International recruitment to adult social care: A guide for councils

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International recruitment can help to boost workforce capacity, bring in additional skills and expertise, and provide a more diverse workforce. However, international recruitment to adult social care also creates the conditions that can enable exploitation of social care staff. The purpose of this guide is to provide an overview of the international recruitment process as it relates to adult social care. It sets out the role of the council as a key stakeholder within this process and signposts to resources that are available to support councils.

Introduction

In September 2020, as a result of the continued high number of job vacancies in adult social care, the Migration Advisory Committee (MAC) recommended that senior care workers were included on the Home Office shortage occupation list. 

In February 2022 care workers were also added to the shortage occupation list and eligible for a Health and Care Worker visa. This means that overseas recruits working in care would be eligible to obtain sponsorship by an eligible sponsor, in other words, the NHS, an organisation providing medical services to the NHS, or an organisation providing adult social care to come and work in the UK. This does not include agencies employing care workers to deliver temporary care.

While it is recognised by government and councils that overseas recruitment to adult social care is not a long-term solution to addressing the workforce challenge facing the sector, it has been welcomed as an approach to tackling workforce capacity pressures in the short and medium term.  

Many councils and providers report that international recruitment can help to boost workforce capacity, bring in additional skills and expertise, and help to provide a more diverse workforce that is more representative of those needing care and support. However, international recruitment to adult social care also creates the conditions that can enable exploitation of social care staff. 

It can lead to safeguarding and quality issues and raise market contingency concerns. In extreme cases it can provide a channel for criminality, including people trafficking and modern-day slavery.

The purpose of this guide is to provide an overview of the international recruitment process as it relates to adult social care. It sets out the role of the council as a key stakeholder within this process and signposts to resources that are available to support councils. 

It is recognised that international recruitment is a dynamic process with rapid learning and development taking place. It is intended that this guide will be updated as developments continue, and emerging good practice becomes available to share. 

This guide is primarily aimed at commissioning, workforce, quality assurance and safeguarding colleagues working in adult social care in councils in England. 
 

What does good international recruitment look like?

Good international recruitment to social care involves the consideration of some key elements that ensure the selection of competent and qualified professionals, while adhering to ethical and legal requirements. 

As with domestic recruitment, the focus should be on a values driven and informed approach.

This checklist describes the characteristics of good international recruitment:
 


 

Key elements in ethical international recruitment

The health and care worker visa
 

The health and care worker visa allows professionals to come to the UK to do an eligible job with the NHS, an NHS supplier or in adult social care. It is tailored to address shortages in the health and care sector.

To qualify for a health and care worker visa, a candidate must:

  • be a qualified doctor, nurse, health professional or adult social care professional
  • work in an eligible health or social care job. The roles on the shortage occupation list relevant to social care are care workers and home carers or home care workers; senior care workers; occupational therapists; residential, day or domiciliary care managers or directors and social workers
  • work for a UK employer that has been approved by the Home Office as a sponsor
  • have a ‘certificate of sponsorship’ (CoS) from the prospective employer with information about the role offered in the UK. This must be a genuine role with a UK employer in the health and social care sector
  • be paid a minimum salary. For social care this is currently £23,200. per annum
  • care providers in England must be CQC registered and carrying out regulated activity to recruit care workers and senior care workers.

An applicant for a health and care worker visa will be expected to: 

  • pay an application fee. The fee depends on the length of time that the recruit intends to work in the UK. Up to three years costs £284 per person, while more than three years is £551 per person. The fee is the same whether the applicant applies from inside or outside the UK. 
  • be able to support themselves financially upon arrival in the UK. Applicants must have at least £1,270 in their bank account and be able to demonstrate that they have had this available to them for at least 28 consecutive days prior to applying. Applicants are exempt if they have been in the UK with a valid visa for at least 12 months and/or if their employer has agreed to cover costs during the first month in the UK. Any dependents will also need to prove that they can support themselves while in the UK.

No other charges should be passed on to the individual applying for a visa. It is important to be aware that recruitment agencies should not charge applicants to match them to roles. Any fees should fall to the employer, not the employee.

More information about the health and care worker visa is available on the government website.
 

Sponsor organisations

Organisations wishing to sponsor international recruits must be registered with the Home Office to enable recruitment into UK-based care sector roles. International recruits cannot be sponsored by private households or individuals, other than sole traders sponsoring someone to work for their business. A list of registered licensed sponsor employers is available on the government website. The list is updated daily.

The duties and responsibilities of sponsor employers who wish to recruit from overseas have been set out by the government. This includes the checks and monitoring requirements of sponsor organisations.

The Department of Health and Social Care (DHSC) has published a code of practice for international recruitment, including best practice benchmarks, for organisations undertaking international recruitment. It is expected that all employers will adhere to the 15 best practice benchmarks when recruiting from overseas. 

Some countries should not be targeted when actively recruiting health or care professionals. These are known as red list countries. Direct applications from these countries are still permitted. 

