Should the government rethink its immigration policy for social care?

New polling shows strong public support for an immigration route to enable international recruitment into social care. We look at the potential impact of the UK’s post-Brexit immigration system on the adult social care workforce in England.

When freedom of movement between the EU and the UK ends in January 2021, the government’s new ‘points-based’ immigration system will come into force. Under current proposals, the vast majority of adult social care roles will not qualify for a work visa. This won’t change much for people outside the EEA, but it will be far harder to recruit people from Europe to fill vacancies in the already struggling sector.

Social care in England is suffering from wide-ranging workforce problems. Last year, vacancies reached 122,000, with around 1,100 people leaving their job each day. And more staff are needed to meet growing demand. The impact of coronavirus (COVID-19) on social care recruitment and retention is uncertain. Vacancy rates fell during the first half of this year and the recession’s impact on the labour market may ease domestic recruitment. But we don’t know how long people who join the sector will stay. The pandemic has piled pressure on the existing workforce and may further increase demand for social care.

How might the new immigration system impact adult social care?

Earlier this year, when asked about the impact of Brexit on home care, a panel of experts, responded that a decline in EU migration was the biggest risk to the home care workforce. Around 17% of adult social care roles in England are carried out by non-British nationals. EU workers have made up a growing proportion of this total in recent years and are an important part of the workforce. The proportion of social care roles in England carried out by EU workers rose from 5% in 2012/13 to 8% in 2018/19 – possibly partly because of increased restrictions on non-EEA migration since 2010. Some regions, such as London, are particularly reliant on EU staff.

People already working in social care in England and the rest of the UK can stay. But come January, those looking to move from abroad to join the workforce are unlikely to meet the new immigration requirements. The main way of accruing enough ‘points’ to get a work visa is to speak English, have a job offer at A-level equivalent or above, and earn £25,600 per year. The overwhelming majority of social care jobs do not meet these last two criteria – in 2019, nearly 90% of social care salaries were below the 'real' living wage. The alternative, if you earn a minimum of £20,480, is to get points with a PhD (unlikely in this sector) or a role on the ‘shortage occupation list’ (to which only senior care workers can be added). For the minority of qualifying roles, the new system means additional fees for migrants and cash-strapped providers. International recruitment in social care will be severely limited.

The latest policy statement on the system rebranded the government’s ‘NHS visa’ as a ‘Health and Care Visa’. But the visa still excludes virtually all social care roles, including care workers and home carers. In May, Boris Johnson promised to exempt all migrant health and care workers from paying the Immigration Health Surcharge to use the NHS. But the government has since updated that care workers will still have to pay the surcharge, although they will be eligible for reimbursement. By contrast, many NHS staff will benefit from an upfront exemption. Current immigration policy plans risk exacerbating existing pressures and uncertainty in adult social care.

A social care visa – what do the public think and why?

One option to reduce the impact of the new system on social care would be introducing a sector-specific route for people to come to work in the UK in social care roles such as care workers or home carers. We can look to other countries for examples. Long-term visas with added rights may be preferable to short-term visa routes.

Our recent polling results suggest strong public support for a sector specific approach. Although there is some variation depending on age, profession or voting intention (see the chart below), over three-quarters (77%) of people overall support a ‘social care visa’.

Support for migration into social care is perhaps unsurprising. Attitudes towards immigration generally have softened since the EU referendum in 2016, when it was a pivotal issue. In August 2019, 54% of people said they would like to see lower migration to Britain, down from 66% in 2015. This June, the lowest proportion (5%) of people since December 1999 considered immigration an important issue facing Britain. Opinions are polarised and opposition to immigration remains high, but for many people it isn't as salient as it once was.

Opinions about immigration also tend to be more nuanced once you start talking about who is moving.. British people care a lot about the skills and professions of migrants. In August 2019, a third (32%) of people wanted to see more care home workers coming from the EU after Brexit. Only 8% wanted to see an increase in bankers.

So why is the government opposed?

The government isn’t budging on social care work visas, saying that ‘Immigration is not the answer to the challenges in the social care sector and, as we implement the new immigration system, we want employers to focus on investing in our domestic workforce.

Certainly, an accommodating immigration system alone will not solve the sector’s workforce challenges. Long-anticipated reform must include a mix of investment and regulation to improve terms and conditions for everyone working in social care. Encouraging people from the UK and abroad to join and stay in social care requires investing in and valuing their skills. Increasing pay wouldn’t just help domestic recruitment – it would likely also mean more roles qualifying for visas under the new immigration system. Encouraging international or domestic recruitment isn’t a binary choice.

But how does the government expect social care employers to invest in its workforce? Local authorities and providers are working hand to mouth because successive governments have failed to provide a sustainable funding settlement for adult social care. According to Home Secretary, Priti Patel, ‘The government’s long-term solution for social care is focused on investing in those who deliver that compassionate and high-quality care.’ This solution doesn’t yet exist. Despite Matt Hancock’s recent reassurance that discussions about long-awaited reform have been ‘picked up again’, it is not going to transpire before the points-based system lands in January.

Meantime, the social care system is on its knees. Increasing barriers to people from Europe coming to work in social care will only make it harder to recruit the workforce needed to provide essential services for vulnerable people. A sector-specific immigration route for social care would avoid some uncertainty about recruitment in the short term, appears to be popular with the public and doesn’t stand in the way of long-term reform to the system.

Lucinda Allen (@LucindaRAllen) is Policy Officer at the Health Foundation.

Tim Gardner (@TimGardnerTHF) is Senior Policy Fellow at the Health Foundation.