Moved by Lord Hunt of Kings Heath
2: After Clause 1, insert the following new Clause—“Duty to commission an independent review of the social care sector in regard to the effects of section 1(1) The Secretary of State must commission an independent review of the matters under subsection (3) and lay the report of the review before each House of Parliament within six months of the day on which this Act is passed.(2) The Secretary of State must appoint an independent panel to undertake the review.(3) The review under subsection (1) must consider an assessment of the effects of section 1 on—(a) the social care workforce;(b) the adequacy of public funding for the social care sector;(c) the ability of care sector employers to improve the pay and conditions of their employees; and(d) such other relevant matters as the independent panel deems appropriate.(4) A Minister of the Crown must, no later than six months after the report has been laid before Parliament, make arrangements for a motion relating to the report to be debated and voted on by the House of Commons and the House of Lords.”Member’s explanatory statement This new Clause would require an independent review of the impact of section 1 of this Act on the social care sectors to be produced and laid before Parliament.
My Lords, I declare an interest as a member of the General Medical Council board.
I want to return to a major theme from Second Reading: the decision of the Home Office to exclude the great majority of care workers from the new health and care visa, as they do not meet either the income or the skills threshold. At Second Reading, the noble Baroness, Lady Williams, justified this by saying that employers had to end what she described as “the easy option” of using migrant labour to undercut our own workforce “for far too long”. She also pointed to the advice of the Migration Advisory Committee, which has maintained that the problems in the care sector are caused by a failure to offer competitive terms and conditions, in itself caused by a failure to have a sustainable funding model—quite.
I certainly do not need reminding of how important skilled care worker jobs are; I want to see more people training and entering the care sector at a decent wage. However, surely it is disingenuous for the Government to call for better wages and conditions, when they have so much influence on the financial health of care services. The Government are the main source of funds for local authorities; they are the direct funder of the National Health Service; and they set the conditions under which the private care market operates. The Home Office, which I have always thought of as being a bit semi-detached, is essentially saying that the Government—of which it is a part—has neglected the care sector over many years. They have been in government for 10 years now and have had a series of reviews, none of which has come to fruition.
Our own House of Lords Economic Affairs Committee reported that, in 2018, 1.4 million older people in England had an unmet care need. It found that publicly funded social care support is shrinking, as diminishing budgets have forced local authorities to limit the numbers of people receiving public funding. Just as demand goes up with the demographics, the funding of social care gets lower and lower in real terms.
When we turn to the workforce, we see a diverse range of nationalities and backgrounds. Some 83% of the workforce is made up of British nationalities, with 7% coming from other EEA countries and 9% from non-EEA countries. As such, the UK is reliant on a fair and balanced immigration system. Overall, however, the social care workforce is already facing a crisis, with more than 120,000 vacancies and a growing level of demand among people who need to access care services. This is a real problem for the future.
We also have the problem that the Government classify social care workers as unskilled. Unskilled? As Mencap points out, their colleagues are trusted every day with people’s lives. They are trained to provide medication, to undertake feeding, to deal with seizures and to administer first aid. They help people manage their finances, their health and their well-being, and they provide emotional support. Unskilled they are not. Yet as Unison has pointed out, many migrant workers are not included in the category of people who have had their visas extended free for a year. Many are struggling to save the large amounts needed for visa renewals.
The Minister says that staff should be paid more. I agree, but is she going to will the means? Will she commit to increasing the level of support to local authorities? Is she willing to see self-funders pay more? If she is, I remind her that if you took the current lifetime pension allowance of £1,730,000 and bought an annuity with it at age 60, you would not have enough to pay the average nursing home fee.
We are in a vicious cycle. After decades of reviews and failed reforms, the level of unmet need in our care system is increasing and the pressure on unpaid carers is growing stronger. The supply of care providers is diminishing and the strain on the care workforce is continuing. And that is before these new immigration controls are imposed at the end of the year.
At Second Reading, the noble Baroness said that she would not be drawn on the details of the long-term social care plan which apparently the Government are still promising to bring forward. She did refer to various sides in the Commons trying to sort a consensus on the way forward, but there is not much sign yet of the Government reaching out, and given the state of the public finances, I would not bet on immediate action in any case. I refer the noble Baroness to the letter in July from the Chancellor to Secretaries of State on the forthcoming comprehensive spending review. From that, it is clear that spending will come under a huge squeeze. It is noticeable that, while the Chancellor said then that he would prioritise the NHS, no mention was made of social care at all.
The argument I put before noble Lords is this. If the Home Office is convinced that the woes of the care sector are entirely down to the sector itself, let it produce the evidence. Let Ministers agree to the quick review that I suggest in my amendment, looking at the funding of the sector and the impact of Clause 1 before shutting off an extremely valuable source of labour for this important but vulnerable part of our society. I beg to move.
My Lords, my noble friend Lady Brinton has her name to the amendment moved by the noble Lord, Lord Hunt, which we support. My noble friend is indisposed at present, but I know that she will be here in spirit. I start by saying to the Minister that I will try not to moan. I generally try not to moan. It is reasonable for her to refer a Member of the House to GOV.UK; my point was that most of the public would be bemused by the reference. I think I can see on my screen that she is nodding.
There was enthusiasm for tabling amendments quickly after Second Reading, especially on what were particularly topical issues. A health and social care visa was one such. It remains topical, as does the whole operation of the social care sector, even though it is not in the headlines quite so much. I have spoken about immigration arrangements being in the rules. The scheme set out in our Amendment 47 may not be ideal—I confess I do not think it is—but it is about pinning down the arrangements into primary legislation to make them not too easy to amend.
My noble friend Lady Brinton and I also have our names to Amendment 57, on a social care visa. Many of your Lordships will have direct experience of the work of those in social care and share what the noble Lord, Lord Hunt, has talked of—the importance of proper payment reflecting the level of skill, which is very significant. As it happens, I cannot praise too much someone who recently cared for a close relative. She came from Romania.
The essential core skills are not ones that can be trained into anyone; there are the practical, technical aspects of care, but you cannot train someone to care as part of their personality. They either have it or they do not. That is why so many carers, little supported, are people who look after their spouses, children or parents at home. I mention this because, last time I mentioned care at home, the Minister thought I meant domiciliary care. That is part of the subject matter of the amendment, but I depart from the scope of the Bill for a moment to recognise the dedication and sheer hard work that family members undertake, which is inadequately recognised. Other noble Lords in the debate may know how much, in pounds and pence, that work saves the state.
The noble Baroness, Lady Masham, will explain the importance of her proposal in Amendment 66. I simply say that my noble friend Lady Thomas of Winchester added her name to that amendment, and she is very sorry that she cannot take part in today’s proceedings.
Also in the group is Amendment 82 of the noble Lord, Lord Patel, which I thought was interesting. Some of us leap in; calmer heads propose an analysis of the issue. I suspect that will not preclude some pithy points in support of progressing with analysis.
My Lords, Amendment 66 would provide for the creation of a fast-track health and social care visa for EEA and Swiss nationals who provide personal care for severely disabled people, after the end of free movement. The visa would be limited to EEA and Swiss nationals who, immediately prior to the commencement of Clause 1 and Schedule 1, had the right of free movement into the UK.
