NHS Employers and unions warn government immigration reforms could cost hundreds of millions and put frontline healthcare support staff at risk

Proposed immigration changes could cost the NHS at least £169 million and jeopardise the futures of 12,000 healthcare workers, NHS Employers and health unions warn today (Tuesday).

They say government visa reform plans will place huge additional costs on health service organisations, create uncertainty for essential support staff and create a two-tier NHS workforce in the process. 

Many international healthcare support workers were recruited to the NHS through the Home Office’s specialist visa routes, which currently provide a pathway to settlement in the UK after five years for skilled workers, including those in health and care.

However, under the proposed reforms, thousands of staff will face a significantly longer route to permanent residence, despite continuing to work in essential patient-facing roles. These healthcare support workers delivering frontline patient care across the NHS could now face a wait of up to 15 years, instead of the current 5 years, to settle permanently in the UK under the government’s proposed immigration reforms.

NHS Employers and health unions* are concerned that extending the settlement pathway will make it harder to retain experienced staff, damage morale and increase uncertainty for both employees and employers. Additional visa-related employment costs also risk placing a significant financial burden on NHS organisations already facing difficult workforce pressures.

NHS Employers and unions are calling on the government to retain the five-year settlement period for healthcare support workers and other NHS staff already living and working in the UK. Final details on the government’s earned-settlement reforms are expected later this autumn.

There is also concern that many of these workers find themselves on the wrong side of a cut-off date imposed by the Home Office for July 2025**, which prevents them from renewing their visa or being able to settle in the UK. This date is unfair and causing additional uncertainty for employers and staff, say unions and employers.

Ben Morrin, chief executive of NHS Employers (part of the NHS Alliance), said:

“Thousands of healthcare support workers and other NHS staff made life-changing decisions to come to the UK and met the requirements to apply for settlement under the immigration rules that were in place when they arrived.  

“If proposals for reform to these rules are confirmed by the government, not only would it be extremely unfair to change the rules for workers who have planned their lives around them, but it would also leave NHS organisations dealing with an eye-watering bill to the tune of at least £169 million.

“High-quality patient care relies on a contribution from the whole team, including those in vital support roles. The NHS needs stability, fairness and workforce growth, not policies that risk making it harder to retain crucial staff.”

Helga Pile, chair of joint health unions and UNISON head of health, said:

“These changes are nothing short of devastating for thousands of health workers and their families.

“They’re a crucial part of the NHS team and at the heart of patient care. They're highly trained and skilled in performing clinical duties and observations, keeping people safe, comforted and cared for. Their expertise and commitment cannot readily be replaced.

“There’s still time for the government to do the right thing, treat staff fairly and rethink these proposals.”