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The UK is on the brink of losing the highly skilled and experienced migrant workers currently propping up the care sector. If the government does not make changes to its new points-based immigration system a major crisis could emerge. These key workers cannot be replaced by digital innovations, while UK workers are increasingly reluctant to enter into what is a low-paid and extremely stressful profession.
It is estimated that the care sector requires 520,000 additional workers before 2035 to support the UK’s ageing population. The sector currently relies on migrant workers. Most migrant care workers are set to be excluded from the government’s points-based immigration system, unveiled in July, because the pay is so low.
From 2021, new rules will require a minimum pay threshold of £20,480. This will effectively prevent migrant care workers and home carers from entering the UK because average pay for care workers is £16,500 per year. Low pay means that, regardless of their ability to accrue transferable points, care workers will not be eligible for visas.
Additionally, the work done by care workers and home carers does not meet the skills threshold for the new Health and Care Visa. This visa will fast track migrants in the healthcare sector, offering reduced application fees and exempting them from the Immigration Health Surcharge (£624 per year from October 2020). But the new visa is only for doctors, nurses and other health professionals – not care workers. Excluding care workers could potentially be disastrous.
Freedom of movement
For the past decade, approximately one in six – or 83,000 – of the 1.5m home care and care workers in England have been non-UK nationals. While the proportion of migrants has been stable, their countries of origin have changed. Most migrant care workers came from outside the EU until 2012, when the current minimum pay threshold of £30,000 was introduced. After 2012, EU migrants took up care work jobs because this minimum pay threshold did not apply to free movement.
Brexit will end free movement for EU care workers at the same time as the new salary threshold is applied to migrants. Currently, the sector has an 8% vacancy rate. Where will desperately needed new workers come from? Leading health bodies, care workers and home carers themselves are deeply worried about this change.
Migrant care workers are typically overqualified. Many have professional healthcare qualifications in nursing, or prior experience in the sector. Care work does not offer adequate remuneration to reflect their skills. It involves depressed wages, long hours and difficult work conditions that discourage British workers. Migrants can endure these conditions when they are able to invest their earnings in property, business and family betterment back home (where many will hope to retire).
For British workers, on the other hand, care work’s low wages rarely lead to better prospects. Many find themselves pushed towards the care sector when they cannot find other work. Often this push comes at a point where they have little security in their housing and personal lives. Adding to their insecurity, around one-quarter of care work is now delivered through zero-hours contracts.
With under-staffing, longer hours or truncated visits, even care workers working steady hours find themselves overwhelmed and exhausted. Research shows that staff shortages and longer hours lead to increased fatigue, irritability, and demotivation for workers – and these conditions can lead to potentially dangerous mistakes.
Chronic labour shortages
But if migrants are blocked from taking these roles then UK residents will be expected to plug the gaps. In April, the health minister, Matt Hancock, began a recruitment drive for the sector, targeting 20-39 year-olds. Previous recruitment drives have done little to alleviate the sector’s chronic labour shortages. Despite a 20% increase in advertised care roles in the first quarter of 2020, applications decreased by 17.8%. Previous drives haven’t affected the sector’s 30% turnover rate which has risen from 23% in 2012. Data on recruitment and retention tell us these are not desirable jobs.
Current care workers report highly exploitative conditions including a lack of adequate sleeping and sanitary facilities. Precarious conditions and low pay have meant some care workers have had to use foodbanks and claim benefits. Meanwhile, in the COVID-19 pandemic, female careworkers and home carers have had the highest death rates of all occupations for women.
Jobs in the rest of the healthcare sector are being transformed. The NHS has furthered its “digital first” approach during the pandemic, spurred on by social distancing requirements, through NHSX – its new digital branch, which was formed in April 2019. With annual investment of more than £1bn, NHSX claims to be the “largest digital health and social care transformation programme in the world”. But the video/telephone/email consultations that are proving effective for other patient and staff groups will be slow to come to care work. Though these technologies can lower costs in other health settings, the feeding, cleaning and personal care which comprises care work cannot be digitised.
Devaluing care and labelling care workers “unskilled” has created a sense of alienationand hopeless frustration for British care workers. Long hours, low pay, intensely physical and emotionally demanding work can undermine the ability of carers to care – either for themselves or others. Improvements to pay and working conditions are long overdue. But it is a change in the new immigration scheme that is needed most, if the emerging crisis is to be averted.
Huge sections of the UK community rely entirely on these un-cared for workers. A coerced and reluctant workforce will most definitely affect the quality of care the sector delivers.
Maddy Thompson receives funding from The Leverhulme Trust.
Deirdre McKay receives funding from the Arts and Humanities Research Council and the Mellon Foundation. She is Chair of the Association of Southeast Asian Studies (UK).