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A decade of lost care and relationships for generations: the need for a post pandemic review of the Adult Dependent Rules


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The pandemic threw into sharp focus the overlooked and marginalised needs of the frail and bereaved elderly parents applying to be regarded as part of their settled families in the UK. The 2012 version of the Adult Dependent Rules for adult parents, siblings and others marked a tightening of UK migration criteria, requiring applicants to demonstrate that, as a result of age, illness or disability, they require a level of long-term personal care that can only be provided in the UK by their relative here because no such care is available in the country of origin.

These harsh immigration rules might be said to run contrary to normal government policy. In 2013, the then Health Secretary Jeremy Hunt made several calls for families to look at how they treat elderly people saying that Britain has to decide as a nation that “loneliness and isolation” among elderly people is “something that we actually want to do something about”.  Entering old age “should not involve waving goodbye to one’s dignity,” Jeremy Hunt told delegates at the 2013 National Children and Adults Services (NCAS) conference. There is a collective “national shame” in ignoring the emotional needs of people in care homes or isolated in their own homes. (Telegraph 23 October 2013). He also told the Daily Mail that British people should be ashamed of how they treat their grandparents, and that residential care should be a last resort. “We should revere our grandparents as they do in China. In those countries, when living alone is no longer possible, residential care is a last rather than a first option. If we are to tackle the challenge of an ageing society, we must learn from this.”

In 2014, JCWI rightly described the ADR rules as Harsh, Unjust, and Unnecessary.

Even when evidence of increased dependency and emotional needs has been provided in ADR applications, that evidence been unlawfully ignored in the Home Office decision-making, with almost automatic entry clearance refusals.

Prior to the Rule change in 2012, around 2,325 applications were made a year to bring adult dependents over to the UK, a relatively small number (approximately 0.0069 % of total immigration to the UK and 0.011% of all non-EU immigration). This fell to just 162 applications in 2016. The Chair of Association of Pakistani Physicians of Northern Europe (APPNE) secured an FOI in May 2021 which revealed the dismal number of ADR visas granted over the last four years: 


A much more humane approach is evident in the data and policies for elderly migration in other countries such as Canada, New Zealand and Australia, with Canada allowing 20,000 elderly parents in 2019, and Australia 7,371 in 2019-20.  Australia even relaxed elderly parent entry rules in the pandemic. 

Of more than 6,000 doctors from the UK who have left since 2015, many have reported this is due to harsh immigration rules preventing them staying together as families. The impact on several generations of grandchildren who are losing out on these valued relationships is irreversible, despite the Home Office stating that their relationships can be maintained by modern technology.

The BMA, GMC, several Royal Colleges, BAPIO and APPNE, BIDA and BINA were amongst those health bodies who followed up a joint letter to the Home Secretary in January 2020 (to no direct response) and asked for a review of the rules by garnering support from peers, and several politicians.

The issue was raised in Westminster by the Chair of the Immigration All Party Parliamentary Group, Stephen Timms in November 2021, who reiterated that the economic costs have been misleadingly overstated in the  2016 review, notwithstanding a lower use of health and social care services in migrant populations, and also that traditionally, elderly parents are looked after at home within their families, the very reason they wish to bring them here especially when coming from countries with lower life expectancy.

There has been significant media commentary, including by The I’s Paul Gallagher who recently focussed on the refusal and dismissal of an ADR application for an 81-year-old Indian woman, with terminal ovarian cancer who now needs palliative care. She and the family were told she was receiving medical care, and family visits can continue somehow. The oncologists and a socio-care expert had pointed to her deteriorating cognitive and physical health, and her psychological and social needs during palliative care, and all agreed that her family alone could provide her with motivation, and the will to live and dignity.                                                           

The BBC has also raised the distress and difficulties for such families split from elderly parents after bereavement, or in need of terminal or end of life care from the family, alongside the need for safe and caring family environments for those with dementia or other vulnerabilities.

The lives and service of many professional health and care staff have been disrupted as they have rushed multiple times in emergencies to look after their parents, (they were unable to even do so during the pandemic, and the parents of many died alone). Their contributions to the communities here are heralded but there has been no effort to review the Rules.

There is an inherent unfairness in the expectation that familial care can be delivered remotely or by multiple trips to the elderly abroad, and these elderly groups are being denied fundamental rights to psychological and physical wellbeing, and the right to be cared for unto death, and within the fabric of their nuclear family.

The appeals that follow under the Rules are often traumatising over the long waits for the hearings. The Refusals are often based on spurious reasons, and often do not refer to the socio-care or medical evidence. 

The Court of Appeal in Mukarkar v Secretary of State for the Home Department [2006] EWCA Civ 1045 stressed that the needs of elderly dependants should be given more culturally sensitive consideration., and that an elderly Appellant is entitled to respect for family and private life  and removal of an elderly man was not proportionate to the legitimate end sought to be achieved under Article 8 (2). In Mukarkar, the Court of Appeal held the removal of an elderly man from a caring family was a disproportionate interference, and breach of Article 8 and Article 3:                                                                                                                                            

“[T]he appellant’s need is not for particular treatment, or hospital care, but for “permanent and constant home help… The availability of medical care (public or private) was no substitute for the ordinary expectation that an elderly and ailing parent would be looked after by his family, and that the ability to do that was an important part of family life for both the carers and the cared-for”

In Britcits v The Secretary of State for the Home Department [2017] EWCA Civ 368, such compassionate regard was acknowledged:

“76. Thirdly, for the reasons I have given the appellant has not established that the conditions for entry and right to remain for ADRs under the new ADR Rules are incapable of practical fulfilment in virtually all cases for parents, let alone for all the categories of ADRs entitled to apply, whose family life engages Article 8. In particular, rejection on the basis of the availability of adequate care in the ADR’s home country turns upon whether the care which is available is reasonable for the ADR to receive and of the level required for that applicant. Contrary to the submission of the appellant, those considerations are capable, with appropriate evidence, of embracing the psychological and emotional needs of elderly parents. “

Finally, it is arguable as per Ainte (material deprivation, Art 3, AM) (Zimbabwe) [2021] UKUT 203 (IAC) that an elderly person without dependable care might struggle to properly access medical services and hence fail to benefit from treatment abroad, and such unmet needs might arguably breach Article 3.

Ten years after they were introduced, a proper review of the Adult Dependent Relative rules is overdue. Misplaced and over-stated financial costs and immigration ‘concerns’ have for too long led policy makers to disregard the human, social and economic cost of this policy. The House of Lords Justice and Home Affairs Committee is currently gathering evidence for an inquiry into the impact of all of the family immigration rules. Written submissions are due by 15 September 2022 and anyone can write in and contribute their views on any or all of the questions.

There’s lots wrong with our asylum, immigration and citizenship laws. If you want to be properly informed, check out my book Welcome to Britain, now available in paperback.

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Usha Sood

Usha Sood is the head of Trent Chambers in Nottingham. Called to the Bar in 1974, she has been practising law since 1990. She was also an academic career as Senior Lecturer in Law at Nottingham Trent University.