Adult Dependent Relative Visa: Medical Evidence

The requirements for an Adult Dependent Relative (ADR) visa are set out in Section EC-DR of Appendix FM of the Immigration Rules. In this post we explore what medical evidence may be required to support an application under the Adult Dependent Relative visa category. 

Requirements for an Adult Dependent Relative Visa

The evidence to be provided in order to meet the requirements of the Adult Dependent Relative visa rules contained in Appendix FM is set out in Immigration Rules Appendix FM-SE: family members specified evidence.

An applicant is required to provide evidence that they require long term personal care which must take the form of: 

(a) Independent medical evidence that the applicant’s physical or mental condition means that they cannot perform everyday tasks; and

(b) This must be from a doctor or other health professional.

In addition, evidence relating to the available care should be from:

(a) a central or local health authority;

(b) a local authority; or

(c) a doctor or other health professional.

Medical Evidence for an Adult Dependent Relative (ADR) Visa

(1) Evidence that, as a result of age, illness or disability, the applicant requires long-term personal care

The applicable Family Policy Adult dependent relatives Version 3.0 guidance sets out the evidence which an Entry Clearance Officer would expect to see in support of an Adult Dependent Relative visa application. It specifies that “medical evidence that the applicant’s physical or mental condition means that they require long-term personal care because they cannot perform every day tasks.” The  guidance goes on to provide examples of such tasks including washing, dressing and cooking. Those wishing to join their relatives who’s health fails to meet this high standard are unable to make an application under the Adult Dependent Relative visa category.

The need for long-term personal care may have arisen unexpectedly, due to illness or a serious accident, or as a result of a progressive decline in health. Although an entry clearance officer has the power to refer an applicant for medical examination, this discretion is not often utilised. As such, it is vital that an expert medical report is provided in support of the application. Our immigration barristers can assist you to identify and instruct a qualified medical professional and/or expert as to the issues that they should address in their medical report.        

(2) Evidence that the applicant is unable, even with the practical and financial help of the sponsor in the UK, to obtain the required level of care in the country where they are living

In order to obtain an Adult Dependent Relative visa it is necessary to prove that the ‘required level of care’ is not available in the applicant’s country of origin and that there is no one there who can reasonably provide it. The rules refer to the required level of care available within the country the applicant is from, which is a very wide test – not, as might be expected, that which may be available in the applicant’s local area. This care includes that provided by relative(s), a home-help, housekeeper, nurse, carer or nursing homes.

Further, the required level of care should be unavailable even with the practical and financial help of the applicant’s family member(s) in the UK. This evidence should be from a central or local health authority, a local authority, or a doctor or other health professional in the country in question. An applicant will be expected to confirm why any private arrangement, which may have been in place, can no longer continue and if no longer affordable, evidence and explanation of the reasons why.  

The evidence required to support an application under the Adult Dependent Relative visa category can be difficult to obtain. In many instances, where the required care is available in the applicant’s home country, the sponsor will be in the position of having to prove that they have sufficient resources to look after the adult dependent relative in the UK whilst at the same time asserting that they cannot afford to pay for the required care in the applicant’s country.  Given the complex nature of these applications sponsors and adult dependent relative applicants may consider seeking expert advice. 

In the case of Ribeli v Entry Clearance Officer, Pretoria [2018] EWCA Civ 611, the Court of Appeal reaffirmed the “rigorous and demanding” nature of the adult dependent relative rules, following the judgment in Britcits v Secretary of State for the Home Department [2017] EWCA Civ 368. In Britcits, the Master of the Rolls noted at paragraph 59: 

“… as is apparent from the Rules and the Guidance, the focus is on whether the care required by the ADR applicant can be “reasonably” provided and to “the required level” in their home country. As Mr Sheldon confirmed in his oral submissions, the provision of care in the home country must be reasonable both from the perspective of the provider and the perspective of the applicant, and the standard of such care must be what is required for that particular applicant. 

It is possible that insufficient attention has been paid in the past to these considerations, which focus on what care is both necessary and reasonable for the applicant to receive in their home country. Those considerations include issues as to the accessibility and geographical location of the provision of care and the standard of care. They are capable of embracing emotional and psychological requirements verified by expert medical evidence. What is reasonable is, of course, to be objectively assessed.”

In deciding whether the required level of care cannot be “reasonably” provided, the entry clearance officer will be looking at the circumstances of the applicant including how far and how difficult it would be for the applicant to travel to access care, and whether they have an emotional or psychological need for a specific type of care. Proving that an applicant has an emotional and psychological need for care from a relative in a different country from their own, i.e. in the UK, can be very difficult. 

The impact of the adult dependent relative rules may result in the permanent separation of elderly relatives from their children who are settled in the UK and may also be British citizens, or may compel  the settled children to leave the UK to return to care for their parents. Only very rarely will settled UK sponsors be able to show that no one can reasonably care for their vulnerable relatives in their home country, although the Court of Appeal’s reminder in Britcits that emotional needs are to be taken into account by the Secretary of State when assessing an Adult Dependent Relative application  has proven to be of assistance to some applicants.

The British Medical Association, together with other leading medical bodies, have repeatedly issued calls for an amendment to the rules to allow settled migrant doctors to bring their adult relatives to be cared for by them in the UK. The BMA’s joint letter to the Home Secretary asking her to exempt doctors from the adult dependent relative rule can be read here. However, since the letter was submitted no further changes to these Rules have been announced.

Contact Our Immigration Barristers

For expert advice and assistance with applications for an Adult Dependent Relative visa or challenging a refusal of an Adult Dependent Relative visa,  contact our immigration barristers on 0203 617 9173 or complete our enquiry form below.