Domestically these countries face the most urgent health and care workforce challenges, and so recruitment of professionals to the UK is discouraged. 

UK Visas and Immigration (UKVI) manage sponsorship and visa processes and ensure sponsors comply with regulatory requirements. 

This includes:

  • compliance with immigration rules. Sponsors must comply with immigration rules, including but not limited to, ensuring that sponsored employees meet the requirements for the health and care worker visa.
  • maintaining sponsorship duties: This includes keeping accurate records of sponsored workers, reporting specific changes or events regarding sponsored workers to UKVI, and fulfilling other obligations related to record-keeping. The Home Office, in their 'Workers and temporary workers guidance for sponsors', set out sponsor duties and compliance.  
  • monitoring and reporting: Sponsors are responsible for monitoring their sponsored employees to ensure they continue to meet the conditions of their visas. They need to report any significant changes to each sponsored worker's circumstances to UKVI.
  • cooperation with UKVI: Sponsors must cooperate with UKVI in terms of audits, compliance checks, or requests for information related to sponsored employees.
  • adherence to conditions: Sponsors are required to ensure that sponsored workers are employed according to the terms specified in their CoS. Also that their employment conditions and rights are in line with UK employment law. 

 

Compliance in international recruitment
 

The Home Office and UKVI set out the rules and regulations that govern organisations who hold a sponsor licence to employ international recruits to work in adult social care in the UK. 

UKVI ensure compliance with immigration laws and safeguard the interests of sponsored employees. Any breach by the sponsor of their duties can result in UKVI suspending or revoking the sponsor licence.

UKVI undertake the following steps to ensure compliance.
 


For health and care workers, the compliance process is particularly stringent. This is due to the potential impact on public safety and the importance of maintaining high standards in health and care services.

UKVI may revoke a sponsor licence for reasons including:

  • non-compliance with sponsorship duties: Failure to comply with the duties and responsibilities outlined by UKVI for sponsors. This includes failure to maintain appropriate records, notify UKVI of significant changes, or adhering to immigration law and regulations
  • employing unauthorised workers: Allowing individuals to work who do not have the legal right to work in the UK
  • failure to report changes: Failing to report changes to UKVI within specified timeframes, for example changes in a sponsored worker's circumstances or employment
  • non-adherence to sponsorship conditions: Not complying with the specific conditions and terms set out by UKVI for sponsored workers through the CoS
  • providing false information or documents: Supplying false or misleading information or documents to UKVI in support of a sponsorship application or during the sponsorship period
  • systemic failures: Widespread or systemic failures in the sponsor's systems or practices that prevent them from effectively fulfilling their sponsorship duties
  • criminal convictions or insolvency: Sponsors facing criminal convictions or insolvency
  • failure to pay fees or penalties: Non-payment of fees or penalties owed to UKVI
  • sponsor poses a risk to immigration control.
     

Steps in responding to non-compliance

Responding to suspensions and revocations can present challenges for councils and partners. There is system-wide improvement work taking place regionally and locally to drive quality in the market and help prevent instances of non-compliance occurring. Some of this activity is outlined in ‘working collaboratively with councils and local partnerships.’

At suspension and revocation stage councils consider the impact on those in receipt of care as well as the impacted workers. These instances can create significant capacity issues, especially where councils are dealing with high numbers of suspensions, revocations, displaced workers and/or unethical practice.

Councils receive notification of suspensions and revocations for commissioned and non-commissioned services. Where services are not commissioned by the council there is still a need to assess and consider the risks and issues impacting local people and recruits.

The considerations and actions required during a suspension or revocation are the same in terms of the assessment and contingency planning process. Not all suspensions will become a revocation, however, there will still need to be an assessment of risk and identification of issues for both. If the compliance check does become a revocation, councils will be required to implement business continuity plans immediately. 

Immediate revocations can be more challenging, particularly where the council is unsighted on the provider, business continuity plans are not fit for purpose, or there are immediate safeguarding issues.  

This section sets out the information needed to respond to non-compliance, based on emerging practice in the sector. It describes the process itself, steps that councils can take to engage with providers and their role in supporting displaced recruits. 

The diagram shows the eight key steps councils and partners are taking as part of effective management of the suspension and revocation process. Further detail is given on each step.
 

1. Notification

2. Conduct local checks

3. Strategy discussion

4. Contact the provider

5. Business continuity/safeguarding

6. Agree MDT approach

7. Engage the provider

8. Support displaced recruits

This information is high level in recognition of the vast differences between individual council areas, resources, practice and the impact of international recruitment. It is advised that councils use these steps to develop a more detailed local process that identifies actions, key responsible officers, and an effective approach to multi agency working locally. 

Step 1: Notification

In 2023 UKVI agreed an information sharing protocol with DHSC, Care Quality Commission (CQC), Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS). The protocol allows councils to be informed of suspensions and revocations at an early stage in the compliance process. The aim of the protocol is to help councils and local partners to mitigate risks associated with non-compliance.

