Part 2: living and working in the UK - what you need to know as a health and care worker

Question 1

Being aware of exploitation and what to do about it

Accepted Answer

Summary

Be aware of the signs of exploitation. These include being forced to work under poor conditions, without reasonable time off and for little or no payment.

Report concerns about pay, work rights, employment agencies or working hours by completing the government’s online form. In Northern Ireland contact the Labour Relations Agency. For confidential free employment law or workplace advice, contact Acas.

Report concerns about serious exploitation and forced labour to the Gangmasters and Labour Abuse Authority (GLAA).

Do not tolerate exploitation. You may feel threatened and vulnerable, but there are organisations to help you. Contact the modern slavery and exploitation helpline.

What to do if you think you are being exploited

People can experience modern slavery and exploitation in different ways. The GLAA has a guide to exploitation in their Spot the Signs booklets and leaflet on labour exploitation. Also see ‘Access to support’ in the National referral mechanism guidance.

Who to tell if there is a problem with your welfare or employment rights

Usually you should tell your line manager if you’re worried about your welfare or employment rights or those of someone you know. You could also speak to your trade union for further advice and support. A list of trade unions and professional associations is provided in the section ‘Organisations to support you during your employment’ below.

‘Freedom to speak up’ guardians

Freedom to speak up guardians help workers to raise issues affecting their ability to do their job. Find your freedom to speak up guardian on the National Guardian website.

Acas

Acas provides advice on the legal minimum wage, working hours and employment agencies for England, Wales and Scotland. If you think you might be underpaid or your employer has unsafe working practices, you can report your concerns in confidence to Acas.

Labour Relations Agency (Northern Ireland)

The equivalent organisation to Acas in Northern Ireland is the Labour Relations Agency.

Jobs Aware

Jobs Aware provides free help and advice to UK workers who have suffered from job scams or unfair working practices.

GLAA

The GLAA is set up to protect vulnerable workers from exploitation. You can report information in confidence about an employer who may be exploiting the welfare and rights of health or social care staff.

Employment Agency Standards Inspectorate (EAS) and Employment Agency Inspectorate (EIS)

The EAS and EIS (Northern Ireland) regulate employment agencies and businesses, and enforces minimum standards of conduct in the UK recruitment sector.

You can report concerns about the conduct of an agency or any other type of recruitment organisation based in the UK. You can also report concerns relating to fees or conduct of agencies not based in the UK.

Care Quality Commission (CQC)

CQC is the independent regulator of healthcare and adult social care services in England. If you have concerns about the care being provided by your employer, you can report this to CQC. Before contacting CQC, you may want to:

speak to your line manager or a senior member of staff about your concerns
read your employer’s whistleblowing policy

CQC’s quick guide to whistleblowing or guidance for workers gives helpful advice on speaking out about poor care and what legal protection health and social care staff will have. You can report concerns to CQC about an experience of care, or a concern about a service you work for.

CQC equivalents in Northern Ireland, Wales and Scotland

The CQC equivalent in Northern Ireland is the Regulation and Quality Improvement Authority.

The CQC equivalent in Wales is Healthcare Inspectorate Wales (for healthcare services) and Care Inspectorate Wales (for care services).

The CQC equivalent in Scotland is Healthcare Improvement Scotland (inspections, reviews and regulation of NHS Scotland hospitals, services and independent healthcare) or Care Inspectorate (scrutiny body for the quality of care services in Scotland)

UK Visa and Immigration (UKVI)

If your concern relates to your visa contact UKVI.

Health and Safety Executive

Report a health and safety issue in a workforce or public space in England, Scotland or Wales to the Health and Safety Executive.

The Health and Safety Executive equivalent in Northern Ireland is the Health and Safety Executive for Northern Ireland.

Local police force

If you think your concern is related to criminal activity you should report it to your local police force. Find your local police force.

Other organisations that can help you

The organisations listed below are all charities offering support and advice specific to labour exploitation:

Unseen provides safehouses and support in the community for survivors of trafficking and modern slavery. They also run the modern slavery and exploitation helpline
modern slavery and exploitation helpline
Salvation Army provides specialist support and advice for victims of modern slavery in England and Wales. Call the Spot the signs helpline if you suspect someone is a victim of modern slavery
Migrant Help provides support and advice to victims of modern slavery. Contact Migrant Help if you, or someone you know, are a victim of human trafficking

Examples of concerns and who to contact

The following examples are issues you may face and who to contact for help in these circumstances.

Money and fees

You are receiving less than the minimum salary requirements for your visa. Contact Acas.

