Unethical sponsorship of migrant workers in the care sector has been making headlines recently, with horror stories of exploitation and abuse bordering on modern slavery.

The UK care sector relies heavily on migrant labour, and employs migrant workers in significant numbers.  As is so often the case, it’s likely to be a small minority of unscrupulous employers tarnishing the compliant majority with a bad reputation.

As a law firm priding itself on equality and fairness for everyone, no matter where they’re from, Truth Legal is keen to promote ethical recruitment, whether domestic or international.

That you’re reading this article shows you’re probably not part of the problem.  However, the below might give you a few reminders and tips to reassure yourself that you can continue to get it right.

If you have any concerns or wish to discuss anything covered below with an immigration solicitor, contact us today.

STEP 1: Know your Code of Practice

The Code in brief

The UK Government’s Code of Practice sets out important principles for the recruitment of health and social care professionals from overseas.

Its full title is the Code of Practice for the International Recruitment of Health and Social Care Personnel in England, and it implements the World Health Organisation’s Global Code on the same subject.

What do I need to know?

  • While not mandatory, all organisations involved in the employment or recruitment of health and social care personnel are strongly advised to adhere to the Code of Practice. This includes private health and social care providers, local authorities, agencies, and the NHS.
  • The Code applies to the appointment of all health and social care personnel, including care workers (residential and domiciliary), medical staff, nursing staff, dentists, and support staff.
  • The Code prohibits active international recruitment from countries on the Red List, with limited exceptions – more on that in the next paragraph.
  • The Code requires that international health and social care personnel have the same legal rights as domestically trained staff in all terms of employment and conditions of work. They must also have the same access to further education, training, and continuous professional development.

STEP 2: Understand the Red List, and the dos and don’ts of active international recruitment

What’s the Red List?

The Red List is a list of countries where active international recruitment is prohibited.  The list is contained within the Code of Practice at Annex A.

Why is it important?

The Red List recognises countries where the emigration of healthcare personnel in large numbers could threaten the country’s ability to meet the health and care needs of its own population.

One of the Code’s key principles is to prohibit ‘active international recruitment’ in countries with existing workforce shortages in health and care.

What is active international recruitment?

Active international recruitment is the process by which an employer or other recruiter targets individuals to market UK employment opportunities, with the intention of recruiting to a role in health or social care in the UK.

Active international recruitment need not be physical nor successful.  It can be virtual, and it doesn’t matter whether or not the actions lead to substantive employment in the UK.

Examples include:

  • Advertising to candidates through any medium.
  • Incentivisation activities such as referral bonus schemes.
  • Referring candidates to vacancies in the UK in return for a fee from the employing organisation (commission).

The flipside of this is that an ‘independent direct application’ from a candidate is not prohibited under the Code, even where the candidate applies from a Red List country.

What is an independent direct application?

An independent direct application occurs where an individual makes an application directly and on their own behalf to an employing organisation.  Direct applications do not use or third party, such as a recruitment agency.

So what can and can’t I do?

Put simply, you cannot actively advertise for candidates from Red List countries, nor market yourself as a recruiter or employer in Red List countries.

If you receive an application directly from an individual residing in a Red List country, you are permitted to employ that individual, provided that the application was made to you directly without the aid of a third party and without any active advertising by you.

STEP 3: Be careful with repayment clauses

What is a repayment clause?

A repayment clause is a clause in a sponsored worker’s employment contract which requires the worker to reimburse the employer for some of the costs associated with their sponsorship.  Specifics can vary, and repayment clauses are legal under UK employment law.

When used appropriately, repayment clauses can be an effective way for conscientious employers to recoup some of the costs of overseas sponsorship, making sponsorship financially viable and attractive.  An industry body recently said that without repayment clauses, overseas recruitment would decrease or even stop altogether.

What is the problem with repayment clauses?

According to trade union Unison, the “unethical implementation” of repayment clauses can leave sponsored healthcare workers vulnerable to exploitation.  There’s evidence that some sponsored workers have felt coerced into remaining in employment by significant debt which would result from a repayment clause if they left early.

It’s easy to see how this becomes problematic, for example if a sponsored worker wants to leave their employment due to poor working conditions, a misleading job description, bullying, discrimination, or harassment.

How do I use repayment clauses ethically?

