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Navigating change: The impact of COVID-19 and Brexit on the workforce

With the ever-changing COVID-19 guidance and updates to immigration policy, providers are constantly learning how best they can support their workforce. In this article, Shereen Hussein, Professor of Health and Social Care Policy at the London School of Hygiene and Tropical Medicine, shares evidence examining the impact.

Brexit and COVID-19 combined have undoubtedly tested the social care sector, its workforce and providers to the limit.

On the one hand, Brexit challenges the ability of the sector to maintain drawing on EU migrants who were able to exercise their free-mobility rights to move to the UK and become a vital part of the British labour force.

COVID-19, on the other hand, has closed borders, caused many UK-based workers to lose their jobs and become suddenly available to take up social care work either as paid workers or volunteers, thus, providing a sudden, yet temporary, supply of willing hands and bodies ready to support the sector during its most challenging times.

The sector has been dealing with confusing guidelines, restrictions, fragmented advice and considerable grief associated with a significant death toll among the older population in general and those who use care services in particular. The sector has shown resilience in the face of such a sea of change but at what cost? The burden on care providers and care workers has been enormous, yet hardly recognised nor acknowledged by adequate financial support or policy reforms.

Workforce demand

As part of our research on the care workforce retention and sustainability, we conducted a recent survey to understand the impact of COVID-19 on care workers. In summer 2020, more than half of respondents to the survey indicated that they increased their working hours, with 18% needing to self-isolate. As this was before the Government ‘infection-control’ fund became available, 18% of those who had to self-isolate reported not receiving any pay during that time. One of the main findings of that survey was the significant impact of the pandemic on workers’ wellbeing and mental health. For example, over 80% of respondents indicated that the amount of time their job made them feel ‘tense, unease or worried’ has either increased a little or a lot since the start of the pandemic.

A role of significance

Migrant workers have consistently contributed to the adult social care sector across all settings over several decades. At an average of a fifth of nearly one and a half million jobs, such contribution has been consistent over the last couple of decades. They continued to support the sector despite several immigration policy changes from earlier expansions of the EU to restrictions on the numbers of non-EU migrants and, more recently, with the Brexit referendum. Migrant workers play even more prominent roles in some geographical regions, such as London and large cities, and in the provision of certain types of care, such as live-in care. While they continue to play a crucial role within the sector, what has changed over the past 20-year period was their profile rather than their significance. This was directly related to the groups allowed to move to the UK and be recruited to the sector governed by changing immigration rules.

Recent workforce data shows an almost equal share of workers who have arrived from within or outside the EU. Furthermore, the two groups of workers (EU and non-EU) are now more evenly distributed across various care settings, in comparison to a higher prevalence of non-EU migrants working more proportionally in nursing and residential care homes observed at the turn of the 21st century.

Perception of social care

There are myriad reasons why the sector continues to rely on migrant workers. Among these is the relatively unattractive employment package care work can offer to potential workers compounded with generally low unemployment rates among the British population. Care work is emotionally demanding and requires a high level of resilience and self-reliance while paradoxically considered a ‘low-skilled’ and low-paid sector with no career progression pathways. The causes of this weak labour market position are well connected both to social care funding and the value the society places on this type of work, whether purposefully or unwittingly.

Before the end of the free-labour mobility within the European Union (EU), social care providers relied on recruiting from the UK, attracting migrants available within the UK labour market with no active overseas recruitment. However, recruitment and intermediary agencies played an active role in positioning social care work as a promising option for potential EU migrants, mainly from Eastern and Central Europe, while in their home countries.

Managing risk

With Brexit and the new immigration points-based system, there does not seem to be a straightforward replacement route for the sector to maintain the necessary supply of migrant workers. As part of the Sustainable Care Programme of research, we conducted a two-round Delphi survey of 30 UK policy and social care experts in 2020 and 2021. Respondents emphasised the potential detrimental effect of these changes on the ability of the social care sector to meet escalating demands on services, especially in the short to medium term. Furthermore, experts warned these adverse effects would be most pronounced in large cities, among smaller care providers with limited HR functions, those providing home and live-in care, and who primarily provide services to people with complex needs.

Over two thirds of them recommended introducing a sectoral visa with the possibility of long-term settlement to ensure a sufficient number of recruits to the sector. While most respondents shared the latter opinion, a small group warned against the potential impact of sector-specific work visas. Their concerns were linked to a potentially increased risk of exploitation of migrant workers if they needed to continue accepting unfair working conditions, fearing losing their work visas. These experts felt this would negatively affect both workers and social care users.

