Simon Bottery, senior fellow at the The King’s Fund, assesses the short and long-term impacts of Brexit on the domiciliary and live-in care sectors.
Remember when we all thought Brexit would dominate the news in 2020?
COVID-19 reminded us that there are some things bigger than trade policy. Yet, while the care sector has been rightly focusing on the huge impact of the pandemic, the UK has left the European Union and there will be consequences for providers, service users and staff. So we need to understand what will happen as a result of the new EU-UK trade and co-operation deal which took effect on 1 January 2021.
The consequences are broad for the health and care sector, covering issues such as reciprocal health care, supply of medicines and medical devices, information sharing, research and clinical trials. But the one that will likely bring about the greatest change is in workforce and immigration.
Workforce and immigration
At its simplest, leaving the EU’s single market means that there will no longer be free movement of labour between the UK and European Economic Area (EEA) countries. All workers arriving from EEA and non-EEA countries are now subject to the same immigration rules, which are based on a new points-based system. This makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers, through a new fast-track visa route, known as the Health and Care Worker Visa. However, that’s something of a misnomer since there are no exceptions made for other social care roles, such as care workers.
This does not, of course, mean that EU careworkers already working in the UK will suddenly lose their right to work here. All workers from EEA nations who are already resident in the UK have until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. Of the over 3.8 million applications concluded by 30 September 2020, 56% were granted settled status and 42% were granted pre-settled status (which they can upgrade to settled status once they’ve been resident for five years).
It does, however, put a major barrier in the way of new care workers arriving from the EU, so as existing care workers move sectors, return to their home countries or retire, they cannot easily be replaced from within the EU. The number of social care workers with an EU nationality – currently around 113,000 – will start to fall. In a sector which struggles to recruit enough staff anyway (the vacancy rate in home care in 2020 was 9%), that is clearly a problem.
How big a problem is likely to be determined by a combination of your location and the type of care you’re providing. Generally speaking, the further out from London and the South East you go the smaller the percentage of EU care workers in the sector. In London, around one in seven of the direct care workforce is an EU national. In the South East, it is around 1 in 8 and in Eastern England around 1 in 10. However, in the North West it is one in 35 and in the North East it is one in 50.
In terms of sectors, residential care is more affected that domiciliary care. Around in 1 in 11 care home workers is from the EU, compared to around 1 in 16 home care workers. However, the biggest impact may be in live-in care. Here, the United Kingdom Homecare Association estimates that European Union nationals make up 50-60% of the 15,000-20,000 live-in home care workforce. This suggests that the impact here may be faster and more profound than in other sectors.
Is there an upside?
Is there an upside to any of this? If you are a family trying to find a live-in carer for your mum or a provider struggling to fill shifts, then no. Fewer workers will exacerbate your and the sector’s problems, not alleviate them. The immediate impact may be dampened by unemployment and furloughing in the wider economy, meaning there are more workers who may choose to work in social care.
The only silver lining you can find – and it is admittedly a thin and tentative one – is that in putting in place the new immigration system the government has in effect accepted the argument of its Migration Advisory Committee that the sector needs more money. The MAC’s view is that ‘funding social care to a level that enables higher wages to be paid, and consequently makes jobs more attractive to the domestic workforce, is the right way to address the workforce issues in the sector, rather than relying on migrant workers to fill the gaps’. The risks of not doing that soon, it says, are stark.
That puts a little extra weight on the government to reform the sector, put some extra cash into it and find a way to ensure its staff receive a better wage. But proposals are now only expected at some stage ‘this year’ so only a wild optimist would hold out the hope of much change in the short term.
The King’s Fund is an independent charity working to improve health and care in England.