Subsection (1) of my proposed new clause says:
“The Secretary of State must provide by regulations made by statutory instrument for the introduction of a fast-track health and social care visa for a relevant person who provides personal care for severely disabled people in the United Kingdom.”
Subsection (2) defines “fast-track” and “relevant person”:
“In this section, ‘fast-track’ means processed by UK Visas and Immigration within three weeks from the day on which the applicant provides their biometric information, and ‘relevant person’ means an EEA or Swiss national who immediately prior to the commencement of section 1 and Schedule 1 had the right of free movement into the United Kingdom.”
The proposed new clause would provide for the introduction of a fast-track health and social care visa for a person who provides personal care for severely disabled people. The visa would be limited to EEA or Swiss nationals who, immediately prior to the commencement of Clause 1 and Schedule 1, had the right of free movement into the UK. This is a probing amendment to see what consideration the Government have given to extending their new health and social care visa to persons who provide personal care for severely disabled people in the United Kingdom.
“new Health and Care Visa will be launched this Summer, creating a new fast-track visa route for eligible health and care professionals and delivering on a key manifesto commitment.”
However, the Government have been criticised for excluding care workers from being able to apply for visas designed to fast-track those coming to the UK to work in the health and care sector.
The Government have faced a backlash because social care workers are not eligible to apply for the visa, although the Migration Advisory Committee, on whose advice much of the new system is based, recognised the workforce shortage faced by social care in its most recent report and did not recommend that care workers be added to the list of shortage occupations. I cannot understand this. Perhaps the Government can tell us why. Instead, the committee said that it hoped the Government’s forthcoming Green Paper on social care would provide more clarity on the future of the sector in the UK and contain concrete proposals to improve terms and conditions for care workers. Waiting is not acceptable. There is a crisis.
Critics have said that the exclusion of care home staff from a post-Brexit, fast-track visa system for health workers could prove to be an unmitigated disaster and may increase the risk of spreading coronavirus. Professor Martin Green, the chief executive of Care England, which represents the largest private providers, has said that the decision amid the pandemic in which 20,000 people have died in UK care homes has the potential to destabilise the sector even further, with disastrous consequences, confirming that there could be no special treatment for carers coming to the UK from the rest of the world.
The Government have said that they hope that Britons will fill the shortfall of around 20,000 workers, equating to 10% of all posts. Currently, 17% of care jobs are filled by foreign citizens. In the debate on Second Reading, I drew attention to this when I said:
“There is a danger that people who cannot get work of their choice are pushed into doing care work, with such horrifying results as happened at Whorlton Hall near Barnard Castle, Thors Park in Essex and Winterbourne View near Bristol, where patients were abused and bullied. This cruelty was exposed by ‘Panorama’. We must surely try to prevent this sort of thing happening again. I hope the Government will listen before it is too late.” —[Official Report, 22/7/20; col. 2251.]
The health and care visa has been designed to attract the brightest and best from around the world. It has been criticised for excluding front-line care home workers and contractors. It has been pointed out that the minimum salary threshold means that many cleaners, porters and other support staff will not qualify. This will discriminate against severely disabled people living in their own home who need paid carers. The Government are discriminating against any care workers.
Vic Rayner, the executive director of the National Care Forum, has said that in London, where around 38% of care workers are non-British, the policy could be “an unmitigated disaster.” She said:
“‘We have 122,000 vacancies, growing demand for our services, and then the tap is turned off like this … It is not good news at all. What you need for good care is a stable, skilled and plentiful workforce. And in the context of Covid-19, where you are trying to minimise movement of staff, any shortages might increase movement of staff and use of agency staff, which we are trying to avoid.’”
Robin Hall, the secretary of the Hampshire Care Association, has said that a shallower pool from which to recruit could drive up wages, which, without greater public funding, would mean fewer staff employed per resident. She said:
“‘That will damage the quality of care we can deliver … You also may have to get less choosy about who you employ, and that’s a dreadful thought. A lot of our EU staff are highly skilled. They are smart, articulate and speak three or four languages. We don’t get that quality of applicants from the UK because of the status the profession has.’”
With the advances in medical treatment made over the years, many severely disabled people are living in the community in their own home. Many of them need live-in or daily carers. We also have an increasing elderly population. A bright young man called David who broke his neck in a rugby accident and was paralysed from the neck down had been cared for by his mother. As she got older, her arthritis became worse. David was fearful that he might end up in a care home, which was something he could not accept. David lived in a comfortable bungalow with a garden and a lily pond. One day he was found drowned in that pond. In desperation, he had driven his electric wheelchair into it to end his life. Surely we do not want more cases like that.
Good care workers who work in people’s homes must be dedicated to the job, get satisfaction from it, be honest, skilled, compassionate and flexible. Caring for severely disabled people is not for everyone, but those who undertake these positions are special and they should be valued, not treated as “also rans”.
I look forward to hearing the Minister’s comments on Amendment 66, and I hope that it will be taken seriously.
My Lords, before I speak to my Amendment 82, I want to support strongly the noble Lord, Lord Hunt of Kings Heath, who spoke with his usual passion when presenting his amendment. I hope the Minister will respond to that.
Amendment 82 can be taken in the context of the Covid-19 pandemic which has highlighted the exceptional contribution and sacrifice made by our health and social care workers every day in protecting and caring for people in the community. It has also made clear how much we depend on our international workforce. Around 29% of doctors working in NHS hospitals and almost 14% of healthcare workers overall in the United Kingdom are from overseas. International workers account for approximately one-sixth of care workers in England.
The pandemic has had a profound impact on all aspects of our health services, but I draw the attention of the House to its impact on the all-too-often overlooked sector of social care. Between March and July this year, there were 30,500 excess deaths among care home residents as well as 4,500 excess deaths among people receiving care in their home. Figures from the Office for National Statistics also show that social care workers are among the occupational groups at the highest risk of Covid-19 mortality. The United Kingdom recorded the second highest number of deaths among healthcare workers in the world, second only to Russia, and a significant number of those deaths were among social care workers. These figures highlight the immense sacrifice and heartbreak that these workers have faced while trying to do their job in a system that was already overstretched. The vital contribution they make to the health system has been overlooked and undervalued for too long.
Adult social care is facing stark recruitment and retention challenges, with an estimated 122,000 vacancies, while the demand for social care workers is expected to rise in line with the UK’s ageing population. The CQC’s State of Care report concludes that workforce shortages in adult social care are
“affected by the lack of value given to social care by society and disproportionate levels of pay.”
The pandemic should serve as a wake-up call that we need to value our social care workforce more. In a sector where one in six of the workers are from overseas, any changes to the UK immigration system that could deter or prevent those who want to work in this country are of deep concern. There is a risk of significant implications for the staffing of health and social care services, as well as the quality of care and patient safety in the future. While measures to help recruit doctors to the NHS, including the fast-track NHS visa, are welcome, the lack of any route into the UK for social care professionals is extremely concerning. The average salary for a care worker in England is between £16,400 and £18,400, which means that individuals would fail to meet even the lower salary threshold of £20,480 to enable them to trade points to be eligible to work in the United Kingdom.