Under the new information sharing protocol UKVI informs DHSC, CQC, LGA and ADASS of a suspension or revocation when a concern or breach has been identified. The email notification identifies the name and registered address of the provider, the reason for suspension/revocation and the number of recruits potentially impacted by it. 

The actual number of impacted recruits may later differ from the early information received. This could be due to the provider operating in several areas, or because they have more licences than the number of workers currently employed. 

The reasons for suspension / revocation will be categorised under a number of headings:
 

  • certificate of sponsorship misuse
  • recruitment concerns
  • monitoring issues
  • recouping of fees
  • supply sponsored worker to third party as labour
  • reporting and document retention
  • genuineness of vacancies
  • failure to retain documents
  • sponsor reporting issues
  • not complying with UK law
  • salary underpayments
  • sponsor poses a risk to immigration control.

On receipt of the email notification, CQC check the registration status of the provider and report any issues to the national group. Information will then be forwarded to the relevant regional international recruitment lead(s) by the national ADASS lead. If the regional lead requires specific or additional information, they liaise with the national ADASS lead, who will contact UKVI for a response.

Step 2: Conduct local checks

When a notification is received, councils assess the implications and issues arising from it by undertaking local checks. 

There are some useful sources of information to help with this:

  • the name(s) of responsible people within the sponsor organisation or any associated companies and/or services can be identified on the provider website, via CQC or Companies House. The CQC can verify if the provider is registered with them
  • the registered address of the sponsor organisation is given on the notification e-mail. However it is advisable to look beyond the registered address of the provider to ascertain the spread of provision across other councils or regions, NHS services and self-funders. Where additional information is found, this is shared with the relevant organisation(s)
  • the safeguarding team in the council and CQC can help to identify any safeguarding and/or other concerns about the organisation. Some non-commissioned providers may be known to the safeguarding teams so important to triangulate information
  • the Home Office online register of worker and temporary worker licensed sponsors will identify locally registered care providers.  

 

Step 3: Strategy discussion

Within 24 hours of notification of suspension or revocation of a sponsor licence many councils are now holding a strategy discussion. The purpose is to agree what action needs to be taken, by whom and who needs to be engaged. A further strategy meeting takes place once the initial information has been gathered. 

There may be obvious issues and complexities identified in the strategy discussion that will require support from other agencies. Given the timescales involved, early contact with other agencies is helpful in enabling an effective multi-agency approach. 

Councils may consider placing a hold on purchasing additional services from the provider until the outcome of the compliance investigation is known.  
 

Step 4: Contact the provider

Consideration needs to be given to determine the best way to approach the provider. The provider may not be known to the council or have a pre-existing relationship with them. Some areas work closely with the local care association at this stage and report finding it helpful in brokering the relationship. 

The purpose of the contact is to understand the implications of the suspension or revocation on service provision, continuity of care, safeguarding for service users and international recruits.

During the contact, councils may wish to clarify with the provider:

  • details of service users supported by international recruits, continuity of care plans and safety implications 
  • if the provider is able to provide continuity of care. If not, what action can the council take to support? Does the council need to make contact directly to inform or provide reassurance? What are the implications for business continuity? 
  • the numbers of workers impacted
  • if the revocation will result in displaced recruits. What can be done to ensure the workers have appropriate support and advice? 
  • other areas where the company operate
  • any concerns of the organisation or support required

Further information about operating areas should be shared with the relevant regional international recruitment lead.  

Step 5: Business continuity / safeguarding

The council has a significant role in supporting the provider to conduct impact assessments, develop contingency plans and to ensure the ongoing continuity of care for people. 

Councils will be presented with a range of providers with differing issues and employing differing numbers of workers. In some instances a provider may have a high percentage of sponsored workers resulting in implications for the wider system in the event of provider failure. 

At suspension stage it may be appropriate for the council to provide information to UKVI to assist in understanding the local relationship. This could be relevant for organisations with an existing contractual relationship with councils. 

In some cases, the scrutiny that takes place due to a revocation, identifies safeguarding and quality issues that need to be addressed with the provider or through formal routes.

Step 6: Agree a multi-disciplinary response

A multi-disciplinary response may have already been initiated prior to this point. However, following contact with the provider new information may have come to light which requires involvement with other agencies. Local partners that the council may need to engage include the provider alliance, other councils contracting with the provider, the police, NHS and so on.

There are several national organisations that are engaged in compliance for international recruitment, including UKVI, CQC, the Gangmasters and Labour Abuse Authority (GLAA) and the Employment Agency Standards Inspectorate (EAS). There is further information about these organisations under signposting to support.

Step 7: Engage the provider

There are many reasons why a provider may have had their sponsor licence suspended or revoked. For some it could be due to management capability or over enthusiastic recruitment, others can be a result of unethical practice or criminal activity. Distinguishing between the reasons will be important for informing risk management strategies for councils. 

It is likely to be a stressful time for providers, who will undoubtedly be concerned for their ongoing business. As a result, some providers may be reluctant to engage with councils. Taking a supportive and collegiate approach and working with the local care association, where available, can help to navigate these dynamics. 
 

