Last reviewed 11 December 2018

Now that the date for departure from the EU is only a few months away, the precise outcome is still uncertain. Jef Smith discusses the possible implications for the care sector.

It is widely acknowledged that the care sector is among those which will be substantially affected whatever happens, so it behoves us to try to set out some possible scenarios and anticipate all contingencies. Forgive me if some of this is out of date by the time you read it.

Medical supplies

To start then, with the highly specific — could care homes run out of drugs for their residents? Committed leavers claim that this is just the sort of trumped-up crisis spread by project fear, but if politics has taught us anything over the last few years it is to be prepared for the unthinkable. When he resigned his ministerial position at the Department for Transport in mid-November, Jo Johnson stated that “There are real questions about how we will be able to guarantee access to fresh food and medicine.”

The Department of Health and Social Care (DHSC) had already asked UK drug companies to have available an emergency six weeks’ supply of medicines over and above their normal stock levels, “in case imports from the EU through certain routes are affected”. Around the same time, the Secretary of State assured GPs, NHS organisations, community pharmacies and other service providers that local stockpiling was unnecessary because the Government was fully prepared, but it was reported that he later told the Cabinet that a run down of supplies in the event of a no-deal exit would risk lives. Feel reassured?

On the longer term question of how the UK’s being outside the EU will affect health services generally, there remain many imponderables. For example, monitoring the safety of medicines is currently co-ordinated at EU level and all medical devices are subject to EU legislation. If there’s no deal, the UK’s participation in the European regulatory network will cease and will have to be replaced by a British substitute. Coping with issues such as these would require legislation in the UK Parliament, the timescale for which is acknowledged to be problematic. Care homes, with concentrations of heavy health service users, should very reasonably be concerned about these issues.

Staffing issues

The biggest challenge of all, however, is likely to be staffing, an area in which the sector already has problems enough, with a vacancy rate of around 6% and turnover above 25%. That latter figure means that around 350,000 people leave their posts annually, presenting managers with formidable recruitment challenges. Predicting staff shortages is an inexact science but DHSC modelling predicts a UK shortfall of nurses of between 26,000 and 42,000 by 2025, while the Nuffield Foundation has estimated that over the same period the care industry will lack 70,000 front-line workers.

These figures suggest that, whatever the politics of the issue, radically limiting immigration is a very bad idea from the point of view of social care. Skills for Care statistics show that about 7% of the 1.3 million employed care workers in England are non-British. This figure grew by one percentage point over the years 2012/13 to 2017/18, but the proportion of non-British EU workers has risen three percentage points and non-EU workers has fallen by the same amount. Experts from the King’s Fund are among many to express concern that both health and social care appear in the last decade to have become increasingly dependent on EU migrants and that this source is now at risk.

There are of course significant local variations. A care home owner from a town in the Greater Manchester region with whom I spoke recently reported that her staff reflect the local population and include no one at all from the EU, so she expects Brexit to have little impact. In some areas, however, the proportion of EU nationals in the social care workforce is as high as 25%; it is 12% across Greater London and 10% in the southeast.

The manager of a home in Lincolnshire, where around 1 in 10 staff members are from continental Europe, tells me that applications from abroad have already fallen steeply; she puts the decline down to the fact that a good deal of her company’s recruitment over recent years has been by word of mouth — existing staff recommending the job to their friends back home — and that such communication has dried up on the uncertainty about the future. The fall in the value of the pound since the referendum has also made working in Britain considerably less attractive.

Commenting on the Government’s proposals to limit immigration after Brexit to selected highly skilled applicants, Professor Sarah Harper of the Institute of Population Ageing at Oxford, said recently, “We need the skilled workers and professionals but we also need the care workers. Losing immigrants from our society is going to have very serious consequences on the way we are going to look after our ageing population.”

Although people already in work here may be allowed to stay, many will return home in due course and probably not be replaced from their countries of origin. It is hard to see how the gap left by the cutting of the steady flow of generally keen and intelligent young workers from eastern Europe on which many providers have come to depend will be bridged. The fact that the fruit picking, hospitality and catering industries may be similarly badly placed will be of little comfort when homes in some areas have to close simply through lack of front-line staff.

The Parliamentary Health and Social Care Committee questioned the Secretary of State on this issue early in the autumn, but the transcript of the discussion does not make for reassuring reading. When the Chair, Dr Sarah Wollaston, asked: “Are you concerned about the impact on social care and people who use social care after we leave the European Union of making it more difficult for people to come here?”, Mr Hancock quoted the fact that the majority of immigrant staff at present are not from the EU, ignoring the strong trend to reverse that split in recent years.

Dr Wollaston pursued him on the much higher costs of recruiting from further afield and on the bureaucracy involved in obtaining visas, but Mr Hancock was unable to give her much reassurance, falling back on the vague claim that the Home Office is keeping visa arrangements under review. Pressed on the committee’s direct experience of hearing from “nurses in tears telling us how they no longer felt welcome working in the UK”, Mr Hancock could only assert, “I want to welcome people who want to contribute, in an appropriately organised way, from right around the world.” Fine words but, frankly, unconvincing.

He went on to claim that the solution to the recruitment problem is “more training domestically”, adding that the whole sector should “make the roles in social care really attractive”. He claimed that “We have a whole strand of work in the department for making the jobs in the health and social care system … yet more rewarding.” This of course reflects widely held views about the low status and poor pay experienced by care workers.

In a 2016 report with the title Brexit and the Future of Migrants in the Social Care Workforce, for example, the charity Independent Age, called for “an increase in the attractiveness of the social care sector to British-born workers”, but such a major shift, however desirable, is not to be quickly achieved. Higher wages, better conditions of service and enhanced training all cost money. These changes would inevitably lead to the sort of fee increases which in the current economic climate local authorities are almost certain to refuse to pay.

The growth in the elderly population, commentators widely agree, will lead to a growing need for social care, and even making social care much more attractive as a profession is unlikely to resolve a personnel shortfall of many hundreds of thousands building up over the next two decades. It seems like madness then to be cutting off at this juncture as fruitful a source of recruitment as the countries of the EU.