Internationally Recruited Health and Social Care Staff: Employment Practices

Kwasi Kwarteng Excerpts

Wednesday 31st January 2024 Westminster Hall

[Kwasi Kwarteng (Spelthorne) (Con)]

I beg to move,

That this House has considered employment practices for internationally recruited health and social care staff.

I am very pleased to introduce this very important debate on a very important issue, which in the hubbub of the emotional conversation around immigration has not, as far as I am aware, been thoroughly discussed or even addressed; it relates to the critical work undertaken by people in the health service and particularly in social care. What I have noticed, and what has been brought to my attention, is that because of high levels of immigration, we have brought in people who are recruited to work in our health and social care system who have often, though not always, been badly treated and poorly paid.

We all know that the health and care worker visa has been exempted from the increase in the earnings threshold for skilled workers, so a lot of the people underpinning our social care and healthcare earn very little income; they are also often very vulnerable and not particularly fluent in English. Given the concern felt by everyone in the House about human trafficking and modern slavery, there is also a real concern that a large number of healthcare and social care workers are being exploited in a way that none of us wants to see.

There is a particular issue with regard to workers who leave their contract before an agreed period. The code of practice allows for this, but there has to be a reasonable expectation; fees owed as a result of workers leaving their contracts early should be reasonable. I have heard reports of fees in excess of £10,000. That is completely unacceptable. In that situation, the contracted employee is being exploited—and it very much has the look and feel almost of extortion. I am sure that the Minister is very concerned about this issue. In the midst of a very charged debate around immigration, it is something about which any Government professing humanity, and looking after our people, should be concerned.

On top of all the exploitation, and in the context of staff who are often highly vulnerable, there are reports that rogue international recruitment agencies have extorted —that is a word I use with some degree of caution, but they have extracted payments—from people. That is really a form, dare I say it, of trafficking. Often when the workers find themselves in the UK, perhaps because of language barriers or a lack of knowledge, they find themselves with no recourse; their employment conditions are often deplorable, but they cannot find a way to push back against some of the more extreme demands. I mentioned repayment clauses, and anecdotally I hear that there is often a lack of understanding of what exactly people are signing up to.

We all understand that we need people who can operate in our social care system and support us in maintaining the health of an ageing population, but that employment needs to be regulated. One statistic that particularly horrified me was that between January and September last year there were something like 76 reports and referrals with modern slavery and human trafficking indicators in the care sector alone. That is a couple a week, and of course that could be just the tip of the iceberg. I am very pleased to be able to have this debate, and I look forward to hearing what the Front Benchers—particularly the Minister—have to say.

I have spoken about the problem and outlined the situation broadly. I think we all feel a measure of concern about it, but we have to look forward and think about ways we can improve the situation. I have spoken to friends, and liaised with people I know at the Royal College of Nursing and some of its officials, and a lot of what they say is eminently sensible: there should obviously be standards for induction; the Department of Health and Social Care needs to establish pastoral and professional support; and there needs to be some sort of structure by which we can monitor potential exploitation and even trafficking in this area.

From what I have heard, we know very little about this phenomenon: we know very little about the number of people whose lives are blighted by exploitative practices. We talk all the time—in this House and outside—about immigration. We talk about the scale of immigration, but we rarely talk about the types of immigration that we are seeing, and I am not aware that we have dealt with this specific issue.

There is a code of practice for the international recruitment of health and social care personnel in England, which was last updated in August 2023, but what is a code of practice? It seems to me that it is really only a start in investigating the seriousness of what is being alleged. Publicly available hard evidence is difficult to come by, but we all know of reports; in my constituency, I have heard pretty hair-raising stories about the conditions in which many such workers find themselves.

I think there is a question about the code of practice. We should always be trying to get the best standards. I am sure that the Minister is fully aware of that, given her experience. We must always be interrogating ourselves, and ensuring that our guidelines and codes of practice are fit for purpose and up to the job. Given reports of rising numbers of exploitation cases, there is a broader question about whether the code of practice for international recruitment is really up to scratch. I know that colleagues and friends in the RCN have questioned whether the current code is really doing its job.

I am afraid to say that the issue of human trafficking and modern slavery will always be associated with immigration and bringing people into the UK. It is a very negative side-effect of seeing huge numbers of people coming into the UK about whom we know very little. I appreciate that the Minister is here today to represent the Department of Health and Social Care, but it is an issue not just for that Department; there are wider agencies of Government and more Departments involved. I will be very interested to hear what she says and, if at all possible, about the work that her Department is doing across Whitehall, with Treasury and Home Office colleagues, to get a better measure and a firmer grip of this chronic and increasing problem.

--- Later in debate ---

[Kwasi Kwarteng]

We have had a wide-ranging and generally quite even-tempered discussion, although people have occasionally strayed into the political stuff. The point of these debates is to have a broad and tempered discussion, and the spirit with which we have debated this matter does the House proud.

This issue has not had the attention that it deserves, and it is clear that Members on both sides of the House and from all parties are concerned about it. It is also abundantly clear that, whoever the election decides will form the next Government, it will be even more important and critical that this issue has our focus, whether that Government is Conservative or Labour. I am delighted that the Minister spoke at length, showing her understanding and experience. This is only really the beginning, and I look forward to more debates in the future on this sensitive and difficult subject.

Question put and agreed to.

Resolved,

That this House has considered employment practices for internationally recruited health and social care staff.