Introduction to the Health and Care Worker Visa for UK Healthcare Employers

The Health and Care Worker Visa offers UK healthcare employers a streamlined, cost-effective route to recruit qualified international talent. Introduced in August 2020 as part of the UK’s points-based immigration system, this specialised category enables NHS trusts, private healthcare providers, and social care organisations to address critical staffing shortages across the healthcare sector.

For UK healthcare employers facing recruitment challenges, this visa route provides significant advantages over standard work visa categories. It has reduced costs and processing times specifically designed to support the National Health Service and social care providers in meeting their workforce needs. Whether you’re a large NHS trust or a small care home, this visa category offers practical solutions to staffing challenges.

Key Benefits for UK Healthcare Employers

Sponsoring workers through the Health and Care Worker Visa offers substantial advantages for UK healthcare employers, including NHS trusts, private hospitals, GP practices, and social care providers:

1.   Reduced application costs for candidates: Lower visa fees make job offers more attractive to international candidates, enhancing your recruitment proposition.
2.   Faster processing times: Applications are typically processed within 3 weeks, allowing for quicker onboarding of essential staff and reducing recruitment lead times.
3.   Immigration Health Surcharge exemption: Your sponsored employees are exempt from the IHS, significantly reducing the total cost of relocation and making your offers more competitive.
4.   Dedicated UKVI support: Access to specialised assistance from UK Visas and Immigration throughout the sponsorship and application process, reducing administrative complexity.
5.   Access to global talent pool: Ability to recruit from an international market of qualified healthcare professionals to fill critical skills gaps that cannot be met domestically.
6.   Staff retention advantage: The visa offers a clear pathway to settlement after 5 years, helping to improve the long-term retention of valuable international staff members.

Eligible Roles for UK Healthcare Employers to Sponsor

As a UK healthcare employer, you can sponsor international workers for the following healthcare and social care roles. The occupation codes listed below must be specified on the Certificate of Sponsorship when recruiting for your NHS trust, private hospital, clinic, or care facility:

Medical and Health Professions

1.   1181: Health services and public health managers and directors
2.   2112: Biological scientists and biochemists
3.   2113: Physical scientists
4.   2211: Medical practitioners
5.   2212: Psychologists
6.   2213: Pharmacists
7.   2214: Ophthalmic opticians
8.   2215: Dental practitioners
9.   2217: Medical radiographers
10.   2218: Podiatrists
11.   2219: Health professionals not elsewhere classified (e.g., audiologists, occupational health advisers)
12.   2221: Physiotherapists
13.   2222: Occupational therapists
14.   2223: Speech and language therapists
15.   2229: Therapy professionals not elsewhere classified (e.g., osteopaths, psychotherapists)
16.   2231: Nurses
17.   2232: Midwives
18.   3111: Laboratory technicians
19.   3213: Paramedics
20.   3216: Dispensing opticians
21.   3217: Pharmaceutical technicians
22.   3218: Medical and dental technicians
23.   3219: Health associate professionals not elsewhere classified

Social Care Roles

1.   1242: Residential, day and domiciliary care managers and proprietors
2.   2442: Social workers
3.   6141: Nursing auxiliaries and assistants
4.   6143: Dental nurses
5.   6145: Care workers and home carers*
6.   6146: Senior care workers*

*Special restrictions apply to dependants for these roles (see Dependants section).

Sponsorship Requirements for UK Healthcare Employers

To sponsor workers under the Health and Care Worker Visa, UK healthcare employers must meet specific criteria established by the Home Office. Whether you’re an NHS trust, private hospital, GP practice, or care home provider, these requirements apply:

Hold a Valid Sponsor Licence

1.   Application process: Submit an online application through the Home Office Sponsorship Management System.
2.   Supporting documentation: Provide company formation documents, evidence of regulatory registration, and proof of legitimate trading.
3.   Compliance systems: Demonstrate robust HR systems for monitoring and tracking sponsored employees.
4.   Key personnel: Nominate responsible officers, authorising officers, and key contacts within your organisation.

Meet Specific Healthcare Sector Requirements

1.   Regulatory registration: Maintain valid registration with the Care Quality Commission (CQC) in England or equivalent bodies in Scotland, Wales, or Northern Ireland.
2.   Active operation: Demonstrate that you are actively carrying out regulated healthcare or social care activities.
3.   Professional standards: Adhere to all quality and safety standards required by sector regulators.

