‘If you want a reference, pay up.’ How UK care homes are exploiting overseas nurses

UNISON has discovered cases of care home employers trapping overseas nurses in exploitative workplaces and charging them thousands of pounds if they try to leave

stressed filipina nurse taking phonecall at home

The UK depends on overseas nurses to keep its care homes, clinics and hospitals running. Without the hundreds of thousands of nurses travelling from abroad to work here, our health services would not be able to function.

Yet despite being the backbone of our health service, these nurses are vulnerable to exploitation. UNISON has recently become aware of care home employers trapping overseas nurses in exploitative workplaces and charging them thousands of pounds if they try to leave.

Hazel* is one of them. An agency based in the Philippines recruited her to a care home in the south of England, coordinated her travel and helped her register as a nurse in the UK.

From her first day in the care home, Hazel’s experience was terrible. “I thought that there would be some kind of induction, but there wasn’t,” she says. ”Suddenly, all this responsibility was thrown at me. I was working 12-hour shifts as the only nurse onsite, responsible for 20 to 30 residents in the home at any one time. I was tasked with the residents’ care, as well as managing the two floors of the home itself, responding to incidents, making discharges, and supporting the care staff too. I was overwhelmed.

“I only received two half-days of basic training for PEG feeding, catheterisation and bloods. Beyond that, nothing. The work was relentless. I would be on the rota for days and nights during the same week, and if someone didn’t come in for the next shift, I would have to work 24 hours, often forced to do certain skills that I hadn’t been properly trained in.”

It wasn’t just the scheduling or lack of training that exhausted Hazel. As she lived onsite, the manager felt entitled to demand that she work at any time. She says: “I had no privacy. If someone called in sick, the manager would come and knock on my door, at any hour, even on my day off. There was no time to rest. On my days off, I left the care home and got the bus to go into town. I knew if I stayed in my room, the manager would demand that I worked.”

Hazel moved out of the care home after three months, and shared a house with two colleagues from the Philippines. After 11 months in total, all three women decided to try and leave the care home.

“It was a huge decision to leave. We’d spent so long preparing to come to the UK. We loved the residents and had settled into the local area. But it wasn’t safe for us to be working in this environment. We were not supported, and if anything went wrong, we could lose our registration.

“But as our visas were sponsored by the employer, if we left our jobs without another sponsor we could be vulnerable to deportation. I was terrified. We had to make sure we could find other jobs where the employer would give us a certification of sponsorship before we handed in our notice.”

The cost of leaving

Hazel and her colleagues found a new employer who agreed to sponsor them. However, her elation didn’t last long. When she handed in her resignation letter, the care company told her that if she wanted to leave before her three-year contract was finished, she would have to repay £9,000 to cover the company’s investment in her.

“It didn’t make sense. They said that this covered training, our uniforms and the first month’s accommodation. It just sounded like far too much money to me. I knew that £3,000 of this was the Immigration Health Surcharge (IHS), which the employer is eligible to claim a refund for, so the cost should not have been passed onto me. But they obviously didn’t realise that I knew that. When I spoke to my local UNISON rep, he said we should challenge their decision.”

UNISON got the care home to remove the £3,000 surcharge, but Hazel agreed to pay the remaining £6,000. In other cases, UNISON has forced the employer to drop all costs. Hazel said: “I was so desperate to leave, so I used savings and my last month’s wage to cover the £6,000 so I could just end this nightmare. I don’t know what I would have done if I didn’t have the savings.

“On top of forcing me to pay these huge fees, the manager made my last month unbearable. They kept finding fault in my work, and calling me asking me why I wanted to leave and telling me that I could be deported. I felt like I was walking on thin ice every single day.”

Hazel is now working for a different care company, where she has received training and is well supported by her manager. However, with roughly 39,000 nurses from the Philippines on the UK nursing and midwifery register, Hazel worries that she isn’t the only one to experience exploitation. She says: “I never knew that this would be how I would be working in the UK. I had such high hopes before I came here. That care home was run like a business, with no care for either residents or staff. It is so wrong.”

Lisa* has a similar story to Hazel’s. After working as a hospital nurse for nine years in Zimbabwe, she came to work in a care home in Northern Ireland, in August 2020. She felt daunted from the start.

“Care homes are very different from hospitals. I was working as the only nurse on site, and there was so much that I just didn’t know, because I hadn’t been trained. For example, how to admit a patient, or what to do if someone got really ill. It was so unsafe – and this was also during COVID-19. If anything went wrong and I lost my registration, I would lose my job and I would have to leave the country.”

Lisa was responsible for 32 residents, across two floors. Due to short staffing, she also had to complete personal care duties.

“It was heavy work. I was working with one care assistant on shift, and doing care work like feeding, as well as my nursing responsibilities. I would always be working overtime, because there was just so much to do. I was attending to residents and doing the paperwork too. It was stressful and unsafe. As a nurse, you need to feel confident in what you’re doing.”

After six months on probation, Lisa expected her salary to go up from £15,000 to £16,000. But her manager extended the probation period without reason.

After a total of 10 miserable months, Lisa found a new job in an NHS trust. But when she asked for a reference, her employer refused and told Lisa that she would have to pay the company £10,850.

“When I requested a breakdown of these charges, it was obvious that they were exaggerated. But the manager said she would not give me a reference unless I paid the full amount.”

Three days later, the company transferred Lisa to another nursing home nearby. “The home was much bigger, there were over 50 residents. It was a completely different setup and there was no induction. I was so stressed. I had to administer medications from 8am-12:30pm, and also do PEG [tube] feeding, which I hadn’t been trained on. I was breaking down in tears all the time from the stress.”

