This week the Wales Centre for Public Policy published a report on how the end of free movement and changes to UK immigration policies could impact the health and social care workforce here in Wales.
To launch this report, I chaired a webinar where the researchers outlined the report’s main findings. We had some interesting discussions about what needs to be done from an employers’ perspective to best support both current and future staff. In case you missed it, you can watch it back here.
For me, there are three take-home messages:
One. The Welsh NHS will be relatively protected from the end of free movement. The Health and Care Visa covers a large list of roles that are essential to the NHS.
And with the larger reliance on non-EU nationals compared the NHS England, the new system will mean that it will be easier, and in some cases cheaper, to hire non-EU nationals. But on the other side of that same coin, it will be more expensive to hire EU nationals compared to the current system of free movement.
Two. Despite favourable immigration policies for the NHS, some groups are at risk of slipping through the cracks. If a points-based immigration system were in place now, approximately 1% of the current workforce wouldn’t be eligible for either a Skilled Worker or Health and Care Visa.
1% doesn’t seem like a big number, but this represents nearly 1000 people currently working in the Welsh NHS in essential roles such as ambulance drivers, social and health care support workers and assistants, as well as patient, emergency care, dental, and pharmacy assistants. While those staff groups are encouraged to sign up to the EU Settlement Scheme (EUSS) to ensure they can still work in the Welsh NHS, this does draw attention to a vulnerable section of the workforce.
Three. The impacts will be far greater for our social carer colleagues. Many roles will fail to meet the skills and salary threshold for a Skilled Worker Visa and have been excluded from the Health and Care Visa. We have continually pushed the message that social care roles are not low skilled, rather they require a different set of skills such as empathy, sensitively and emotional intelligence.
Many people in the sector were eagerly awaiting the release of the Migration Advisory Committee’s (MAC) review of the Shortage Occupation List (SOL). The hope was that this review would recommend adding essential social care roles to the SOL, thus making it easier to recruit the staff they need.
But was this hope met?
The MAC report did suggest adding roles such as nursing auxiliaries and assistants and senior care workers to the UK-wide SOL. While this is a welcome step in the right direction, since the scope of the review was based on the proposed skill and salary threshold, many care roles in less senior positions remained excluded.
The MAC does however draw a great deal of attention to social care. For many years, the MAC has been suggesting that the UK Government address the funding model for the sector to increase pay and therefore make roles more attractive to a domestic workforce. Especially with the added public value of both health and social care in the response to the COVID-19 pandemic, if no action is taken now there will be ‘stark consequences’ for social care, which means knock-on impacts for the NHS.
The Cavendish Coalition, which the Welsh NHS Confederation is an active member of, responded that while the spotlight is welcome, it still falls short of protecting the social care sector.
But now we must ask: where do we go from here?
At a Welsh level, the upcoming Senedd elections in May 2021 is an opportunity to call for a more integrated health and care system. What impacts one will impact the other, and work cannot be done in silos.
At a UK level, we hope this research will add to the body of literature supporting the need for social care reform and push for the need to seriously consider social care when further developing the points-based immigration system.
As always, the Welsh NHS Confederation will continue to support its members and the sector at large to encourage an integrated, supported, and sustainable health and social care system.