In short: under the Government's response to A Fairer Pathway to Settlement, a Health and Care visa holder's settlement pathway depends on what the job is and when they arrived. Nurses, doctors and other occupations in Annex C qualify for a five-year pathway. Care workers are not on that list, but those who entered or switched into the route before the May 2025 Immigration White Paper keep the five-year period if they meet the route's requirements. Care workers who came after that qualify through the ten-year pathway.
Status: the response was presented to Parliament in November 2026 as Command Paper CP 1707. It is the Government's policy, not Immigration Rules, and it says further guidance will be published before implementation. Until a Statement of Changes is laid and comes into force, the rules in force when you apply are the ones that govern your application.
1. Nurses, doctors and other public service occupations
Eligible workers in specified health and education occupations — for instance doctors, nurses and teachers — can qualify for settlement after five years, provided they meet the other settlement requirements. The qualifying occupations are the health and education public-sector roles that the Immigration Rules already identify as paid on national pay scales, following the Migration Advisory Committee's advice.
The health occupations listed in Annex C are:
- generalist and specialist medical practitioners
- physiotherapists, occupational therapists, and speech and language therapists
- psychotherapists and cognitive behaviour therapists, clinical psychologists, other psychologists, and therapy professionals not elsewhere classified
- midwifery nurses, registered community nurses, registered specialist nurses, registered nurse practitioners, registered mental health nurses, registered children's nurses, and other registered nursing professionals
- pharmacists, optometrists and dental practitioners
- medical radiographers, paramedics and podiatrists
- other health professionals not elsewhere classified
- social workers
The education occupations listed are further, secondary, primary, nursery and special and additional needs teaching professionals, and head teachers and principals. Annex C does not include care worker occupations.
Someone in a listed occupation does not need to earn £50,271. The response gives a social worker earning below that figure as an example of someone who can still use the five-year route.
2. Care workers who arrived before May 2025
The response treats existing care workers as "a unique cohort". It describes how recruitment expanded between 2022 and 2024 to meet acute shortages, and also says the route was abused: rogue sponsors offered jobs or hours that did not exist, and many people did not go on to do the genuine care work required.
It introduces a targeted, one-off transitional arrangement:
- Who: care workers who entered, or switched into, the route before publication of the Immigration White Paper in May 2025.
- What they keep: the existing five-year qualifying period, where they meet the applicable salary (£25,000 a year), sponsorship and employment requirements. They must also meet the strengthened minimum requirements, including criminality and English language, unless an exemption applies.
- If they do not qualify after five years: they will not qualify simply by completing five years. They can apply for a further five-year Health and Care visa, restricted to genuine work in the sector, with no recourse to public funds, to give them more time to meet the requirements.
- After May 2025: care workers who entered or switched in after that point qualify through the standard ten-year pathway.
If your sponsor loses its licence
The response recognises that some care workers have lost their sponsor through no fault of their own. From 1 February 2027, care workers who lose their job because a sponsor licence is removed will have up to 120 days to secure a job offer and a further 60 days to resolve their visa and employment status. If they cannot secure a job offer within 120 days, or resolve their status within 180 days, the visa will be curtailed and they will need to leave the UK. The Government says it will continue to work with care workers to help them find a new employer.
3. Health and education workers below RQF 6
Workers in healthcare and education occupations below RQF 6 that are on a national pay scale — the response gives nursing auxiliaries and teaching assistants as examples — keep a five-year route if they came to the UK before the May 2025 White Paper and meet the requirements of their visa. This is a one-off arrangement for the existing cohort. Those arriving later qualify through the ten-year pathway, with the chance to qualify sooner.
The ten-year default
Where none of these routes applies, the default is ten years, with earnings of at least £12,571 in five of the seven years immediately before applying. The response assesses earnings on a "best years" basis, recognising maternity or parental leave, caring responsibilities and ill health. For the three-, five- and ten-year pathways you must also not have accessed public funds in the last five years or committed a qualifying immigration breach.
The response's own examples
- An existing care worker who meets the requirements. Entered on a Health and Care visa in 2023, remained in genuine sponsored employment and meets the salary and other requirements. They keep the five-year pathway.
- An existing care worker who does not. They will not qualify simply because five years have passed, but will be supported to move into genuine sponsored employment on a Health and Care route.
- A care worker who switched into the route after May 2025. The transitional arrangements do not apply. They qualify through the ten-year pathway.
The minimum standards everyone must meet
These cannot be offset by higher earnings or public service:
- Good character and suitability. Any adult with a criminal record in the UK will be refused settlement.
- No outstanding Government debt, including NHS debt, tax debt and litigation debt owed to the Home Office.
- English at B2 (the current standard is B1), subject to exemptions for children, people aged 65 and over, and people unable to meet it because of a physical or mental condition.
- The Life in the UK test.
- Sustained contribution.
A specified immigration breach committed as an adult places you on the 20-year pathway whatever you earn.
What the Home Office expects
Its illustrative forecast puts 136,000 Health and Care route holders (excluding care workers) on the five-year pathway. For care workers, it says 196,000 are in the cohort, and indicatively around 146,000 could be eligible for the transitional arrangement and around 50,000 would be on the ten-year pathway. These are estimates, and the response says the size of the care worker cohort is uncertain.
What governs your application today
The rules in force when you apply. If you are counting towards settlement now, you are counting under the current rules. See our Earned Settlement page.
Sources
- GOV.UK: A Fairer Pathway to Settlement — Government response to the consultation, CP 1707 (PDF) — public service on pages 12–13, Chapter 8 on pages 37–41, Annex A and Annex C (pages 54–55)
- GOV.UK: Immigration Rules — Statements of Changes
- GOV.UK: Settle in the UK
This is general information, not legal advice. This page reports a policy response, not a prediction, and is not a basis for delaying or accelerating an application.