Internationally Recruited Health and Social Care Staff: Employment Practices

Tim Farron Excerpts

Wednesday 31st January 2024 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your guidance this afternoon, Mr Hosie, and it is great to follow the hon. Member for Strangford (Jim Shannon). The right hon. Member for Spelthorne (Kwasi Kwarteng) has made a great contribution to the House by securing this important debate and making his interesting opening speech.

The exploitation of workers, wherever they are from and whatever the circumstances, is unacceptable, and we should stand against it. Likewise, we should be deeply concerned about the state of social care in our country. The two things are clearly interlinked. The background, of which I am sure many Members will be aware, is a sharp rise in shortages in the social care workforce. That rise essentially followed from Brexit, but other issues will have led to that shrinking of the labour pool.

Perhaps understandably, the Government’s response in February 2022 was, among other things, to lower salary requirements and visa fees for migrant social care workers. That has had a significant impact on the numbers of people coming in on social care visas: there were 101,000 social care visas in 2022-23, up from 22,000 just the year before—a fourfold increase. As a result, vacancies have fallen. It does not feel like that in my part of the world, but the stats bear that out: there has been a reduction from 10.6% to 9.9% in 2023. The vacancy rate for the UK economy as a whole is 3.5%, so a bit of maths tells us that the vacancy rate in social care is getting on for three times above the national average. The increase in the number of care worker visas continues to accelerate, with 34,000 applications in quarter 3 last year.

One observation made by those who analyse the sector more scientifically—but it is my personal observation in my community as well—is that migrant workers are to a large degree replacing UK workers, who are moving to more attractive sectors. Incoming migrant workers are therefore not really filling gaps at all. Rather, they are filling additional gaps that British workers are vacating simply because care is not attractive financially or in other ways.

That highlights the big problem that is the source of all this. Social care is an utterly vital sector on which many of us depend, yet we pay a pittance to the people who lovingly and professionally care for the most vulnerable in our communities. They often have poor job security and poor working conditions, which of course impact on recruitment and retention. If this were improved, there is no doubt that we would secure more UK workers in the profession, and perhaps not put ourselves under pressure when it comes to the obvious issues of exploitation.

There was a debate in Westminster Hall this morning on hospitality and tourism. When people like me say that part of the answer is to have less restrictive visa rules for migrant labour, the Government say the answer is simply to pay British workers more. I would say to the Government, “Take your own advice.” Social care workers are paid a pittance because we underfund social care, so if the Government believe that is the way to ensure British people work in this sector, then pay them properly, and do not exploit people who come in from overseas either, because they are hugely valuable to what we are trying to achieve.

Exploitation should seriously worry us all. There are many pieces of evidence—the right hon. Member for Spelthorne set many of them out wisely and correctly—but one figure that really blew me away comes from the charity Unseen, the modern slavery and exploitation helpline. It reported a—wait for it—606% increase in the number of modern slavery cases in the care sector from 2021 to 2022. That is an absolutely astonishing increase.

As an adjunct, talking about migration policy is often emotive. Through the Government’s Illegal Migration Act 2023—it is the Act that is illegal, rather than the act of immigration—people arriving on our shores by irregular means will not have access to this country’s modern slavery provisions, unlike others. What will be the consequence? Many victims of modern slavery will not get the care they need. I also suspect that we will find that people will to our shores and simply not claim asylum, going under the radar, and that they will be exploited all the more outrageously.

Returning to the issue at hand, the director of labour market enforcement has identified adult social care as a high-risk sector for labour exploitation, with live-in and agency care workers believed to be at particular risk. Employers who are guilty of exploiting their staff are unlikely to demonstrate any better set of ethics towards the vulnerable residents who are also in their care. The increase in the salary threshold for skilled workers will not apply to those coming in on health and social care visas, yet people on those visas will, from 11 March, not be permitted to bring in dependants. That is a cruel and demoralising thing to do to people who we rely on to care for those we need the most. It is likely to lead to fewer applications, worse retention, and therefore a bigger problem for our social care sector.

