On further exploration of the new immigration legislation, and having taken advice from a solicitor, it seems things will be even worse for disabled people who employ PAs and care workers directly through Direct Payments or CHC funding and that even if care work was classed as a shortage occupation as individual employers this route to employ new or replacement staff not resident in the UK would not be available to use. In fact it looks like once again this group of disabled people have been completely forgotten about. Below is a briefing we’ve prepared to use.
None of the current Immigration routes for non-UK staff. who require Home Office permission to work, appear to be available for disabled people to use if they are individual employers whose social care and support for independent living is funded through Local Authority Direct Payments or Continuing Health Care funding when they need to recruit new, or replacement staff.
We think a continuing ability for individual disabled people and Care Agencies providing live-in care workers to recruit non-UK care workers or Personal Assistants (PAs) is crucial to prevent a social care ticking time bomb, which will result in a devastating shortage of skilled, qualified social care workers, This would not only put disabled people’s lives at risk but would also increase both pressure and avoidable expense on our NHS and Adult Social Care services. This very real danger cannot be over emphasised but can be avoided if prompt action is taken.
Proposed Solutions
1) We would ask for an immediate extension of the legal time frame allowing EU and other workers to continue to work in the UK without applying for settled, pre-settled or frontier worker status. The current deadline is June 30th 2021 and we ask that this is extended until at least December 31st 2021.This is in order to take appropriate account of the many and numerous impacts of the pandemic and to allow time for the development of more effective, long term solutions. The development of these solutions should involve individual disabled employers and Deaf and Disabled People’s Organisations.
2) As the current routes to employ non-UK staff as Personal Assistants (PAs) or live-in Care Workers do not apply to individual employers we feel that a route which has the same level of flexibility as the Frontier Worker scheme is needed to allow such workers to come to work in the UK but not settle here. This would only need to be a specific route for a small group of individual disabled people and social care workers[1] and it would not grant such workers automatic freedom of movement or require that their dependents were able to move to live in the UK. The current routes to employ non-UK care workers fail to address new needs of disabled people, the types of work and the types of employers.
3) It is vital that any research into migration and social care occupation shortages involves disabled people who are users of adult social care especially those who directly employ Personal Assistants (PAs) and care workers as well as Deaf and Disabled User Led Organisations.(DDPOs) in addition to Trade Unions and Social Care agencies. So far disabled people and DDPOs have not been consulted on these issues notwithstanding their expertise in this area.
The Social Care Sector The social care sector includes a variety of employment options. Many social care workers work in care homes and nursing homes, others work in domiciliary care, which is where the workers go into disabled and older people’s own homes, for short periods of time, to provide social care support.
We are concerned that when the Home Office talk about social care workers they in fact mean Social Workers who are mainly employed by Local Authorities to assess disabled people’s needs. These two groups are very distinct and whilst Social Workers are covered by the skilled worker route. Social care workers, who actually meet the ‘hands on’ needs of disabled people are not, and certainly not where their prospective employer is an individual.
Another important group of social care workers are employed by individual disabled people either through PAYE or on a self employed basis directly by disabled people who receive a direct payment to fund their care from a Local Authority or through Continuing Health Care funding. On the whole disabled people who require this type of social care have high support needs and require 24 hour input. While social care is provided in individual service users’ homes working patterns vary enormously but usually a team of social care workers are needed to meet people’s needs such as being hoisted in and out of bed, assisted with personal care needs, sometime involving manual bowel evacuation, having medication, drinks and food provided, supporting the use of Bipap and Cpap machines fro breathing, and being supported to work and take part in society.
To employ PAs disabled people have to become employers with HMRC although they remain an individual employer only so are unable to sponsor staff to work in the UK through any of the current pathways – skilled worker, shortage occupation or Health and Care Worker routes which as individual employers they are unable to utilise. Alternatively they can employ Care Workers through an agency which provides live-in care support where staff often work on a self employed basis. Again disabled people who use these options to employ staff are currently left without any means to employ new, replacement staff outside of the resident workforce.