Step 8: The role of councils in supporting displaced recruits

International recruits are an important part of the local social care workforce. It is in the best interests of the council and system to retain and support recruits where possible. 

A sudden loss of employment, arising from the revocation of the employers sponsor licence, would leave many international recruits feeling vulnerable. This in turn may potentially lead to safeguarding and other support needs. 

Re-employment

It is not the responsibility of councils to find employment for displaced workers. Often the recruit themselves will be proactive in finding new employment. Councils can however support providers in connecting displaced workers with new employment opportunities. For example by organising or supporting job fairs.

There may be local providers with a sponsor licence who are willing to step in and sponsor displaced recruits. Having good connections with the provider network and understanding the market can help to identify the providers with sponsor licences who may be able to employ displaced workers. 
 

Signposting to support and advice

Councils can work with regional and local partners to ensure there are services in place to provide support and advice to displaced workers. For international recruits, knowing where to access support and advice can reduce vulnerability and empower them to navigate the implications of a sponsorship revocation. Signposting to support and advice services needs to be part of an ongoing process and not just take place at the revocation stage. 

There can however be challenges connecting with the international workforce at this stage. Councils are not currently provided with the names of displaced international recruits as a matter of course. The best route to connecting with recruits can be through the employer, staff networks and other community and support services. Sometimes workers may disappear into another area of work or become a victim of exploitation before they can be reached by the council or someone from the sector. 

Ensuring that workers are informed about support and advice routes should be part of a good induction process. Councils can also take steps to ensure that information is visible in the workplace, such as in staff rooms or through training courses. Unions are also a good source of support and information. Social media networks are a powerful way of building peer support communities between international recruits.

No recourse to public funds (NRPF)

Displaced recruits may find themselves with no recourse to public funds (NRPF). A NRPF condition is usually imposed when a person has been issued with leave to enter or remain for a temporary purpose, such as to visit, study or work. 

Local authorities have a duty to provide support and assistance to individuals, including those with NRPF, only under certain circumstances. The responsibility is outlined in the Children Act 1989, the Immigration and Asylum Act 1999, the Care Act 2014 and the Mental Health Act 1983, as amended in 2007.

Here are some key points:

  • children's services: Councils have a duty to safeguard and promote the welfare of children, regardless of their immigration status. If a child is in need and has NRPF, the council may provide support, accommodation, and other services to ensure their well-being.
  • adult social care: If an adult is vulnerable and has care and support needs, the council may have a duty to assess those needs and provide necessary support, irrespective of immigration status. Councils are not required to meet the needs of individuals with NRPF who do not meet the legal thresholds for care and support, when these needs have arisen because of destitution.

Each individual is likely to require a case by case assessment and the No Recourse to Public Funds Network has produced guidance for council officers working with people with no recourse to public funds who are destitute or at risk of homelessness. 

The network run the NRPF Connect database which seeks to expediate Home Office decision making on individual cases and make recommendations for wider council practice.
 

Checklist for councils

Understanding council responsibilities

Ethical recruitment and retention of care workers is the responsibility of a number of national and local partner organisations, including councils. 

Government sets immigration policy and the Home Office and UKVI are responsible for ensuring compliance by issuing, suspending or revoking licences to providers. Providers are responsible for ethical recruitment, pastoral care and the pay and working conditions of their staff. 

Directors of adult social care have responsibility for three key elements of international recruitment:

  • safeguarding under the Care Act
  • market shaping, commissioning, contract management and quality assurance
  • working collaboratively with providers and local partnerships.

This section outlines current and emerging practice in these three key areas, with practical steps councils can take to ensure ethical international recruitment. 

 

Safeguarding

Unethical international recruitment can present safeguarding challenges for councils. As well as the potential detrimental impact on the people who are drawing on care and support, recruits and their dependents could present with care and support needs.  

Ethical international recruitment incorporates a focus on ensuring that recruits have the required language skills to be able to undertake their role effectively. They have an induction process that enables them to understand the cultural nuances of life in England so that they can adapt to living and working here. 

There may be differences in the approach to delivery of care in the UK and different legislative frameworks that recruits need to get used to. Approaches to dementia care, person centred approaches and deprivation of liberty, for example, can be fundamentally different to overseas. 

Recruits need good pastoral support to ensure that they are not isolated and have their basic needs met, particularly in the early weeks and months. Where these support needs are not met there can be quality of care or safeguarding implications for the people in receipt of care. 

In extreme cases people who are recruited unethically from overseas may be exposed to criminality. This may take the form of modern slavery, debt bondage or labour exploitation.

The CQC, in the 'State of Care 2022/23' reported that there was a notable rise in referrals for concerns regarding modern slavery and labour exploitation within the UK Care sector. In 2022/23 CQC made 37 referrals, more than four times the number of referrals made in 2021-22.