You have been charged a recruitment fee by your employer or a UK agency. Or your employer is making deductions from your wage for recruitment fees. Contact EAS or EAI (if recruited using an agency) and GLAA.

Money is being deducted from your pay and your employer won’t explain why. Contact Acas if you are employed directly. Contact EAS or EAI if you are an agency worker.

You are being forced to repay extortionate fees associated with your recruitment, accommodation or food, with no control over the debt you have accrued. Most of the money you earn is being taken to pay off this ‘loan’. Contact your local police force and the GLAA. In relation to repaying agency fees, contact EAS or EAI.

Working hours

You are concerned about your working pattern or your employer is not giving you enough hours of work required for your certificate of sponsorship. Contact Acas.

You are being forced to work excessively long hours. Contact GLAA, the Health and Safety Executive and/or your local council (if you work in social care).

You are being physically or verbally threatened for not working beyond your contracted hours. Contact GLAA and your local police force.

Contract

You have been forced to sign a new contract which is less favourable than the one you signed when you agreed to take the job. Contact Acas.

Leaving your role

You have been asked to re-pay excessive fees to your employer when you resigned. Contact Acas.

Quality of care being provided

You are concerned about the level and/or quality of care being provided by a health or care provider. Contact CQC and your local council (for social care).

Documents

You have had your identity documents or passport withheld by your employer. Contact GLAA and your local police force.

Visa

Your employer has threatened to have you deported or remove your certificate of sponsorship. Contact GLAA, your local police force and UKVI.

You have been charged for the certificate of sponsorship by an organisation promising you a visa and a job in the UK. Contact Action Fraud if you believe this is a scam. If you have already paid a fee and/or received a fake certificate of sponsorship, report this as an immigration or border crime.

Fraud

You have been offered an easy way to achieve the required English language test score or to pass a competence or pre-employment check. You should report concerns to Action Fraud and notify your local police force.

If you suspect fraud in the NHS, concerns should also be reported to the NHS Counter Fraud Authority.

Question 2

Arranging accommodation

Accepted Answer

Summary

Make sure you have a clear plan for where you will live, who is arranging it and for how long.

Consider the points set out below if you are taking up the offer of ‘tied accommodation’.

For advice on looking for a home through a private landlord or letting agent, see Shelter.

Contact Citizens Advice or your  local council if there are problems with your rented accommodation and your landlord is not helping. The council can make a landlord take action to correct any problems.

Tied accommodation

Your employer may provide you with accommodation when you arrive (usually for a few weeks or months). It may be offered free of charge, or you may be asked to repay the rent. This is known as tied accommodation.

Ask your employer in advance:

how long you can stay in the accommodation
how you will be paying rent. This will either be out of your wages (your payslip should show the deductions for rent) or as a separate payment

Your employer must provide you with a tenancy agreement detailing your rent and the conditions of your tenancy for you to agree and sign.

Check the rent is reasonable compared with other accommodation in the area before you sign an agreement.

Look for alternative accommodation well before your stay comes to an end.

You do not have to take up the offer of tied accommodation. You are free to source your own accommodation independently.

Accommodation allowances provided by an employer can be taken into account when calculating National Minimum Wage or National Living Wage. This means you could be paid less than the advertised salary if your employer is covering the cost of accommodation.

However, accommodation allowances cannot be taken into account when considering the salary requirements for a Health and Care Worker visa. Your basic salary must meet the minimum salary requirements for your role.

Private accommodation

You can find accommodation in the private sector by searching for housing websites. Shelter provide advice on looking for a home through a private landlord or letting agent.

You will usually have to pay a holding deposit to reserve a property and you may be asked to give references to show you can afford the property. You can ask your employer to provide a reference.

Some landlord or agents ask for a guarantor. This is someone who signs an agreement that they will pay your rent if you do not pay it. Read the private renting guidance to find out about your rights and responsibilities when renting privately.

You may consider sharing a house with other people in what is known as a house in multiple occupation (HMO).

This means you’ll be sharing with at least 3 other people and/or you share a toilet, bathroom or kitchen facility with someone else.

The property must be of a reasonable standard, for example the property should not be overcrowded and there should be enough cooking and bathroom facilities.

Shelter give more information about reasonable accommodation standards and landlord responsibilities.

Who to contact if there is a problem

Contact Citizens Advice or your local council if there are problems with your rented accommodation and your landlord is not helping. The council can make a landlord take action to correct any problems.

Question 3

Worker legal rights, working hours and taking on additional work

Accepted Answer

Summary

Your rights as a worker are protected by UK law. Read the GLAA workers’ rights leaflet.