Due to lack of direct knowledge about social care provision too often the needs of this latter group of disabled service users is forgotten about which seems to be the case now.
It appears any EU and EEA staff working in the UK by December 2020 have the option to apply, before June 30th 2021 for settled status or if they do not wish to settle here at a later date for pre-settled status, or Frontier Worker status. However there is at present no option for these schemes to be extended to new staff who were not working in the UK by December 31st 2020. As the turn over of staff in social care remains high loss of such future workers will exacerbate the overwhelming pressures that our crumbling social care system already faces. We are asking for a similar scheme to the Frontier Worker scheme to be implemented to allow disabled people who employ PAs directly or live-in care workers through an agency to be able to continue to recruit new, replacement staff from outside of the UK in the future.
The features of the Frontier Worker scheme appear to work well as typically many PAs and live-in care workers have not moved to the UK permanently but come to work for an individual and may work one week on, two weeks off where they typically return home. This flexibility appeals to the social care workers and enables many disabled people to have their needs met in a satisfactory manner.
Shortage of Care Workers and PAs
Due to the low pay and low profile of social care work there is too often an assumption that anyone can do it. This is a major misconception that bedevils the sector and directly leads to disability inequality and the wasted human potential that flows from inadequate support for disabled people.
Given the life and death nature of the work performed by social care workers the implications of having staff that are unsuitable for their roles is particularly concerning.[2]
As service users, future service users, family, friends and supporters we know from many years of experience that it is vital to have every path open to enable the recruitment and retention of staff with the key values, behaviours, personality, client synergy and skill set to deliver high quality, safe, and value-for-money services. Recipients of social care know from lived experience that it is not possible for just anyone to become a satisfactory care worker/PA.
It is well documented that the social care sector suffers from a massive shortage of skilled staff and that demand far outstrips supply. Even if some UK unemployed workers entered the sector we do not think that alone would help solve this shortage particularly in the short term.
For over 30 years some of the workforce delivering social care support has come from the EU, EEA and other countries as well as the UK, and this system has worked relatively well for individual disabled employers. The salaries paid to staff are the same regardless of where they originate from and is limited by the size of disabled people’s social care packages which of course is part of the postcode lottery in social care.
Skills for Care estimates that 56 percent of the adult social care workforce are non-UK workers coming to the UK from abroad to work. if we consider the current staffing ratios of just 2 typical organisations that introduce care staff to disabled people, PA Pool and Independent Living Alternatives, they both have 50-60 percent of their current workers who are not UK nationals which could lead to an unmanageable shortage of workers in this specific part of the sector in the future. The high turn over of PAs and care workers also means that disabled people must have a future ability to recruit suitable staff. Failing to establish a route by which individual disabled people can continue to recruit good quality staff could literally be a matter of life or death for them.
The provision of quality care is important to the mental and physical wellbeing of a vast swathe of the UK’s disabled and older people – who are often denied rights and opportunities many non-disabled people take for granted. We are deeply concerned about a dramatic worsening of their quality of life, and loss of freedom leading to many becoming imprisoned in their own homes without the support needed to live independently.
Figures from the Office for National Statistics (ONS) estimate there are 112,000 unfilled vacancies at any one time in the Adult Social Care sector – a rate of 8% – compared to an overall vacancy rate of 2.7% across the UK economy as a whole. Other estimates are as high as 120,000 vacancies in total across the sector at any one time.
In 2019-2020, 143,000 care workers and PAs left the industry, and the retention rate is worryingly low, particularly during the first year of working.
27 per cent of Adult Social Care Workers are aged over 55 and will need to be replaced in the future as they age or become unable to continue with physically demanding work.
Many perform skilled tasks similar to Nursing and Health Care Assistants, who are able to continue working in the UK, and are also on very low wages. Disabled People whose care and support is funded through Continuing Health Care have primarily medical needs as well as social ones.