As a consequence of this treatment, recruits may suffer the effects of deprivation in the form of poor or no accommodation, inadequate funds to live on and inadequate support for dependants. All these circumstances may result in support needs from councils or the wider public sector. 

Many places have developed multi agency approaches to tackle modern slavery and exploitation in the care sector. Initiatives have included awareness raising and developing system improvements to mitigate the risks of unethical international recruitment. 

Community Safety Partnerships have safeguarding responsibilities as part of their broader commitment to enhancing public safety. There may be activity taking place within the partnership to respond to modern slavery and criminal exploitation.
 

Emerging practice examples

Sandwell Slavery and Trafficking Operational Partnership (SHOP)

SHOP is a dedicated partnership of law enforcement agencies, councils, and non-governmental organisations (NGOs) working together to tackle modern slavery and human trafficking.

SHOP focuses on prevention, identification, and support for victims as well as pursuing perpetrators and disrupting exploitative activity.

The partnership works closely with care agencies, care homes, and local councils to raise awareness of exploitation and modern slavery, provide training, and implement effective safeguarding measures.

SHOP facilitates information sharing and collaboration among its members, enabling a coordinated response to combat modern slavery. Through intelligence gathering and joint operations, SHOP targets organised criminal networks involved in exploiting vulnerable individuals in the care sector. The partnership supports victims by providing safe accommodation, access to healthcare, counselling, and legal assistance, helping them on their path to recovery and empowerment.

SHOP actively engages with communities, stakeholders, and the public to raise awareness about modern slavery and encourage reporting of suspicious activities or concerns. The partnership has produced guidance to support their aim of addressing modern slavery in the sector.

SHOP and its partners strive to create a society where modern slavery has no place, protecting the rights and dignity of all individuals in the care sector.

Greater Manchester - Programme Challenger Partnership

Programme Challenger is Greater Manchester’s partnership response to tackling serious and organised crime. The modern slavery unit is one of a number of teams operating within Programme Challenger.

The unit was established in 2015, when it was recognised that there was a rise in crimes of slavery, human trafficking and exploitation in Greater Manchester.

The unit comprises a multi-agency team that works with local and national partners to: 
 

  • provide a high level of care for victims
  • raise awareness with the public and professionals about the various forms of slavery, trafficking and exploitation
  • encourage people to report any concerns they have
  • improve understanding of modern slavery through intelligence collection and develop operational strategies with partners to respond to the problem.

The Modern Slavery Unit has mobilised a cross sector working group to prevent exploitation in the care sector. The working group comprises representatives from the integrated care system, Greater Manchester Combined Authority, Greater Manchester police and adult safeguarding boards. Links are also made to the Good Employment Charter, CQC, councils and Age Friendly Greater Manchester to explore and tackle the issue.

The working group has developed a guide to exploitation in the care sector to create a shared understanding of the challenge. The guide lays the foundations for a pan Greater Manchester protocol for commissioning, quality assurance and safeguarding and additional targeted communication.

Identifying and reporting unethical practice


Modern slavery, debt bondage, labour exploitation and other unethical practices can be difficult to identify. International recruits may be fearful of engaging with authority or discussing their situation with other people. This may be because of previous life experience, concerns about losing their visa or coercive control by others. 

The exploitation can also be hidden by virtue of the working arrangements or employer. Recruits working in home care or employed by agencies may have fewer opportunities to access support and information than those working as part of a team in a care home. 

Employment Agency Standards (EAS) Inspectorate has oversight of agencies in the social care sector. In a webinar in 2023 they shared some examples of unethical practices they have found, including:

  • work finding fees being charged by some agencies
  • fees being charged for additional services
  • charges for certificates of sponsorship
  • students working in excess of their visa allowance
  • potential National Minimum Wage issues.

The University of Nottingham Rights Lab, working with councils and the LGA, produced a guide on establishing modern slavery risk assessment and due diligence in adult social care for commissioning officers and managers within adult social care teams in councils. It provides advice on to how to set up effective local systems to identify and manage the risks of modern slavery. 

There are several organisations that have a role in the oversight of ethical working practices in the social care sector, including UKVI, CQC, GLAA and EAS. These organisations are key partners when dealing with unethical practice. Information about these agencies, their roles and signposting for further information are given at the end of the guide.

Checklist for councils

Market shaping, commissioning and contract management

Local government responsibilities around international recruitment are not explicitly outlined in the Care Act. However, international recruitment influences the workforce composition and service provision within the adult social care market, thereby impacting the broader efforts of market shaping by councils. 

When market shaping and commissioning services, councils should consider the potential contribution and challenges associated with international recruitment in their strategies.

Local provider market capacity, quality and continuity of care can be impacted both positively and negatively by international recruitment, depending upon individual provider approaches. It is important to be clear about the difference between good providers undertaking ethical international recruitment, providers who are less proficient and need support, opportunists wanting to secure labour for new or expanded business and unscrupulous or criminal activity associated with trafficking and slavery. 

Local partners will take a different response to each of these groups and scenarios, often with different lead organisations.  
 

