and can continue to live in the UK.
Example – future dependents of those on a Health and Care Visa (care worker):
Jasmine is from Turkey and looking for work as a care worker in the Winter of 2024.
Her role is on the ISL and she will need to make at least £23,200.
Her partner, Emir, will not be able to join her as part of her visa application. If he wishes to come to the UK, he will need to be sponsored individually by an employer or look for another route.
Jasmine will be exempt from the IHS.
Example – current dependents employed by an NHS trust, Skilled Worker Visa (hotel manager):
Jemal is married to Raquel, and they have a young son. Raquel is a hotel manager employed on a Skilled Worker Visa at a local hotel. She has worked in this role for two years on a three-year visa. Jemal has the right to work in the UK and is employed as a Band 2 porter at an NHS trust.
When Raquel renews her visa, she will not be subject to the £38,700 salary threshold as she is already in route. Her pay would be expected to increase in line with resident workers.
Jemal, Raquel and their son will need to pay the increased IHS of £1,035 per year per person. Raquel will still be able to live in the UK with her dependents. Jemal will retain his right to work.
Example – future dependents employed by an NHS trust, Skilled Worker Visa (civil engineer):
Clark is from the USA and has a job offer to come to the UK as a civil engineer (SOC 2121) in the Autumn of 2024. He has a wife and three children to support and would like them to be able to move to the UK with him.
Clark will need to ensure that the job meets the £38,700 salary threshold. His role is not on the ISL. He will be able to bring dependents with him as part of his visa. His wife, Clara, will be given the right to work in the UK. She can apply to roles in the UK, including as a HR officer (in which she has previous experience) in an NHS trust.
The family will be required to pay the IHS of £1,035 per person per year.
Example – current dependents on a Family Visa, British national employed by an NHS trust:
Anthony is a British national working as a sonographer at an NHS trust on a salary of £28,407. He has been married to Holly, originally from Australia, for five years. Holly is currently in the UK working in childcare on a Partner Visa (family visa route) which is set to expire in 2025. Holly will need to renew her visa before she can apply for indefinite leave to remain.
Since Holly was in route before the new immigration rules came into force, Anthony will not have to meet the increased minimum salary threshold of £29,000 salary threshold on the family visa route. He will need to meet the minimum salary threshold which was in place when Holly first applied for her visa.
Holly can continue to live and work in the UK. Holly will need to pay the IHS of £1,035 per year.
Example – future dependents employed by an NHS trust on a Family Visa:
Kathryn is a British national working as a financial advisor in Yorkshire. She is currently married to Chris, who is a resident of Japan. Chris is wanting to join his wife in the UK in the summer of 2024 and work in the NHS as a Band 3 healthcare support worker. To do this, Kathryn will need to meet the increased minimum salary threshold of £29,000.
If Chris wishes to come to the UK in 2025, Kathryn will need to meet the higher threshold of £38,700.
Chris will be subject to the IHS and be given the right to work in the UK. He will be able to apply for any roles as a healthcare support worker across the UK.
The government has reassured us that, while it is determined to reduce net migration, it understands the importance of internationally educated health and care workers. We understand that these changes are likely to result in a number of questions, especially for internationally educated staff and those working on international recruitment.
Please see the FAQs below and continue to check the NHS Employers and GOV.UK websites for latest information.
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