Written evidence from the International Longevity Centre – UK (ILC-UK) (BRE0066)

Executive Summary
 

Current adult social care staffing

• Around 1 in 20 (6%) of England’s social care workforce are EEA migrants, equating to around 84,000 people.
• Greater London has the highest proportion of social care workers born in the EEA and without British citizenship, at 10.6%
• In the first part of 2016 alone, over 80% of all migrant care workers who moved to England to take on a social care role were from the EEA.
• The rate at which EEA migrants have been filling vital care worker vacancies is accelerating as immigration rules affecting non-EEA workers continue to place limits on unskilled labour. In the first part of 2016 alone, over 80% of all migrant care workers who moved to England to take on a social care role were from the EEA.
   

The challenge of Brexit

• 90% of England’s social care workers born in the EEA (78,000) do not have British citizenship
• Turnover and vacancy rates in the social care workforce have been steadily rising for the past decade, and 2016 saw them rise further to 24.3% and 5.1% respectively.
• If thousands of EEA migrant care workers lose their right to work in England as a result of post-Brexit immigration changes, it will be almost impossible to close the already sizable social care workforce gap.
• In a zero net migration scenario, the social care workforce gap could reach just above 1.1 million workers by 2037.
• In a (more likely) low-migration scenario, where the sector remains as attractive as today but the Government commitments to reducing net migration, there will be a social care workforce fap of more than 750,000 people by 2037.
   

Government priorities

• The rights of non-UK passport holding EEA born social care workers must be protected.
• Immigration policy must reflect the needs of the older and disabled people who rely on social care for their independence.
• If the Government does commitment to reducing net migration, the Government must also commitment to increasing in the attractiveness of the social care sector to UK born workers.

Introduction

1. The International Longevity Centre – UK (ILC-UK) is a futures organisation focussed on some of the biggest challenges facing Government and society in the context of demographic change. The ILC-UK is part of the International Longevity Centre Global Alliance, comprised of 17 partners across the globe.
    
2. We ask difficult questions and present new solutions to the challenges and opportunities of ageing. We undertake research and policy analysis and create a forum for debate and action.
    
3. Our policy remit is broad, and covers everything from pensions and financial planning, to health and social care, housing design, and age discrimination. We work primarily with central government, but also work with local government, the private sector and relevant professional and academic associations.
    
4. ILC-UK would welcome the opportunity to provide oral evidence to the Committee. 
    
5. Our primary goal is to ensure a sustainable future which accommodates the needs of an ageing population. Our submission is focusing on Government priorities for health and social care in negotiations on the UK’s withdrawal from the European Union.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   The role of migrants in the social care workforce
    
6. The latest estimates available in 2016 highlight that: • 280,000 workers in the adult social care sector are foreign born (circa 20% of the workforce) • 84,000 workers in the adult social care sector are EEA-born However, in recent years, the proportion of EEA migrants coming to England to work in social care has dramatically increased. Over 80% of migrant social care workers who arrived in England in 1995 were born outside the EEA, and 20% were born in the EEA. By 2016 the proportions had completely reversed.
   
    
7. Among migrant workers who arrived after 2010, the share of EEA-born migrants has increased steadily by Source: Our elaborations using NMDS-SC individual workers’ file, June 2016 Proportion of new entrants Year of arrival Non-EEA EEA (non UK) an average of nine percentage points per year, meaning more than 4 in 5 migrant care workers who have arrived in 2016 to date, were born in the EEA.
    
8. In terms of numbers, at least 19,000 EEA-born migrants have come to work in the social care workforce in the past five years, but even this number is likely to be an underestimate[1].
    
9. In 2015, we established that a greater percentage of EEA-born care workers are full time (63.6%) than is the case for other migrant care workers (51.1%) and indeed UK-born workers (51.5%).
10. We also highlighted how 4 in 5 (80.9%) EEA-born care workers work in the private sector. Given this accounts for larger amounts of growth within the care workforce than statutory local authority care, EEA-born workers in the private sector could be most exposed to the impact of Brexit[2].
     
11. If this flow of EEA migrants is restricted in future, without a concurrent improvement in the rights of migrants from outside the EEA to come to the UK to work in social care, the implications for the social care workforce – and the older and disabled people they support – are likely to be severe.
    
    What is the immigration status of current EEA migrants?
    
     
12. Only around 1 in 20 (5.2%) EEA migrants in professional social care roles have British citizenship. • Only around 1 in 20 (5.4%) EEA migrants providing direct care have British citizenship. • Only around 1 in 15 (6.8%) EEA migrants in other social care roles have British citizenship.22 • Only around 1 in 6 (16.7%) EEA migrants in managerial/ supervisory social care roles have British citizenship.
     
13. Overall, we estimate that only 5,800 of the current 84,000 EEA migrants working in social care have British citizenship. That means that around 78,000 – more than 5% of the total social care workforce – do not.
     
