United Kingdom: ‘Come and care for our sick, then go home’
Definitions, legal, historical and institutional frameworks.
Health and Care Worker Visa
The Health and Care Worker visa is a British work-migration route for certain doctors, nurses, health professionals and workers in health and social care occupations. Applicants must, among other requirements, have an eligible job with an employer authorised to sponsor overseas workers and meet the pay requirements applicable to their occupation.
The visa may be granted for several years and extended for as long as the conditions continue to be met. For eligible categories, it provides a route towards permanent settlement. Rules concerning dependants vary by occupation and the date the person entered the route.
Care workers and senior care workers played a particular role in expanding this route after 2021. Direct overseas recruitment for these two categories closed on 22 July 2025. Transitional provisions still allow, until 2028, certain applications to be made from within the United Kingdom by people already employed in these occupations.
The Health and Care Worker visa should therefore not be treated as a single, static scheme. Eligible occupations, salary thresholds, dependants’ rights, and the ability to change employers have all been amended over time.
Indefinite Leave to Remain
Indefinite Leave to Remain, generally abbreviated to ILR, is the principal permanent-settlement status in the British immigration system. It allows a person to live, work and study in the United Kingdom without a time limit tied to the original visa. Subject to the relevant conditions, it may also provide a route to British naturalisation.
For holders of a Skilled Worker visa or Health and Care Worker visa, the rules currently published provide, in principle, for the possibility of applying for ILR after five years of qualifying residence and work, subject in particular to requirements concerning salary, employment and continuity of residence.
ILR is not citizenship. A person who obtains it remains a foreign national unless and until naturalised. A prolonged absence from the United Kingdom may also affect the status.
The debate over ‘earned settlement’ concerns precisely a possible change to the qualifying period and criteria for reaching this status. The rules currently in force must therefore be distinguished from reform proposals.
Earned settlement
The expression ‘earned settlement’ refers to the British proposal to reform access to permanent settlement by making the qualifying period and conditions more dependent on a migrant’s contribution and circumstances. It forms part of the government’s reform programme; not all proposed features are yet law.
The announced principle is to replace, for certain categories, the present standard route with a longer baseline qualifying period that could be reduced or increased according to specified criteria. Discussions have covered income, employment, integration, compliance with the rules and possible reliance on certain benefits.
The proposal is particularly sensitive for workers already settled in Britain. Applying a reform to people who entered under a system offering a prospect of settlement after five years would alter the timetable around which some have organised their family and professional lives.
This sheet must therefore be read chronologically. At the end of September 2026, earned settlement remains a reform project. Final rules must be distinguished from scenarios, consultations and government announcements.
International recruitment of health and care workers
International recruitment of health personnel brings together a country’s labour needs, workers’ professional choices and the capacity of countries of origin to maintain sufficient staffing levels. Doctors, nurses and other professionals may migrate for better pay, different working conditions, specialist training or family reasons. Destination countries may also use that mobility to fill their own shortages.
In 2010, the World Health Organisation adopted the Global Code of Practice on the International Recruitment of Health Personnel. It does not prohibit individual mobility. It promotes ethical recruitment, improves co-operation between countries of origin and destination, and limits the harmful effects of large-scale recruitment on fragile health systems.
In May 2026, WHO Member States strengthened this framework. The amendments notably include internationally recruited care workers and encourage co-investment in the health systems and workforces of countries of origin.
The issue can therefore be reduced neither to ‘brain drain’ nor to the individual freedom to migrate. It also concerns publicly financed training, domestic shortages, recruiters’ practices and the international distribution of the costs and benefits of mobility.