Adult social care could be a victim of the government’s immigration white paper

The launch of the government's new immigration white paper focused on Keir Starmer's promise that new 'tighter' rules would see migration numbers fall 'significantly'. But at the next election he won't be judged on migration numbers alone. In fact, some polling suggests that improving public services is the number one issue on which the public will judge the government.  ²² https://www.ippr.org/media-office/voters-want-the-government-to-put-fixing-public-services-ahead-of-balancing-books-new-polling-finds  And Labour has put improving public service performance at the heart of its missions. The government will now have to address the white paper's impact on key services – with adult social care at the fore.

On adult social care, the government broadly faces three politically unpalatable choices:  

• Welcome people from outside the UK who are willing to work in a relatively low-paid sector
• Raise wages substantially to attract more British staff to the sector – a decision which will require increased funding for local authorities
• Allow adult social care access and performance to decline further.

With the first choice apparently ruled out, the choice facing ministers is clear cut.

Though flawed, care visas were vital for improving access to care after the pandemic

This government is not the first to wrestle with that trilemma. When faced with the same choices, the last government initially chose to liberalise immigration rules in 2022, before tightening them again in 2024.  

There were issues with that approach, not least the rise in exploitation of care workers that came on that route,  ²³ https://assets.publishing.service.gov.uk/media/6602a6b765ca2fa78e7da854/An_inspection_of_the_immigration_system_as_it_relates_to_the_social_care_sect…  which this government is right to point out and attempt to address.  

But it is also undeniable that liberalisation massively contributed to the expansion of the adult social care workforce over the last few years. Between 2021/22 and 2023/24, the number of people working in the sector rose by 92,400.  ²⁴ This refers to the number of filled posts in local authority and independent providers, so excludes the NHS and those working for direct payment recipients, because this is the only data that Skills for Care provides.  That was driven entirely by an increase in staff from outside the UK and European Economic Area (EEA), which rose by 161,400. The number of British staff working in the sector declined by 62,400 in that time.

That was one reason that the government was able to increase access to care over the last couple of years.  As one interviewee put it to us last year “[the sector] would have been lost without international staff”.  ²⁵ https://www.kingsfund.org.uk/insight-and-analysis/long-reads/social-care-360-access#2.-service-delivery

Restricting care visas further could harm the sector

The last government’s decision to tighten eligibility for care visas led to a large reduction in applications: from 158,100 in 2023 to 31,500 in 2024. 

At the same time, there has been a slight reduction in the vacancy rate, from 8.1% in 2023/24 to 6.8% in March 2025, according to the most recent estimates.  ²⁶ https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/Workforce-intelligence/publications/Topics/Monthly-tracking/Recruitment-and-retenti… It’s impossible to say why those two trends have gone hand in hand, and until new data is released, we will not be able to see if there has been a rise in the number of British workers in the sector.

The government should not be complacent, however. The need for international staff has not disappeared. Skills for care estimates that independent providers still recruited 42,000 people in 2024/25, which is a significant drop from the 105,000 in 2023/24, but still more than double the 20,000 in 2021/22.  ²⁷ https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/Workforce-intelligence/publications/Topics/Monthly-tracking/International-recruitme…

And the sector faces other workforce headwinds this year. The government’s decision to increase employer national insurance contributions (NICs) and the national living wage (NLW) at the 2024 autumn budget means that providers will find it very difficult to employ the same number of people without increasing fees.

The government’s subsequent decision to only partially compensate local authorities for the NICs rise means that funding for the sector will go less far. 

Higher pay for care workers will require much more funding

The white paper did little to clarify how the government intends to support adult social care after these changes. It pointed to a policy change from earlier this year, which requires providers to attempt to recruit someone already in the UK before recruiting from abroad,  ²⁸ https://www.gov.uk/government/news/new-rules-to-prioritise-recruiting-care-workers-in-england  and promises to establish Fair Pay Agreements (FPAs) which it hopes could lead to higher pay for carers.  

But nowhere does the government address the fiscal elephant in the room: paying care workers more will require the government to spend substantially more on the sector. That seems unrealistic when the fiscal envelope is so tight. We forecast that under current government spending plans, local authorities’ core spending power will only increase by 1.3% per year in real terms between 2025/26 and 2029/30. After accounting for population growth, spending power basically flatlines between 2025/26 and the end of the parliament. 

This is not the first time since Labour took office that the adult social care sector will be left disappointed by a government announcement. First, chancellor Rachel Reeves announced that Labour would scrap charging reform. Then, Wes Streeting, the health secretary, announced that Louise Casey would lead a commission looking at social care reform, effectively pushing substantive reform of the sector into the next parliament.  

The government’s latest announcement on migration is therefore just another blow to the government's stated ambition to meaningfully improve performance in adult social care before the next election.