JSL Healthcare Recruitment Agencies

“There is a lot of noise, and a lot of misinformation, circulating about Joint and Several Liability and what it means for health and social care agency staffing.” That is a direct quote from Dan Blake, a recognised figure in healthcare staffing, published on 13 March 2026. He is right. The agencies bearing the brunt of that misinformation are the ones least deserving of it. Healthcare recruitment has always operated differently from the broader staffing sector, and that difference matters enormously when you are trying to understand what JSL healthcare recruitment agencies actually need to do. The short answer, in most cases, is far less than vendors are currently telling them. 

Why Healthcare Staffing Is Different 

The staffing sector is not one homogeneous block. Healthcare agencies typically engage nurses and carers directly. Workers are employed, processed through the agency’s own PAYE, and placed with care providers under a straightforward supply arrangement. That model has regulatory backing, sector-specific tax treatment and, in most cases, far more oversight than the legislation was ever trying to create. 

Dan Blake put it plainly: “In many cases, this advice is coming from neutral vendors or frameworks that operate across multiple sectors, with care just being one of them. The problem is they are applying a one-size-fits-all interpretation of the legislation without properly understanding how healthcare staffing actually works.” 

The VAT Nursing Concession and Why It Matters 

HMRC provides an exemption that allows qualifying healthcare staff to be supplied without VAT, provided the agency employs those workers directly. The concession is contingent on direct employment. If an umbrella company is inserted between the agency and the nurse or carer, the structure changes. The agency is no longer directly employing the worker. That change risks breaking the concession entirely, making the supply VATable. 

As Dan Blake noted: “If you insert an umbrella between the agency and the nurse or carer, you risk breaking the concession and making the supply VATable.” This is why umbrella companies are rarely used in healthcare. It is not an oversight. It is a rational commercial and compliance decision that agencies made long before JSL was introduced.

Own-PAYE Is the Standard Model in Healthcare 

Running your own PAYE is not a workaround in healthcare recruitment. It is the standard. Agencies directly employ the workers they place, process wages through PAYE, deduct tax and National Insurance at source, and bear full employment obligations. The supply chain is clean, direct and compliant by design. 

This matters under JSL healthcare recruitment agencies’ guidance because Joint and Several Liability targets tax losses in supply chains involving non-compliant intermediaries. If there is no intermediary and no non-compliance, the mechanism does not exist. For a deeper breakdown, see our guide to own-PAYE vs umbrella under JSL. 

Cucumber Recruitment operates exactly this model. Workers are directly employed, wages processed through their own PAYE, and the structure confirmed as compliant by Kangs Solicitors, the REC, Deloitte and two separate vendors. 

Vendors Are Applying Blanket Requirements Without Understanding the Sector 

The most damaging thing happening in healthcare staffing right now is not JSL itself. It is the response to JSL from neutral vendors who lack sector knowledge to distinguish between a compliant healthcare agency and one that requires intervention. 

Dan Blake: “What I’m increasingly seeing is neutral vendors trying to protect themselves by imposing blanket compliance requirements across their panels, shifting costs to agencies without actually reducing the risk.” For a fuller account of how neutral vendors are responding to JSL, the picture across the sector is instructive. 

CQC registration and compliance requirements already impose audit, worker vetting, employment verification, and governance standards that exceed those many generalist staffing frameworks now demand under JSL. Healthcare agencies are not ungoverned. They operate in one of the most regulated environments in the staffing sector. 

What Healthcare Agencies Should Actually Do 

Understand what JSL healthcare recruitment agencies are actually exposed to before accepting any vendor’s characterisation. If your agency directly employs workers, runs its own PAYE and does not use umbrella companies, you are operating in a fundamentally different risk category. 

Get independent legal advice from advisers who specialise in healthcare staffing. The VAT nursing concession, own-PAYE models and CQC compliance all interact with JSL in ways that generalist employment lawyers may not anticipate. If a vendor is demanding structural changes, ask them to explain the specific legislative basis. For the broader context, see JSL for recruitment agencies. And understand why due diligence under JSL is not a defence before spending on products that do not reduce your exposure. 

Frequently Asked Questions

Does JSL apply to healthcare recruitment agencies? 

JSL applies across the staffing sector, but its practical impact on healthcare agencies depends on the operating model. Most healthcare agencies employ workers directly under their own PAYE and do not use umbrella companies. Because JSL targets non-compliant intermediaries, agencies without those intermediaries face a materially different risk profile. 

Why do healthcare agencies not use umbrella companies? 

The VAT nursing concession. HMRC exempts qualifying healthcare staff from VAT when employed directly by the agency. Inserting an umbrella risks breaking the concession, making the supply VATable. Own-PAYE direct employment is the standard model in healthcare staffing. 

What is the VAT nursing concession? 

An HMRC provision allowing qualifying healthcare workers to be supplied without VAT when directly employed by the agency. The concession is contingent on direct employment. If an umbrella is inserted, the exemption may no longer apply. 

Do care agencies need SafeRec accreditation? 

Care agencies running their own PAYE without umbrella companies are not the target of SafeRec accreditation. SafeRec is designed for umbrella compliance. Requiring a care agency to obtain it is an inappropriate application of a generalist tool to a specialist sector.