In response to the vast increase in reports of exploitation of those on the health and social care visa, the Government have announced that care providers in England will be required to be regulated by the Care Quality Commission in order for them to sponsor visas. It is a good thing that care homes will have to be regulated by the CQC to sponsor migrant workers. My question for the Minister, however, is will they be required to have a minimum CQC inspection rating of good or outstanding before they are able to do so? Secondly, have any extra resources been provided to the CQC to enable them to undertake this role with the health and social care visa, given the additional effort it will involve? What powers will they have to enforce labour standards? Surely, due to the concerns raised, recruitment should only take place via agencies on the ethical recruiters list. I would be interested to hear what the Minister has to say about that.

We need to value care work, and we need to reflect that in the pay and conditions people receive. That includes treating migrant workers well. I reiterate that the decision to end their rights to have family with them is cruel and pointless, given that those people will not have recourse to public funds anyway. It is a cruel and almost performative piece of policy. It seems that the Government feel all the more inclined to give into the temptation to put silly populism and appeasing a small number of people out on the margins of the electorate ahead of governing wisely and compassionately. Whether I agree with the Government of the day or not, I always hope they will govern wisely and compassionately, yet this is another example of them failing to do that.

Labour market enforcement needs to be better resourced. It is important to establish a single enforcement body that is accessible to workers in practice and adequately funded, that is provided with robust enforcement powers, and that has secure reporting pathways. The Government must separate all labour market and immigration enforcement activity.

I have a few other thoughts about what else the Government ought to think about doing. The Health Foundation has suggested that we need to recognise that workforce planning must take account of the range of social care services and providers, as recruitment and retention can differ from place to place, and can vary considerably by care provider. For instance, places offering contract employment will find it hard to retain staff, and in some places the availability of public transport can have a massive impact on the retention of personal assistants. For those living in Cumbria, in Appleby, Ambleside or Arnside, the existence of the £2 bus fare is completely irrelevant if there ain’t no bus for them to use. That applies to people working in social care, but also to other parts of our community.

It is worthwhile getting to the very bottom of all this, which is the way we treat social care. Had we been living to the ages that we are now, when my late, great, right hon. Friend the noble Lord Beveridge wrote that important report in the 1940s, and if families had been as they are today, then I am sure social care would have been included in the national health service right from the beginning. Yet in the decades that have followed, we have attached it to the side of the health service, like a rickety lean-to. It is time we treated social care as we always should have: as integral to, and equal to, the national health service.

The situation is awful. What are the diseases we fear —those which, I guess, we fear more as we get older? Maybe the two main ones are dementia and cancer. But what a lottery: those with cancer at least get their care provided through the national health service, while those who end up with dementia are on their own and might lose absolutely everything. That is a nonsense. I want us to channel Beveridge and do what he would do today, which I am certain would be to ensure that social care workers are considered equal in value to those working in the health service, and are paid and treated accordingly.

That is why I think that free personal care is something the Government should consider seriously. I am very proud that the current Scottish Government maintain a policy that we introduced when we were in power alongside the Labour party in the ’90s and noughties. These issues are particularly relevant to communities such as mine. We are 10 years above the average age in Westmorland and Lonsdale. Our need for care is that much greater than in other parts of the country, and we value it hugely.

By the way, it is also vital that we value unpaid carers, who look after loved ones at great cost to themselves, and to whom we owe a huge debt. We should do more than just say thank you; we should change payments, benefits, and all sorts of other allowances that allow them to succeed. It was an honour for me to do the Great North Run last year, to raise funds for Carer Support South Lakes. Let us make sure we back those outfits that support our carers so well.

In conclusion, I am asking that we take the issue of exploitation seriously, that the Minister answers the questions that I and others have put to her today, and that we recognise that this is all a function of our failure to treat the labour market wisely and compassionately, and our failure to treat social care as we should. If we invested in social care properly and paid carers properly, the knock-on effect would be happier people who stayed in their positions, who were easier to recruit in the first place and who had career prospects. Those who are cared for would be happier and better cared for, and the pressure on our national health service would evaporate, or at least be alleviated, almost overnight.

In my communities in Morecambe bay and the rest of Cumbria, often more than 32% of the beds in our hospitals are occupied by people who are fit to leave, but for whom there is no care package to help them to leave. That has consequences for A&E waiting times, cancer waiting times and ambulance response times, and it is all down to the fact that no one has yet been brave and compassionate enough to tackle the care crisis meaningfully. I hope this Government will do, but if they do not, I am determined to play a part in doing just that in the next Parliament.