The current proposals for new immigration controls risk exacerbating the current social work workforce shortages and, as a result, putting some of the most vulnerable members of our society at risk, as already mentioned. Social care staff play an integral role in the efficient and safe running of the health service, and it is vital that any future immigration system recognises this. We owe our overseas health and social care staff a huge debt of gratitude. We should do all we can to keep these dedicated workers and ensure that there are no barriers to future recruitment.
It is important to grow our domestic workforce to help to meet workforce challenges, and to improve working conditions, pay and training as part of that. However, we must also provide an entry route for overseas staff who want to join such a vital part of a healthcare system that would struggle to cope without them. There is a consensus across healthcare organisations, as well as growing support for the idea from parliamentarians right across the political spectrum, that social care needs a long-term, sustainable solution that includes better funding. In the short to medium term, the immigration system must include a migratory route that meets the needs of the social care sector, which is facing severe challenges. We now need the political will to act and reverse this public policy omission.
I therefore hope that my amendment will be supported. It is supported from outside very strongly—by the Royal College of Nursing, the British Medical Association, UNISON, Independent Age and the Royal College of Physicians. It places a duty on the Government to report on migratory options for health and social care workers ineligible for the skilled-worker route.
The amendment would require the Secretary of State to lay before Parliament a report setting out in detail the options for overseas workers excluded from the skilled-worker scheme, within a period of 30 days beginning on the day on which this Bill is passed. It would need to specify a migratory route for care workers, home workers and healthcare support workers. It is time we recognised the vast contribution of the social care workforce to our community. Showing that there is a migratory route into the UK for them would be a step towards achieving this. They have demonstrated that in low-paid jobs they provide good social care, and even die for us, as shown by Covid-19.
I had not indicated that I intend to divide the Committee today, but I look forward to the Minister’s response and I will reserve my judgment. All I can say is that the support for this amendment outside and from all sides is immense, and I hope the Minister will respond to that.
My Lords, I shall speak in favour of my Amendment 93. It is obvious that many of the amendments in this group are heading towards the same sort of thing, which is protection for people of all kinds as well as holding the Government to account for what they do. I support several of the amendments that have been spoken to, and I have been moved by some of the speeches from noble Lords.
My amendment is supported by over 50 organisations from all the devolved nations, including the Health and Social Care Alliance Scotland, Macmillan Cancer Support, UNISON and the Association of Camphill Communities. Amendment 93 would require an independent evaluation of the impact of the effects of the Immigration and Social Security Co-ordination (EU Withdrawal) Bill on the health and social care sectors across the UK. This would be made after consulting the Secretary of State for Health and Social Care, the Scottish Ministers, the Welsh Ministers, the relevant Northern Ireland department, service providers, those requiring health and social care service and others. One would hope that this would be automatic with any measure that a Government introduce as they really need to know whether it is working or not.
Proposed new subsection (1) would require the Secretary of State to lay a copy of the report before both Houses of Parliament no later than one year after this Bill is passed. Proposed new subsection (8) would require a Minister of the Crown to make arrangements not later than six months after the report has been laid before Parliament, for the report to be debated and voted on in both Houses.
My amendment is necessary to safeguard the interests of the many people who rely on the contribution of EU citizens and non-EU citizens for the provision of health and social care across the four nations. This of course includes disabled people, children and young people, older people, unpaid carers and those with long-term health conditions. I should perhaps declare an interest in that I am getting older and this might apply to me in a decade or two.
Prior to the UK leaving the EU, a number of studies had highlighted the significant adverse impact of Brexit on the health and social care sectors across the UK. These studies, and the initial information about the points-based immigration system provided in the Home Office’s policy paper, The UK’s Point-Based Immigration System: Policy Statement, suggest that the ending of freedom of movement and the introduction of a points-based immigration system will potentially have a major adverse impact on the health and social care sectors across the UK. I think every speech so far has highlighted that fact.
The proposed independent evaluation that would be introduced by Amendment 93 could play a key role in supporting the health and social care sectors across the UK, helping them to address a range of concern about the proposals. These include concerns that many health and social care workers from other European countries, and from non-European countries, would not meet the proposed income threshold under this system, and that the requirement to have a job offer is unnecessarily restrictive, and will create addition administrative burdens and cost for health and social care organisations trying to recruit staff from abroad. As we have heard, there is a lack of recognition of health and social care specific skills, experience and professional qualifications in the proposed points-based system. As a result, it does not recognise the skills and experience of the workers from across the EU, and from non-EU countries, to enrich health and social care support and services here. Nor does it value the sector and its growing importance as a result of demographic changes.
There is much wrong with the Government’s immigration policy, but health and social care will feel a particularly brutal impact. This independent analysis is required so that the Government can think properly about the needs of health and social care and develop policy accordingly.
My Lords, I declare my interest as chair of the National Mental Capacity Forum. I speak to Amendments 2 and 66, to which I have added my name, and I strongly support Amendment 82, tabled by my friend Lord Patel.
The current proposals will exclude a group of workers we desperately need: carers for those with physical and/or mental disabilities, especially, as my noble friend Lady Masham highlighted, those with spinal injuries and similar severe physical constraints, and those with severe impairments of mental capacity for a wide variety of reasons. Many of these people are at a high risk of Covid and some will have been on the official shielding list. They wish to remain in their own homes and need care around the clock. For them, a live-in carer is the best option, but the annual salary of such a carer will fall below the level to accrue points in the system. That workforce just does not exist here. UK residents are not coming forward to train as live-in domiciliary carers.
Those carers already here are fearful that they will not obtain leave to remain. UNISON is calling for key workers to remain here and be eligible for NHS care—that is, to be exempt from the “no recourse to public funds” criteria—during the pandemic. Around 17% of the social care workforce is made up of migrant workers, with 115,000 European nationals and 134,000 non-EU nationals.
Vacancy rates in the care sector now stand at 6.5% in England, and 38% of care agencies report vacancies. In related sectors—sectors that support frontline, hands-on care workers—29% of hospital doctors in the NHS and 12% of healthcare workers overall are from overseas. Austerity has led to local authority spending on adult social care shrinking by 7% per person in the past decade. Price is by far the most dominant factor in decisions on care commissioning. Councils have tightened eligibility thresholds in recent years, meaning that at least 1.5 million elderly and disabled people have unmet care needs.
The sector was already in crisis before Covid-19. The problem will not be solved by rising unemployment: significant skills are needed to deliver high-quality care. Good care is complex; bad care kills. Just because care work is low paid and badly undervalued does not mean that it is low skilled. While staffing shortages and recruitment problems in the sector require a holistic solution, it is disingenuous for the Government to call for better wages and conditions in sectors left out of their new immigration plans. The criteria for the points system include the threshold of £20,480 for those with additional tradable points, such as an occupation on the shortage occupation list, and a fast-track NHS visa for applicants with a job offer who speak English and are trained to a recognised standard. [Inaudible]—workforce meets even these criteria. Others in low-paid health and social care sectors, such as clinical scientists, lab and theatre technicians, porters and cleaners, many of whom are EU nationals or from elsewhere overseas, play an integral role in the efficient and safe running of the health and care services, yet none of them would fit these criteria. I fear that the rhetoric of cutting immigration is being driven forward, ignoring the devastating effect on the NHS and social care sectors, despite all the nice words about how these people have coped and saved lives while themselves at risk during Covid.
