(UNITED KINGDOM) Up to 50,000 nurses trained overseas could leave the UK if new immigration reforms go ahead as planned, the Royal College of Nursing has warned, raising fresh fears for an already stretched National Health Service. The figure comes from research the union released on 20 November 2025, suggesting that almost half of internationally educated nurses are now planning to move away from the country rather than build long-term lives and careers in British hospitals.
What the government proposals would change
The research centres on government proposals to tighten rules for migrant health staff in a bid to cut net migration. The most far‑reaching change would be to extend the route to Indefinite Leave to Remain (ILR) from five years to ten years for many workers, including nurses who came from abroad. The plans also include:
- Tougher English language and skills demands
- Reduced access to public benefits for people on temporary visas (expanded application of No Recourse to Public Funds rules)
- Higher cumulative fees across a longer period on temporary visas
Under present rules, many migrant nurses can apply for ILR after five years of lawful residence, which gives them strong long‑term security. Official guidance on ILR is published on the UK government’s website at gov.uk. The proposed move to a ten‑year wait would mean double the time on temporary visas, with higher fees over that period and longer exposure to NRPF rules that block access to most welfare support.
Survey findings and where nurses might go instead
The RCN surveyed more than 3,000 internationally educated nurses. Key findings:
- 42 percent said they are already planning to leave the UK.
- 70 percent of those considering leaving said low pay was a key factor.
- 40 percent pointed directly to the planned immigration changes as a reason for thinking about quitting the UK.
Many respondents are not necessarily returning to their country of initial training. Instead, they are looking at other destinations that actively recruit health workers—most commonly Australia, Canada 🇨🇦, and New Zealand. These countries often promote:
- Shorter routes to permanent status
- Higher pay
- Easier access to family support
If tens of thousands of nurses choose these destinations over the UK, professional bodies warn that British hospitals could find it even harder to fill rotas and cut treatment backlogs.
Recent context: visa numbers and care-worker rules
The RCN’s research comes as new data show foreign nurse visa approvals have collapsed by roughly 80 percent year‑on‑year, sharply reducing the flow of new staff into the system. That drop follows earlier steps to narrow entry routes for care workers.
- On 22 July 2025, the UK stopped accepting new visa applications for care worker and senior care worker roles.
- A limited transition period until 2028 allows current holders in those roles to renew and keep working.
Union officials and health managers say this decision has already left some care homes struggling to cover shifts. They fear knock‑on effects for hospitals when social care cannot discharge patients quickly.
RCN’s demands and proposed mitigations
The Royal College of Nursing is urging ministers to rethink key parts of the immigration plan. Their main asks include:
- Keep the five‑year path to ILR, or at least shorten the suggested ten‑year period.
- Lift No Recourse to Public Funds (NRPF) for migrant nurses so they can claim help during personal emergencies, family crises, or sickness.
- Reduce visa and settlement fees, including for ILR applications, which can be hard to pay on nursing salaries—especially for staff with children.
- Strengthen protection against discrimination and provide better support for migrant staff in the workplace.
The RCN argues that a clear and fair route to settlement helps hospitals retain staff and gives nurses confidence to put down roots in their local communities.
Impact on hospitals, services and workforce
Health leaders warn that if even a share of the possible 50,000 nurses do leave, the impact on patient care could be severe. The UK is already dealing with:
- Long waiting lists
- High demand in emergency departments
- Shortages in community services
Experienced migrant nurses often carry key skills on busy wards, lead teams, and train new recruits. Losing them at scale would not only reduce staff numbers but could also drain hard‑won knowledge from hospitals and clinics.
“If word spreads that it now takes a decade to gain firm roots in the country, while pay stays low and access to public support is tightly limited, the UK may slip down the list of preferred destinations for skilled health workers.”
The individual dimension
For many nurses, the choice is deeply personal. Many have already spent years in Britain, built friendships, and started families. The move from a five‑year to a ten‑year wait for ILR would mean:
- More time worrying about visa renewals and changing rules
- Greater financial strain from repeated visa and settlement costs
- Longer periods under NRPF constraints
Some nurses may decide it is safer to move to countries where permanent status comes more quickly, even if that means uprooting their lives again.
Political and operational pressures
Officials now face pressure from several sides:
- Unions and migrant groups want reforms softened for key workers, especially in health and social care.
- Some politicians back tougher rules, arguing the same rules should apply across work routes and that lower migration will push employers to improve pay and training for local staff.
The government has not yet released full legal drafts of the new measures, leaving nurses to plan their futures based on broad policy outlines rather than firm rules.
Wider recruitment picture
According to analysis by VisaVerge.com, many destination countries that compete with the UK now stress not only pay, but also support for families and clear routes to long‑term status when recruiting abroad. This competitive international environment matters because:
- The UK has relied heavily on foreign staff to keep wards open and services running.
- A decline in international recruitment, combined with planned tighter rules, risks accelerating staff losses.
Key statistics (at-a-glance)
| Item | Figure / Detail |
|---|---|
| RCN survey size | >3,000 internationally educated nurses |
| Planning to leave | 42% |
| Citing low pay | 70% of those considering leaving |
| Citing immigration changes | 40% of those considering leaving |
| Possible number leaving | Up to 50,000 nurses |
| Drop in foreign nurse visa approvals | ~80% year‑on‑year |
| Care worker visa applications stopped | From 22 July 2025 (transition until 2028) |
Final considerations
As debate continues, hospitals across the country must plan for the risk that a large share of their international workforce could seek jobs elsewhere over the next few years. Managers already used to running services with thin staffing margins may find it even harder to keep wards open, cut waiting times, and meet growing demand from an ageing population.
For many in the health service, the immediate question is whether immigration policy will adjust to protect this workforce, or whether the UK will test how far its health system can stretch with fewer international staff to hold it together.
The Royal College of Nursing warns that planned UK immigration reforms—raising the ILR residence requirement from five to ten years, tightening language and skills tests, expanding NRPF, and increasing cumulative fees—could prompt up to 50,000 internationally trained nurses to leave. An RCN survey of over 3,000 nurses found 42% planning to leave, with low pay and immigration changes cited. Foreign nurse visa approvals have fallen roughly 80% year‑on‑year. The RCN calls for preserving a five‑year ILR route, reducing fees, and lifting NRPF protections for nurses.
