After the clapping stops: the crisis facing migrant workers in the care sector

By Dr Agnes Turnpenny,
University of Kent

The COVID-19 pandemic has shone a spotlight on care work like never before. Care workers and other key workers have been applauded and celebrated, yet there is a looming crisis facing the social care sector. British and migrant care workers have stood shoulder to shoulder through the pandemic, yet Brexit and the UK’s immigration system create specific risks for migrants. EU citizens rights’ have been put at risk by the EU Settlement scheme. At the same time, migrants from outside the EU and new arrivals face extraordinary visa fees, difficulties securing and maintaining their status, and vulnerability to exploitation. On 20th  April 2021, we held an online event to discuss the risks that migrants who work in the care sector face, what this means for the sector, and what needs to happen to ensure their rights are protected. The session, chaired by Nadia Whittome, Member of Parliament for the Labour Party for Nottingham East, and featuring presentations by Professor Shereen Hussein from the London School of Hygiene and Tropical Medicine on the contribution of migrants to the social care sector (click here to download slides), Caitlin Boswell from the Joint Council for the Welfare of Immigrants on the risks of the EU Settled Status Scheme, and testimonies from Kinga Milankovics, a live-in care worker from Hungary and Myrna (not their real name), an undocumented Filipino care worker.

What is social care and how does it work?

Social care offers personal care and practical support for people who need care and support due to disability, illness, old age, and their carers (NAO 2018). It includes diverse services, such as care homes and nursing homes and care and support provided in people’s homes. Unlike the NHS, adult social care is not free, and a significant number of people have to arrange and pay for their own care.

The workforce and job roles in social care are hugely varied and include a range of direct care, management, professional and ancillary roles. Around 1.5 million people work in adult social care in England, more than the number of NHS workers.

The importance of migrant care workers to social care in England

Non-British nationals make up 14% of the UK population, but form 17% of the social care workforce in England1 : 8.7% (131,000 people) are non-EU nationals, and 7.6% (113,000 people) have an EU nationality. Some areas and job roles are even more reliant on migrant care workers. For example, in London 38%, and in the South-East 23%, of the workforce are non-UK nationals; and more than a third of registered nurses working in social care (mostly in care homes and nursing homes) are non-UK nationals.

The overall share of migrant workers has changed very little over the last decade, but their number increased by at least 18,000 as part of a growing workforce (see Figure 1). Migrant workers are therefore essential to ensure the sustainability of social care provision.

Figure 1: Percentage of non-British national workers in the adult social care workforce between 2012 and 2020

Figure 1

Why does social care rely on migrant workers?

Social care has one of the highest rates of job vacancies in the economy. It is estimated that around 7% – 112,000 social care jobs – are vacant in England. There are many reasons for this, but two facts are significant:

  • Although many social care jobs do not require formal qualifications in England, care is highly skilled and demanding work, and it is also characterised by long and unsocial hours.
  • At the same time, social care is one of the most undervalued and lowest paid sectors. The majority of care workers are paid just over the national living wage, and many are on zero-hour contracts.

The main reason for social care providers to recruit migrants is the shortage of local workers willing and able to work in social care. Recruiting care workers from outside the European Union became very difficult –nearly impossible – after the immigration reforms of the coalition government in 2010-2012. Therefore, most non-EU migrants are already in the UK when they are hired to work in social care.

Until the end of 2020, EEA nationals could move to the UK for a job in social care, although many were already living here when they decided to enter the sector. Our research with migrant care workers in the Sustainable Care programme has highlighted the variety of motivations and routes to the sector and the wealth of experience and diversity migrants bring.

The shortage of care workers is expected to get more acute: Skills for Care estimates that the number of social care jobs will increase by more than 30%, equivalent to half a million new jobs, by 2035.

How is the immigration system putting care workers, and the care sector, at risk?

