Jef Smith looks at the figures and issues surrounding retention and recruitment in social care in the light of Brexit.

At the annual social care conference organised by consultants Laing and Buisson (L&B), there is a regular session overviewing the sector’s workforce issues. A decade or so ago, the presenter each year would produce graphs showing trends in the expansion of need and the availability of staff to meet that requirement. It looked then as if an enormous crisis was imminent, the available pool of potential workers totally unable to meet the demand; the shortfall was in the hundreds of thousands.

Well, it didn’t happen. Predictions of increasing need, virtually inevitably consequent on the growing elderly population, have not, owing to the massive cuts in local authority resources we all know about, translated exactly into a proportionate growth on the supply side. Some growth has taken place, however, so L&B’s predictions were not wrong-footed only by austerity. What has happened is that the increase in workforce numbers did not, in the event, have to depend entirely on homegrown personnel. Instead, immigration from the European Community took up much of the slack.

Britain’s decision to leave the EU will therefore have, as yet, unpredictable but potentially massive implications for social care. Skills for Care, in the 2016 edition of its annual publication The State of the Adult Social Care Sector and Workforce in England, points out that the “high reliance on overseas workers … raises questions regarding the sustainability of the workforce and could create challenges with workforce supply”. When the introduction to that report described the issue of the nationality of workers as “a hot potato”, it was certainly not overstating the gravity of the situation.

As might be expected, the majority of the adult social care workforce are British, but the still significant non-British minority — 17% — is substantially larger than the proportion of non-Brits in the population as a whole, which is only 8%. Furthermore, that 17%, again predictably, is not spread evenly across the whole country. The numbers of non-British workers vary from a mere 5% in the northeast, 8% in both the northwest and Yorkshire and Humber, 12% in the Midlands, and 14% in the southwest, to 19% in Eastern England and 22% in the southeast. All of these, however, are dwarfed by London, where no less than 41% of social care workers are non-British.

Skills for Care which assembles these statistics then breaks the non-British figures down into EU and non-EU origins. Here, the disparities are somewhat less dramatic, the range for immigrants from the EU running from 3% in the northeast to 12% in London. Overall, 7% of the workforce come from the EU and a further 11% are of non-EU origin, 7% is still significant; 12% is really quite substantial.

The withdrawal of the UK from the EU is widely expected to stop the flow of European immigration, depriving the care industry — not to mention the NHS, parts of which have a somewhat similar workforce profile — of a major source of recruits. There are mixed feelings about the immigrants from mainland Europe who have filled the personnel gap in care homes since late in the last century. Many, at least initially, speak limited English and, in a field in which communication with people who are themselves often deprived of language skills through physical and cognitive disability is vital, this might be thought a serious handicap. Few, except the minority of nurses, have any relevant qualification and not many have had significant experience of care work before arriving in Britain.

What they initially lack in expertise, has been made up, many argue, by enthusiasm, intelligence, flexibility and strong motivation. The responsibility for training such recruits rests heavily on employers, which some argue is wholly appropriate but which indisputably adds a managerial and financial burden to already stressed providers. The commitment of many of these young people to long-term careers in care or even to staying in Britain beyond a few years of gaining experience and language skills is also in doubt. Social care also faces constant competition for staff from the health services, and the greater financial and promotional prospects offered by the NHS has led to a drain of experienced workers and contributed an annual turnover rate now running at 27%, equivalent to 900 people leaving their posts each day. In short, an arrangement which has all the hallmarks of a short-term fix to the problem of a basic grade staff shortage has been institutionalised and become something close to a permanent feature.

The situation after Brexit

That, of course, is a summary of the position before Brexit became the central feature of the UK’s social and economic politics. Britain’s exit from the EU now looks very likely to bring an end to the free movement of labour, limiting or severely curtailing immigration from continental Europe. For many of the advocates of Brexit, this was a central objective since comprehensively curbing immigration, despite all of the promises and efforts of Home Secretaries over recent years, is clearly impossible while Britain is obliged by its EU membership to have open borders with the 27 other states of the Union.

The social care workforce is still predicted to grow from its present level of around 1.5 million to 2.2 million in 2025. Meeting this demand would be immensely challenging under any circumstances, but to cut off a major source of recruitment at this juncture looks like crass folly. As well as choking off immigration, Brexit as currently conceived puts at jeopardy the status of EU citizens already living and working in the UK. The Government is sympathetic to the plight of such people — around three million, it is reported — and has promised that sorting out their future will be an early priority in negotiations. Nevertheless, it has felt unable to offer any guarantees yet, and the fear of eventual deportation could persuade some currently settled workers to return home prematurely and others who were considering coming to Britain to change their plans. Will care homes be forced to close simply by staff shortages — along with all the other stresses they face — or can anything be done to mitigate Brexit’s effects?

There remains a very slim chance that by some magic of negotiation, not yet apparent free movement of labour could be preserved as part of a deal to maintain Britain’s access to the single market. This looks very unlikely, however, and advocates of Brexit would undoubtedly call foul if it actually came about. Short of that probably impossible aspiration, various formulae could be explored to allow controlled immigration to continue in specified sectors where the need for labour beyond what the domestic market can provide can be demonstrated.

Social care in general and residential homes in particular, look like worthy candidates for such special treatment, particularly if they can be bracketed with the health services whose lobbying muscle is much stronger. Much has been made, for example, of the potential use of a points system which would enable individual applicants for entry to Britain to be judged against the need for the particular contribution they could offer, but precedents tend to focus on specific professional or trade skills, while EU immigrants taking up care posts are generally characterised by a lack of recognisable qualifications or a track record in similar work. Others have argued that any scheme should concentrate on relatively high earners. One pro-Brexit group, for example, recently called for work visas to be limited to people earning at least £35,000, a level which would certainly exclude anyone aiming for a front-line job in a care home.

Another difficulty is that equally persuasive cases can be made in several other areas of the labour market, finance, catering, hospitality and the arts among them. The Government’s negotiating machinery is going to be heavily overloaded over the next 18 months so complicated are the issues Brexit throws up, and it is already apparent that even some important cases will simply be squeezed out of consideration by even more pressing business.

Non-EU immigration is, of course, not directly affected by Brexit. Is it possible that this source, controversial as it may have been in the past, could take on more of the strain of meeting British needs for workers? Non-EU citizens already outnumber immigrants from the EU in the social care workforce throughout the country as a whole and in London, the respective figures are 12% and 29%. Given, however, that anti-immigrant feeling goes well beyond European developments, it would seem perverse for any government to allow non-European immigration to increase significantly. Again, special categories will gain exemption but, except for nurses about whom controversy has continued for many years, that helps the care sector only marginally.

The hard truth is that care homes in the future will be driven increasingly to rely on home-grown talent. There are those who will argue that this will create a healthier situation and will oblige managers to focus more strongly on retention and staff development over the long term as opposed to exploiting transient migrants. Increases in the minimum wage should also aid recruitment generally, though of course they too come at a cost.

The argument that a ready supply of immigrant workers has given employers a false buffer against the ultimately healthy pressures of having to nurture the workforce consistently has much in common with the claim that the bracing shock of Brexit will somehow galvanise the economy as a whole, forcing employers to explore as yet undiscovered sources of strength, and heralding a new era of gloriously independent prosperity. Such trends, or the more pessimistically calculated alternative scenarios, will take many years to work out, but it is already clear that managing the social care workforce is not going to get any easier in the foreseeable future.

Last reviewed 23 May 2017