Recent Changes for Social Care Employers (2024)

From 11 March 2024, organisations sponsoring care workers must:

1.   Be registered with the Care Quality Commission (CQC) or equivalent regulatory body.
2.   Be actively conducting regulated care activities.
3.   Demonstrate adherence to ethical recruitment practices.
4.   Implement appropriate training and support systems for international staff.
5.   Pay the genuine market rate for all sponsored roles.

Sponsorship Process for UK Healthcare Employers

1. Preliminary Steps

1.   Labour market testing: In most cases, advertise the role domestically first to demonstrate that no suitable settled workers are available (some exemptions apply for shortage occupations).
2.   Job description: Prepare a detailed job description matching one of the eligible occupation codes.
3.   Candidate selection: Conduct interviews and verify that international candidates meet all qualification and registration requirements.
4.   Right-to-work checks: Establish processes to verify right-to-work documentation throughout employment.

2. Issuing a Certificate of Sponsorship (CoS)

1.   CoS allocation: Request a defined certificate of sponsorship from your organisation’s allocation or apply for an undefined CoS through the Sponsorship Management System.
2.   CoS details: Complete all required fields accurately, including job details, work location, salary, and working hours.
3.   Sponsor declarations: Confirm that the role meets genuine vacancy requirements and minimum salary thresholds.
4.   CoS assignment: Assign the CoS to your candidate through the Sponsorship Management System.
5.   Reference number: Provide the CoS reference number to the candidate for their visa application.

3. Supporting the Application Process

1.   Document guidance: Provide clear guidance to candidates on required documentation.
2.   Maintenance certification: Consider certifying maintenance on the CoS to simplify the candidate’s financial requirements.
3.   Professional registration: Assist with professional registration processes where applicable.
4.   Application tracking: Implement systems to track application progress and anticipated start dates.

4. Pre-arrival and Onboarding

1.   Accommodation support: Consider providing initial accommodation or assistance with finding suitable housing.
2.   Relocation package: Develop a comprehensive relocation package to attract top talent.
3.   Induction programme: Create a specialised programme covering clinical and cultural aspects.
4.   Mentor assignment: Pair international staff with experienced colleagues to support their integration.
5.   Registration completion: Ensure any outstanding professional registration requirements are completed.

Ongoing Compliance Responsibilities for UK Healthcare Employers

As a UK healthcare employer with sponsor status, you have continuing obligations to the Home Office that must be integrated into your HR processes and workforce management:

Record-Keeping Duties

1.   Maintain complete personnel files for all sponsored workers.
2.   Keep copies of qualifications, professional registrations, and right-to-work documentation.
3.   Record attendance, absences, and any period of unpaid leave.
4.   Document any changes to work conditions, locations, or duties.

Reporting Requirements

Report to the Home Office within 10 working days:

1.   If a sponsored worker fails to start work on the expected date.
2.   If they are absent from work without permission for more than 10 days.
3.   If their employment is terminated early or they resign.
4.   If there are significant changes to their role or salary.
5.   If you have reason to believe they are breaching their visa conditions.

Compliance Visits

1.   Be prepared for announced or unannounced compliance visits from Home Office officials.
2.   Ensure all relevant documentation is readily available for inspection.
3.   Train key staff on sponsor duties and compliance requirements.
4.   Conduct regular internal audits of your sponsorship processes.

Dependants: Important Information for UK Healthcare Employers

Understanding dependant visa rules is crucial for UK healthcare employers when making job offers that include relocation packages, mainly when recruiting internationally experienced healthcare professionals:

General Eligibility

Most sponsored healthcare workers can bring their:

1.   Spouse or civil partner, or unmarried partner in a relationship similar to marriage for at least two years.
2.   Children under 18 who are dependent on them.

Restrictions for Care Worker Roles

Critical information for social care employers:

1.   From 11 March 2024: Workers sponsored under occupation codes 6145 (care workers) and 6146 (senior care workers) cannot bring dependants to the UK.
2.   Existing dependants: Those already holding dependent visas before this date are unaffected.
3.   Recruitment implications: This restriction may affect your ability to attract and retain care workers with families, requiring appropriate expectations management during recruitment.

Financial Considerations

Employers should be aware that:

1.   Dependants must pay the Immigration Health Surcharge
2.   The financial burden on employees with families can be significant.
3.   Some employers offer additional financial support for family relocation as part of their benefits package.