The new immigration system ended the right to free movement for EU workers. It introduced a new points-based immigration system for everyone moving to the UK for work from 1st January 2021 (Home Office 2020). The new system will exclude the majority of care workers from coming to live and work in the UK under a Tier 2 work visa for two main reasons: the majority of job roles in social care are below the minimum qualification level (Level 3) and paid less than the general salary threshold (£25,600 per year).

As of March 2021, senior care worker roles were added to the Shortage Occupation List, which will allow more people to qualify for a (Health and Care Worker) visa to work in social care. Employers – especially the many thousands of small and medium-sized organisations involved in social care provision – will need support to comply with the new requirements.

All care workers with an EU or EEA nationality in the UK before the 31st December 2020 must apply to the EU Settlement Scheme (EUSS) before 30th June 2021, to continue living lawfully in the UK. JCWI’s own research found that without urgent action, large numbers of EU care workers are at risk of falling out of legal status and rights after the EUSS deadline, which would have a significant impact on the care sector already struggling to recruit enough staff.

The Government’s Hostile Environment policy is also affecting migrant care workers. A recent freedom of information request found that fewer than one in six of more than 44,000 “intelligence-led” Home Office immigration enforcement raids on people’s homes since the introduction of the Hostile Environment policy have resulted in deportations, according to data obtained by the Guardian. According to this data, there were 190 immigration raids on care homes, resulting in the removal of just 37 care workers from the UK between 2015 and 2019. The impact of these raids on elderly and vulnerable residents and staff is difficult to overestimate and these actions are hard to justify.

Undocumented migrants, many of whom work in care, are at the sharpest end of the Hostile Environment. Without the protections afforded to people with legal immigration status, they are hugely vulnerable to exploitation and unable to seek support due to fear of criminalisation or removal, trapped in a cycle of exploitation. The way the EUSS is currently designed is likely to create a significant new population of undocumented EU migrants, vulnerable to harmful Hostile Environment policies, including detention and removal.

Elderly person smiling sat in chair and care worker standing smiling

What needs to change to protect care workers and the care sector?

The challenges of social care and care migration are complex and intertwined. First and foremost, the sector needs the long-promised reform to deliver better and sustainable funding alongside a workforce plan to improve employment conditions – pay and job security – and recognition. The contribution migrants make to social care must be recognised regardless of their immigration status, and we need a fair system, does not exploit migrant care workers or creates conditions that increase vulnerability and exploitation.

In the immediate future, the EU Settlement Scheme deadline must be lifted to ensure EU-national care workers, colleagues, friends and neighbours can continue living and working in the UK.

As the pressure of the COVID-19 pandemic eases on the sector and the impact of the new points-based immigration system becomes more evident, we will need to focus on addressing the following risks and injustices:

  • Many migrant care workers arrive via non-work routes and must pay the NHS Health Surcharge when their colleagues recruited directly with a Health and Care Visa do not have to pay. This highlights how arbitrary and discriminatory the NHS Health Surcharge is.
  • The impact of ‘no recourse to public funds’ on migrant workers in sectors characterised by poor employment conditions – including social care – must be reviewed and ensure that individuals and families are not put at risk of destitution.
  • Employer sponsorship and restrictions on changing jobs can leave workers vulnerable to exploitation. Its impact must be better understood in sectors characterised by high staff turnover and poor employment conditions, such as social care.
  • The implementation of the EUSS will need long-term monitoring and follow-up to make sure that nobody who is eligible fails to transition from pre-settled to settled status. In roles where people are at risk of being unable to secure settled status (e.g. live-in care), more information and support is needed about alternatives (e.g. frontier worker status).
  • The risks and drivers of labour exploitation and modern slavery of undocumented migrant care workers and unregulated care must be better understood and addressed.

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1 No data available for Scotland, Wales and Northern Ireland.

Agnes Turnpenny

Dr Agnes Turnpenny works on the Sustainable Care programme on the team studying Migrant care workers in the UK: an analysis of sustainability of care at home. Click here to learn more about this work.

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