The situation escalated further when Lisa handed in her notice. She says: “As soon as I sent in the letter, the manager told me that if I was leaving, I had to pay the £10,850. I didn’t have the money. And I knew that £3,000 was the IHS surcharge. I even showed them the government website where it said the IHS cost should not be passed onto the employee, but they just kept saying ‘We need £10,850’, and threatened to take it out of my salary if I didn’t pay it.”

The care home withheld Lisa’s December pay packet, including the COVID-19 government incentive to health workers. When she asked for a copy of her payslip, to see how much of the £10,850 it would cover, they refused to send it.

“I was devastated. I never agreed for them to take my pay. To suddenly not be paid your Christmas salary is so upsetting, especially when you are working so hard during COVID-19. I felt like I was letting my whole family down. The manager told me they would be taking my next month’s pay too”

Unethical recruitment

With the support of UNISON, Lisa has finally left the care home, but she has still not received the last two months of her pay.

Her family have been able to survive on her husband’s wages as a care assistant, but the whole situation has left Lisa extremely distressed. “I was so emotional all the time, and I went on antidepressants to cope. I didn’t understand the UK’s employment law at all. I had to ask my friends: ‘Is it normal that you’re not allowed to leave a job if you are unhappy there?’.”

One in eight nurses, midwives and nursing associates in the UK are from outside Europe, and the UK’s ‘hostile environment’ immigration policies, including the costly IHS, have created a landscape rich for exploitation. Although there is a code of practice to ensure ethical recruitment and that nurses are treated fairly, this isn’t legally enforceable.

UNISON national officer for nursing Stuart Tuckwood says: “The UK government boasts of its ethical approach to the international recruitment of nurses, but Lisa and Hazel’s experiences show that many are being trapped and exploited by immoral employers.

“It’s unacceptable for the government to turn a blind eye to these practices. They must now step up and show everyone how they are going to stop nurses from being exploited.”

UNISON is fighting to protect workers like Hazel and Lisa, and to hold rogue employers to account. If you have come to work in the UK and have experienced similar treatment, or are aware of nurses in this situation, please get in touch: h.group@unison.co.uk.

*Both names have been changed for safeguarding purposes.

10 thoughts on “‘If you want a reference, pay up.’ How UK care homes are exploiting overseas nurses

  1. Pauline Bacon says:

    This seems to me to be bordering or even crossing over into on modern day slavery! As most care home residents are paid for by a Local Authority (LA) I would expect/demand that LA’s would be expressly forbidding such practices as part of their contracts. This would be in line with their This definitely needs to be reported to the LA in the area where it is happening and to the CQC to inspect the homes concerned. these poor nurses and health care assistants should not be fighting these awful employers on their own and I am so glad that UNISON is taking up their cases.

    Under their commissioning arrangements LAs should under their Public Sector Equality duty “build equality considerations in the organisation’s relationships with suppliers.”

    It seems shameful to me that our council taxes via our County, unitary or borough councils are funding this exploitation. We all have a role to play in stamping this out by asking questions of the LAs we live in to question them about ensuring that none of our taxes fund such practices. Members should be asking questions in public sessions of their LA to make them commit to finding out if any of the care homes where they commission beds are carrying out such exploitation practices.

    I am not against the care homes recouping legitimate costs of travel and training but they MUST be able to prove that these costs are realistic and that staff have time to pay this back, not be left with no money for food or rent.

  2. David Penketh says:

    Absolute disgrace but another example of the failure of current social care policies and practices. I have always thought that this is a grossly underpaid sector and until one of your parents get old enough to need that support you will never know of how poor this system is.
    I can’t understand how Local Councils can’t oversee these companies and where serious transgressions(like the ones above) are raised they should lose their certification. There needs to be oversight of care homes similar to OFSTED for children. How is it that we have legislation for youngsters yet nothing similar for the elderly?? ALL vulnerable people in our society deserve protection!!

  3. Harry says:

    These care homes should be exposed on social media for their extortionate and illegal practices.

  4. David says:

    I hope UNISON reported these workplaces to the HSE and CQC

  5. I was once a victim of what Hezal is going through, Luckily for me, when I arrived in the UK, the first thing I did was to locate my embassy and registered myself.
    So when the victimisation started, I contacted my embassy for help, because my travelling document had been confiscated, which became my reason to stay with the care home against my wish.
    This is a long story, but let me make it short.
    Through my embassy consulate department, several letters were written to the care home to release my passport or face the law. unfortunately for the home, it is clearly written that this passport is the property of xxxxx and has been legally issued to the name bearer whose photo appeared on the passport. this was how I was rescued. During the period of attempting to leave, I surfer a lot of psychological, emotional, and financial trauma, really didn’t where to go or whom to turn to.

  6. By the way, this happened years back, not recently.

  7. Bibiana Maenzanise says:

    Good day! I used my savings to come when the employer said they will reimburse all costs on arrival but from July to date they only gave me £446 and if asked they keep saying send receipts which I have done more than 5 times. What should I do?

  8. Robert Eleck says:

    The government should intervene now that there is a massive international recruitment and this exploutation must come to an end. There is gross abuse people working without off, forced to drive, forced to buy cars for company use, people accruing hidden debts, poor salaries etc People are threatened with deportation and being told to be grateful they were brought into UK. CQC,Police and NHS should send in Private investigators especially in the black owned care companies. They are full of fraud, deception, abuse and greed. Help he poor people bringing change to the UK lives.

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