New UK settlement rules announced in November 2026: What they mean for healthcare workers and English tests

On 2 November 2026, the UK Government’s Home Secretary Shabana Mahmood announced her final decision on the UK’s new "earned settlement" system. The standard wait for indefinite leave to remain (ILR) doubles from five to 10 years, with shorter routes for people who contribute more to the UK’s key workforce gaps.

The plans were first set out in November 2025 and went out to consultation. Some elements were softened after a backlash from Labour MPs. Most notably, a proposal to make foreign care workers already in the UK wait 15 years for settlement has been dropped.

For the health and care workforce, and the thousands of health and social care workers who sit English tests (mostly IELTS but also OET) with MTS each year, the detail matters. This post explains what has changed, who qualifies for the faster routes, and which English test healthcare workers actually need.

The key changes at a glance

How long someone waits for settlement will now depend on what they earn, the work they do and how they arrived.

Every applicant will also need to meet some baseline conditions:

• Speak English to a high standard

• Owe no debt to the government, such as unpaid tax

• Earn at least £12,571 a year for at least three years, in line with the income tax threshold

• Have no criminal record as an adult

The changes apply to migrants already living in the UK, but not to anyone who has already been granted settlement. Children under 18 can still settle with their parents and are exempt from the English language and Life in the UK test requirements. Separate, longer timelines apply to refugees, particularly those who arrived by small boat or another irregular route.

What it means for healthcare and care workers

The health workforce has come out of the final decision better than many expected. There are three groups to know about.

• Skilled health workers such as doctors and nurses keep a five-year route to settlement, alongside teachers and social workers.

• Lower-skilled health and education staff, such as nursing auxiliaries and teaching assistants, also get five years, but only if they arrived in the UK before May 2025.

• Care workers can settle after five years if they arrived before May 2025 and earned at least £25,000 a year while meeting their visa conditions. The earlier proposal for a 15-year wait has been scrapped.

Care workers who arrived from May 2025 onwards, or who earn below £25,000, fall back on the standard 10-year route unless another fast-track applies to them.

Whatever the route, every applicant still has to meet the English requirement. That is where the type of test matters.

Which English test do healthcare workers need?

It depends on whether the job is a regulated profession. Doctors, nurses, midwives and dentists usually do not need a Secure English Language Test (SELT) at all. Care workers and other unregulated roles do.

Regulated professions: IELTS Academic or OET

To work in the NHS, doctors, nurses and midwives must first register with their professional regulator, and each regulator sets its own English requirement. The Home Office then accepts that result for the visa: if you are sponsored as a doctor, dentist, nurse or midwife and have passed an English assessment accepted by your regulator, you do not need to prove your English again.

The regulators accept IELTS Academic or the Occupational English Test (OET), and their bar is far higher than the visa bar.

For OET, the GMC requires Grade B (350 or above) in all four sub-tests, and doctors must take the medicine version. The exemption only works one way: a B2 SELT pass counts for nothing towards GMC registration, for example.

Care workers and unregulated roles: a SELT at B2

Care workers have no professional regulator to vouch for their English, so they need a Home Office-approved SELT such as IELTS for UKVI. Since 8 January 2026, first-time Health and Care visa applicants must reach B2, up from B1.

There are transitional protections. People who held the visa before 8 January 2026 and are extending or updating can stay at B1, but anyone switching in from a different visa needs B2.

English for settlement: B2 from 26 March 2027

The BBC describes the settlement English requirement as a "high standard". In practice, that usually means B2 level English. From 26 March 2027, most people applying for indefinite leave to remain will need to pass an English test at B2, up from B1 today.

That has two practical consequences:

• Care workers who entered at B1 will need to re-test at B2 with a SELT exam (like IELTS for UKVI) before they can settle, even if their visa itself never required it.

• Timing matters. Anyone close to qualifying under the current rules may want to take legal advice about applying before the new requirements come in.

The Life in the UK test remains part of the settlement process too, so most applicants will need to pass both an English test and Life in the UK before they apply.

How MTS can help

Whether you are a nurse, dentist or doctor preparing for a professional registration, a care worker who needs a SELT B2 for your visa or settlement, or an employer supporting international staff, the first step is knowing which test you need and booking early.

·        MTS delivers IELTS Academic tests at 15 UK and Ireland test centres. We offer both the IELTS Academic on Computer and the IELTS Academic on Computer (Writing on Paper) options.

·        MTS provides a booking service for IELTS for UKVI IELTS bookings at our website.

·        MTS delivers OET exams in Manchester in the UK, under contract.

This post is for general information only and does not constitute legal advice. Immigration rules can change, so always check the latest guidance on www.GOV.UK or speak to a regulated immigration adviser or lawyer.