Internationally Recruited Health and Social Care Staff: Employment Practices

Amy Callaghan Excerpts

Wednesday 31st January 2024 Westminster Hall

[Amy Callaghan (East Dunbartonshire) (SNP)]

I thank the right hon. Member for Spelthorne (Kwasi Kwarteng) for securing this debate. He made balanced and measured remarks and I share a number of his concerns.

I will begin my contribution with a huge and heartfelt thank you to our NHS and social care staff in Scotland, many of whom looked after me during the four months I spent at the Queen Elizabeth University Hospital in Glasgow back in 2020 and who care for my constituents in East Dunbartonshire in our many care homes, GP practices, pharmacies and hospitals. This debate discusses a critical aspect of an issue that I continue to raise time and again: NHS workforce shortages. The Government’s latest draconian plan to curtail immigration, banning those who come to these isles to work in the care sector from bringing their families, including children and spouses, is another shambolic and cruel attempt by the Government to shift blame. Anti-migrant and quite frankly racist rhetoric has become symptomatic of contemporary Britain, largely fuelled by the Government’s culture war. In introducing the change in legislation, they have concocted a narrative that frames migrant workers as the problem. Let me be clear: this Government are the problem.

They have allowed our health and social care workforce to crumble in front of our eyes due to 14 years of austerity, starving it of much-needed investment. Preventing overseas care workers from bringing their families is a dehumanising move, viewing migrant workers as resources to be used for work rather than as the people that they are; people with families whom we need to come to these isles. Migrating to the UK for such arduous and underpaid work might be someone’s best bet for a better future, but in doing so they are forced to leave their dependants behind, having to leave their families to care for ours.

Overseas care workers have been treated appallingly by this British Government. Many sold everything to fund their move to the UK. The Home Secretary and the rest of the Cabinet clearly do not value the social care sector since they were content to sign off on the visa rule changes. Disappointingly, the Health Secretary has defended the visa changes too. The only thing the announcement will achieve is to break up families, scare workers and erode trust.

Now, social care workers who come here face a sentence of destitution, and it is far too simplistic to suggest that there are ample numbers of people already based here to fill the gaps in the health and social care workforce. It is not a sector that pays adequately and people do not want to fill the gaps in employment, so we need people to come from overseas too to fill the skills gaps. The sector is struggling, and struggling badly, due to terrible political decisions.

Skills for Care, the workforce development and planning body for adult care in England, estimates an average 9.9% of roles in adult social care were vacant in 2022-23. That is the equivalent of approximately 152,000 vacancies. What are the Government doing to address those vacancies? They are making it harder for people to come here and fill them. The number of vacancies decreased by around 11,000 between 2021-22 and 2022-23 partly because of increased recruitment of overseas workers, demonstrating how crucial those recruits are in tackling the shortages we face.

Donald Macaskill, the chief executive of Scottish Care, has said that workforce shortages are

“an enormous challenge, and one of the reasons for that is the legacy of Brexit”.

He went on to say that

“what we need is a flexible immigration policy, which isn’t as hostile and toxic as the one we have now”.

The fact of the matter is that the social care sector cannot function without overseas staff.

Plans to prevent overseas care staff from bringing family members with them to the UK risk worsening the sector’s already significant shortages. If care workforce numbers fall, unmet needs will continue to escalate. Too many people in need struggle to access good care as it is. The plan to curb migration for care sector workers will undoubtedly only make that worse. We have an ageing population, which will need more care and we will struggle to provide that care without international recruitment. Those needs are being undercut by this British Government. Social care requires a major fix, but this certainly is not it. Without migrant staff, care homes could close and support would disappear for the vulnerable living in their own homes. The Minister must rethink this cruel visa plan before permanent damage is done.

There is another area in which this British Government cause a headache for our constituents. If the new restriction reduces the number of people who are migrating to the UK to work in the already understaffed care sector, it is unpaid carers who will bear the brunt. Those unpaid carers are already in a dire situation, with evidence suggesting that they are more likely than non-carers to live in poverty, to be isolated and to be depressed. Although many family members would continue to care for loved ones, even with more paid help, we should not underestimate the importance of paid care workers in providing support and respite.

