Roughly one-third of workers in the UK’s wider adult care sector are migrants, according to the Work Rights Centre. Around 280,000 came to the country under a Health and Care Visa between February 2022 and July 2025, a route that has since been suspended by the Labour government over fears it was being abused. Holders of the visas brought with them 429,200 dependents, many of whom also ended up working in the care sector.

At the time the visa was suspended, Labour — under then-prime minister Keir Starmer — lagged far behind Nigel Farage’s far-right Reform UK in voter surveys. With migration high on voters’ concerns, the ruling party in September 2025 tasked a new home secretary, Shabana Mahmood, with introducing even greater restrictions on new arrivals, as well as non-citizens already working in the UK.

The government has signalled that, from July 2028, migrants will no longer be able to renew their Health and Care Visa, and instead will have to transfer to a Skilled Worker route. That carries a much higher salary requirement, and domiciliary care businesses — many of whom rely on contracts from local authorities — say they don’t get enough funding to cover pay cheques of that scale. 

“I will have to either downsize or just sell to a corporation,” said Shweta Maulayah, a managing director of a small care business called Maucare. “This is something that I built with passion, but I would not be able to financially keep it afloat.”

The 2028 date looms large for many businesses and workers in the domiciliary care and supported living sector, which combined is worth around £15 billion (US$20 billion), and their jitters are being heightened by Mahmood’s so-called “earned settlement” proposals. 

Under current rules, a person arriving in Britain must stay for five years before they can apply for settlement, meaning most carers who came in 2022 and early 2023 would be eligible by the time the Health and Care Visa expires. But now Mahmood is proposing that the five-year baseline should be extended to 10 years, with reductions for high earners and those who make exceptional contributions to society through volunteering.

Maulayah started recruiting from abroad in January 2023, and so has several staff who wouldn’t be eligible for settlement under those terms before the July 2028 visa deadline. “How am I going to keep them if it goes to 10 years?” she asked.

Prime Minister Andy Burnham is leaning towards excluding care workers from the extension, according to a report in the Times newspaper, though it’s unclear whether the Home Office would support exemptions for people with Health and Care Visas. 

Some Labour backbenchers object to the application of the new rules to people already in the country. Bloomberg reported in March that more than 100 parliamentarians signed a private letter urging the home secretary to rethink her plans. Left-leaning Labour lawmakers have made a set of demands, according to one person familiar with the matter, including that the new timelines for settlement shouldn’t be applied retroactively, that people from the same household should be able to benefit from the same timeline, and that the maximum timeline to claim settled status should be seven years.

Cabinet ministers including Energy Secretary Miatta Fahnbulleh and Housing Secretary Angela Rayner have also refused to publicly back Mahmood’s reforms. Mike Tapp, a former Home Office minister who worked with Mahmood on the proposals, has also called for an exemption for care workers.

During Labour’s annual conference last month, the home secretary gave a first hint that she was rethinking aspects of her reforms.

“I know that, throughout our consultation process, some have said elements of these reforms are not fair,” she said. “We will come to a position that balances fairness for those who came here legally and fairness to British citizens across this country.”

But that might come too late for some care firms. One owner of a domiciliary care business in the south of England, who was granted anonymity discussing commercial matters, said the uncertainty has prompted her to explore options to sell her firm or wind it up.

Even if exemptions from Mahmood’s reforms were introduced for care workers, she worried that current restrictions on hiring workers from abroad ultimately made her business unsustainable, as she’d find it hard to hire British staff willing to work at the pay levels her contracts with the local authority allow.

Maulayah faces the same dilemma. “We’re not getting a lot of locals joining this industry,” she said. “Even youngsters that go to career fairs, they’re not that interested because they feel that care is a low-skilled job. One of them said to me, ‘I’d rather stack shelves in Tesco,’” she said, referring to the Tesco Plc supermarket chain.

Back in 2022, the industry was crying out for more staff. Thousands of workers from European Union countries had left the UK following Brexit, while its ageing population meant there was relentless demand. 

But, following an influx from countries such as India and Nigeria, it emerged that unscrupulous care agencies were abusing the sponsored visa route. A Bloomberg investigation last year revealed that many carers who entered the UK to work in good faith were being charged tens of thousands of pounds for their visa by the business who was supposed to be sponsoring them, but that there was no job for them when they arrived in the country. 

Speaking to journalists on Friday, Burnham stopped short of committing to all of Mahmood’s proposals. “We’ve been consulting on those reforms, and we will come forward with our decisions soon,” the PM said. “But I strongly support the Home Secretary when she says that settlement is a right to be earned through contribution.”

Proposals are expected next month. A spokesperson for the Home Office didn’t respond to requests from Bloomberg for comment.

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