Delayed NHS pay award risks making overseas nursing staff ineligible for visa renewal, as RCN warns Home Secretary that new immigration rules threaten nursing workforce

The government's failure to give NHS staff their pay award on time risks leaving overseas nursing support workers ineligible for their visa renewals, with ‘devastating consequences for those affected', the Royal College of Nursing (RCN) has warned following changes in visa rules announced by the Home Office. 

The new rules will increase the minimum salary threshold for a Skilled Worker visa from £23,200 to £25,000, below the current entry-level salary (£24,071) for a Band 3 NHS worker, including nursing support workers.

The changes are set to take place on 9 April, and with the RCN not expecting this year's NHS Agenda for Change pay award to be implemented prior to that date, the College says it risks leaving staff already working in the UK whose visas are currently up for renewal ineligible. 

In a letter to the Home Secretary, Yvette Cooper, RCN General Secretary and Chief Executive Professor Nicola Ranger has warned that a delayed pay award will make entry-level band 3 staff ineligible for visa renewals. 

In the letter, Professor Ranger said:

"It is our understanding that the Agenda for Change NHS pay award will not be made before the 9th April 2025. A delayed pay award will mean that entry-level band 3 staff will become ineligible for visa renewals until a revised pay scale is in place. 

“If action is not taken by the Home Office and Department of Health and Social Care to address this gap, it will have devastating consequences for those affected.”

Professor Ranger also warned government that if the next pay award doesn't bring staff back above this threshold, it risks making entry-level NHS Band 3 workers permanently ineligible, with significant ramifications for the nursing workforce.

Professor Ranger said:

“There is a risk that if governments do not take action to ensure that 2025/26 pay scales provide Band 3 staff with a salary above the new threshold, these roles will no longer be eligible for sponsorship.”

In December last year, the government confirmed it had only budgeted for pay rises of 2.8% for NHS staff, a figure the RCN described as “deeply offensive".

The College has asked how the Home Office and Department of Health and Social care intend to bridge the gap, and whether staff will still be awarded visas until NHS staff receive their pay award for 2025/26.  

The RCN has already had nursing staff, including senior nurses, contact them about the changes in the threshold, concerned of the implications it will have either for themselves or for the nursing teams they oversee. Without intervention, those who are unable to renew their current visas will have 60 days to seek alternative employment that takes them above the £25,000 threshold under the new sponsorship rules. 

The RCN has warned that the invaluable contribution of nursing support workers to safe and effective patient care cannot afford to be lost. Nursing support workers are involved in every health and social care setting, providing frontline care to patients. 

The implications would also extend to settings such as social care, with many care roles falling short of the new £25,000 a year threshold. While government has committed to a Fair Pay Agreement for staff in the sector, implementing the new threshold prior to any agreement risks leaving care workers without sponsorship and at risk of exploitation from their employer. 

The RCN has previously raised concerns with the Home Office over the delays to the investigation into the exploitation of internationally educated nurses working in social care. The delay is leaving internationally educated care workers at risk from unscrupulous employers who are using repayment clauses to demand thousands of pounds from migrant care workers, leaving staff unable to leave their jobs and trapped in appalling conditions years after they were first hired.

Ends 

Notes to editors

The full copy of the letter to the Secretary of State for Home Affairs is below:

I am writing to raise an urgent concern regarding the immigration policy changes announced by the Minister for Migration and Citizenship on the 12th of March which are set to increase the minimum salary threshold from £23,200 to £25,000 for staff on the Skilled Worker visa. 

As you will be aware, the Royal College of Nursing (RCN) is the UK's largest nursing trade union and professional body. We represent more than half a million members across the NHS, the independent sector, and the social care sector. We have many internationally educated staff in our membership who make vital contributions to the UK's health and social care sector each day. 

I am concerned about the impact of immigration rule changes on NHS Band 3 staff, in England, Wales and Northern Ireland, this includes nursing support worker roles (under occupation code 6131: nursing auxiliaries and assistants) who are critical to the delivery of safe and effective care. The new immigration rule changes will mean that entry-level Band 3 staff in England and Wales, and all Band 3 staff in Northern Ireland, will no longer meet the required minimum salary threshold for sponsorship.

It is our understanding that the Agenda for Change NHS pay award will not be made before the 9th April 2025. A delayed pay award will mean that entry-level band 3 staff will become ineligible for visa renewals until a revised pay scale is in place. If action is not taken by the Home Office and Department of Health and Social Care to address this gap, it will have devastating consequences for those affected. There is a risk that if governments do not take action to ensure that 2025/26 pay scales provide Band 3 staff with a salary above the new threshold, these roles will no longer be eligible for sponsorship. 

I would be grateful if you can provide detail on how the Home Office intends to bridge this gap and confirm if an exemption will be applied for Band 3 staff requiring visa renewals in the period before the NHS Agenda for Change pay process for 2025/26 concludes.

I would also like to ask the Home Office to confirm what assessment it has made on the potential impact on health and care delivery, and if this has been raised with officials in governments' health departments. 

This announcement will also impact migrant care workers working in social care teams, many of these staff will be paid below the new salary threshold of £25,000. The RCN recognises the need to address the pay of staff in the care sector and continues to engage in discussions to further this aim. However, an immediate increase of the minimum salary threshold has the potential to leave care workers with visas due for renewal without a sponsored job and at risk of destitution and exploitation. 

I look forward to receiving your response and would welcome an opportunity to meet with you to discuss these issues alongside my concerns regarding the exploitation of migrant staff in the care sector as outlined in in my letter dated 7th March 2025.