The nation appears to be at an impasse, which future historians will debate for many years to come. At the time of writing, a Brexit deal has not been agreed. Dates for votes have been repeatedly moved and disagreement reigns. At times, it feels as though the leaders of this country are playing a game of chance – a real-life deal or no deal on an enormous scale.
However, we cannot change the position we are in. What we can and must do now is take stock of the reality of the decisions that have been made and evaluate what we as a sector might face as the exit date approaches.
The biggest challenge for us is the uncertainty over immigration, and what we need most for our EU staff is clarity and certainty. Both health and social care rely heavily on talented colleagues from abroad to provide the care our communities need, and the recently published White Paper on immigration has not offered a definitive answer on whether a salary threshold of £30,000 will be imposed.
This proposed threshold, based on the advice of the Migration Advisory Committee, suggested the distinction between a skilled and unskilled workforce should be made based on salary, when we know the value and skill of our lower-paid colleagues is not defined by their wages. It is a relief that there will be further discussion on this, and we can only hope either the threshold will be scrapped altogether or lowered considerably.
An immigration policy based on skills and benchmark pay scales will no doubt add to uncertainty and could affect providers’ ability to deliver care and support to those who need it. The new immigration system must adjust skills and salary levels to ensure that social care can be properly staffed.
While it is anticipated that there will be some provisions for doctors and nurses coming to the UK after Brexit, this does not include allied health professionals, and there will be major implications for the social care workforce in particular. Either Government must fund wage increases or it must make special provisions for health and care.
There is an ever-growing elderly and vulnerable population who need care and support around the clock – set to double to nearly 5 million by 2035 – while predictions indicate the care industry could face staff shortages of 380,000 by 2026. If the salary threshold is maintained without wage increases or other provisions, we could find ourselves letting people down who most need our help.
Furthermore, if the social care crisis is not addressed, there will be major knock-on effects for the wider population and the economy. People who are best cared-for in their homes or in the community will need more support from their families, straining other areas of the labour market as well as the NHS.
In addition to the White Paper, Government announced the current Immigration Health Surcharge would double as of December 2018. This means, for example, that a migrant care worker on a five-year visa will now pay £2,000 to use the NHS.
According to the Home Office, the health surcharge has brought more than £600m to the public purse over the past four years. The increase will bring in a further £220m and this will be used, we are told, to fill NHS funding gaps – but it could have serious implications for those who have to pay it. This, combined with the lack of clarity over the salary threshold, could well make a potential migrant worker think twice about moving to the UK.
For years, providers have looked overseas to help address the ongoing recruitment crisis in social care and, over the past three years, this has led to an increase of about 40% in workers coming from EU countries. With this in mind, and with the knowledge that there are more than 100,000 vacancies in the sector currently, it is perhaps not surprising that employers are concerned about their ability to attract care workers from outside the UK post-Brexit.
Alongside this, we may have some real challenges with supplies of medicines and medical equipment as we are heavily reliant on the EU for these vital supplies.
Whether we leave with a deal or without, the shape of our relationship with our neighbours in continental Europe will change. We must now focus on ensuring we do not create barriers that will have a fundamental impact on the sector’s ability to provide care and support in a sustainable manner to those who need it. We must find ways to make careers in social care appealing, both financially and professionally, to those from the UK and from abroad.
Photo credit: Laurence Cawley/BBC