Warning after warning has shown how the NHS and care sectors will collapse without their overseas workers. That is why there is a need for a fast-track category health and social care visa, as outlined by my noble friend Lady Masham, and an urgent need for the criteria to be looked at independently, as proposed in Amendment 2.
We cannot put our heads in the sand and think that unemployment will miraculously and rapidly create a workforce of skilled, low-paid carers to look after those with complex needs, and that vacancies will evaporate. They will not. I believe that we will be coming back to these issues at Report, and dividing the House.
My Lords, I speak in support of Amendment 47, to which I added my name, but I also strongly support other amendments in the group, particularly that of my noble friend Lord Patel, who spoke powerfully in favour of making sure that we do not create barriers preventing health and social care staff coming to this country. I do not want to duplicate what others have said, so I will speak briefly about the difficulties we have in recruiting staff over here, which others have certainly emphasised.
The NHS employs half a million staff and has 100,000 vacancies reported by trusts, many of them among low-paid workers. This figure is projected to rise over the coming years, rather than diminish. Our problems will become pretty well impossible to manage unless we do something about it.
We want more support staff employed in primary care. This has been a policy goal for a long time and the NHS long-term plan continues to reflect this ambition, but the number of support staff working in community services has continued to fall, and I expect it to continue to do so. GP surgeries are desperate to appoint support staff but cannot do so. As others have said strongly, a similar picture applies to the social care sector, where we have 8,632 vacancies, according to the latest available data—surely unsustainable, as the number of elderly people needing care rises relentlessly, not to mention, as others have, the many people with disabilities and a range of problems.
The NHS Long Term Plan acknowledges that international recruitment will continue to be vital in the short to medium term if we are to deal with our staff shortages. This is being constrained, says a report by the Health Foundation, by immigration policies. Surely the Government need to pay attention to that, and I hope the Minister will respond to that point. Immigration policies are really causing problems for our health and social care services. Instead of imposing barriers to EEA and Swiss entrants, would it not be better for Ministers to concentrate on reducing barriers to well-qualified migrants with good English from the rest of the world? Amendment 47 is key, as are the other amendments in this group, if we are to improve our health and social care staffing or to avoid a serious drop in the quality and availability of these crucial services. I look forward to the Minister’s response.
My Lords, I support all the amendments in this group. I have added my name to Amendments 47 and 66, but the intentions and sentiments already expressed so well by many noble Lords are ones that I fully endorse. I thank the noble Lord, Lord Hunt, the noble Baronesses, Lady Hamwee and Lady Masham, and other noble Lords for the excellent way in which they have explained the urgent need for measures in the Bill that specifically address the shortage of social care staff. I implore my noble friend on the Front Bench, who I know cares about this issue as much as so many of us around the House, to take back to the department the strength of feeling across the House on this matter and address some of these issues before Report.
We are talking here about the biggest failure of social policy in modern times. The inadequacy of our social care provision is already well documented and well known, and the Government are already committed to addressing this issue as soon as possible. We cannot move forward and improve the quality of social care without staff. We cannot mechanise this. Care workers may be low paid, but that does not mean they are low skilled. They are essential to enabling increasing numbers of people to live decent lives. We are not talking about bringing in low-paid shelf stackers; we are talking about the emotional, physical and mental well-being of some of our most vulnerable citizens.
Given that the Government are the main funders of social care and have not yet funded adequately social care providers who employ staff who might generally earn above the £25,000 cut-off, that imposes on the Government a duty to ensure that our immigration policy does not deter those who might be willing to work for less than that figure—most of the people who work in social care already do so—from coming to this country when, as we have already heard, around one in five of our social care staff is already from overseas.
I know my noble friend responded to these concerns at Second Reading by saying that the Government hope that Britons will fill the shortfall, but hopes are not good enough. It takes time to try to find any UK nationals, train them in the right skills and raise the standards of pay. What are these elderly and disabled people supposed to do in the meantime? They need care. I therefore hope my noble friend might still consider the implications of these amendments, or at the very least agree to a transitional, temporary social care visa, perhaps for five or 10 years, that specifically enables social care providers and individuals who need to employ somebody to care for them in their own home to find those overseas workers who are willing to come here and fill the gaps we currently have, rather than having an immigration system that rules out being able to bring them in.
My Lords, it is a pleasure to follow the noble Baroness, Lady Altmann, and I very much agree with what she had to say. I am speaking primarily in support of Amendments 2 and 93, but I am supportive of all these amendments. I underline the importance of what the noble Baronesses, Lady Masham and Lady Finlay, said about personal care.
When the Bill was postponed in the House of Commons, I thought that perhaps the Government were thinking again about the treatment of care workers in the points-based system in light of the Government’s and the country’s applause for them during the height of the pandemic. How naive I was; there was no rethink. Despite the crucial role they played and continue to play and the range of skills involved in their work—organisational, clinical and
“soft skills of empathy and patience”,
as the chief executive of the National Association of Care & Support Workers has explained—the Government, as has already been said, continue to confuse pay with skill and contribution.
Back in February, the Home Secretary herself conceded that
“care is not a low-skilled occupation”— so why is it being treated as one now? To do so in the proposed points-based system is in effect discriminatory, as the equality impact assessment makes clear. It says:
“The Government is aware that prescribing a minimum … threshold could have differential impacts on individuals on the basis of their sex. Women may find it disproportionately more difficult to meet the threshold than men.”
Indeed, but there is no “could” or “may” about it. It will have a differential impact and women will find it disproportionately difficult because, of course, women make up the majority of care workers. Moreover, black and minority ethnic women are disproportionately represented in the care sector, and the equality impact assessment shows that BAME workers will also be adversely affected by the salary threshold.
In the Commons, the Immigration Minister said that
“our vision for the future of the care sector is about providing rewarding opportunities to UK-based workers, not basing it purely on immigration.”—[
Likewise, the Minister, at Second Reading, said that
“the immigration system is not the sole solution to the employment issues in the social care sector.”—[
No one is suggesting that immigration provides the sole solution or that the future of care should depend purely on immigration but, to quote the Cavendish Coalition of 37 organisations in health and social care:
“For a sector where one in six are foreign nationals and which is struggling with 122,000 vacancies in England alone it would be unwise to believe that domestic recruitment will solve all social care’s immediate problems.”
It warns that we are
“swiftly heading towards an alarming destination with no obvious solution for the care sector.”
Can the Minister explain how the Government will ensure that those “rewarding opportunities” to which the Immigration Minister referred are to be provided when local authorities are already on their financial knees? As we have heard, funding has gone down in the care sector and the Government have done nothing about it over their 10-year period in office. Do the Government believe that the market will miraculously provide the solution in the absence of immigrant labour?
I might feel greater confidence in the Government’s
“vision for the future of the care sector”—[
My Lords, this has been an excellent debate. I associate myself in particular with Amendments 2 and 82 but, like other noble Lords, I support many of the amendments in this group in principle.