Back to the Code of Practice for guidance, which states that any repayment clause must abide by the following four principles:


  • The repayment clause must be set out in the contract, and ideally also in the job offer letter. It must be explained to the candidate in full before the job offer is accepted.
  • An itemised list of costs should be provided to the migrant to show how the amount has been calculated.
  • Only genuine costs, which can be proven with evidence, can be reclaimed.
  • Costs must be reclaimed through auditable methods, such as bank transfer or salary sacrifice. Cash payments should not be used.

Proportionate costs:

  • The repayment clause must seek reimbursement only of those expenses met by the employer on behalf of the worker, such as relocation expenses, visa fees, and regulatory exam fees.
  • Other recruitment costs should not be reclaimed from the worker. This includes agency fees, the immigration skills charge, the sponsor licence fee, or the certificate of sponsorship fee.
  • A monthly repayment plan should be offered.


  • A repayment schedule should be provided and costs should taper downwards with time. An example is set out here:
  • Leaving within 0 to 12 months: can be charged 100% of total itemised expenses.
  • Leaving within 13 to 24 months: can be charged 50% of total itemised expenses.
  • Leaving within 25 to 36 months: can be charged 25% of total itemised expenses.
  • Leaving after 36 or more months: no repayable expenses after 36 months of service.


  • Employers should be flexible, consider individual circumstances, and make decisions on a case-by-case basis. For example, it may be appropriate to waive a repayment clause where:
  • The health and wellbeing of a healthcare worker is adversely impacted.
  • The worker is leaving due to bullying, discrimination or poor working conditions.
  • The worker’s circumstances have changed beyond their control.
  • The worker wishes to move roles for career progression.

By applying these four principles, employers can be confident that they are using repayment clauses ethically and appropriately.

STEP 4: Use agencies with caution

Organisations holding a sponsor licence are listed on the publicly available Register of Licensed Sponsors.  Agencies have been known to use this list to approach employers with offers of providing staff from overseas, and even paying you to take on migrant workers.

Of course, many agencies are legitimate and helpful to employers with staff shortages, but agencies should generally be approached with some caution, especially if their offers sound too good to be true.

And take care with right-to-work checks on agency staff.  For ordinary employers, the right-to-work regime requires that agencies carry out right-to-work checks where agency staff are used.  However, a higher requirement exists for employers holding a sponsor licence.  They must carry out their own right-to-work checks on agency employees, not under the right-to-work regime, but rather under Home Office guidance which applies specifically to sponsoring employers.  Tricky.

STEP 5: Comply with your duties as the holder of a sponsor licence

If you are a sponsoring employer, it is never a bad idea to remind yourself of the compliance duties which fall to you as the holder of a sponsor licence.  These duties include:

  • Performing effective right-to-work checks on all employees, regardless of their nationality, and as noted already, extending this check to include workers who are not necessarily employees.
  • Reporting certain activity of sponsored workers to the Home Office, such as if a sponsored worker doesn’t start the role on time, or they are absent without good reason for more than ten consecutive working days.
  • Keeping records pertaining to sponsored workers, including copies of passports, contact details, and records of holidays and other absences.

By understanding the Code of Practice – and principles such as the Red List, active international recruitment, and the ethical use of repayment clauses – UK employers can continue to enjoy the benefits of international recruitment, confident that their sponsored workers are employed ethically and appropriately.

A final note on sponsoring within the care sector

New immigration measures were unveiled on 4 December 2023. The most relevant here is that from Spring 2024, businesses sponsoring care workers will now be subjected to regulation by the Care Quality Commission.

Additionally, dependents are banned from joining care workers, this is likely to deter highly skilled care workers from contributing to the UK.

If you’d like to discuss this, or any other immigration issue, with our team of experts, please contact us today.

Video: FAQs About Ethical Recruitment In The Care Sector

Guide to Chapters

  1. Introduction (00:00)
  2. What’s the Problem? (00:25)
  3. What’s the Solution? (01:32)
  4. What’s a Repayment Clause? (02:18)
  5. Code of Practice: One-Minute(ish) Explanation (02:39)
  6. The Red List: Two-Minute(ish) Explanation (03:51)
  7. Anything Else I Should Know? (05:29)

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Catherine Reynolds
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