Today in the UK, if someone performs unpaid family care for 35 hours or more a week and earns under £139 a week from paid work, they can claim carer’s allowance to help them get by, but that allowance is only £76.65 a week. The Minister is already struggling to attract workers within the UK to work in the care sector, and now she is facing additional barriers to overseas recruitment. That is all due to colleagues who are so obsessed with decreasing net migration that they will happily watch an understaffed health and social care service fall into further ruin.

How does the Minister justify dissuading social care workers from immigrating to these isles, when they are quite literally keeping our system afloat? When will the Government finally commit to solving the underlying problem by making care work a more attractive career path and by training, retaining and reforming in the health and social care sector? That last point was explored in depth by the hon. Member for Strangford (Jim Shannon).

This Government fundamentally are not acting in Scotland’s best interests. We want and need more people to come and work in our health and social care services, not fewer. The alleged problems that this British Government are trying to address with their new policies on overseas recruitment are not issues for Scotland. We strive to create a warm and welcoming environment that encourages people from overseas to make Scotland their home. We want and need overseas recruits here. The Tories’ hostile environment is not working, but there is another path for Scotland. The Scottish Government have outlined their vision in the policy paper, “Building a New Scotland: migration to Scotland after independence”. That policy will make it easier for people with skills and expertise to come to Scotland and contribute to our businesses, communities and economy. We would set visa fees at a fair level and offer family schemes to encourage those who come to Scotland to put down roots and make Scotland their home.

The Scottish Government are also supporting international recruitment with a pilot project that was launched in summer 2023 to support providers with sustainable and ethical international recruitment and to gather information on how we can best support both providers and the workforce through the visa sponsorship process and develop supporting materials to be shared across Scotland. We will not ask overseas workers to abandon their families to come and care for ours; that is not what Scotland is about.

Only once these decisions can be made by Scotland, for Scotland and in Scotland can we have the full power to ensure that our health service is well staffed and well looked after. It is clear that whatever party forms the next Government in this place will not make decisions based on Scotland’s specific needs, and it is only once we achieve independence that we can ensure that our NHS and the health and wellbeing of our ageing population and our population more generally are in safe hands.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I am grateful to my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) for opening the debate and setting out some of the challenges we face in international recruitment in health and social care. I pay tribute to our international health and care workers, who play an important part in our health and care system, looking after people and bringing their skills, equipment and compassion to look after loved ones. We benefit enormously across the UK from their knowledge and skills. In return, it is imperative that employers, whether in health or social care, provide a safe and supportive environment for their staff to work in.

I want to be clear that international recruitment is not the long-term answer to our health and social care workforce needs. We have been clear about that as a Government, and I have been clear about that personally. That is one of the reasons why, on the NHS side, we have our long-term workforce plan, investing in training our home-grown healthcare workforce. On the social care side, we have a 10-year vision for social care, which includes ambitious workforce reforms, which are in progress, including the first ever national career structure for care workers and new national qualifications. I am determined that care workers—indeed, care professionals —be recognised for their skills and supported in their work and career.

I would say to the SNP spokesperson, the hon. Member for East Dunbartonshire (Amy Callaghan), that she should read up on these care workforce reforms, as should the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who called a moment ago for a care workforce pathway. I know he is relatively new to this role—we have not done that many debates opposite each other—so I ask him to go take a look online. He will see our care workforce pathway programme, which we have published and which we worked closely with the sector on to develop this national career structure. We did so exactly because it was one of the things we knew was missing from social care, and because when people come into social care, they want to see that they have an opportunity to progress in that career. We are also developing national training that will be recognised across different employers. Those are just two of the headline policies of a truly ambitious reform programme for the social care workforce.

[Amy Callaghan]

I do not particularly appreciate being given homework by a Minister who is doing so much damage to the health and social care sector in Scotland. I have certainly done my homework already—I do not need to be given some by her.

[Helen Whately]

I think it is probably helpful if I move on, rather than our having some sort of back and forth.

