The decision by the United Kingdom to leave the EU will have significant impacts on the social care sector. It is too early to say exactly what all these impacts will be, but from our current knowledge, we are going to see at best a period of uncertainty, and at worst a significant challenge to the social care services.
The main area of concern is the workforce. Currently about 1.7 m people work in social care and 6% of them come from EU countries. On the face of it, 6% of our workforce might not seem like an impossible percentage of people to replace, but these figures hide some really important variations.
Firstly, there are a number of specialist posts which are difficult to recruit. Both social care and the NHS are suffering severe nursing shortages, and without access to EU staff these shortages could become even more acute.
The effects of nursing shortages are felt at the front line, where there is a lack of staff to cover basic functions – and both social care and health struggle on a daily basis to have enough nurses to meet their regulatory criteria. But the other impact is the increased use of agency nursing, which is very expensive, and puts significant financial burdens on both the NHS and social care.
In social care, we are seeing some areas very dependent on EU migrants. In London and the south-east, where there is a shortage of labour, EU migrants make up a bigger percentage of the social care workforce. Similarly in many rural areas, where it is difficult to recruit staff, we see EU nationals playing a much greater role in delivering care.
The Prime Minister has said clearly that Brexit means Brexit, and as a sector we will have to think clearly about how we replace this much-needed EU workforce. However, we cannot do this alone, and there are some things that we expect the Government to do to help us sustain health and social care.
Firstly, if we cannot rely upon EU nationals, we should think about spreading the net wider and enabling suitably qualified people to come to work in the UK from other countries. One of the biggest challenges we face comes from the current Migration Advisory Committee’s Shortage Occupations List, which requires people to have a certain level of salary before they can be considered for work visas.
The problem is that social Care, and to a lesser extent health, is not a high paid occupation, and so if we link visas to salary levels, we will never get the required number of overseas applicants. HM Government need to address this issue as a matter of urgency, and break the link between salary and shortage occupations.
It is my view that the shortage occupations list should be just that: a list of occupations where there is serious difficulty in recruiting the appropriate staff.
In the longer term we need to have a much clearer policy within the UK to grow our own staff and to train and support them to become high quality social care workers. In saying that, it must be remembered that the reason we went to EU countries for social care staff was because we had serious difficulty in recruiting UK nationals, many of whom did not want to do this complex and difficult work for such poor pay.
The next part of a plan for growing our own workforce has to be proper commissioning by local authorities of social care services. In some areas of the country, residential care for people with several health conditions, including dementia, is commissioned at £2.30 per hour. This figure is not sustainable and does not allow care providers to recruit, train and properly pay the dedicated workforce in this vital service.
Whatever happens as we negotiate our departure from the EU, the British Government must take decisive action to secure an appropriate workforce for the social care sector. This cannot be left for two or more years. The crisis that we are facing is happening now, and we need an immediate response.
If the Government fails to deliver a coherent strategy for social care, we will see many people go into crisis, and end up in an NHS hospital. This will put the NHS at the point of collapse, and this will not serve anyone.
We do not know what the final settlement between the United Kingdom and her European partners will be, but in health and social care, there is no time to think about a long-term solution because the crisis is now and the solutions must be immediate.
By Professor Martin Green, Chief Executive: Care England