14. Perhaps most worrying of all, our 2015 analysis revealed EEA migrant care workers are most represented in direct care (5.3%) and professional (8.7%) roles. So, the fact that it is in these job roles we see the fewest number of EEA migrants with British citizenship hints at the possibility of larger-scale losses in hands-on jobs that older people most rely on.
     
15. In the event that EEA migrants without British citizenship lose their right to live and work in the UK – something the Prime Minister has refused to rule out to date – there would be a dramatic effect on vacancy rates within the care sector in England. Moreover, as long as there is uncertainty about this possibility, there is likely to be an increased risk that current workers consider leaving the UK and potential migrants from EEA countries think twice before taking up vacant roles in the UK.
    
     

16. The distribution of EEA-born care workers, and the likelihood of those social care workers having British citizenship, is not uniform across the UK. Please see the table below for further information.
    
     

17. The social care workforce in London could lose almost 20,000 workers in almost 21,000 jobs[3] • The social care workforce in the South East could lose almost 23,000 workers in more than 24,000 jobs[4] • Even in the North East, which has the fewest EEA migrants, and the smallest overall population, the social care workforce could lose more than 1,000 workers in the same number of jobs[5].

18. The impact of these losses on the social care vacancy rates across the country would be profound. Some types of job role may be more severely affected than others, not least registered nurses, where the Centre for Workforce Intelligence has already explained there is an acute shortage of adult nurses in social care[6].

19. But at least in the short and medium terms it is highly likely that many care roles would go unfilled across many of the English regions, and that older and disabled people would struggle to get the care they need.
    
    What are the long-term implications of post-Brexit changes to migration policy for the social care workforce?

20. To estimate the longer-term impacts of changes to migration policy on the social care workforce, we have modelled future social care demand against four migration scenarios, based on ONS projections[7].

21. 1. Zero migration: no net migration; population increases by 0.2% on average between 2014 and 2037.
    
    2. Low migration: net migration of 101,000-102,00 per annum; population increases by 0.4% on average between 2014 and 2037.
    
    3. ONS principal migration projection: net migration of 164,000-165,000 per annum; population increases by 0.5% on average between 2014 and 2037.
    
    4. High migration: net migration of 226,000-227,000 per annum; population increases by 0.7% on average between 2014 and 2037.

22. 1. The proportion of the working age population in England working in the adult social care sector remains the same, at 4.1%.
    
    2. The sector gradually loses attractiveness (perhaps as a result of ongoing low wages and relatively challenging working conditions) and falls to 3% of the working age population by 2037.
    
    3. The sector gradually increases in attractiveness (perhaps due to better training provision, better pay or better working conditions) and rises to 5% of the working age population by 2037.

23. Our estimates of the needs of the future social care workforce are based on an increase in demand for social care, resulting from our ageing population – in 20 years, almost a quarter of the population will be over 65[8].

24. The table below displays the care sector workforce shortage across the four scenarios, with the attractiveness of the sector as a variable. The table also displays the resultant care dependency ratio, i.e. the number of social care workers to every older person.
    
    Policy Recommendations

25. The Government must ensure that all EEA migrants currently working in social care in the UK have the right to remain post-Brexit.

26. The social care workforce, particularly in London and the South East, is acutely vulnerable to the loss of thousands of care workers. Vacancy rates in the sector have been steadily increasing since 2009, and would likely dramatically increase if EEA migrants were forced to leave their current social care roles.

27. This could be done in a number of ways – from retaining freedom of movement within the EEA to granting special dispensation to those working in care to retain their right to work, as Simon Stevens has already called for on behalf of NHS workers.

28. The Government should ensure that future migrant social care workers are appropriately recognised in any new approach to migration.

29. In a zero net migration scenario, there could be a social care workforce gap of 1.1 million people by 2037. Even if the social care sector’s attractiveness increases dramatically over time, and the UK government successfully embraces effective new care delivery methods, it is likely to be impossible to fill that gap without migrants from both inside and outside the EEA joining the social care sector.

30. As such, it is vital that any new approach to immigration recognises the urgent need for more social care workers in the UK, and provides a clear path for migrants to fill UK social care vacancies. This could be achieved in a number of ways from guaranteeing freedom of movement within the EEA, to allotting care workers priority access rights in a work permit system.

31. If the government does not recognise the vital contribution made by social care workers in any new immigration system, it will be older and disabled people who will lose out.

32. The Government must secure the funding of social care in England. Without a clear plan to ensure sustainable funding for the provision of social care in England, it is hard to see how the sector can become more attractive to British-born workers or develop the new models of care delivery it will need.

33. We have argued that the best way to quantify the level of funding needed and identify its sources, is through an independent cross-party commission to examine funding for both social care and the NHS.