I turn to the question in hand, which is specifically to do with international recruitment and the reasonable concerns raised by my right hon. Friend the Member for Spelthorne about the exploitation of some workers who come to support us in this country in health and social care. One of the things he spoke about was the code of practice. He is absolutely right that we have a code of practice for the international recruitment of health and social care personnel, which sets out ethical recruitment and employment standards that employers must adhere to. The code is kept under regular review. In fact, my right hon. Friend referred to the update of the code last year. I can assure him that my Department works closely with the Royal College of Nursing and other trade unions and stakeholders to strengthen that code and make sure it addresses the current issues and ethical concerns. For instance, we have set out stricter principles on the use of repayment clauses in employment contracts, and the code is now explicit that charging recruitment fees is illegal under UK employment law. I absolutely agree with my right hon. Friend that we should continue to make sure the code of practice truly captures all that it needs to, and is as effective as it can possibly be.

Alongside the code of practice, we have the ethical recruiters list. This contains a cohort of recruitment agencies that have agreed to operate in accordance with the rules of the code. The list is run by NHS Employers, and it makes it easy for employers in the NHS and the social care sector to check that recruitment agencies are signed up to meet the high ethical recruitment standards we expect. Any organisation suspected of breaching the code will be investigated, and can be removed from the list.

Most overseas staff have a positive experience working in the UK, but I acknowledge that, regrettably, this is not the case for all. We know there are some rogue agencies and employers that take advantage of people who want to come to the UK to work. We have published guidance for prospective overseas candidates to help them make informed decisions and prepare for life in the UK. The guidance sets out what candidates should check in their employment contracts before signing them, what working rights and standards they can expect in the UK, and how to recognise and deal with exploitation, should that unfortunately be something they experience.

My Department is working with colleagues in the Foreign, Commonwealth and Development Office to disseminate that guidance effectively, so that it reaches prospective candidates at an early stage and helps make informed decisions and avoid scams and unethical practices. We want them to be able to do that in their home countries, before they even apply to work here in the UK.

My right hon. Friend the Member for Spelthorne mentioned punitive repayment clauses in employment contracts. We are clear that those are unacceptable, and in certain cases illegal. There are some instances where repayment clauses may be used legitimately to cover some up-front costs incurred, should an employee decide to leave their job after a short time. But in all cases, employers must make it clear in contracts what is to be reclaimed, and how and when that will take place. Instances where repayment clauses are excessive, or extended over a lengthy period, have the effect of trapping international workers into jobs, and that is unacceptable. Repayment clauses cannot be used by employers to cover the cost of agency fees, certificates of sponsorship or the immigration skills charge.

As I mentioned, the code was updated to address that issue. The NHS has gone further, producing additional bespoke guidance for NHS employers to explain how to implement the code’s principles when using repayment clauses. That will ensure transparency and fairness in employment contracts for all international recruits working in the NHS.

Another issue raised by my right hon. Friend is that of recruitment agencies charging international candidates high fees to find them work in the UK. For UK-based agencies the law is clear: charging a candidate any recruitment fee to find them a job in the UK is illegal. The Employment Agency Standards Inspectorate is the organisation responsible for regulating employment agencies, and it will investigate such misconduct and prosecute where appropriate.

However, we do face the challenge of agencies based overseas that fall outside the UK’s jurisdiction. Regrettably, we have limited direct levers to stop the unethical treatment of workers overseas, but we have taken steps to try and mitigate the risk as far as possible. First, our international candidate guidance, which I mentioned a moment ago, warns potential candidates that they should not be paying any kind of fee to find work in the UK, and that they should not work with any agency that requests such a fee. Secondly, our embassies and high commissions are actively working with higher-risk countries to tackle exploitative practices by recruitment agencies overseas. NHS Employers, as holders of the ethical recruiters list, undertakes regular spot checks of agencies on that list to ensure they are complying with the code of practice.

As a Department, we are working collaboratively with the labour enforcement agencies that take action against those breaking the law in the UK. Those include the Gangmasters and Labour Abuse Authority, UK Visas and Immigration, and the Employment Agency Standards Inspectorate. We therefore have a multi-agency approach across Government which uses our collective intelligence, capabilities and resources to respond to concerns about exploitation. That includes providing insight, advice and guidance to businesses and supply chains in relation to possible labour market offences.

My right hon. Friend mentioned language skills and the potential challenge for somebody whose English might not be fluent, to navigate the landscape and know their employment rights, for example. It is clearly important that the language skills of anyone providing care in England are good enough to communicate with their employer, the people they provide with care, and other care and healthcare professionals.

