Zimbabwean NHS and Care Workers in the UK: Rights, NMC Registration, and Exploitation Risks

Tens of thousands of Zimbabweans have come to the UK in recent years through the Health and Care Worker visa route, drawn by the promise of stable employment, career progression, and escape from Zimbabwe's chronic economic difficulties. The reality for many has been far more complicated — and in some cases, deeply exploitative. ## The Scale of the Movement Following the UK government's 2022 decision to add care workers to the shortage occupation list — filling approximately 165,000 vacancies in care homes and domiciliary services — Zimbabwe became one of the primary source countries alongside India, Nigeria, and the Philippines. The brain drain has been significant enough that Zimbabwe's government has formally demanded compensation from the UK, noting it spends roughly $70,000 training each doctor. The UK, by comparison, spends around £230,000 training a doctor domestically — and saves considerably by recruiting already-trained professionals from abroad. ## NMC Registration for Nurses and Midwives For qualified nurses and midwives, working in a clinical capacity within the NHS requires full registration with the Nursing and Midwifery Council (NMC). The process for overseas-trained professionals involves several stages: **Step 1 — Self-assessment and eligibility**: Applicants must hold a recognised nursing qualification (GNM, BSc, MSc, or equivalent) and submit evidence of at least ten years of school education prior to nurse training. **Step 2 — English language proficiency**: Accepted tests include IELTS Academic and OET. Combined scores across two sittings are acceptable provided those sittings are no more than six months apart. **Step 3 — Computer-Based Test (CBT)**: This theoretical exam is conducted at Pearson VUE centres and can be taken in Zimbabwe or another country before arriving in the UK. **Step 4 — OSCE (Objective Structured Clinical Examination)**: This practical clinical competency test is conducted at designated centres within the UK. It assesses hands-on nursing skills against current UK pre-registration standards. **Step 5 — Supporting documents**: A health declaration, employer references, and a character certificate (police clearance from Zimbabwe, or a DBS check if already in the UK) are all required. **Fees**: Full NMC registration costs £140, with provisional registration at £90. The annual renewal fee is £120. When all associated tests and fees are accounted for, the total cost of achieving NMC registration typically reaches approximately £1,170. These costs are borne by the applicant and should be factored into any financial planning. Registration is mandatory before undertaking any independent nursing practice. Working in a care assistant or support worker role does not require NMC registration, but such positions fall under separate visa and employment conditions. ## The Care Visa and Its Collapse For non-nurse care workers, the Health and Care Worker visa was the standard route. Official government fees were relatively modest — £284 for visas up to three years and £551 for longer ones. However, a significant ecosystem of exploitation grew around the Certificate of Sponsorship (COS) that underpins each visa. Every care worker on this visa is tied to a specific sponsor employer. If they wish to change jobs, they must find a new sponsor within 60 days or face deportation. Given that care firms regularly lose local authority contracts or go out of business entirely, this 60-day window left many workers acutely vulnerable. In May 2025, the UK government under Prime Minister Keir Starmer permanently scrapped the care worker visa, citing widespread abuse and exploitation. Hundreds of sponsoring companies had already had their licences revoked. This has left those already in the country urgently needing new sponsors, while those who had paid recruitment fees in Zimbabwe — sometimes thousands of dollars — found their plans abruptly ended. ## Exploitation: What Was Happening A UNISON study titled *Caring at a Cost*, based on surveys of more than 3,000 migrant care workers conducted between November 2024 and January 2025, documented systematic exploitation. Zimbabweans featured prominently among respondents. Common abuses included: - **Illegal recruitment fees**: UK law prohibits recruitment agencies from charging workers placement fees. Despite this, WhatsApp groups circulated offers to connect workers with COS certificates for fees ranging from £4,000 to £7,000. Zimbabwean-run agencies in the UK were reportedly among those charging such fees, sometimes prioritising relatives and friends for COS allocations before selling access to others. - **Wage deductions below legal minimums**: Some employers docked wages for accommodation, training, or other costs, leaving workers below the national living wage. Any deduction that brings a worker below that floor is unlawful, regardless of any contract clause. - **Overcrowded and inadequate housing**: Workers described being housed four to a room in unheated flats, with no cooking facilities — sometimes directly tied to their employment as a condition of their visa. - **Zero-hours contracts**: Workers were offered little or no guaranteed work after arriving, leaving them financially stranded in the UK. - **Threats of Home Office reporting**: Employers threatened to report workers' circumstances to immigration authorities, a tactic used to discourage complaints. Lawyers note this is a misrepresentation — reporting a worker's situation to the Home Office is a routine employer obligation, not a deportation mechanism — but for workers unfamiliar with UK legal norms, the threat was effective. - **Scams in Zimbabwe**: Fraudsters in Zimbabwe sold fake healthcare qualifications and bogus sponsorship packages. One documented case involved a woman paying $3,000 to an agent in Harare without any employment materialising. ## Know Your Rights If you are a Zimbabwean care or health worker in the UK, the following apply regardless of your visa conditions: - You are entitled to at least the national living wage for all hours worked. - Illegal deductions that push your pay below this rate are unlawful and can be challenged through an employment tribunal. - A recruitment agency cannot charge you a placement fee — this is illegal under UK law. - Your employer should not be threatening you with Home Office reports as a means of control. - If your employer loses their sponsorship licence, you have 60 days to find a new sponsor. UNISON and Citizens Advice can assist during this period. - NMC-registered nurses have the additional protection of their professional registration — exploitation or coercion relevant to your practice can be reported to the NMC. Organisations that can help include UNISON (the relevant trade union for health and care workers), Citizens Advice, and specialist immigration solicitors. Taffi Nyawanza, head of immigration at Mezzle Law in Birmingham, has been publicly active on issues affecting Zimbabwean workers in this sector.