Proposed changes to UK immigration rules could hand the NHS a bill of at least £169 million, according to NHS Employers and health unions, while leaving the futures of 12,000 healthcare workers in doubt. The warning, issued on Tuesday, centres on government visa reform plans that would impose substantial additional costs on health service organisations and create uncertainty for the support staff the service depends on.
The money question sits at the heart of the dispute. Many international healthcare support workers joined the NHS through Home Office specialist visa routes, which currently allow skilled workers, including those in health and care, to apply for permanent residence in the UK after five years. Under the proposed reforms, that route would stretch dramatically. Staff delivering frontline patient care could face a wait of up to 15 years rather than five, even as they continue working in essential patient-facing roles.
For NHS organisations, the financial implications are considerable. NHS Employers and the unions argue that extending the settlement period would make it harder to retain experienced staff, damage morale and deepen uncertainty for both employees and employers. Additional visa-related employment costs risk placing a significant financial burden on organisations already managing difficult workforce pressures. The groups are urging 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.
The full warning, including the cost estimate, is set out at https://www.nhsemployers.org/news/nhs-employers-and-unions-warn-government-immigration-reforms-could-cost-hundreds-millions-and, where NHS Employers and its union partners detail their case to ministers.
Ben Morrin, chief executive of NHS Employers, which is part of the NHS Alliance, said thousands of healthcare support workers and other NHS staff had made life-changing decisions to come to the UK and met the requirements to apply for settlement under the immigration rules in place when they arrived. If the reforms are confirmed, he argued, it would be extremely unfair to change the rules for workers who planned their lives around them, and NHS organisations would be left dealing with an eye-watering bill of at least £169 million. High-quality patient care, he added, relies on the contribution of the whole team, including those in vital support roles, and the NHS needs stability, fairness and workforce growth rather than policies that make it harder to retain crucial staff.
Meanwhile, there is a timing problem. Unions and employers point to a Home Office cut-off date of July 2025, which prevents many of these workers from renewing their visa or settling in the UK. They describe the date as unfair and say it is generating further uncertainty for employers and staff alike.
Helga Pile, chair of the joint health unions and UNISON head of health, described the changes as nothing short of devastating for thousands of health workers and their families. She stressed that these staff are a crucial part of the NHS team and at the heart of patient care, highly trained and skilled in performing clinical duties and observations, keeping people safe, comforted and cared for. Their expertise and commitment, she said, cannot readily be replaced, and there is still time for the government to do the right thing, treat staff fairly and rethink the proposals.
For employers across the health service, the stakes are both financial and operational: a multi-million pound cost exposure, a retention risk among experienced frontline staff, and a workforce planning question that remains unresolved until the government confirms the final shape of its reforms later this autumn. Whether ministers absorb that £169 million warning before then may decide how many of the 12,000 stay on the payroll.