Health Policy December 19, 2018
New ‘skills based’ immigration system must account for healthcare needs

By Daniel Male - Accountable Care Journal

Home Secretary, Sajid Javid, today outlined the government's position to bring immigration down to 'sustainable levels' as it launched its long-awaited the White Paper on the subject. So what does this mean for health and care workers?

The new rules will mean that low-skilled workers from the EU may no longer have an automatic right to work in the UK after Brexit. If this is to be the case going forward, what will be the conditions for the new 'skills-based' system?

In the 'shake-up,' which the Home Secretary has called the biggest for forty years, the immigration system will be shaped around skills rather than where people come from. This is planned to be phased in from 2021 and also ensures that there will be no limit on the number of 'genuine' international students who come to the UK to study.


The White Paper includes: 

  • Getting rid of the current cap on skilled workers from the EU and elsewhere,
  • A consultation on the £30,000 salary threshold for five-year visas for skilled migrants, 
  • Allowing visitors from the EU to come to the UK without visas, 
  • A system for low-skilled workers to apply for visas for up to one year.

The Conservative Party outlined targets in their most recent election manifesto to 'reduce immigration to the tens of thousands. ' While the Home Secretary is unwilling to commit to a 'specific target,' the wider question remains, election pledge or not, what levels of immigration are in the best interests of the country.

The white paper has been widely criticised due to the 'uncertainties' it presents over the minimum salary threshold which is currently thought to be set at £30,000. Shadow Home Secretary, Diane Abbott, responded to the announcement, labelling the timescale a 'disgrace' and adding her concerns surrounding this threshold.

What does this mean for workers in health and social care?

Nurses and doctors from outside the EU qualify for Tier 2 visas, where there is currently a limit of 20,700 people per year. However, the Migration Advisory Committee recently advised that this should be scrapped.

In the year to June 2018, net migration from the EU was 74,000 with non-EU net migration standing at 248,000, according to Office for National Statistics data. While the figures show that EU migration is at it's lowest rate since 2012, overall migration numbers remain broadly the same due to increases from outside the EU.

The response from the health community was widely sceptical.

Safron Cordery, deputy chief executive of NHS Providers, said to BBC Radio 4: "You have got starting salaries for nurses at £23,000 - also for paramedics, midwives. Junior doctors starting salaries at £27,000, healthcare assistants at £17,000, all coming in way below that £30,000 cap."

Meanwhile, Danny Mortimer, chief executive of NHS Employers, said: “The proposals in the Immigration White Paper do not provide a long-term solution to the needs of the NHS across nursing and other professions. They continue to confuse high pay with high skill and high value: The staff from the UK and around the world working in the NHS and social care do not command high pay but are hugely skilled and provide vital services to our families."

Mortimer also welcomed the opportunity to 'engage further' on the White Paper in the hope of delivering a 'more sophisticated' immigration system for the future.

Considering workforce shortages, the Cavendish Coalition recently projected that the NHS could be short of 51,000 nurses by the end of the Brexit transition period. In response to the White Paper, it expressed its concerns "whether the visa proposals in the Immigration White Paper will encourage the numbers of care staff social care needs to sustain services."

Cavendish Coalition co-convenors, Danny Mortimer, Nadra Ahmed and Sara Gorton, added: "While it is anticipated there may be some provisions for doctors and nurses coming to the UK after Brexit, this ignores physios, paramedics and other allied health professionals and there will be severe implications for the social care workforce in particular as well as outstanding concerns on doctor and nurse recruitment."

This comes alongside other calls for special provisions to be made for health and care.

The Immigration and Social Security Coordination (EU Withdrawal) Bill will be published on 20 December to end free movement and creates the legal framework for the future borders and immigration system.

More information can be found here.


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