Earned Settlement: What the New Rules Mean for the Health & Care Sector

Health and Care covers workers sponsored in eligible health occupations (for example in the NHS, NHS suppliers and adult social care) and in adult social care, most will hold the Health and Care Worker visa, a form of Skilled Worker permission. For earned settlement, the sector matters in three ways:

1. eligible public service occupations paid on national pay scales qualify for a permanent five-year pathway;
2. health workers below RQF level 6 on national pay scales who arrived before May 2025 keep a five-year route on a one-off transitional basis; and
3. care workers have their own transitional arrangements.

Common occupations (SOC 2020 codes) within health and care include:

• Nurses and midwives: 2231 Midwifery nurses; 2232 Registered community nurses; 2233 Registered specialist nurses; 2234 Registered nurse practitioners; 2235 Registered mental health nurses; 2236 Registered children’s nurses; 2237 Other registered nursing professionals (eligible for the permanent five-year pathway)

• Social workers: 2461 Social workers (eligible for the permanent five-year pathway)

• Healthcare support roles: 6131 Nursing auxiliaries and assistants (five-year route only under the one-off transitional arrangement if in the UK before May 2025 and on a national pay scale; otherwise ten years)

• Care workers: 6135 Care workers and home carers; 6136 Senior care workers (care worker transitional arrangements if on the route before May 2025; otherwise the standard ten-year pathway unless an accelerated pathway is me

SOC codes above follow Appendix Skilled Occupations and should be checked against the current Immigration Rules for each worker’s CoS.

Useful resources:

Appendix Skilled Occupations (https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-skilled-occupations )

Health and Care Worker visa (https://www.gov.uk/health-care-worker-visa)

Why should I read this?

In November 2026, the Home Office published its response to the consultation on “A Fairer Pathway to Settlement”, alongside a statement by the Home Secretary to the House of Commons. The response confirms a new system for indefinite leave to remain (‘ILR’), which the government calls “earned settlement”, taking forward a commitment originally made in the government’s Immigration White Paper published in May 2025.

What will the new rules involve?

Under the new rules the default wait for ILR will rise from five years to ten years, with faster or slower pathways linked to specific factors such as character and contribution. Sponsored workers will remain tied to their employer for longer, increasing sponsorship costs. Workers on lower pay face the biggest change, with consequences for recruitment, retention, pay and workforce planning. The response does not confirm a timetable for the new rules to take effect; however, the Home Secretary has announced that the changes will begin to be laid from the December 2026 Immigration Rules and will be implemented over the course of 2027.

What has changed since the consultation?

The consultation ran from 20 November 2025 to 12 February 2026 and received over 200,000 responses. The government has made three significant changes to its proposals following consultation:

• It has dropped the proposed 15-year route for workers in roles below degree level
• Volunteering will no longer shorten the wait
• C1 (advanced) English will no longer provide a shorter route

Removing the proposed 15-year pathway is a positive development for employers of workers in occupations below RQF level 6. These workers will generally be subject to the ten-year pathway, although they may qualify sooner if they meet the requirements for an accelerated pathway. For care workers and healthcare support workers recruited after 12 May 2025, the ten-year pathway will be the norm, as few will likely reach the £50,271 accelerated threshold.

The new settlement pathways

Wait	Who qualifies	Main earnings test
3 years	Highest earners and the highest talent group	£125,141 a year in three of the last four years
5 years	Higher earners, eligible health and education workers (e.g. doctors, nurses, midwives, allied health professionals and social workers in Annex C (page 54) occupations)), and people with a British connection	£50,271 a year in three of the last five years
	Care workers who entered or switched into the route before 12 May 2025	£25,000 a year
10 years	The new default for everyone else, including care workers and healthcare support workers who joined after May 2025	£12,571 a year in five of the last seven years
20 years	People whose immigration non-compliance or access to public funds prevents them from qualifying for an earlier pathway	£12,571 a year in five of the last seven years

 

The thresholds are linked to the income tax bands and will move with any future changes to those bands. Earnings are assessed using a “best years” approach over a longer period, so maternity leave, caring responsibilities or illness need not result in a longer route to settlement. Couples can also combine their income, with a household threshold of £25,142 a year.

Pay will therefore play a significant role in how quickly a worker can settle. Skilled Workers earning below £50,271 will face a ten-year wait, double the current five-year period, while a pay rise above £50,271 could halve that wait. Employers may therefore see more requests for pay rises linked to settlement and may need to consider how this interacts with existing pay structures.

Doctors, nurses, midwives, allied health professionals and social workers in Annex C occupations qualify for the five-year pathway regardless of salary, provided they meet the other settlement requirements, because their pay is set by national pay scales. The government’s own example is a social worker earning below £50,271 who can still use the five-year route. Annex C draws on the health and education SOC 2020 occupations in Appendix Skilled Occupations whose going rates are based on national pay scales, so employers should check that each worker’s occupation appears on that list. The public service table does not include care workers, senior care workers or nursing auxiliaries.