Understanding the market


Councils can take steps to understand the extent to which international recruitment impacts the local market. This includes knowing the number of providers in the area that hold sponsor licences, the number of workers and type of organisation. 

It is important for councils to understand what is happening in relation to international recruitment in their area due to its potential impact on business continuity. However, there are challenges for councils in capturing this information. 

Due to the complex nature of the social care market, it can be difficult to get a clear view of the number and nature of providers and agencies with sponsor licences in any one area. The government publish a register of licensed sponsors, however this is based on the registered address of the provider and does not identify areas of operation.

Not all locally based social care providers or agencies will be commissioned by the council. Others will be registered in different areas from those in which they operate, and councils are not routinely provided with this information. 

In some areas, the number of providers operating will create challenges of scale in gathering the information on those with sponsor licences. 
Some regions have tested the use of capacity tracker to gain additional information about international recruitment. 

The addition of questions about the number of workers sponsored and in which business area, has given a better understanding of the market. It is anticipated that this approach will be adopted nationally which will help councils in understanding the local market. 

The West Midlands has sought to address this issue through the development of an international recruitment sponsors dashboard. 
 

Emerging practice example

West Midlands ADASS (WM-ADASS)

Councils in the West Midlands recognised the importance of international recruitment to the care system, with recruits adding much needed capacity. However, data on international recruitment was limited and not sufficiently granular to allow councils to maintain oversight of the extent of international recruitment activity within the local care market. 

Too frequently the first indication that a council had of the involvement of international recruits within the market was on receipt of a formal notice of licence suspension or revocation from UKVI. At this point the risk of worker displacement was already high. 

In response, partners in the West Midlands developed an international recruitment sponsors dashboard to improve the data on international recruitment and enable a more proactive approach to be taken. The dashboard combines Home Office and CQC datasets to present a full picture of CQC-registered sponsor organisations, registered care locations and licence suspensions and revocations. 

Partners in the West Midlands region anticipate that the dashboard will:

  • provide oversight of international recruitment sponsorship activity within the region and council boundaries, including raising awareness of the scale and distribution of international recruits
  • support the development of a targeted support offer to sponsor organisations
  • support the development of a targeted place-based support offer to international recruits
  • help with risk mitigation and contingency planning, particularly for areas with high concentrations of international recruits
  • aid the response to suspensions and revocations and implementation of risk mitigation plans aimed at redeploying recruits at risk of displacement.

There is an opportunity through the commissioning and contract management process for councils to manage some of the risks presented by international recruitment.

Emerging practice examples


West Midlands proactive approach to reduce suspensions

Partners in the West Midlands are working with commissioners to understand need at sponsor licence suspension and revocation stages to inform a checklist.

Commissioners recognise that there are opportunities for pre-emptive, proactive and preventive work that can be done before the licence suspension stage. If done well, they believe that the work could help to reduce some future suspensions.

Greater Manchester protocol on exploitation in the international social care workforce

The Greater Manchester authorities are developing a protocol on exploitation in the international social care workforce. 

The aim of the protocol will be to ensure a more consistent approach to reducing exploitation across the ten Greater Manchester boroughs with a focus on:

  • what is included in commissioning contracts to set expectations of employers
  • what quality assurance checks are carried out to retain an oversight of overseas workers
  • understanding what the roles and responsibilities of different organisations are in reducing exploitation and what they can do to support
  • producing a set of Greater Manchester principles and communications that can be applied to local arrangements and embedded in each of the ten councils. 

Sandwell Council advice for enhancing practices in relation to modern slavery

Sandwell Council, as part of their guidance on addressing modern slavery, have developed advice for working practises in the care sector. This includes undertaking:

  • holistic assessments: Conduct comprehensive assessments that go beyond paperwork, focusing on worker welfare and well-being.
  • collaboration with stakeholders: Foster partnerships with care agencies, law enforcement, and NGOs to share information and address modern slavery. 
  • training and awareness: Provide training to commissioners on recognising indicators of modern slavery and ensuring an effective response.
  • regular monitoring and inspections: Implement routine inspections to identify and respond to potential instances of exploitation and take necessary action. 
  • engagement with workers: Actively listen to workers' experiences, concerns, and feedback to improve oversight and protection.

Checklist for councils
 

Working collaboratively with providers and partnerships

It is a duty under the Care Act for councils to work collaboratively with providers and local partners. Collaborative working is particularly important for international recruitment given the number of stakeholders and the fact that responsibilities for ethical international recruitment are spread across the system. 

Both providers and international recruits may have support needs. If these needs are not met, it can have implications for service delivery and consequential demand on the wider system. Councils are not accountable for meeting all of the support needs, but they could be accountable for adverse outcomes that emerge as a result of them not being met. By collaborating with partners, councils can work to mitigate risk and support the effective management of ethical international recruitment.  
 

