This series was supported by the Pulitzer Center and produced in partnership with the nonprofit newsroom Type Investigations, with additional support from the Gertrude Blumenthal Kasbekar Fund and the Puffin Foundation.
When Maria arrived in England in March 2022, she had certain expectations. She knew she would be living on the Isle of Wight, a beautiful piece of land off the southern coast of the United Kingdom. This was her first time leaving India, so everything was new and exciting. Maria had signed up with a private firm to work as a domiciliary care worker, providing care for the elderly or infirm in their own homes. It was quite different from her previous experience as a nurse in India, where she worked in operation theatres and cardiology wards. However, she saw it as a temporary change, driven by her desire for a better quality of life, better education for her children, and eventually working in the well-staffed and well-resourced hospitals of the National Health Service (NHS).
What Maria didn’t anticipate was her overwhelming work schedule: 20 home visits a day, driving from one house to another. Her workday began at 7 am and ended at 10 pm, with a hurried lunch eaten in the car. On top of that, she had never learned to drive on English roads and had to deal with the constant demand for more money from the Indian employment agency that had recruited her. Maria had already paid the agency around £6,000 ($7,150) to secure her job, a practice that is illegal in the UK and exploitative in India. She was bullied over the phone and her family back home was threatened. One incident involved the agency uploading a photo of her 18-month-old child on a WhatsApp group as a means of intimidation. The photo was taken down after just 10 minutes, likely due to concerns about potential abuse. Maria, a 29-year-old nurse who requested to remain anonymous, is one of many nurses and care workers who have migrated to the UK. These individuals are employed in privately run care homes or work for private companies that send care workers to patients’ homes. Brexit and the pandemic have resulted in a shortage of social care workers, with nearly 100,000 vacancies in the sector as of 2021. An additional 40,000 people left their jobs in the last six months of 2021. According to Nadra Ahmed, chair of the UK’s National Care Association, there is simply not enough domestic workers to fill these positions.
To address the shortage, the British government made it easier for foreign care workers to obtain work visas. In 2022, 30,000 visas were made available, with a minimum annual salary of £20,480 ($23,570) and the option to renew the visa for up to 12 months. Workers could also bring their families to the UK, potentially allowing them to settle there permanently. While the new visa policy has helped address the staffing crisis, it has also led to a surge in labor exploitation. Interviews conducted by Quartz and Type Investigations with nurses, care home officials, recruitment agency employees, and nursing union representatives in India and the UK revealed widespread labor exploitation. Agencies in the UK, India, and other countries charge nurses thousands of pounds to find them care jobs and process their paperwork. This leaves nurses in significant debt and tied to exploitative contracts, which is considered “modern slavery” by the UK government. Some agencies deceive applicants by promising services they never deliver, while others have questionable credentials or hidden identities. The British government’s Department of Health and Social Care has stated that it is working with enforcement agencies to take action against those breaking the law. The Gangmasters & Labour Abuse Authority (GLAA), one such agency, has identified and offered assistance to over 50 Indian care workers who are victims of abuse and modern slavery since the start of 2022. However, many exploited workers are unaware of the GLAA and its resources.
In Maria’s case, she wasn’t aware of the GLAA, nor were the other nurses who arrived with her. One nurse even returned to India within weeks, feeling isolated and overwhelmed by the financial demands of her agency. Maria decided to endure the challenging circumstances to repay the loan she had taken. However, she sometimes wonders if she should have come to the UK at all.
In Maria’s home state of Kerala, nursing is a highly respected profession. Many nurses from Kerala work in hospitals not only in India but also in other countries. The Kerala government operates its own agency to place nurses overseas, and tens of thousands of nurses emigrate from the state every year. When the pandemic hit, Maria returned to Kerala, where her husband owned a car rental agency in Kochi. She planned to study for the International English Language Testing System (IELTS) to qualify for working in the NHS, which typically hires nurses from India and other countries. However, the demand for foreign nurses significantly increased during the pandemic, leading to a staffing crisis in the UK. The NHS has a rigorous recruitment process for hiring foreign nurses, working only with “ethical” recruiters who charge candidates no fees. The NHS covers all costs, including visas and travel, for these nurses. However, the process is highly competitive, making it difficult for nurses like Maria to qualify. The “carer” visa category, which supplies workers to private care companies and care homes, is less regulated and has less stringent requirements than an NHS visa. Nurses with other care experience can qualify without a nursing qualification, and the language proficiency requirement can be met with overseas degrees taught in English, even if fluency is lacking. This allows individuals who can afford agency fees to enter the UK to work in the care sector.
In January 2021, Maria went to a Kochi agency to inquire about the carer visa and was quoted a price of 600,000 rupees (around £6,300 or $7,500).…
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