A constant theme since Second Reading is the need for key workers to continue to supply workforce in the UK, not least in the NHS and social care. It is a matter of fact that, quite apart from us potentially sending out the wrong message to those coming from countries other than the EEA and Switzerland—international care workers on whom we currently depend—many of our care home workers and care workers in general are sourced from Poland, Latvia, Estonia, Lithuania and other EEA countries. I therefore suggest that this is a wake-up call to the potential immediate crisis that the social care sector could face on
I always remember that during my time as an MP, when I used to ask the local jobcentre where the main vacancies were, the answer usually came back that the vacancies that were the most difficult to fill and therefore the longest on the register were those in the care sector. I hope this might provide an opportunity to really look again at the status of social care workers. They are the flip side to the NHS family. I remind the Committee of my interest in that I come from a medical family; my brother and father were GPs, and I currently work with the Dispensing Doctors’ Association. We can see the extent to which we were dependent on care homes taking often still quite poorly patients out of hospitals in the immediate pandemic circumstances of Covid-19.
I hope that my noble friend the Minister will use her good offices to liaise with the relevant departments in this regard, particularly the Department of Health and Social Care, to look at valuing the skills and caring qualities of our social care workers and look to raise their salaries to more realistic levels.
I also ask my noble friend whether a compromise in this regard, particularly in view of the visa requirements, might be to look at whether it would be appropriate for the immigration system that will commence in the new year to have a two-year temporary work visa so as not to leave the country potentially short-staffed in this crunch period, as we deal with the knock-on effects of Covid and its economic consequences and as a result of our ending the transition period as we leave the European Union.
Furthermore, like other noble Lords who have spoken, I am deeply concerned that many of the details are not in the Bill and that we are relying very heavily on secondary legislation and a points system, the details of which are not that transparent.
I conclude by lending my support to Amendment 2 in particular, in the names of the noble Lords, Lord Hunt and Lord Adonis, and the noble Baronesses, Lady Finlay and Lady Brinton. It requires the Government to commission an independent review of the social care sector, which would, I hope, cover many of the points that I raised today.
I also support Amendment 82, in the name of the noble Lord, Lord Patel, which would introduce a duty to report on migratory options for health and social care workers who are ineligible for the skilled worker route. It is nonsensical to have such a constraint on a sector on which we are so heavily dependent.
I found the speech by the noble Baroness, Lady Masham, very moving. In my days as an MP, I visited a Leonard Cheshire home, where I encountered the tragic case of a young Olympic rower who had suffered a stroke and was incapacitated. If this Bill was passed, these two amendments—and all amendments in this group—could do so much good for people of all ages who are in care, particularly the vulnerable and the disabled in the community.
I want to return to the points made by the noble Lord, Lord Hunt of Kings Heath, in his introductory remarks. The important amendment in this group is Amendment 2. All the others could be things that potentially fall out of a review, and so the key is to have that review and then look at the most appropriate way forward.
Many of the issues that have been spoken to in this debate are not new; we have been talking about social care for as long as I have been in the House. We could say many things about the current situation we find ourselves in, and some of the issues are fairly long-standing. One that I talk about a lot, but not many others do, is the fact that there are currently about a million people who are ageing and do not have children. Our health and social care service is predicated on the fact that you have children who will look out for your needs in any health or care setting. We will have 2 million people in that position by 2030. We have, therefore, an acute and growing need for paid social care. Also, at the moment, a number of our biggest care providers are owned by private equity firms, run at very low cost and margins—they are not about to stay in this business if they cannot do that, and to them, it is a business.
At Second Reading, the noble Baroness talked about the need for the United Kingdom to stop colluding in an international trade in low-cost care. I can understand that argument but, at this moment, given where we are, we would be the first affluent western country to take itself out of what is, in effect, an international market in care. No other affluent western country—nor Australia, for that matter—has solved its care problem by suddenly turning off all access to people from other nations. It would be a very bold statement if we were to do that, but noble Lords have today pointed out the dangers of doing so.
The noble Lord, Lord Hunt, is right to argue that, at this moment, there is a case for a review. The Government, if they were not being so ideologically pure on the matter, would want to give themselves flexibility in addressing these issues as they arise. There is no need to do this: it is just government ideology. The Government could bring in a transitionary process, over about five years, that would enable people to get through a period of uncertainty. I therefore commend Amendment 2 to the Minister and ask her to look at some of the other amendments in this group.
My Lords, I will focus on Amendments 82 and 93, and particularly their implications for reviewing the need, or otherwise, to recruit nurses and doctors from overseas. I am grateful to the noble Lord, Lord Patel, and the noble Baroness, Lady Jones, for tabling them.
I suspect, however, that these amendments are based on the common fallacy that the NHS needs to recruit doctors and nurses overseas because supposedly not enough British people want to do these jobs. That is simply untrue. The latest year for which UCAS figures are available is 2019; I apologise to the House for giving out-of-date figures at Second Reading. The most recent figures show that 53,000 young British people applied to train as nurses last year, of whom 20,250 were turned away—that is 43% of applicants, or nearly half of those who applied. UCAS unfortunately does not produce figures on the same basis for those seeking to train as doctors, but it is clear that an even higher proportion of those who apply to medical school are turned away.
This is a double scandal. First, it means that tens of thousands of young Brits who aspire to serve their country as doctors or nurses are refused that chance and have to pursue less attractive options. Secondly, we have to recruit tens of thousands of doctors and nurses from abroad, mostly from countries that are far poorer, have fewer medical staff per head of population, and can ill afford to train people who then migrate to the United Kingdom.
This double scandal is compounded by the way this issue is excluded from the national debate. Why do we allow this situation to persist? We allow effectively unlimited numbers of students to study every subject from art history to zoology. The only subjects where places are numerically restricted are medicine, where they are formally restricted, and nursing, where they are de facto restricted.
I will pass over the political reasons why it may have seemed wise to advocates of mass immigration to invoke the needs of the NHS and nurses and doctors to sanctify their cause. The other reason is nakedly economic: we found it cheaper, in the short term, to employ people trained at the expense of foreign taxpayers, rather than pay to train our own citizens. At the same time, relying on nurses and other health workers from abroad, on whom many other noble Lords have focused, helps to keep wages low. What a paradox it is that many noble Lords who have spoken today and railed against the level of inequality in our country pursue a policy whose prime justification, as they have made clear today, is that it depresses the wages of the lowest-paid people in this country and keeps them below what economists call the domestic market clearing rate—the rate at which we could meet our needs from our own employees.
I was at first minded to support these amendments, but, on looking more closely, I note that one thing the reports that they call on the Government to produce do not cover is the scope for training more of those aspiring to become nurses and doctors in the UK, so that we can end the plundering of foreign health services. That is a very significant omission and shows that there is a blind spot in this discussion, which I hope we will not perpetuate in future debates.
I had intended to withdraw from the debate, but having heard the noble Lord, Lord Lilley, I have to say that I agree very strongly with what he said. The debate so far has covered the case for a short-term arrangement to make sure that our failure to train in recent years can be made up for, but there is no justification in the medium term for taking doctors and nurses to look after people here from countries that need them far more than we do. That is our responsibility; it is time we trained our own and got a grip on it.
