The influential Migration Advisory Committee (MAC) were asked to look at the impact of Brexit on the adult social care sector. What they have to say makes an interesting read on the issue of carers. It makes recommendations from a much wider perspective offering new models and new ways of looking at the issues facing this industry. It invites the public sector as well as the NHS to consider a number of ways to offer social care in a person’s home. For most of this article I will be referring to large sections of the report as they are written. Those looking at the care industry should read this report and look at ways of engaging with MAC to develop workable models.
The report acknowledges that social care sector is facing a workforce crisis.
Care workers were placed on the shortage occupation list since December 2021 following the acknowledgement of crisis and upon MAC’s recommendations. They also qualify separately for Health and Care visas.
MAC made an interesting observation about care workers who are still considered not to be at RQF Level 3:
We also recognise the anger that many within the sector have felt at workers being viewed as ‘low-skilled’. We categorically disagree that care work is low-skilled;[our emphasis] although some basic technical skills can be acquired through training, other skills are vital attributes in providing good quality care, such as emotional and physical resilience, communication, planning and organisation, problem solving skills as well as understanding individuals’ needs. We also recognise the further strain that the ongoing COVID-19 pandemic has caused the sector, with workers going above and beyond to continue providing a vital service in challenging conditions.
The Skilled Worker route is now the principal sponsored immigration route for hiring migrant workers in social care. This is through the Health and Care visa or through it being on the shortage occupation list. The advantage of it being in the shortage list is that it enables employers to sponsor care workers for a minimum salary of £20,480 per year. This is particularly useful for small employers.
MAC has recognised the need to make the system of sponsorship for employers easier:
We recommend that the Government either conduct or commission research to identify administrative burdens for employers and workers that could be eliminated across the Skilled worker route. This analysis should consider both the benefits to the integrity of the immigration route of specific requirements, and the burdens on those who must fulfil them.
On the issue of the Immigration Skills charge:
We recommend the removal of the Immigration Skills Charge for all Health and Care visas. More broadly, it would be useful to conduct a full review of the Immigration Skills Charge across the entire Skilled Worker route.
Mac also has a view on Settlement Rights and fee waivers:
We recommend that workers who spend the full 5 years working in nursing or care roles on the Health and Care visa should either receive a complete settlement fee waiver or pay a lower fee, that is no higher than the unit cost of processing. The cost of this recommendation should not be passed on to other visa fees.
Care Workers placed on permanent occupation list:
The MAC recommends that the decision to make care workers eligible for the Health and Care worker visa should be made permanent, i.e., should not have an automatic sunset date. This will give more certainty to employers in the sector.
By placing it on the Occupation Code it will also recognise the skill level of the care workers.
For those on the Shortage Occupation List (SOL):
MAC recommends that the Government keep care workers on this list until the next review.
It points out that:
While any future SOL review will examine the situation in the labour market at that time, realistically it is very unlikely that shortages in the social care sector will be resolved in such a short period. The MAC would likely only be minded to remove care workers from the SOL in the event of a very substantial change in the conditions facing social care employers.
It goes on to consider direct employment of care workers:
A small, but highly impacted, proportion of people who receive care and support in the UK directly employ care workers, and stakeholders from this sector have told us how vital those care workers are to these people being able to function and live independent lives. They also told us about the difficulties in finding and recruiting suitable individuals to provide personal care, and the high harm to their lives when they could not find appropriate care.
MAC considered models in other countries for provision of social care. They have concluded that there are better ways of achieving the same objectives through the existing Skilled worker route. It points out that the regulations already allow an agency to sponsor a migrant provided that they are delivering a service to a client (rather than simply providing workers).
It should therefore be possible for organisations to use the Health and Care visas to employ care workers, with individuals using personal budgets to purchase care and support services from those organisations. The important distinction is that the care worker must be formally employed by the agency rather than the person receiving care and support.
They suggest:
That Local Authority’s have a role in shaping social care markets and the MAC would encourage DHSC and the Devolved Administrations to work with local authorities to support the development of this market.
However MAC goes further and recommends the setting up of a pilot scheme:
There is likely to be a small group of people who receive care and support who would not want to use an agency to contract care services in their home. They would prefer to have more involvement in the recruitment of the person they will rely on for their care and not be required to pay agency fees. Whilst using an agency would be the preferred model for many, if the Government is clear that allowing people who receive care and support to directly hire workers is a fundamental element of social care policy, the Government could consider the introduction of a pilot umbrella scheme. Under the scheme, an umbrella body would be appointed to sponsor care workers from overseas and people who can show their level of need requires live-in care would be able to directly recruit from the umbrella body.
MAC have offered to be involved in the design and evaluation of such a pilot if the Government decided to pursue it and also strongly urges close involvement with the sector.
The Home Office usually accept the recommendations of MAC. This time there is much more depth to the recommendations especially on the pilot umbrella scheme. It will be interesting to see how far their recommendations go.