National and regional infrastructure


Every region in England has one or more people who act as a professional lead for international recruitment in their area. ADASS and the regional international recruitment leads support DASS’s and regional colleagues in the instance of a sponsor having their sponsor licence suspended or revoked. The steps in the compliance process are set in the guide.

We are supporting the sector through the facilitation of a national network of international recruitment leads. This network includes colleagues from DHSC and other key partners. The aim of the network is to share good practice and collectively develop solutions to common challenges around international recruitment.

Utilising funding from government all regions or sub regions have developed international recruitment partnerships or hubs that are focussed on driving quality in international recruitment. Some offer support to providers, supporting the training and pastoral needs of recruits, as well as initiatives to match recruits to new employers when needed. 

Emerging practice examples

West Midlands ethical recruitment service and hub

A new regional ethical recruitment service offer for all CQC accredited care providers and councils operating in the West Midlands is currently being developed. The development is being led by West Midlands Employers on behalf of WM ADASS, Shropshire Council and the DHSC. 

The key components of the regional service include:

  • a human resources subscription service
  • an independent employment law support and advice service
  • a framework of ‘approved’ ethical recruitment managed service providers or agencies.

North West London Overseas Recruitment (NWLOR) and North West London Health and Social Skills Academy

North West London Overseas Recruitment (NWLOR) programme is hosted by the Integrated Care Board (ICB) and is part of the wider people programme. The programme was established to enable collaborative, system wide recruitment to address workforce gaps across NHS Trusts, social care and primary care.

The NWLOR programme is delivered by a team of experts employed by the NHS. Recruitment is managed directly, without the involvement of third-party agencies and the services are free for candidates. Practices are centred on safe and ethical recruitment of international healthcare professionals into the workforce, taking an inclusive and equitable approach, whilst adhering to the DHSC Code of Practice.

The team offer a fully managed, end to end service, including:

  • advertising and candidate attraction: NWLOR work in collaboration with interested parties to establish campaign objectives and deliverables. The team create adverts and social media content to engage the targeted audience.
     
  • screening and interview selection: NWLOR manage the screening process for all shortlisted applicants with at least one registered clinical lead on the selection panel. The team invest time in getting to know the applicants during the screening stage, creating a safe environment for applicants to sell their knowledge and experience as well as answering competency-based interview questions to determine their clinical suitability.
     
  • offer management and compliance: Employers can be assured that all appropriate checks are undertaken by the NWLOR team, in line with NHS and UK Government guidelines. The team offer immigration advice and are able to support throughout the entirety of the UKVI sponsor licence process, including the assigning of certificates to individual candidates.

Employers have access to a 12 month pastoral support and an in-depth education curriculum package, provided by NW London Health and Social Skills Academy.

Bespoke programmes are led by an experienced clinical education team, which includes registered nurses. These programmes can be tailored to support a variety of staff groups and support begins ‘in country’ before a candidate transitions to employment in England. 

Welcome booklets are provided which give comprehensive information about living in NW London, for example, accessing key services, housing and bills, taxes and pensions. These are followed up via individual appointments, where recruits have the opportunity to ask questions and complete the care certificate self-assessment to ascertain current skills and knowledge. By completing a personalised career development plan, knowledge gaps can be identified. It also provides an opportunity to ensure that the programme is adequately designed to support the recruit and complement existing employer provision.

A face-to-face induction, undertaken in partnership with employers, provides an overview of the health and social care system, different services and roles, partner organisations and key information on health and wellbeing for the new recruits. A comprehensive curriculum, delivered in partnership with local Universities and NHS Trusts, is tailored to each cohort, and includes topics such catheter care, wound care, managing behaviours that challenge, end of life care and compassionate communication. Additional modules expand on topics such as Deprivation of liberty safeguards (DOLS), the Mental Capacity Act (MCA) and multi-agency safeguarding. The academy is working closely with employers to enhance the curriculum with sessions to cover UK culture, diversity and inclusion and person centred care.

The academy has been commissioned to support other staff groups across the NWL footprint, including nursing and midwifery, and a bespoke Nursing and Midwifery OSCE offer is under development. This will enhance the holistic approach being taken by NW London to international recruitment.

The Social Care Training Hub: Supporting social care staff in Lancashire and South Cumbria

The Social Care Training Hub has been developed by Lancashire and South Cumbria Integrated Care Board (ICB) to support adult social care organisations with staff training and workforce development. The hub brings together education and training resources as a ‘go to’ place for information about workforce education and development. 

The hub offers information and support with career development and student nursing placements. It provides a fully funded programme of training available to all care staff who are looking after residents of Lancashire and South Cumbria. This includes a programme tailored to international recruits transitioning to a new role in Lancashire and South Cumbria.

The Translating Care programme

The Translating Care programme aims to support international staff in settling into new UK job roles in the care sector. Delivered over three full days, the course aims to build understanding of British values. The topics covered include:

  • health and social care values
  • equality and diversity
  • safeguarding and protection
  • prejudice and discrimination
  • employability.

