Health, Immigration and Labour’s Contradictory Electoral Base

The pressure on the UK's health and social care services cannot be separated from changes to migration policy and the broader political choices confronting the Labour Party. In 2024, the Conservative government implemented significant legal migration restrictions, including a ban on overseas care workers and students bringing dependants, and a steep rise in the salary threshold for skilled workers to £38,700. These changes were part of an effort to curb net migration and have already had visible effects: recent data suggests that net migration is likely to fall sharply over 2025.

However, this decline in migration coincides with a worsening crisis in the NHS and adult social care. Overseas workers have long been central to the health and care workforce. The recent restrictions have led to thousands fewer care worker visa applications, with providers already reporting rising vacancies. This compounds pressures on the NHS, because when care services are unable to safely discharge patients into the community, hospitals are left overstretched with 'bed-blocking'. In essence, a crisis in care cascades into a crisis in health.

International students also play a crucial economic role, contributing an estimated £41.9 billion annually to the UK economy. Limiting their ability to bring family members may reduce the attractiveness of UK institutions, undermining university funding and putting downward pressure on local economies and health trusts reliant on their fee income.

This is the context for Labour’s political dilemma. On one side, the party is leaking votes to Reform UK, which has surged in recent polls. A poll in early 2025 suggested that Labour was just 6 points ahead of Reform (23% to 17%), projecting 278 seats for Labour versus 120 for Reform. The Tories trailed Labour with just 20% of the vote — only marginally ahead of Reform — and may pivot further to the right to reclaim lost ground rather than risk formal collaboration with their insurgent rivals. The possibility of a Labour minority government looms.

Yet, the heart of this contradiction lies in Labour’s divided voter base. According to polling, 55% of those who voted Labour in 2024 but now intend to vote Reform rate immigration as the most important issue, while 58% of loyal Labour voters rate health and the NHS as one of their top three concerns. Among those switching to Reform, this falls to just 47%. This divergence indicates a structural tension in Labour’s electoral coalition: appealing to voters anxious about immigration risks alienating its base that prioritises public service investment.

The danger here is twofold. First, if Labour adopts restrictive immigration policies to placate swing voters, it undermines the labour force needed to sustain the NHS and social care. Second, if it does not challenge the narrative that immigration is the root cause of pressures on public services, it reinforces the legitimacy of the far-right framing that fuels Reform's rise.

Labour’s attempt to straddle this divide — through fiscal caution and technocratic health reform on one hand, and rhetorical nods to border control on the other — risks satisfying neither camp. Without a bold, integrated strategy that links migration, care, and public health investment — underpinned by an honest account of the economic role migrants play — it is likely to be squeezed between a rising Reform and a re-radicalising Conservative Party.

In short, Labour’s electoral viability hinges not just on triangulating policy priorities, but on reshaping the debate around who sustains the health system and why the crisis we face is structural — not demographic.