My Lords, I rise to support my noble friend Lord Hunt’s amendment and the brief, excellent speech he made at the beginning of this debate. I also want to reinforce points that have been made by the majority of your Lordships, with the exceptions of the noble Lords, Lord Lilley and Lord Green. Although I do not dispute for a minute that both noble Lords have a point, they have highlighted what I hope to put across this evening, which is the complete contradictions that exist in this debate.
I shall start by picking up those points made by the noble Lords, Lord Lilley and Lord Green. I am presuming that, when we reach Report, they will be moving amendments that will remove the so-called health and social care route announced in July, because under that route doctors and nurses could be recruited from across the world to fill vacancies at that level.
One of the contradictions that I want to highlight relates to young people. Young people who cannot find a job anywhere else due to the aftermath of Covid-19—the 20% drop in GDP and the knock-on effect on unemployment—might decide to go into social care. Most young people I speak to want a career and to be able to progress, and there is progression in both residential and social care. However, as things stand with the proposals by the Government, the area from which we would allow people to be brought in from overseas would be at that higher level, whereas at the lower level the vacancies that have been mentioned—122,000 in England alone—would not be fillable from outside the country. I do not know whether the Government believe that, given the crisis in unemployment that is about to accelerate, people will just take up those vacancies even if they are not emotionally and physically suitable to take up caring duties. As has been made clear in this debate, you have to be a particular type of person to take up some of the less attractive duties of caring for someone who is severely disabled or frail and has dementia.
The contradictions, also mentioned by the noble Baroness, Lady Barker, abound. We all want to see improved wages in this sector. That would not only reward people morally for what they do but help fill vacancies. But the danger of simply putting money into the sector, given the level of private equity ownership, might well be that it gets creamed off, rather than helping to fill vacancies. Or, they will simply close the homes if the money is not provided, which will cause an even bigger problem—as part of the contradictions, we would end up with older, frailer and more severely disabled people in hospital settings, which are more expensive but would allow for staffing to be brought in from outside this country. We saw that in March and April, when people who should have been in different settings in the first place were cascaded out into the residential sector unchecked for Covid-19 and ill-prepared in terms of PPE to be able to deal with it. The consequences, as the noble Lord, Lord Patel, said, are obvious for all of us to see.
The biggest contradiction of all—and I put this to the noble Lords, Lord Lilley and Lord Green—is that, on the centre-left in politics, people are generally suspicious of markets and, on the right, people generally embrace markets. But as I said on Second Reading, in the case of the labour market, the situation is reversed, and those who believe vehemently in markets are against a labour market and against being able to draw in from across the world those who have something to offer the area we are talking about this evening.
We need to sort out the contradictions. That includes the issue of austerity, which led to a bigger downturn in funding for local government services and those funded by local government than any other public service area in the country, with the result that local government has been struggling both with its own direct health provision and with funding in the market and the ability to sustain services.
I have one question—I have learned over the Covid-19 period that you do not get an answer from the Minister unless you ask them a question. My question is simple, and the Minister might be able to answer it tonight: we know what the vacancy level is, but do we have an up-to-date picture of the turnover level in the social care sector? The turnover gives you an idea of how long people can stand working in this challenging but often rewarding setting. What steps might have to be taken if the Government’s hope is that the downward pressure on job availability will help fill, in the short term, the vacancies that we have talked about?
At the end of the day, what we are talking about is the care of human beings. We are not talking about markets or political or economic theory; we are talking about the reality of caring for people in their own homes and stopping them, therefore, having to move into hospital, residential care or residential settings that are dealing with people at very difficult times of their lives. In the end, we have to care enough to get it right.
Who can argue about the need for a properly skilled, staffed, trained social care workforce? “Skilled and settled”, I think, was the phrase used by the noble Baroness, Lady Masham of Ilton. That is why the issues in subsections (3)(a), (3)(b), (3)(c) and (3)(d) in the noble Lord’s proposed new clause seem entirely appropriate questions to ask. But when they are tied back into an immigration Bill, I begin to get nervous. The noble Lord, Lord Blunkett, talked about contradictions, and I listened carefully to what he said, but the fact is that the issues in subsections (3)(a) to (d) are issues for the sector not linked directly to the immigration matter we are discussing this evening.
I recognise I am probably swimming against the tide, but it is important to realise that workplace psychologists will tell you that you go to work for three reasons. First, you go for the money, and let us not be precious about that. Secondly, and equally importantly, you go for what they call self-actualisation —to improve and increase your life skills, work with decent people, have career progression, have a good performance that is noted and rewarded and, hopefully, operate in an atmosphere of good team spirit. Those are the internal desires most people have in going to work.
The third area is external reputation. When you mention where you work, what do people say in the saloon bar of The Dog and Duck or around the table at a dinner party?
It is worth taking those three yardsticks and applying them to the social care sector. First, there is the money. There is no getting around it: £8.70 an hour is clearly not good enough when compared with £9 for stacking shelves in a supermarket. However, money is not the only motivator here, and when we turn to self-actualisation —the second of the criteria that I mentioned—the situation is quite serious. I have had the privilege of serving on the boards of many companies in my career. When I join one, I often say, “Tell me about your staff turnover.” No staff turnover is not an attractive thing; very often it means that the company has got a bit complacent and is not at the cutting edge, and that the service is not as good as it could be. You want some staff turnover—5%, 10%, that sort of level—to provide the dynamic but, if it rises above that level, it is operationally destructive, distracting and expensive, and the quality of the service starts to fall away.
I understand that in 2018-19 there was a 32.2% turnover in directly employed staff in the sector. Worse, among care workers the turnover was 39.5%. Further evidence of a lack of considered career progression is that half the workforce—excluding registered professionals —have no relevant social care qualifications, which seems to me a question not of money but of managerial grip and organisation, and of making the sector better managed.
Lastly, on the external reputation, one of the great advantages and developments of the pandemic is that people have begun to see how useful, worthwhile and attractive social care can be. People have begun to think about it. Long may that continue but, historically, we all must accept that its reputation has not been that good.
This is a system under acute stress, as many noble Lords have said. The danger of amendments such as these is that they will result in new arrivals, and that immigration will be used as a crutch to maintain what is close to being a broken system. I cannot believe that this is the right approach. More importantly, if the sector believes that it has a “get out of jail free” card, to use the inference that the Minister made when winding up at Second Reading, then there is no pressure on the sector to make any improvements or changes to how the businesses are run or operated, nor indeed is there any pressure on the Government to do likewise. We must find ways to improve the operational performance and the financial performance.
I have two final points. First, on the issue of morality, referred to by my noble friend Lord Lilley, the noble Baronesses, Lady Barker and Lady Meacher, and the noble Lord, Lord Patel, recruitment in this area is a zero-sum game. What we have, other people lose. Maybe one could say that within the EU there is sufficient prosperity for us not to worry about it, but the noble Lord, Lord Patel, mentioned the wider recruitment. This is a very serious issue. We must look ourselves in the mirror and decide whether it is right and fair for us to be recruiting doctors, nurses and care workers from less- developed countries. It may be serious within the EU, but it certainly is serious around the world.