On successful completion of the course, learners will gain level 1 certification in safeguarding and protection and prejudice and discrimination. For accreditation, learners will need English skills at entry 3 or higher. Evidence of this or completion of online literacy assessments will be needed prior to the start date of the course.

Local partnerships, community and voluntary organisations


Local partnerships, community and voluntary organisations can help when responding to the needs of international recruits. Many may already be working with international recruits or have services that would be of benefit to them. Some areas have commissioned locally based organisations to provide additional support and advice to recruits. These include Citizens Advice Bureau, Justice and Care and the Salvation Army.

 

Provider networks


Engaging with provider networks and local care association alliances on international recruitment gives an opportunity to build a consistent approach to market development, due diligence and quality assurance. 

Strong relationships across the network can help to develop collaborative approaches to support the needs of the sector and the recruits. It can also help with managing the challenges when a sponsor licence is revoked or re-employing displaced workers. 

Networks offer an opportunity to share knowledge and resources, alongside a space to collectively drive quality. The guide signposts to resources or support with ethical international recruitment.
 

Checklist for councils
 

Ensuring capacity to manage risk

Planning for capacity to manage risk is complex. Revocations can occur suddenly, having implications for business continuity and the safety of people in receipt of care and support as well as resulting in high numbers of displaced recruits who may need support. 

Councils are increasingly trying to mitigate some of the risks presented by building international recruitment considerations into commissioning and contract management processes as outlined in the guide. However risk strategies need to be developed for instances where mitigating action is not effective. 

This section sets out some of the current system challenges and considerations for risk planning.

  • International recruitment is not limited to any single council or region of the country and some providers operate in multiple locations nationally. Not all providers or agencies will be directly commissioned by the council to which the provider is registered and therefore the notification is sent. Some may provide services to residents in the company registration area and others may be operating in a different council area. This can create challenges in understanding the local market, and at revocation stage.
     
  • At present, the Home Office do not share aggregated data with councils, the LGA or ADASS on compliance.  As data controller the Home Office do not share information about sponsor licences unless there is a suspension or revocation. In practice this can result in councils having to respond quickly based on limited information. 
     
  • Initiation of a revocation or suspension will require a quick response from local government. A revocation could have continuity of care and safeguarding implications and, depending on complexity, may require a multi-agency response and additional resources. 
     
  • Not all suspensions will result in a revocation, but they will still require input from the council in relation to risk assessment, potential safeguarding and business continuity planning. 
     
  • Whilst there are many good providers engaged in ethical international recruitment, there are also organisations engaged in criminal activity including immigration crime, modern slavery and labour exploitation. Councils need to determine which organisations they are working with and what support is needed, if any.
     
  • With NRPF international workers could quickly become destitute and/or vulnerable to exploitation. Where a person finds themselves with no accommodation or income, they may approach the council for help. 
     

Checklist for councils
 

Signposting to services

The Care Quality Commission (CQC) help to ensure that care providers adhere to fair and lawful employment standards. In November 2023 CQC published a regulatory policy position on modern slavery and unethical international recruitment. The new assessment framework enables CQC to routinely assess how a provider is managing the risks of modern slavery and ensuring the wellbeing of internationally recruited staff.

Employment Agency Standards Inspectorate (EAS) protects the rights of agency workers by ensuring that employment agencies and businesses treat their workers fairly. It is part of the Department for Business and Trade. EAS is responsible for seeking compliance with the Employment Agencies Act 1973. This legislation requires recruitment agencies, including those in social care, to abide by specified minimum quality standards. 

Gangmasters and Labour Abuse Authority (GLAA) works in partnership to protect vulnerable and/or exploited workers. It has the responsibility to license and regulate labour providers in regulated sectors. This includes ensuring compliance with employment standards, preventing worker exploitation, and investigating cases of labour abuse or modern slavery. 

HM Revenue and Customs (HMRC) National Minimum wage. Payment of the national minimum wage is enforced by HMRC on behalf of the Department for Business and Trade. They provide information to employers and prevent wrongdoing. If an underpayment is identified employers will receive a notice of underpayment setting out arrears due and the penalty, which is 200 per cent of the total underpayment (max £20,000). 

Justice and Care is a charity that provide support to victims of modern slavery. They work alongside the police and other regional partners to identify people trapped in modern slavery and support them to be free. 

Modern Slavery and Exploitation Helpline is operated by Unseen UK an anti-slavery charity. The helpline provides advice and guidance to those who believe they have seen or experienced modern slavery or human trafficking. They can help with access to support services and can make referrals into the National Referral mechanism. 

The National Referral Mechanism (NRM) is a framework for identifying and referring potential victims of modern slavery and ensuring they receive the appropriate support. Only first responder organisations, which includes local authorities, can refer a potential victim of modern slavery into the National Referral Mechanism. Referrals are then actioned by the Home Office. 

UK Visas and Immigration (UKVI), which is part of the Home Office, is responsible for determining who has the right to visit or stay in the country. They should be contacted when there is suspicion a sponsor organisation is involved in immigration crime, or other unethical practice.