This is a guest post by Silvia Miele.
Since the 1990s, the English Adult Social Care system has been facing several challenges: from an ageing population with complex needs, to funding gaps, inequalities of provision, an unstable and fragmented market providers landscape, staff retention issues and finally the covid-19 pandemic. Brexit is just the most recent of a long list of threats, adding another layer of uncertainty to a social care system which has been on the verge of a systemic reform for almost three decades – and is still waiting for government to find the political courage to enable that.
How is Brexit Affecting Adult Social Care?
One of the threats endangering the sustainability of the Adult Social Care system is its high staff turnover rate, which reached 30.4% in 2019/2020, equating to 430,000 people leaving their jobs. For registered nurses in social care, turnover figures rise to 41.3% (compared to 9.4% in the NHS). This is not a new phenomenon, as turnover rates in adult social care have been growing by 10.2% between 2012/2013 and 2019/2020. At the same time, care demand has been steadily increasing.
Currently, EEA nationals represent a vital component of the UK social care workforce. It is uncertain how many are going to leave because of Brexit and how this will impact EU migrants’ decisions to move to the UK in the future. Effective planning is further hindered by lack of systematic data, as the responsibility of delivering social care has been devolved to a multitude of private market providers storing data in distinct databases and in different formats.
It was estimated by Independent Age that in 2015, 1 in 5 of the social care workforce (18.4%) in England was born abroad, including 150,000 residential care homes and 81,000 adult domiciliary care workers, most of whom come from non-EU countries (around 191,000). However, in the last decade EU migrants became the main group of foreign-born social care workers, accounting for 80% of all new non-UK labour, and their presence in the adult social care system rose by 68% from 2011 to 2016. The greatest share of EU nationals working in social care is clustered in Northern Ireland (9.6%), followed by England (4.9%), Scotland (4.4%) and Wales (2.4%). Reliance on EU rather than non-EU migrants has increased as immigration rules for people coming from non-European countries limit unskilled labour entry in the UK, while the right to freedom of movement was granted to Europeans before Brexit.
The social care workforce gap produced by Brexit has been estimated to range from 350,000 people in the most favourable scenario, to 1.1 million people in the worst-case scenario by 2037, depending on levels of migration from the EU. This will likely depend on the new regulations around EU migration. From January 2021, thresholds currently in place for skilled migrants have been replaced with a points-based immigration system, equally applicable to EU and non-EU migrants. New migrants will have to prove skills in the English language and have a job offer lined up in a skilled profession, with a minimum salary of £25,600. For jobs in the shortage occupation list, the salary threshold drops to £20,480.
To tackle these issues, the government has launched a Health and Care Visa. This is a fast-track visa route that will enable healthcare professionals who fall within the list of “skilled” jobs a more rapid and affordable way to gain the right to work and live in the UK. While senior care workers are included in this list, care workers are not categorised as a shortage occupation. With an average annual salary of £19,000, they are far from meeting the salary threshold of £25,600 that would guarantee their right to settle in the UK.
Tackling High Turnover in Social Care
The instability that adult social care is experiencing is further aggravated by the current coronavirus pandemic. To avoid consequences that Professor Martin Green, Chief Executive of Care England, has defined as “potentially disastrous”, several proposals have been advanced by the sector to boost the national supply of health and social care professionals, on the basis that international recruitment should constitute just one component of a wider holistic workforce strategy. These include increasing medical school places and guaranteeing additional funding for clinical placements for nursing, midwifery, and physiotherapy. Furthermore, additional proposals would entail return to work schemes to encourage care staff back to the sector, incentivising agency staff to become permanent, making care jobs more attractive by offering training and better pay, and opening up routes from social care roles into nursing and allied health professionals.
Meanwhile, authorities, provider leaders, unions and charities are pressuring the government to rethink the new immigration policy for care workers. This needs to be easy to action, transparent and cost-effective for future migrants. Regarding EU nationals, the Home Office should ensure that even in a no-deal scenario the settled status programme for EU citizens, that enables eligible EU migrants to continue living and working in the UK, will be abided by. Indeed, regardless of which type of Brexit is awaiting us, it is essential to make rapid decisions around the new system that is going to replace the abolished Free Movement of Labour.
 Care England is the largest representative body for independent social care services in the UK.
About the author
Silvia Miele is a Postgraduate Research Student at the University of Surrey.