NHS Immigration Reforms Could Cost £169 Million, Unions Warn

NHS Employers and health unions warn that proposed UK immigration reforms could cost the NHS at least £169 million and jeopardise the futures of 12,000 healthcare workers, many of them international staff on health and care visas. The reforms would extend the settlement wait from five to up to 15 years.

NHS Employers and health unions have warned the UK government that proposed immigration reforms could cost the NHS at least £169 million and jeopardise the futures of 12,000 healthcare workers. The warning, issued on 12 October 2026, is directed at plans that would extend the route to permanent residence for international healthcare support workers from the current five years to up to 15 years.

Many international healthcare support workers were recruited to the NHS through the Home Office's specialist visa routes, which currently provide a pathway to settlement in the UK after five years for skilled workers, including those in health and care. The reforms would leave thousands of staff facing a significantly longer route to permanent residence despite continuing to work in essential patient-facing roles.

NHS Employers and the unions say the changes would place huge additional costs on health service organisations, create uncertainty for essential support staff and create a two-tier NHS workforce. They are also concerned that extending the settlement pathway will make it harder to retain experienced staff, damage morale and increase uncertainty for both employees and employers.

The warning is significant for Filipino healthcare workers in the UK, many of whom were recruited through the same health and care visa routes and planned their families' futures around the five-year settlement rules. Kislap infers that Filipinos already working in NHS support roles, and those weighing a move to the UK, could face longer separation from family reunification plans and greater uncertainty if the proposals are confirmed.

There is also concern that many of these workers find themselves on the wrong side of a cut-off date imposed by the Home Office for July 2025, which prevents them from renewing their visa or being able to settle in the UK. Employers and unions say this date is unfair and is causing additional uncertainty for employers and staff.

Ben Morrin, chief executive of NHS Employers, part of the NHS Alliance, said the workers made life-changing decisions to come to the UK under the rules in place when they arrived.

"If proposals for reform to these rules are confirmed by the government, not only would it be extremely unfair to change the rules for workers who have planned their lives around them, but it would also leave NHS organisations dealing with an eye-watering bill to the tune of at least £169 million."

Helga Pile, chair of joint health unions and UNISON head of health, said the changes are nothing short of devastating for thousands of health workers and their families, and that the staff are highly trained, skilled and at the heart of patient care. She urged the government to treat staff fairly and rethink the proposals.

The reforms stem from the UK government's White Paper Restoring Control Over the Immigration System, published on GOV.UK, which sets out plans to tighten migration routes. Welsh councils have separately warned that the same proposals risk worsening the social care crisis by restricting international recruitment for care worker roles.

What happens next

NHS Employers and unions are calling on 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, and Filipino healthcare workers in the UK should monitor official announcements from the Home Office and NHS Employers as decisions land.

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