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Can Rishi Sunak Curb Migration Without Also Bringing Down The NHS?

Prime Minister Rishi Sunak visits the Nissan factory, Sunderland (Alamy)

7 min read

Prime Minister Rishi Sunak is under renewed pressure from restless Conservative MPs to massively reduce net migration before the next general election, but how he does that without putting further strain on the health service and the economy is not clear.

Sunak has said he is prepared to take further action to reduce the number of people allowed to legally settle in the UK, which he thinks is "simply too high" at present. Downing Street and the Home Office are now looking at new restrictions they can introduce to reduce the number of people coming to the UK from abroad after new figures published this week put recent net migration at record high levels.

While net migration is widely expected to fall in the long term, the big headache for a Prime Minister already under pressure to improve his party's dire opinion polling is that a huge tranche of Conservatives MPs on the right of the party want to see the headline figure slashed before the general election, which must be called before the end of next year.

“This is [government's] last chance to act now," Miriam Cates MP, an increasingly-prominent figure on the right of the Tory party, told PoliticsHome earlier this week. "Because otherwise we cannot go into the next election saying that we've fulfilled that promise.”

On Thursday, the Office for National Statistics (ONS) said net migration in the year up to June 2023 was 672,000, while the figure for the whole of 2022 was revised from 606,000 to 745,000. Non-European Union immigration has surged since Brexit, with the two big drivers of the most recent immigration being international students and health and care workers.

The New Conservatives group of right-wing Tory MPs has said the issue of reducing legal migration was "do or die" for the Conservative party. Neil O'Brien, the Conservative MP for Harborough, Oadby & Wigston has demanded "immediate and massive action".

PoliticsHome understands one measure now being considered by the government is restricting the number of dependents (partners and children) that care workers can bring with them to UK, mirroring revised rules for international students. 137,999 visas were given to dependants of health and care workers in the year up to June 2023, according to the Home Office — a 182 per cent increase on the previous year.

Ministers are also considering raising the annual salary threshold for skilled work visas as part of the fresh action that Home Secretary James Cleverly could announce as soon as next week.

Boris Johnson, the former prime minister who relaxed visa rules when in 10 Downing Street, in his column for The Mail this week called for it to be raised to £40,000.

But despite the government's insistence that net migration is too high, there is an acknowledgement that parts of the UK workforce — particularly the NHS and care sector, which are both under severe strain — rely on overseas workers and that cutting off the supply of those staff is not a serious option in the short-term. No10 and the Home Office are therefore focussed on having more control over secondary factors, such as dependents, in order to avoid trying to hit an arbitrary target for the number of foreign workers themselves. 

While some Tories on the right of the party remain vocal about their desire to see the headline legal migration figure fall dramatically, many are concerned about the economic damage incurred in pursuit of a political goal when Government is already struggling to spark growth.

When the Home Office announced last year that foreign students, excluding postgraduates on PhD research programmes, would be prohibited from bringing dependents to the UK from January 2024 in a bid to lower net migration, there were warnings that doing so would harm the UK's higher education sector and associated towns and cities. Speaking to PoliticsHome this week, one former secretary of state echoed that concern, and worried that further valuable sectors risked bearing the cost of a Conservative party row over immigration.

“There is concern in multiple departments that we have got a very successful higher education sector and we shouldn’t let it become a victim,” they said.

“Public concern about immigration is much more likely to be around people arriving undocumented without jobs to go to. It is not about people coming here to study computing.”

Another former Cabinet minister told PoliticsHome they wished some Tory MP would "stop obsessing about the numbers," arguing that the care sector in particular would come under extreme pressure without the help of overseas workers. 

Stuart Hoddinott, a senior researcher at the Institute for Government think tank specalising in health, stressed that the recent surge in foreign care workers coming to the UK was a "direct result" of the government decision in early 2022 to add them to the Shortage Occupation List, therefore making it easier for care providers to recruit staff from overseas. 

“They decided to put health and care workers on the shortage occupation list, and it has been wildly successful. They achieved what they wanted to achieve, which was to fill vacancies in the health and care service," he told PoliticsHome. "It shouldn’t come as a shock.”

He noted that the government had taken the step to liberalise visa rules because in the last few years there has been a "huge movement" of British staff out of the NHS and care sector at a time when public demand for these services is growing.

“It is a question of priorities,” he said. “The government can stop this trend [of high levels of foreign health and care workers] if they want to, but it will mean missing their targets and NHS performance getting worse.

“Our research for Performance Tracker showed that the crisis last winter in the NHS and social care would have been much worse without international staff.”

Marley Morris, Associate Director at the Institute for Public Policy Research, told PoliticsHome the big "trade off" facing the government is that in order to convince more British people to work in the NHS and care, they will have to significantly increase salaries and improve working conditions — which ultimately will necessitate spending a lot of money.

Care workers are among the lowest paid in the country, and around one in five residential care staff live in poverty, according to The Health Foundation. Lucida Allen, a senior policy officer at the independent charity, said overseas workers play a "vital role in filling staffing gaps in social care", but stressed that international recruitment is "no replacement for more fundamental government action to improve recruitment and retention in social care".

"Sustained government investment and action is needed to grow and support the care workforce in the long term, including by improving their pay and conditions," she said.

Morris added that a sharp reduction in net migration also risks making it harder for the Prime Minister to fulfil his 'grow the economy' pledge — which took a significant hit on Autumn Statement day when the OBR revised down its growth forecasts the next few years.

 “If the government cuts net migration, it will lose some of its fiscal space," he said.

“When you cut net migration, you are cutting your prospective labour force and that has an impact on GDP and potential tax revenue. And we are talking billions in tax revenue.”

He added that foreign workers who secure visas to work in the UK tend to be younger and less likely to use the NHS, and probably won’t have access to benefits, meaning they have “less impact on public services, in that sense", compared with the average person in the UK.

The political pressure on Sunak to bring down net migration before the next election is unlikely to recede. But whether he will be able to deliver the sort of reduction that his anxious backbenchers are pushing for without unintended consequences that turn off voters looks increasingly doubtful. 

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