The Tier 2 cap of 20,700 appears to play a limited role in Government attempts to restrict net migration. If the monthly cap for COS is reached and an application is rejected, the employer has to reapply. The cap was reached for three months in a row in 2015, so the problem carried on being rolled over. The problem has been huge for public sector roles, in particular nurses, because they are not earning high enough salaries to reach the heightened salary bar. It has been stated that Nursing does not therefore pay enough to compete in the market for a Certificate of Sponsorship once the cap is under pressure and salary becomes the determining factor. On 15 October 2015, the Home Secretary wrote to Sir David Metcalf on the subject of nursing shortages. As a result, it was "exceptionally agreed to place nurses on the shortage occupation list on a temporary basis''. The Home Secretary asked the MAC to report back to her by 15 February 2016 after reviewing the full evidence and information provided.
The situation for nursing is complicated by changes to Immigration Rules which mean that workers from outside the EEA who were granted Tier 2 visas after 6 April 2011 must earn £35,000 or more after six years, before they can successfully apply for leave to remain. The Royal College of Nurses stated that, most nurses affected by this rule change earn between £21,000 and £28,000. Overseas workers on a Tier 2 (General) visa can work in the UK for a maximum of six years. They are entitled to apply for indefinite leave to remain after five years, so they have one year in which to apply and secure leave to remain, leave, or switch into a different category. The RCN said this may force up to 3,365 nurses currently in the UK to leave the country from 2017, and that forcing them to leave will negatively affect patient care due to the loss of vital skills and experience. The decision to put nurses on the Shortage Occupation List means that those nurses subject to the Immigration Rules changes, and who were at risk of having to leave the country if they did not earn £35,000 after five years, will now be able to apply to stay and continue to contribute to the NHS.
It is believed that one of the aims of the cap is to incentivise training and recruitment of domestically trained nurses. The Government has been requested through parliamentary publications, to set out its plans to increase the number of nurse training places available, and confirm whether nurses will remain on the Shortage Occupation List until such time as the number of domestically trained nurses reaches the Department of Health's target.