The second round of this survey took place in February 2021. Participants recommended social care workers be included on the list of shortage occupations, a step taken later by the Government in March 2021. However, experts recommended further actions to ensure the social care sector can meet demand, including lowering the salary threshold and considering a sector-specific work visa scheme.

Longer-term strategy

The findings from these different projects present some concerning messages about an overwhelmed workforce operating within a sector faced with severe challenges and unclear pathways to new recruitment channels. The immediate influx of workers facilitated by the unfortunate events of the pandemic did not seem to be sufficient to address the sector’s needs for a continued supply chain of workers. Participants in our expert surveys and interviews felt that the only way forward is to prioritise investing in creating better jobs within the sector that can attract local workers in the longer term.

The end of the Brexit transition period (and free movement of EU workers) coincided with the second wave of the COVID-19 pandemic impacting the labour market, international migration and the social care sector in diverse and significant ways. Despite the impact of the pandemic on other sectors – resulting in higher numbers of people losing their jobs or being furloughed – and Government campaigns to attract people to work in social care, vacancies and staffing pressures remain significant. These shortages are likely to increase as now the hospitality sector is re-opening and the temporary surplus of workers will drain.

Furthermore, there are concerns that these events will impact on the structure of the social care market. For example, there are some early indications of an increased market share of live-in care due to fears associated with the experience of care homes at the onset of the pandemic. There are also questions around the potential growth of a grey market of care and an increase in the share of private/domestic arrangements between users and workers.

The key message is that the priority should be to improve care work jobs and conditions as part of broader social care reforms. However, such reforms have been seeing considerable delays. Further measures are needed to promote making the sector attractive for various workers across age groups and with different backgrounds while acknowledging the role of migrant workers.


Mike Thomson, Litigation Executive for Employment at Royds Withy King, shares his legal advice for providers.

Senior Care Worker

  • On 6th April 2021, the role of ‘Senior Care Worker’ was added to the Shortage Occupation List (SOL), which reduces the requirements for recruiting migrants from overseas into the role.
  • The minimum salary is now £20,480 per annum or 80% of the going rate for the role, whichever is higher. The going rate for the role is £16,900 per annum based on a 39-hour week and 80% of that salary is £13,520. The minimum amount a Senior Care Worker can be paid is therefore £20,480 as this is higher than 80% of the going rate.
  • Due to the lower going rate for the role, you could offer contracts with more than 39 hours per week and reduce the hourly rate until the salary either meets £20,480 or the current National Minimum Wage depending on the age of the migrant. As the salary must be at least £20,480, there is very limited scope for recruiting part-time workers.
  • Note that the worker will need to actually be working the number of hours that they are contracted to work and the duties need to clearly relate to a Senior Care Worker as opposed to a Care Worker (which isn’t an eligible role). You will need to demonstrate this to the Home Office in the event of a compliance visit.

Right to Work Checks

  • In order to complete a valid right to work check, you should review the individual’s identity documents (passport/biometric residence permit) to verify that they are who they say they are. Normally this needs to be conducted face to face, but it can currently be carried out over a video call. Employers will not be required to carry out a physical check once the position reverts back.
  • If you fail to carry out a proper right to work check you could be liable to a fine of up to £20,000 per illegal worker plus criminal sanctions. You could also have your sponsor licence revoked.

EU Settlement Scheme

  • The EU Settlement Scheme is due to close on 30th June, at which point EEA nationals will no longer be able to use their passports as valid identification for a right to work check. Employers should send communications out to staff to remind those who need to apply to do so, and that if they don’t, they may lose their right to work in the UK.

Shereen Hussein is a Professor of Health and Social Care Policy at the London School of Hygiene and Tropical Medicine. Email: Shereen.hussein@LSHTM.ac.uk  Twitter: @DrShereeHussein

What impact will the changes to immigration policy have on your organisation? Do you feel equipped to navigate the change? Share your comments below.

 

 

 

 

 

About Shereen Hussein

Shereen Hussein is a Professor of Health and Social Care Policy at the London School of Hygiene and Tropical Medicine. She is an established multi-disciplinary research leader with extensive social care and health research experience working primarily with policymakers in the UK and internationally. Her background is in medical demography, statistics and computer science. Shereen is a Co-Director of PRUComm, focusing on health and social care systems and commissioning. Shereen currently leads an extensive research portfolio specific to the social care workforce and service organisation.

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