Sustainable Care Publications

This Policy Brief outlines early findings from a new study of migrant labour in England’s homecare sector
led by Professor Shereen Hussein at the University of Kent. The study forms part of the wider Sustainable Care: connecting people and systems research programme, and draws on:
• A review of existing evidence about migrant care workers in the UK
• A survey of 32 people with expertise and knowledge of social care and migration, focused on issues of
demand and supply
• Interviews with 25 migrant homecare workers
• Ongoing comparative analysis of the sustainability of migrant care work in eight countries, to be reported
separately.
Data were collected, in 2019-2020, at a time of uncertainty associated with the UK’s departure from the
European Union, its future immigration system, and ongoing challenges in adult social care.
Key points to inform debate
• Migrant care workers have been important in homecare for over a decade
• In the short-to-medium term, and in some regions, the sector will remain reliant on migrants to fill
vacancies
• Demand for migrant homecare workers is driven by local labour shortages in a context of uncompetitive
and unattractive employment conditions
• Past acute workforce shortages in homecare occurred despite unrestricted access for EU workers
• Immigration rules and visa systems affect the number and types of migrants attracted to the sector
• Live-in care, a growing market segment, attracts high proportions of migrant care workers. If migrant
workers’ rights are restricted, the risk of exploitation in this segment could be high
• Given the expected continued and increasing demand, urgent consideration should be given to
introducing a sectoral visa scheme.

Key messages
Some 168,000 British people are resident, and receive their British state pension, in Spain. Many more
live in Spain on a permanent or semi-permanent basis but are not registered in Spain as residents. Many
migrated years or decades ago and now have care needs. Their family or other support networks may
provide financial or emotional support but are often in the UK and cannot provide proximate care. Most
older British people cannot speak Spanish and struggle to access help from Spanish social services; as
a result most formal care is obtained through British care companies with individuals paying privately.
Those on low incomes and with few assets or savings who need help cannot afford care, leaving Britishrun
voluntary organisations to ‘step in’ and organise and/or pay for care.
About the study
This study explored how older British migrants in Spain experience ageing, investigating their
wellbeing, access to and experiences of care. We interviewed 34 older British people living in the Costa
del Sol in February 2019. They had lived in Spain for between 3 and 47 years (on average for 18 years)
and most were approached through British-run voluntary organisations in Spain (which may affect our
conclusions). Their ages ranged from 58 to 95 years (average age 78 years). Ten were men and 24 were
women, and they included people receiving personal care or support in the home, people providing
unpaid care to a family member and people not receiving care but who may do so in the near future.
The research described in this Policy Brief was undertaken in 2018-19 by Dr Kelly Hall, University of
Birmingham. It is one of several studies being undertaken by our team researching Care ‘In’ and ‘Out of’
Place: Towards Sustainability and Wellbeing in Mobile and Diverse Contexts, as part of the ESRC-funded
Sustainable Care: connecting people and systems programme.

• Our research aimed to understand experiences of ageing and access to care and support.
• We interviewed people born in the Caribbean, Ireland and Poland who arrived in Britain as young people and who are now retired.
• Most participants were over 80 years old and were experiencing a range of complex health issues related to older age.
• All participants were living in their own home or in sheltered housing.
• We focused on two areas – London and South Yorkshire.
• This report communicates our key findings to those who participated in the research and to the community organisations who support them. The report is the starting point for a process of co-producing recommendations with key stakeholders, including older migrants.

The concept of wellbeing has been included in policy literature in the four nations of the UK since the early 2000s, with a specific focus on social care from around 2011 (although there was reference to wellbeing as early as 1968 in the Seebohm report which recommended the creation of local authority social services departments to “enable the greatest possible number of individuals to act reciprocally, giving and receiving service for the well-being of the whole community” [p180]). Two main waves of political interest in wellbeing have been identified. The first, in the 1960s, highlighted that Gross Domestic Product (GDP)/ Gross National Product (GNP) were imperfect means of measuring how well a society is functioning. It sparked an interest in developing other social indicators, stalled in the 1970s (as nations entered recession) and re-emerged in the 1990s as interest in wellbeing, including in developing countries, revived.

In the UK, Prime Minister David’s Cameron’s 2010 speech on wellbeing and the need for more precise measurement of the concept is seen as a key point in establishing wellbeing as a policy priority. A so-called ‘watershed’ speech, it called for measures of wellbeing to assist in assessing Britain’s progress in more than merely economic terms. Cameron challenged three notions. First, he refuted the idea that wellbeing is a distraction from the ‘urgent economic tasks at hand’, citing Robert Kennedy. Second, he contested the notion that improving wellbeing is ‘beyond the realm of government’, citing Joseph Stiglitz and Amartya Sen. Third, he questioned the idea that wellbeing is a woolly, poorly defined concept and thus hard to measure. In response, the UK’s Office for National Statistics created a national programme to develop measures of wellbeing and an ensuing national debate on ‘what matters to you’ led to the development of a national wellbeing measurement framework with objective (e.g. employment, life expectancy) and subjective (e.g. life satisfaction, anxiety, meaningfulness) measures.

This review summarises main policy developments on wellbeing in the field of adult social care since 2000 in the four nations of the UK.