Minimum requirements for every applicant

Subject to limited exemptions, every applicant must meet five requirements. Higher earnings cannot compensate for failing any of them:

• Meet the strengthened good character and suitability requirements, including in relation to criminality
• No unpaid government debt, including NHS (National Health Service) charges, tax, National Insurance and Home Office legal costs
• English at B2 level
• A pass in the Life in the UK test
• A record of sustained earnings of at least £12,571 a year

An individual who overstays, breaches a visa condition or uses deception will move onto the 20-year route, regardless of earnings. Breaching a condition of leave includes working outside the sponsored role, for example a care worker undertaking supplementary work in an ineligible occupation code or for an unsponsored employer.

Criminality will be assessed more strictly under the new system, meaning that offences may have greater consequences for settlement than they do under the current rules. This could affect the ability of employers to retain sponsored workers they had expected to remain in the UK long term.

Which routes count towards ILR?

The Home Office plans to close the ten-year long residence route. Time spent on temporary routes will no longer count towards ILR. These routes include:

• Student and Graduate
• Global Business Mobility
• Temporary Worker routes, including Seasonal Worker
• Youth Mobility and High Potential Individual

Time spent on the Skilled Worker, Global Talent, Scale-up, Innovator Founder and UK Ancestry routes will still count. However, not all immigration routes qualify for every settlement pathway. Applicants must hold permission on a route eligible for the relevant pathway and meet the applicable contribution, integration, character and residence requirements. Eligibility for the shorter three- and five-year pathways will therefore depend on the route held and the relevant earnings, public service, British connection or highest talent criteria.

Employees on the Graduate or Global Business Mobility routes will begin building qualifying residence only when they move onto an eligible route. Employers intending to retain them in the UK long term may therefore wish to consider an earlier switch to the Skilled Worker route.

Time on the Health and Care Worker visa, as a form of Skilled Worker permission, counts towards settlement. This is particularly relevant for overseas graduates moving into NHS or care roles.

Dependants

A partner who arrives with the main applicant can settle at the same time, while a partner who joins later must complete the same qualifying period. Children under 18 can settle with their parents. Young adults aged 18 to 24 who retain child-dependant status can settle with their family without the individual earnings test, but must meet the other adult mandatory requirements. Dependants aged 25 or over must qualify in their own right.

These rules may also affect retention. For employees with families, a longer or different route to settlement for their dependants may influence whether they remain in the UK, particularly where they have older children.

From 26 March 2027, partner and adult child dependants will need to meet English language level B2, increased from B1. This may affect a Skilled Worker’s ability to apply if their dependant is unable to meet the English language requirement.

Transitional protection

The government has rejected a general exemption for people already in the UK. Protection is limited to three groups, two of which are specific to health and care:

• Care workers who entered, or switched into, the route before the 12 May 2025 Immigration White Paper will keep a five-year route. They must earn £25,000 a year and meet the other eligibility requirements. Those who do not qualify after five years can apply for a further five-year Health and Care visa and then apply for settlement again.

• Health and education workers below RQF level 6 on national pay scales, such as nursing auxiliaries, will keep a five-year route if they came to the UK before 12 May 2025 and meet the requirements of their visa. This is a one-off arrangement.

• Skilled Workers sponsored before April 2024 can extend on their current salary terms until 2035.

From 1 February 2027, care workers who lose their employment because their sponsor’s licence is revoked will have up to 120 days to secure a new job offer, followed by a further 60 days to resolve their visa and employment status. If they cannot do so, their visa will be curtailed. The government has said it will help affected workers find a legitimate provider. Most current sponsored workers will receive no protection. The new rules will apply to them when they apply, so employers should explain this risk to staff early.

Care workers who switched into the care route after May 2025 have no transitional protection and will normally follow the ten-year pathway.

What happens next?

The Government will publish further technical and operational guidance before implementation. Changes will begin to be laid from the December 2026 Immigration Rules and will be implemented over the course of 2027.

• Key actions for your organisation

• Map each sponsored worker’s date of qualification for ILR taking into account previous qualification routes

• Map sponsored workers earnings against the new thresholds and consider salary progression to date of ILR

• Review immigration assistancepolicies and consider whether ILR costs and extended sponsorship periods will be funded, and whether clawback provisions are appropriate

• Budget for longer sponsorship periods and sponsorship costs over a ten-year period

• Review pay and promotion plans for staff near the £50,271 threshold

• Consider how responses will be made to workers who request pay rises for settlement purposes

• Update retention plans for staff facing a longer wait

• Consider the dependant position as staff may need longer sponsorship to allow dependants to apply together or where dependants cannot meet the requirements

• Tighten checks on sponsor duties and right-to-work compliance and consider how compliance can continue to be resourced and met with a larger skilled worker population

• Brief staff on the B2 English, criminal record and other requirements and consider putting together an FAQ

• Track the Home Office guidance and start date

Health & care employers specifically should also:

• Check each worker’s SOC code against the Annex C public service list to identify who qualifies for the five-year pathway

• Identify care workers and healthcare support workers who joined the route before 12 May 2025, and check whether care workers meet the £25,000 salary and sponsorship requirements

How we can help

Our global mobility and immigration team advises employers at every stage of sponsorship and settlement. We can review sponsored workforces against the new rules, help organisations plan their pay, reward and retention approaches, and train HR and global mobility teams on the changes.