By law, you must not work more than 48 hours a week on average, unless you ‘opt out’. Even if you opt out, you must take rest breaks from work.

Limiting the hours people work is important for everyone’s health, safety and wellbeing.

Know your worker legal rights

The GLAA information leaflet sets out your legal rights as a worker and what you can expect from your employer. It’s available in 19 languages.

Working hours

You cannot work more than 48 hours a week on average. This law is sometimes called the ‘working time directive’ or ‘working time regulations’.

Even if you opt out of the maximum 48 hour working week you should take regular rest breaks from work.

Additional work

On a Health and Care Worker visa, you can do additional paid work as long as you’re still doing the job you’re being sponsored for.

Question 4

Employment changes and your visa

Accepted Answer

Summary

Your visa may be affected if you change jobs, lose your job, or your employer loses their sponsorship licence. Read the sections below to understand what you need to do if this happens.

Do not accept threats of deportation by your employer. Your employer cannot deport you - the Home Office will decide whether to cancel your visa or not. If they do, you can apply for another visa. See ‘If a sponsor threatens you with deportation’ below for more information on what to do.

If you want to move jobs

Your Health and Care Worker visa and your right to remain in the UK is linked to your employer. If you want to change employers, you’ll need to ensure your new employer is a Skilled Worker sponsor licence holder and willing to sponsor your visa in the new role. Your new sponsor must be A-rated (which means they have the systems and processes in place to allow them to meet their sponsor duties) and will be able to issue you with a new certificate of sponsorship.

You’ll need to apply to update your Health and Care Worker visa.

You may need to pay fees to your employer if your contract included a repayment clause. For information on what to look out for when signing a contract with a repayment clause, check part 1, Annex A, ‘Applying for health and social care jobs in the UK from abroad’.

If you lose your job

If you lose your job (this could be through dismissal or redundancy) your employer will inform the Home Office. If the Home Office decides to cancel your visa, they will write to advise you that your Health and Care Worker visa is ending, and will tell you how long you have left before you need to leave the country or apply for another visa. This will usually be 60 days or the time remaining on your visa if it’s less than 60 days.

You can stay in the UK if you find another health or care job with a new employer who holds a sponsor licence and can issue a new certificate of sponsorship. You’ll need to apply to update your Health and Care Worker visa. Do not travel overseas while your new visa application is being processed; your immigration status will not be protected and may result in your application being withdrawn.

For further advice on losing your job if you have a Health and Care Worker visa, see the citizens advice website.

Employers can lose their sponsor licence if they don’t maintain their sponsor duties or are found to be in breach of the immigration rules.

Find out what to do if your employer loses their sponsor licence.

Do not accept threats of deportation by your employer. Your employer cannot deport you.

They must tell the Home Office if they stop sponsoring you, and the Home Office will decide whether to cancel your visa or not. If the Home Office does decide to cancel your visa, they will write to let you know.

They will normally allow you up to 60 days from the date they write to you (or however long you have left on your visa if it’s less than 60 days) to find another role with an employing sponsor, switch onto another visa route or arrange to leave the UK. If you find a role with another sponsor or want to switch visa routes, you’ll need to make a new application to the Home Office to extend your stay in the UK.

Contact UKVI, your trade union (if you’ve joined one) or a diaspora association (see the list of associations in Annex A below for support with the process).

How long a visa lasts

Employers decide on the length of the Health and Care Worker visa they will sponsor. Usually this is for 3 years but it can last up to 5 years. You will need to apply to extend your visa and those of any dependents before the expiry date. To do this will incur visa application fees. You should check with your employer if they will pay for your visa extension or if you will be expected to meet the costs yourself.

Find out what to do and how much it will cost if you want to extend your visa.

After 5 years you may be able to settle permanently in the UK (‘indefinite leave to remain’). There are certain conditions which need to be met and fees apply.

No access to public funds

You cannot claim public funds on a Health and Care Worker visa (the government refers to this as ‘no recourse to public funds’). This means you and your family members will not be able to claim most benefits, tax credits or housing assistance.

You may be able to access other help and wellbeing support. NHS England has information about a range of financial wellbeing support and ideas to help health and care staff make their money go further.

Question 5

Equality and inclusion in the workplace

Accepted Answer

Summary

Do not tolerate racist behaviour, discrimination, bullying or harassment.

You’re legally protected from discrimination by the Equality Act 2010. If you think you’ve been unfairly discriminated against, you can contact the Equality Advisory Support Service for help and advice, or contact your trade union.

You should be given the same career development and learning opportunities for progression as UK trained workers.