I will give just one example. When the Ebola virus struck Sierra Leone, there were 136 doctors there, one for every 45,000 people; in this country, the equivalent figure is one for every 300 people. At that time, there were 27 Sierra Leone doctors working in the NHS. If we had not employed those people, we could have given a 20% boost to Sierra Leone’s health facilities. It is not the answer but when we set out our stall for the future we must consider our attitude towards the less developed world, and whether we will, as the noble Baroness, Lady Barker, said, take ourselves out of the international market for health and social care workers.
My other point is about the dependency ratio, the ratio between those in work and those who are in education or are retired. A 26-year old from overseas who comes to work in a care home here will, in 40 years’ time, be looking to go to the care home as a patient, not as a worker, requiring more people to come and look after them. Therefore, we will need to find other ways to boost the sector. David Attenborough has called this a population Ponzi scheme. The noble Lord, Lord Turner of Ecchinswell, who is not in his place today, said that if you wish to keep the dependency ratio as it was in 2006, you must plan to have 100 million people in this country by 2060, compared to the 66 million that we are today. While I absolutely understand the good intentions of all noble Lords who have been putting forward these very worthwhile amendments, on balance I must ask the Minister to reject them.
My Lords, it is clear that many fear the impact that a sharp and purely tailored approach to ending free movement on growth could have in certain important economic sectors, especially within Northern Ireland. The move to reduce the £30,000 salary threshold to £25,600 for skilled migrants coming to the UK is welcome. However, it is not sustainable in Northern Ireland because quite a number of jobs, especially in the care sector, pay less than £25,600. The requirements of the sector have always been different from most of the rest of the economy, but I address my remarks mainly to Amendments 2, 82 and 93, and the need for workers in the health and care sector.
The pandemic has shown the enormous contribution of overseas workers to our health and social care system. Indeed, they have put their lives at risk to keep us safe. Over these last months the care sector has been under extreme pressure, and clearly any major changes will have serious consequences. Unless we have a breakthrough with a vaccine, care homes and that sector of our health provision will still be battling Covid-19. A large percentage of our doctors in the NHS are from overseas, yet there are thousands of posts vacant across the medical profession. There are serious staff recruitment and retention problems within health and social care, even with freedom of movement and flexibility of opportunity. Added to this is an ageing population with increasingly complex care needs. The Government have ambitious plans to fill staff vacancies, which noble Lords have spoken about, but it will take a concerted effort and a very considerable period of time to train doctors and nurses—even if they are recruited tomorrow—and to provide thousands of professional care home staff for our various facilities across the United Kingdom.
In my opinion, this is a mammoth task. It is not realistic to pretend that we can address the vacancy shortage within a short period. To suggest that those who have lost their employment elsewhere would adequately fill these vacancies is also unacceptable, as we are speaking about a caring profession; vulnerable people who need assistance need loving, professionally skilled attention. I fear that deterring the recruitment from overseas of care assistants and other junior care workers who already have skills will lead to a serious decline in the quality and availability of care for the most vulnerable in society.
We also need an independent evaluation of the impact of the Bill on the health and social care sector across the United Kingdom. The appointment of a person independent of government should be done following consultation between the Secretary of State for Health and Social Care and the relevant Ministers in the devolved Administrations. If what is being done under the Bill is right and professionally competent, there is nothing to fear from such a comprehensive independent evaluation. This new clause requires the Secretary of State to lay a copy of the report before both Houses of Parliament no later than one year after the Bill is passed, and that no later than six months after the report is laid it will be debated and voted on in the Commons and Lords. The effects of these changes on disabled people, older citizens, children and young people and those with long-term health conditions—in other words, those who rely on the service provided by health and social care to make life bearable—could be profound. Therefore, we had best be sure that we get it right.
My Lords, I wish to speak particularly to Amendments 2, 47 and 57. I strongly agree with the excellent opening speech on this group by my noble friend Lord Hunt and with many other speeches, including those of the noble Baroness, Lady Altmann, and my noble friend Lady Lister. This Bill illustrates that the pandemic has revealed fundamental flaws in the present United Kingdom non-EU immigration system and the Government’s post-Brexit plans for immigration. In an economy which previously had record levels of employment, and despite the joblessness effects of Covid on the labour market, their proposed points-based system could produce damaging labour shortages in many sectors, including the NHS, social care, which has been spoken about authoritatively in this debate, farming, food processing and construction.
None of this should come as a surprise, as the 2016 referendum campaign was based on rhetoric falsely linking the free movement of EU workers with the legacies of Tory austerity: housing shortages, depressed wages and huge cuts in public services, especially social care. The promise to take back control of borders may have appealed to nationalistic jingoism, but it was never rooted in the reality of modern Britain, where EU and non-EU migrants of all skills levels and income brackets keep the economic and social wheels turning. EU and other migrant workers were always, in fact, net contributors, through tax and national insurance, to the National Health Service, social care and other public services. Despite the Government’s intention to equate low pay with low skills and low value, the pandemic has abruptly brought migrants’ significant front-line roles as key workers in keeping the country afloat to the attention of the public, among whom it is now widely recognised, whereas perhaps it was not in 2016. As the Joint Council for the Welfare of Immigrants has stated, the Bill
“will deny our communities the care and professionalism contributed by migrants in these areas, to our own detriment.”
The Bill does not set out in detail what the future points-based UK system will look like. These changes will be covered in unamendable Immigration Rules. The Bill gives the Government Henry VIII powers to modify primary or secondary legislation as appropriate. Despite the Government’s claims that these powers are usual, they will diminish the role of Parliament in an area of policy where many, including the Lords’ Delegated Powers and Regulatory Reform Committee in its 2019 46th report, have concluded that greater scrutiny is already required.
In the social care sector, on which millions of extremely vulnerable British people depend—many of them our relatives, in care homes and in their own homes—the vast majority of social care roles do not meet the planned immigration system’s salary threshold of £25,600. The noble Lord, Lord McCrea, who spoke immediately before me, emphasised that point in relation to Northern Ireland. Using data collected before—I stress, before—the height of the Covid-19 pandemic, Skills for Care estimated the number of vacancies in the sector at 133,000. It also estimated that 5% of the 1.65 million workforce, or more than 80,000 staff, are at risk of losing their employment rights at the end of the transition period, in a sector where nearly half of employers are already struggling to fill existing vacancies because of low pay, anti-social hours and the demanding nature of care work.
The Government, in their wisdom, have decided that front-line social care staff will be excluded from their fast-track health and care visa, with the Home Secretary stating that this will encourage employers to invest in workers from the UK. Who is going to pay for this? Will it be people receiving care, cash-strapped local authorities, whose budgets have been massively cut, or private-sector care providers, many of whom are teetering on the brink of financial collapse? Parliament’s library briefing confirms that
“a wide range of organisations are concerned that short-term funding pressures remain. In 2018, the Local Government Association estimated that adult social care services faced a £1.5 billion funding gap by 2019/20 and £3.5 billion gap by 2024/25.”
