The provision of suitable, accessible and affordable care is a major factor in enabling older people to live independently. The current debate about the present and future challenges of the long-term care system in the UK has focused more on the financial sustainability than on the human resources needed to ensure high-quality services. In particular, little attention has been paid to the increasingly important role played by migrant workers in the delivery of paid personal services to the older population.
Since the mid-1990s the employment of migrant workers in care roles has increased at unprecedented levels. Recent research by the ESRC Centre on Migration, Policy and Society (COMPAS) explored experiences of migrant workers, their employers, and older people in institutional and home care settings, revealing major challenges both for recruitment and employment practices, and for the quality and continuity of care provision.
Nearly one in five care workers employed in the UK residential and home care sectors are migrants coming from either the EU - Poland and other new EU member states, or third countries - mainly Zimbabwe, the Philippines, India and Nigeria. Nearly half of them have come to the UK since the beginning of the 2000s, accounting for about 40% of the expansion of the workforce in the last decade. These figures suggest that reliance on the migrant workforce has become a structural feature of the long-term care sector. Multiple factors have contributed to this. First and foremost, the demand for migrant workers in the care sector is associated with employers’ perceptions and experiences of a shortage of UK-born workers. About two-thirds of residential and home care providers report difficulties in hiring UK-born workers, who are considered difficult to recruit because they will not accept the low wages of just above £6 per hour in the private sector, and requirement to work nights and shifts in care jobs. This explains, for example, why the demand for migrant care workers is significantly higher in private organisations than in domiciliary care services run by local authorities – the latter typically pay higher wages and provide more secure contractual conditions.
However, for many organisations the inability to find UK-born workers is not the only, or even the principal, reason to hire migrant carers. Care providers consider the employment of migrant workers more often as an advantage than as a challenge for their businesses. For instance, the vast majority of organisations employing migrant workers agree that migrants have a good work ethic, are respectful towards older clients and are willing to learn new skills. According to one private care provider in the South East of England, 'Migrants are more punctual. They don’t take time off without genuine cause. They’re more willing to do extra work if it’s available; they’re polite, very personable … and more willing to be open and friendly'. Nearly 1 in 3 employers consider the quality of their services to have improved by employing migrant workers – compared with less than 1 in 10 thinking that the quality of care has worsened.
Although the availability of migrant workers has significantly helped ‘fill the gaps’ in the provision of care for older people, the extensive reliance of private care providers on the foreign-born workforce is not unproblematic. Issues around language and communication were reported by employers, migrant workers and older clients alike. Interviews with migrant workers also raised issues related to their experiences of discrimination and unequal access to employment rights, including lower pay, longer and less favourable shifts, unpaid overtime, lack of security of minimum hours, and unfair treatment in relation to training opportunities, promotion, and disciplinary and dismissal procedures. These experiences are also influenced by racial tensions and various types of economic and legal constraints. Over 40% of employers agreed that migrants were not always well accepted by their older clients and several reported episodes of verbal abuse, namely towards black carers. Migrants with restricted right to work in the UK are more often 'willing' to accept low pay and unfair or abusive conditions because care work is among a limited range of low-paid jobs they are able to access.
Staff shortages and workload pressures were also experienced by migrant care workers and by older people as constraints on the development and continuity of their care relationships, 'Sometimes I forget their names. It’s a shame but, you know, I can’t remember every name when I’m working in 20 or 30 different homes and I meet hundreds of people. I’m trying to remember them, their needs, what they like, what they don’t like', said a Polish agency worker. These barriers to relationship-building are detrimental to the delivery of 'good care' as described by older care recipients, who emphasize the importance of its relational dimension – the need for a carer 'to have a chat with', 'who listens to me', who is 'like a friend'.
The tensions between the high reliance of the care sector on migrant workers and these employment and care challenges have significant implications for policy-making in both immigration and social care. The employment of migrant workers in long-term care is taking place within increasingly restrictive immigration channels, culminating in the implementation by the coalition government's cap on the number of non-EU nationals entering the country as well as restricted access to the labour market for foreign nationals with temporary leave to remain in the country.
The current negative economic climate puts even more pressure on the government's agenda to cut inflows of new migrants from the hundreds of thousands to the tens of thousands. The government's plan includes not only a cap on skilled immigration which affects Senior Care Worker visas (listed among the shortage occupations), but also more stringent requirements for other visa categories, such as spouses and students, who make a large contribution to staffing the care sector.
Employers in the care sector are finding it increasingly difficult to obtain or renew Certificates of Sponsorship. This is affecting also opportunities for migrant carers who work in the sector to renew their work permits. The English Community Care Association (ECCA) is taking the government to court over the current proposal to cap the number of non-EU migrants because of the potential disruption caused to care services for vulnerable adults, and violation of migrant rights to private and family life.
There is a clear need to balance the rights and entitlements of two vulnerable groups - the right of migrants to decent employment conditions and equal treatment, and the right of older people to high-quality care services. In this respect, an immigration policy which selects workers on the basis of formal qualifications and measurable skills does not match the needs of the care sector, where 'soft skills' - such as commitment, kindness, compassion or sympathy - are equally, or even more, important for the well-being of older care recipients.
The care sector is likely to remain highly dependent upon the migrant workforce in the future. The increasing demand for personal care services due to a rapid population ageing and the decreasing provision of informal care will put even more pressure on the care industry. Although interventions aiming to improve the working conditions and the attractiveness of care jobs for all workers are possible and highly desirable, the current and likely future constraints in the allocation of public resources, and the historically low prioritisation of social care for older people, make the re-qualification of the long-term care sector, and its complete reliance on the domestic labour supply, a difficult goal to achieve.
Yet until recently changes in immigration policy were undertaken with little awareness of the potential implications for the staffing of the social care sector; while social care policy equally lacked recognition of the role of migrant workers and of its implications for the quality of care – the recent Department of Health's Adult Social Care Workforce Strategy still makes no mention of migrant workers. If the provision of long-term care continues to depend upon large numbers of migrant workers, it should be among the priorities of policy-making in the immigration and care sector to tackle the significant unresolved issues related to their employment. The role of migrant carers has to be planned and not an unintentional consequence of the low prioritisation of the sector.