Care providers must ensure that their chosen candidates have the skills needed to work in care and should assess a candidate’s English proficiency at the interview stage of recruitment. For somebody to work in social care, employers should ensure a good standard of English. For staff from overseas, the Home Office sets English language proficiency requirements. Individuals are required to prove they can speak, read, write and understand English to at least level B1 on the common European framework of reference for language scale.

My right hon. Friend also asked about cross-Government work in general on tackling exploitation. I can assure him that we are working across Government. My Department is working particularly with the Home Office and UKVI, both at official and ministerial level. I have had several conversations with Home Office Ministers about our care worker visa scheme and what we are doing to tackle the risk of exploitation and abuse.

I worked closely with Home Office colleagues on the recent changes to the care visa. We agree about striking the right balance with overseas care workers, who are supporting us in some of the challenges of meeting the social care and healthcare need in the UK. We also need a balance between international workers and our home-grown workforce, ensuring that there are safeguards for international recruits.

Following those conversations, we have announced changes to the care visa scheme, as referred to during this debate. One is that, as of March, we will no longer allow care workers to bring dependants with them. Another safeguard is that we are restricting sponsors to CQC-registered care providers. At the moment, as long as someone is providing social care, CQC-registered or not, it depends on the sort of care provided.

The Government do not have all the answers at the centre, and I feel strongly about that. That is one reason why, as we have introduced the care worker visa, we put £15 million funding into regional partnerships of local authorities, to have established leads around the country for international recruitment, to support employers and recruits. I meet our regional leads, to hear what it is like in their areas, and to discuss what they are doing on the ground to support employers and social care staff. For instance, they are supporting providers with legal and HR advice on recruiting and employing international staff.

There is a specific example relevant to this debate. East of England has commissioned Unseen to run seminars and provide one-to-one support for care providers on safeguarding and spotting signs of exploitation. I continue to work with those leads to get the best possible insight on the ground on the extent to which internationally recruited workers may face difficulties. That could happen if someone has been brought here for a job with a particular sponsor who loses the licence to employ them, and the leads are working hard, trying to support recruits in that situation. I am also setting up a meeting directly between our regional leads and the Home Office and UKVI, to ensure that they share their intelligence directly, making the most of the leads’ work and insights.

I want to come briefly to some of the points made by the hon. Member for Westmorland and Lonsdale (Tim Farron). He mentioned the connection between social care supply and delayed discharge in his local area, which is something that I have done a huge amount of work on over the past year. I want to be clear, particularly on this topic, that social care does not exist just to discharge and support the discharge of patients from hospital. Social care is absolutely an end in itself, supporting both older people and those of working age with care needs.

We know that there is a connection between discharge delays from hospital and social care, because some people who are delayed in hospital, when they are medically optimised for discharge, are in need of social care packages. That is why we put in an extra £600 million in funding to support discharge over the past year, and there is another £1 billion coming this year. We have also put in an extra £570 million of funding to support social care. Just this morning, I was talking to a number of directors of adult social services from local authorities who assured me that that funding has made a meaningful difference to social care funding and supply.

I know that there are still significant financial pressures, and the national living wage increase puts an additional pressure on care providers and local authorities for the coming financial year. While that increase is a good thing for those at the bottom of the pay scale, it also places financial pressure on employers and those funding social care. I assure the hon. Member for Westmorland and Lonsdale that that increase in supply, thanks in part to the extra funding, has helped to speed up discharges over the past year and reduced some of the delays, and we have seen an increase in the number of people being discharged both overall and particularly with social care support. We have made progress on that point.

I come back to this point in closing. I want to be categorically clear, in the light of this debate, that no member of staff in health or social care should face abuse of any kind, and illegal and unethical international recruitment and employment practices will absolutely not be tolerated. Internationally recruited staff play a really important part in caring for people across health and social care. They have helped us to build and increase our health and social care workforce. On the NHS side, we have achieved our manifesto commitment of 50,000 more nurses. On the social care side, we have over 20,000 more care workers in the care workforce. We have seen vacancies come down and retention improve, so we have been making progress on both the social care and the NHS workforces. While international recruitment plays an important part, it goes hand in hand with our work as a Government to build up our home-grown workforce both on the NHS side, with our NHS long-term plan, and the social care side, with our ambitious social care workforce reforms.