You might find some of the cultural differences difficult at first and adjusting will take time. Where possible, your employer should offer training to ensure your colleagues understand the culture of their international colleagues and to help you learn and adapt to working in a different culture.

Discrimination in the workplace

Employers cannot treat workers less favourably than others because of certain protected characteristics (including age, race, religion or sexual orientation).

It is illegal for an employer to give discriminatory terms of employment, deny promotion, training or withhold benefits, facilities, or services on the grounds of a protected characteristic.

Workers are protected against discrimination at all stages of employment (including recruitment and dismissal). See information on discrimination at work and what you can do if you think you’ve been unfairly discriminated against. You can contact the Equality Advisory Support Service for further information and advice.

Bullying and harassment

Bullying and harassment is behaviour that makes someone feel intimidated or offended Find out more about harassment in the workplace and advice on what to do about it.

Continuing professional development

You should be given the same career development and learning opportunities as UK trained workers. Your line manager should provide you with information about continued professional development and what opportunities are available.

Professional support is important throughout your whole career and should be based on your individual preferences and career aspirations. As part of this process, you should be offered an annual personal development review and a personal development plan.

The following organisations have more information on continuing professional learning opportunities:

Adapting to cultural differences

Your employer should encourage a compassionate and inclusive culture. Where possible, training should be offered to ensure your colleagues understand the culture of their international colleagues and to help you learn and adapt to working in a different culture.

You might find some of the culture differences difficult at first and adjusting will take time. Ask questions and seek support from your employer if you are finding it difficult.

Question 6

Workplace pensions

Accepted Answer

Summary

All employers must offer a workplace pension scheme and automatically enrol eligible workers in it.

More information on pensions, including free and impartial advice is available from Money Helper.

Workplace pension

A workplace pension is a way of saving for your retirement that is arranged by your employer. A percentage of your pay is put into the pension scheme automatically every payday. All employers must offer a workplace pension scheme and automatically enrol eligible workers in it.

If you are joining the NHS, you may be eligible to join the NHS Pension Scheme.

If you leave the UK before you reach normal pension age, your NHS pension can be paid to an account abroad. However, if you leave within 2 years of joining the scheme, your pension contributions (but not those made by your employer) will be refunded to you.

Question 7

Healthcare services

Accepted Answer

Summary

As a migrant worker, you are entitled to receive healthcare in the UK.

Follow the links in this section for more information on the services available.

As a migrant worker, you are entitled to receive healthcare in the UK. This includes primary care, such as seeing a GP, and other services such as urgent care, sexual health services and other hospital services. Depending on which visa you have, this may be free or you may need to pay.

For more information, see:

Local sexual health services in England and Scotland

England

Local sexual and reproductive health services offer sexual and reproductive health support, including HIV testing and HIV prevention drugs (Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP)), free of charge.

Scotland

Local sexual health clinics offer sexual and reproduction health support free of charge, including HIV testing and prevention. In addition Waverley Care is Scotland’s HIV and Hepatitis C charity and provides advice and support for people living with or at risk of HIV and hepatitis, and information about sexual health.

Question 8

Organisations to support you during your employment

Accepted Answer

Trade unions and professional associations

Consider joining a UK based health or social care professional trade union or professional association as soon as you begin your employment. These organisations can support you in lots of ways, including providing employment and immigration advice, access to legal services and other professional services. If a problem arises, they can get you the right support and representation.

If you join after a problem has occurred it is harder for these organisations to represent you - so consider joining when you first start your job. You’ll need to pay a membership fee, but some trade unions offer a discounted membership fee for international members.

Information on specific trade unions and professional associations:

Professional regulatory organisations

If you will be working in a role that is professionally regulated, the professional regulatory bodies can provide advice and guidance on what you need to do to join the register. They will also investigate any concerns about your fitness to practice. For contact details for the professional regulatory bodies see part 1, Annex C, ‘Applying for health and social care jobs in the UK from abroad’.

Religious support groups

Religious support groups can provide a safe and supportive space with people who share your experiences and find comfort in faith. Your employer may be able to provide information about these local groups. If your employer does not hold this information, reach out to a diaspora association or your local council.

Diaspora groups and associations

Diaspora groups or associations are communities or networks of international health or care workers of the same nationality or culture. They can link you up with other international recruits from your home country and support you with your continuing professional development. Information on nursing and medical diaspora associations, support organisations and charities are in Annex A below.

Question 9

Annex A: list of diaspora associations and support organisations

Accepted Answer

Nursing associations

Nursing associations are voluntary sector organisations representing international nurses and midwives and are working to advance and promote the pastoral and professional support available to them as well as ensuring their health and wellbeing.