One impact of the Covid-19 pandemic is likely to be even further pressures on the social care sector and an even greater need for suitable social care workers. “IPPR research suggests that following the COVID-19 pandemic there will be a substantial increase in staff leaving the sector. Reduced access to overseas recruitment could impede the delivery of safe care to residents owing to reduced staff numbers.[3] Care Sector UK also warn that “The demand for live-in care and in the rest of social care will increase due to COVID-19 and people frightened of their relatives going into care homes.”[4]
We know that the government has stated that they want young unemployed people to enter the care sector as their unemployment rates are high however while recent levels of youth unemployment are higher than they have been since 2016, due to the impact of Coronavirus on employment, by historical standards unemployment levels for young people remain low.[5] Compared to European Union countries we rank 20th in having the lowest youth unemployment rates. In January 2021 410,000 under 24 year olds were unemployed so even if they all entered the care sector and remained working in it there would continue to be a shortage of between 71,000 and 79,000 care workers.[6]
Young UK workers in many cases do not have the maturity to carry out this demanding and skilled type of work well and often have never had to look after themselves let alone another adult with high support needs. Also individual disabled employers often need their PAs and care workers to be able to drive them to prevent social isolation or to go to work and often younger workers do not drive. There are also restrictions on younger drivers if someone has a vehicle from the Motability scheme which vary depending on the size and make of the vehicle. We know however that disabled people who have less severe impairments and who don’t need 24 hour support often employ younger workers as they can be paid less which allows their limited funding to stretch further and there are other parts of the social care sector in which they could be of valuably utilized.
It is difficult to find statistical evidence to support these views and the Office for Statistics Regulation states a scarcity of funding has led to under investment in data and analysis and adds there is little information on the quality of care and outcomes for those who experience social care.[7]
Lack of engagement with disabled people
The Migration Advisory Committee (MAC) which advises the government over shortage occupations and immigration matters has failed to consult or engage with individual disabled people or DDPOs while putting in place further barriers which will adversely affect our lives and right to live independently in the community.
We believe it is vital for disabled people to retain full choice and control over who provides often intimate personal care and support allowing them to contribute to society. Choice and control are essential in order to avoid the abuse and disempowerment of disabled people that can too easily occur when social care workers are not suited for their job roles. This is evidenced by recurrent scandals. Whorley Hall and Winterbourne View being just two examples of this sadly all too common phenomenon.
MAC are calling for an increase in funding for the sector with the implicit implication that having a shortage of staff will force up wages in the sector.[8]
While we absolutely support an increase in social care funding and are calling separately for a national social care system funded through taxation and free at the point of need. We are also deeply concerned about what will happen should there be a gap in availability of skilled and suitable social care workers from outside of the UK and availability of a replacement pool of workers. This is literally a life and death situation for disabled people and they must not become collateral damage in pursuit the removal of freedom of movement. The inherent dangers this would create for disabled people must be acknowledged and mitigated by the adoption of the solutions we have put forward.
[1] Only an estimated 430,000 disabled people receive a Direct Payment,Personal Budget or CHC funding and not all of these require 24 hour support. https://digital.nhs.uk/data-and-information/publications/statistical/adult-social-care-activity-and-finance-report/2019-20/4.-long-term-care figure 17
[2] P129 ibid- “It is essential that people recruited to job roles across health and adult social care are the right people, with the right values. Evidence shows that people recruited for their values impacts upon retention, productivity, absence, and service user satisfaction.”
“Not all applicants are suitable to carework… regardless of the terms and conditions…. empathy, sensitivity and emotional intelligence are key skills”.
[3] p 129 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/927352/SOL_2020_Report_Final.pdf
[4] P129 ibid
[5] https//:researchbriefing.file.parliament.uk and ONS Labour Market statistics bulletins.
[6] ONS vs GMB union figures on shortages
[7] www.statisticsauthority.gov.uk/wp-content/uploads/2020/01/19_11_15_socialcare_SRv3.pdf
[8] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/927352/SOL_2020_Report_Final.pdf
