The requirements for an Adult Dependent Relative (ADR) visa are set out in Appendix Adult Dependent Relative to the Immigration Rules. In this article, we explore what medical evidence may be required to support an application under the Adult Dependent Relative visa category.
1. Key Medical Evidence Requirements
The applicable Family Policy Adult Dependent Relatives Version 7.0 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 the applicant must provide "medical evidence that the applicant's physical or mental condition means that they require long-term personal care because they cannot perform everyday tasks." The guidance goes on to provide examples of such tasks including washing, dressing and cooking. If the applicant cannot provide evidence that they require this high level of personal care they will be unable to make a successful application for an Adult Dependent Relative visa.
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 in identifying and instructing a qualified medical professional and/or expert and provide guidance as to the issues that need to be addressed in the medical report.
2. Proving the Required Level of Care Cannot Be Provided Locally
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.
Gathering evidence can be complex. For example, the applicant's family members in the UK will need to prove that they have sufficient resources to look after the applicant in the UK, but insufficient resources to pay for the required care in the applicant's country (provided that care is available in the first place). Given the various complexities, potential applicants and their family members may consider seeking legal advice.
3. Case Law Regarding Medical Evidence
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."
4. Assessing Whether Care Can Be "Reasonably" Provided
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.
5. Emotional and Psychological Requirements
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. However, 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. Some applicants may provide a psychiatric or psychological report outlining their mental healthcare needs and whether these require them to be looked after by their families in the UK.
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, or may compel the settled children to leave the UK to return to care for their parents.
6. Impact of the ADR Rules and Calls for Reform
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. You can read the BMA's joint letter to the Home Secretary asking her to exempt doctors from the adult dependent relative rule. However, since the letter was submitted no further changes to these rules have been announced.
7. 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.
8. Frequently Asked Questions
What medical evidence is required for an Adult Dependent Relative visa?
Applicants must show that, due to age, illness, or disability, they require long-term personal care and cannot perform everyday tasks. Expert medical reports are strongly recommended.
What does "long-term personal care" mean?
It refers to ongoing support for essential daily activities such as washing, dressing, and cooking, which may arise from progressive health decline, illness, or a serious accident.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
