Reform UK's proposed policy to introduce an annual levy on employers for overseas staff could inflict significant damage on the NHS, social care, and education sectors across the UK, according to warnings from leading experts. The plan, which includes a 'migrant worker surcharge' and increased employer National Insurance contributions for all non-UK passport holders (with the exception of Irish citizens), aims to incentivise organisations to prioritise British employees. However, think tanks and professional bodies argue that this approach fails to acknowledge the critical reliance these sectors have on international workers, often due to insufficient numbers of available UK staff.
The King's Fund, a prominent health think tank, has voiced concerns over the potential financial strain on the NHS. With approximately 20% of NHS England's workforce comprising non-UK nationals, any additional costs imposed by such a levy would stretch an already beleaguered service. Suzie Bailey from the King's Fund suggested that these extra expenses would inevitably necessitate cuts elsewhere, ultimately impacting the quality and availability of patient care. Similarly, Professor Victoria Tzortziou Brown, President of the Royal College of General Practitioners, highlighted the counter-productive nature of penalising overseas GPs, many of whom have undertaken specialist training within the UK at public expense. She noted that general practices, typically small independent services, could be disproportionately affected by increased employment costs, potentially hindering patients' access to vital care.
The social care sector, already grappling with rising demand and a shortage of UK workers exacerbated by the Covid-19 pandemic, would also face severe challenges. Jane Townson, Chief Executive of the Homecare Association, explained that employing overseas care staff is already more expensive and complex. A levy that disproportionately targets lower-paid workers, as Reform UK has indicated, would place an unbearable burden on providers. Townson warned of reduced access to essential home care services, increased hospital bed blocking, potential exploitation of workers, and widespread provider failures, ultimately shifting costs back onto the public purse.
In education, while non-UK nationals constitute nearly 6% of teachers in England, their presence is particularly crucial in secondary schools and in subjects facing persistent shortages, such as languages and physics. James Zuccollo, head of school workforce at the Education Policy Institute, pointed out that many overseas teachers are long-term UK residents, some with settled status. He cautioned that the policy would not only deter future recruitment but also impose a charge on existing staff who have contributed to UK schools for years. The Higher Education Policy Institute also raised alarms about universities, many of which are currently operating with deficits. Nick Hillman, the think tank's chief executive, stated that increased wage bills for a workforce where salaries can account for up to 60% of budgets could push some institutions to the brink of bankruptcy.
This proposed policy comes at a time when the NHS continues to face significant workforce challenges, with recent data from NHS Digital showing over 120,000 vacancies across NHS trusts in England as of March 2026. Official UK health data consistently highlights the critical role of international recruits in filling these gaps, particularly in nursing and medical specialties. NICE recommendations frequently emphasise the importance of a well-staffed, diverse workforce to deliver high-quality patient outcomes. Any measure that restricts or penalises the recruitment of overseas professionals could exacerbate these existing pressures, potentially leading to longer waiting lists and reduced service provision across the health and social care landscape.