UK immigration policy for those on a Health and Care Visa or Skilled Worker Visa

Key points 

• From 11 March 2024, care workers and senior care workers are unable to bring dependants when they migrate to the UK, and only CQC-registered providers in England will be able to sponsor Health and Care Visa applicants. All other occupation codes can continue to bring dependants as normal. 
• From 4 April 2024, Certificates of Sponsorship issued for applications to the Health and Care Visa route for those occupations paid by NHS bands will need to meet the national pay scale for their role or the new minimum salary threshold of £23,200 (whichever is higher). This is an increase from £20,960.
• Roles that are not on a national pay scale will need to meet a general salary threshold of either £29,000 or the lower going rate for the role, whichever is higher. This will apply to both new applications and to extensions to existing visas.    
• Employers should bear in mind that the current going rates may increase for future applications.
• As of 6 February 2024, the Immigration Health Surcharge increased to £1,035 per person per year for those required to pay, such as skilled workers and their dependants.   
• All Health and Care Visa holders will continue to be exempt from paying the Immigrational Health Surcharge (IHS).  
• From 4 April 2024, Certificates of Sponsorship issued for overseas workers requiring a general Skilled Worker Visa (such as data analysts, IT and finance professionals, etc) but sponsored by an NHS organisation will need to meet the new salary threshold of £38,700. This will not be increased in stages. 
• Those already on a Skilled Worker Visa before the immigration rules change should be exempt from the new salary thresholds (standard going rates) when they change occupation or sponsor, or settle. However, they will be required to meet the new lower salary threshold (lower going rate) for their role (and their pay should progress in line with resident workers).   
• The Immigration Salary List (ISL) replaced the Shortage Occupation List (SOL) from 4 April 2024. Occupations on the ISL can be recruited to on a salary below the general salary threshold. These occupations will still need to meet a threshold of either £23,200 (for Health and Care Visas), £30,960 (for general Skilled Worker visas), or their occupation-specific threshold, whichever is higher.  
• The minimum income requirement for family visas has been increased to £29,000 from 11 April 2024. The plans to increase the family visa salary threshold to £38,7000 is on hold until a MAC review is complete. The salary threshold will stay at £29,000 pending completion of the review.

Below is a description of how these changes will impact various international staff across the NHS and social care. All scenarios are based on the Agenda for Change pay scales 2024/25, which are subject to annual review. 

The Home Office intends to continue updating going rates each April based on the latest available salary data. Employers should bear in mind that the current going rates may increase for future applications.

Health and Care Visa 

• Applies to those on a Health and Care Visa (such as nurses, doctors, allied health professionals, etc). A list of applicable roles can be found on  GOV.UK.  
• The Health and Care Visa is a sub-type of the Skilled Worker Visa. During the application process, candidates will be asked if they are applying for a Health and Care Visa and will need to select yes.  
• Only CQC-registered providers in England will be able to sponsor care workers or senior care workers.
• Salary threshold – national pay scale roles: the minimum salary threshold will increase to £23,200 for occupations on national pay scales where applicable. This will apply to both new applications and to extensions to existing visas. 
• Salary threshold – not on national pay scale roles: the general salary threshold will increase to £29,000 for occupation not on national pay scales. This will apply to both new applications and to extensions to existing visas. 
• Immigration Salary List: for Health and Care Visa occupations on the ISL (laboratory technicians, pharmaceutical technicians, care workers and home carers, and senior care workers), the salary threshold is set at either £23,200 or their occupation-specific threshold, whichever is higher.   
• Immigration Health Surcharge: current and future visa holders will continue to be exempt from the IHS.  
• Dependants: Health and Care Visa holders can still bring dependants to the UK as part of their visa (except care workers or senior care workers see below on social care). Dependants have a generic right to work meaning that they can be employed by the NHS, in another sector or not work.  

Skilled Worker Visa

• Applies to those roles not eligible for a Health and Care Visa (general Skilled Worker Visa) but sponsored by an NHS trust (such as IT and finance professionals, administrative staff, etc).  
• Salary threshold: From 4 April 2024, new applications will need to meet the increased general salary threshold of £38,700. This will not be increased in stages. 
• Those already in the Skilled Worker route before the immigration rules changes are eligible for a lower going rate when changing sponsor, job role or extending. The Home Office would expect their pay to progress at the same rate as resident workers in the same role; therefore, they would be subject to the updated 25th percentiles using the latest pay data when they next make an application to change employment, extend their stay, or settle. This is in-line with normal practice. 
• Immigration Salary List: for occupations on the ISL, a threshold of either £30,960 or their occupation-specific threshold, whichever is higher. 
• Immigration Health Surcharge: they will need to pay the increased immigration health surcharge (IHS) of £1,035 per year per applicant.  
• Dependants: they can still bring dependants to the UK as part of their visa. Dependants have a generic right to work meaning that they can be employed by the NHS, in another sector or not work. 
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Social care 

• Only CQC-registered providers in England will be able to sponsor care workers and senior care workers.
• Care providers who were sponsoring workers in exclusively non-regulated activities (and therefore not required to be registered with the CQC) before the rules change should be able to continue to sponsor these workers, including for extensions to their visa on those terms, but not hire new ones.
• Salary threshold: the general salary threshold for health and care worker occupations not on a national pay scale will increase to £29,000. This will apply to both new applications and to extensions for existing visas. 
• Immigration Salary List: for Health and Care Visa occupations on the ISL (currently including care workers and senior care workers), the salary threshold will be set at either £23,200 or their occupation-specific threshold, whichever is higher.  
• Immigration Health Surcharge: they will continue to be exempt from the IHS.
• Dependants: Health and Care Visa applications for care workers and senior care workers received after 11 March 2024 will no longer be able to bring dependants to the UK as part of their visa. 
• Care workers and senior care workers already in the route will be able to remain with their dependants, including extending, changing employer (within their SOC code) and settlement.
• Where a care worker or senior care worker is in the route before the immigration rules change, but has not yet brought dependants, they will be allowed to bring dependants during their sponsorship (on this visa).
• Individuals who are in the UK on any other route, including where that route permits dependants, who switch into the Health and Care Visa as a care worker or senior care worker after 11 March 2024, will not be able to stay with (or bring over) dependants.

Dependants 

• Dependants of those on a Health and Care Visa and Skilled Worker Visa can be employed by an NHS trust at any role regardless of skill level or salary threshold, as long as the main visa holder meets the appropriate general salary threshold. 
• The minimum income requirement for family visas (i.e. British citizens bringing dependents to the UK) starts at £29,000 from 11 April 2024. The incremental rise of the salary threshold to increase to £38,700 by early 2025, has been put on hold until a MAC review is complete. 
• From 11 March 2024, care workers and senior care workers under the Health and Care Visa will not be able to bring dependants as part of their visa application. 
• Care workers and senior care workers already in the route will be able to remain with their dependants, including extending, changing employer (within their SOC code) and settlement.
• Where a care worker or senior care worker is in the route before 11 March 2024 but has not yet brought dependants, they will be allowed to bring dependants during their sponsorship (on this visa).
• Individuals who are in the UK on any other route, including where that route permits dependants, who switch into the Health and Care Visa as a care worker or senior care worker after 11 March 2024, will not be able to stay with (or bring over) dependants.

The government has reassured NHS that, while it is determined to reduce net migration, it understands the importance of internationally educated health and care workers. We understand that these changes are likely to result in a number of questions, especially for internationally educated staff and those working on international recruitment. 

Source: nhsemployers.org