Settlement Options for UK Healthcare Employers

Understanding the settlement pathway helps UK healthcare employers develop long-term retention strategies for international staff, which is particularly valuable given the ongoing recruitment challenges in NHS and social care settings:

Settlement Eligibility

After 5 years of continuous employment, sponsored workers can apply for Indefinite Leave to Remain if they:

1.   Have maintained continuous UK residence.
2.   Continue to meet salary requirements.
3.   Pass the Life in the UK Test.
4.   Meet English language requirements.

Employer Benefits of Settlement

Supporting settlement offers significant advantages:

1.   Increased workforce stability and reduced turnover.
2.   Return on investment in training and development.
3.   Enhanced organisational knowledge retention.
4.   Improved recruitment proposition when highlighting clear settlement pathways.
5.   Diversification of your leadership pipeline.

Supporting Settlement Applications as UK Healthcare Employers

Consider implementing these retention-focused initiatives in your NHS trust, hospital, or care organisation:

1.   Clear career progression pathways for international staff aligned with NHS career frameworks.
2.   Support for Life in the UK Test preparation, potentially through your organisation’s learning and development department.
3.   English language development programmes tailored to UK healthcare terminology and communication needs.
4.   Mentoring schemes pairing international staff with experienced UK healthcare professionals.
5.   Recognition programmes for service milestones that acknowledge the valuable contribution of international healthcare workers.
6.   Integration into UK healthcare-specific leadership development programmes.

Cost Mitigation Strategies for UK Healthcare Employers

1.   Develop multi-year international recruitment plans to maximise return on investment, particularly for NHS trusts with predictable workforce needs.
2.   Implement robust retention strategies for sponsored staff, reducing the need for repeat recruitment campaigns.
3.   Consider establishing dedicated international recruitment and compliance teams for larger UK healthcare organisations.
4.   Partner with recruitment agencies specialising in international healthcare professionals with experience in UK healthcare settings.
5.   Join ethical recruitment schemes and international partnerships that align with NHS and UK healthcare values.
6.   Explore potential funding through NHS England international recruitment programmes or Health Education England initiatives.
   

Frequently Asked Questions for UK Healthcare Employers

1. How long does it take to obtain a sponsor licence?

Standard processing time is 8-10 weeks. Priority service can reduce this to 10 working days for an additional fee.

2. Can we sponsor part-time healthcare workers?

Yes, but the salary must be prorated from the full-time equivalent and meet the minimum hourly rate requirement.

3. What happens if a sponsored employee wants to change roles within our organisation?

You can report the change if the new role is in the same occupation code and has an equivalent salary. If it’s a different occupation code or significantly different duties, you may need to issue a new CoS.

4. Are there limits to how many international staff we can sponsor?

There is no predetermined cap, but the Home Office will assess whether your recruitment plans are reasonable for your organisation’s size and needs.

5. What are our obligations if we need to terminate a sponsored worker’s employment?

You must report the termination to the Home Office within 10 working days. The worker typically has 60 days to find a new sponsor or leave the UK.

6. Can sponsored workers take additional employment?

They can undertake supplementary work of up to 20 hours per week in the same occupation code without additional sponsorship.

7. How often do we need to renew our sponsor licence?

Sponsor licences must be renewed every 4 years. Renewal applications should be submitted at least 1 month before expiry.

8. What happens during a compliance visit?

Home Office officials will check your HR systems, sponsor workers’ files and attendance records and interview key staff about compliance procedures.

9. Can we sponsor nurses before they complete their UK registration?

Yes, under certain conditions. Nurses can be sponsored as pre-registration nurses for up to 8 months while completing their UK NMC registration process.

10. What are the consequences of non-compliance with sponsor duties?

Consequences range from action plans for minor issues to downgrading, suspension, or revocation of your sponsor licence for serious breaches.

11. Can we reduce a sponsored worker’s salary after they arrive?

Reductions are only permitted in minimal circumstances, such as company-wide salary reductions or reduced working hours requested by the employee. The salary must still meet minimum thresholds.

12. What records must we keep for compliance purposes?

You must maintain copies of right-to-work documents, professional qualifications, attendance records, contact details, and evidence of any reported changes.

13. How can we help sponsored workers prepare for settlement?

Consider offering support for English language development, Life in the UK Test preparation, and clear career progression pathways.

14. Is there a cooling-off period if a sponsored worker leaves the UK?

The cooling-off period for Skilled Worker visas has been removed so that former employees can return to the UK on a new visa without a mandatory gap.

15. Can we recoup sponsorship costs from employees if they leave early?

You may include reasonable cost recovery clauses in employment contracts, but these must be clearly stated, proportionate, and not constitute a penalty.