Government Admits It Doesn't Know How Many NHS Staff Will Be Hit by Immigration Rule Changes
The government has made a startling admission as its consultation on major immigration reforms draws to a close: it does not know how many National Health Service staff will be affected by the proposed changes to indefinite leave to remain rules. Health minister Karin Smyth confirmed her department lacks information on the national impact of the plans on NHS workers, raising serious questions about the policy's implementation.
Proposed Reforms and Their Scope
The proposed reforms, announced by Labour last year, seek to significantly extend the period required for individuals to gain settled status in the United Kingdom. Under current rules, individuals living in the UK on specific valid visas for five years automatically qualify for indefinite leave to remain (ILR). The new proposals would double this requirement to ten years for many applicants, with some potentially facing a fifteen-year wait.
While doctors and nurses directly employed by the NHS are exempt from these new rules, staff in social care and private healthcare – including those working on NHS-contracted cases to reduce treatment backlogs – will be impacted. Applicants would also need to meet additional criteria, including language proficiency and demonstrating a "sustained and measurable economic contribution." The government additionally intends to make it more difficult for visa holders to bring dependants into the country.
Ministerial Admission and Parliamentary Response
In response to a written parliamentary question from Labour MP Neil Duncan-Jordan, Ms Smyth stated: "The department does not hold information on the number of existing National Health Service workers nationally… who could be affected by proposed changes to the rules on indefinite leave to remain." This admission has sparked significant concern among opposition politicians and healthcare unions.
Mr Duncan-Jordan, MP for Poole, criticised the approach, stating: "The Government is pushing through sweeping immigration changes, yet the Department for Health and Social Care does not even know how many NHS and care workers will be affected. That should ring alarm bells." He further described the policy as "un-British" and an attempt to pander to political rivals, adding that it risked squeezing out the very workers keeping the social care sector afloat.
Strong Opposition from Healthcare Unions
Trade bodies representing healthcare workers have voiced strong and unified opposition to the plans. The Royal College of Nursing (RCN) has labelled the proposals a "grave error," with director of policy Amber Jabbal warning that their analysis indicates one in ten registered nurses would be affected. Ms Jabbal cautioned that thousands could be "driven away" from health and care settings during a period of severe existing staff shortages.
Helga Pile, head of health at the Unison union, warned that the changes would divide the NHS workforce, creating a split between "high and low skilled" workers. She stated: "Every overseas worker in the NHS will be affected if they don’t already have residence rights. That will leave key workers in limbo for 15 years under these proposals and will cause chaos for long-term planning in healthcare." Ms Pile concluded that introducing such "life-altering rules" without proper assessment was "nothing short of reckless."
Context of Declining Applications and Government Rationale
The controversy comes against a backdrop of declining health and care worker visa applications. The number of people applying for such visas in the UK nearly halved last year, with approximately 61,000 applications compared to 123,300 in 2024. This decline followed earlier changes which ended overseas recruitment for care workers and raised the minimum salary for skilled workers.
Introducing the consultation in November, Home Secretary Shabana Mahmood framed the policy as strengthening the government's stance on immigration, stating: "To become a part of this country, permanently, is therefore not a right but a privilege – and one that must be earned." A Department of Health and Social Care spokesperson reiterated that while the government values overseas staff, "it is important we are not over-reliant on international recruitment at the expense of giving opportunities to our own homegrown talent." The department confirmed its upcoming workforce plan, due this spring, would further detail NHS staffing strategy.
Calls for Clarity and Proper Assessment
With the consultation on these ILR reforms set to conclude in a fortnight, there have been mounting calls for greater clarity and a proper impact assessment. Dora-Olivia Vicol, chief executive of the Work Rights Centre, echoed these concerns, stating: "We urgently need a detailed impact assessment. Without it, this consultation is a farce."
The situation highlights a significant disconnect within government, with critics pointing to the troubling scenario where one department promises a new strategy for social care while another introduces policies that could destabilise its workforce. As the deadline for the consultation approaches, the lack of concrete data on the policy's impact on vital NHS staff remains a central and unresolved issue.