While the points-based system is a fundamental change, other aspects of the non-EU immigration system such as enforcement, the right to bring dependants, settlement criteria, asylum, no access to public funds and more will remain unchanged when EU citizens without settled status become subject to them in 2021—next year. The pandemic has demonstrated that because of these policies, many such migrants are at significant risk of exposure to the virus, fear accessing healthcare, lack access to safe housing and are unable to stop working or to self-isolate because they are on poverty wages. This is not only detrimental to the health of migrant communities; the health of the wider public is also put at risk.
The Bill is a missed opportunity to deal with many more important questions, on which I support contributions and amendments from noble colleagues, including measures to combat modern slavery and indefinite detention, and to address family reunion for refugees and safe routes for unaccompanied children. These unresolved issues mean that the existing UK immigration regime for non-EU immigration is already a stain on our national reputation. Its extension to EU citizens from 2021 is a matter of deep regret, creating a new Brexit generation alongside the Windrush generation.
All British citizens living in the EU want to be reassured that we will uphold the treaty rights of EU citizens in the UK, the better to insist that they are upheld for our citizens in the EU. The Bill fails to provide that reassurance. If the Government want to retain the respect of our former friends and partners, they should listen to the concerns expressed by EU ambassadors and others and accept amendments which will guarantee the rights of the Brexit generation of European Union citizens, including vital social care workers, who have legally made their lives in our country, by writing them into this primary legislation.
My Lords, we have heard from across the Committee the concern about this crisis in social care. Many noble Lords have considerable expertise on this topic and I am grateful to them for sharing their knowledge.
History will record the failure to deal with the fragile state of the provision and funding of social care as one of the major failures in domestic policy, and one has to say that particularly of the last 10 years of Conservative and Conservative-led government. I wish that as much energy had been applied to this subject as to Brexit. It shows a peculiar set of priorities.
I do not know whether the Government are being ideologically pure, to use the term employed by my noble friend Lady Barker. I certainly think that they are being obdurate and, I am afraid, unintelligent in not responding to the enormous problems in social care. The idea that in a short space of time we are going to find loads of people in the United Kingdom who want to work in this sector when they have never previously shown any interest in, inclination towards or aptitude for such work is pie in the sky. We learn that there are 120,000—the noble Lord, Lord Hain, referred to an estimate of 133,000—vacancies in the social care sector. When a quarter of a million social care workers—that is, 20% of the workforce—are EU or non-EU nationals, the ending of free movement under this Bill will lead to even greater shortages of staff.
I agree that it is wrong to exclude care workers from the health and care visa route, since only maybe senior care workers will be included under the salary level criterion. My understanding is that Canada and New Zealand have sector-specific visa routes. Since they are flavour of the month, why don’t we follow countries like them?
I was very moved by the tragic account from the noble Baroness, Lady Masham, of the suicide of quite a young man through the fear of a lack of care. I experienced this a little when my late husband, four years before he died, had to have a leg amputated due to sepsis. He benefited from carer support, as well as, I hope, from my support. I can absolutely relate to the emotions—the fear and anxiety—of people, whether the elderly or those with a range of disabilities, who do not know whether they will be able to get care either in a care home or in their own home.
As many noble Lords have pointed out, low skilled and low paid does not equal low value. My noble friend Lady Hamwee and the noble Lord, Lord McCrea, referred to the right caring personality being one of the necessary skills, but somehow that seems to be disregarded as though it comes with the territory, not least with women. Women are expected to be natural carers; well, we are not necessarily.
My noble friend Lady Barker referred to an acute and growing need for paid social care as the number of people without children grows to, I think she said, 2 million in 2030. I am one of those guilty parties—I have failed to grow the population—and my noble friend makes a very good point. Many families are not necessarily in a position anyway to provide care within the family, but she makes a very good point about a factor that increases the necessity.
Various amendments call for a review. Some of them could talk about health and social care but the emphasis in this debate, just like Amendment 2, which was very ably moved by the noble Lord, Lord Hunt of Kings Heath, has rightly been concentrated on the social care sector, which is where we are facing a crisis. One of the factors in that crisis is going to be the lack of an adequate workforce, and quite honestly it is astonishing if the Government do not respond to that. I hope the Minister can give us some hope of progress when she replies to the debate.
Like the noble Lord, Lord Patel, and others, I congratulate my noble friend Lord Hunt of Kings Heath on his powerful speech opening this debate. I wish to speak in particular to Amendment 57 in this group, to which my name is attached, although I agree with the concerns that have been expressed by noble Lords who have spoken to other amendments in this group. I note that the noble Lord, Lord Hodgson of Astley Abbotts, advised the Minister to reject my amendment before I have even spoken to it, though I fear that my speech will probably only reinforce his view of his advice to his noble friend.
The amendment would make provision for the Secretary of State to provide a dedicated social care visa for EEA and Swiss nationals who had the right to free movement and have a job offer to work in the social care sector, and to their dependents. They would not be subject to the NHS surcharge or the immigration skills charge and the visa route would be available for three years from the end of the transition period, with the option to extend for further years if necessary.
The thinking behind the amendment is that the Government’s intention to suddenly shut the entry door at the end of the transition period in a few months’ time on the overwhelming majority of future overseas social care workers under the criteria laid down in the new points-based immigration system, and the exclusion of care workers from the qualifying list for the health and care visa, will have serious and immediate adverse consequences for our already stretched social care provision in the UK. The amendment would remove the suddenness associated with this policy change through the social care visa available for three years with an option to extend, and would give the social care sector a realistic chance of being able to adjust to the loss of a significant source of labour.
A Commons Home Office Minister said in July said that the reason why care workers had been excluded from the qualifying list for the health and care visa was that the Government had a “vision” for the social care sector that it should no longer
“carry on looking abroad to recruit at or near the minimum wage”,
and that the Government’s priority was that in future care sector jobs would be
“valued, rewarded and trained for, and that immigration should not be an alternative.”—[
If that means significantly better rates of pay and an associated increased degree of widely accepted and acknowledged professionalism in the underpaid and undervalued social care sector, that is to be welcomed—a widely accepted and acknowledged professionalism that does not leave care homes and care workers at the back of the queue when it comes to personal protective equipment and does not regard the care sector as so forgotten and unimportant as to send vulnerable people from hospital into care homes who have not been tested for Covid-19.
The fundamental change needed is far from the current position and cannot be achieved in the space of the next few months, when the transition period ends, without potentially serious adverse consequences for those who are vulnerable and dependent on care provision either at home or in a home. It requires a change of culture and attitude both towards and within the sector, a change that the Government have to accept is their responsibility to lead. That will take time, as the Government implicitly accepted when they said in July that with the vast majority of social care staff employed in the fragmented private sector, their
“ability to influence pay rates there” is limited.
Some 17% to 20% of the social care workforce are migrant workers, with 115,000 EEA nationals and 134,000 non-EEA nationals. Vacancy rates in the care sector now stand at 6.5% in England and 5.5% in Scotland. Since there are already 100,000-plus vacancies in England’s care sector alone and the current flow of people from abroad to fill low-paid care sector jobs is about to dry up, the Government cannot possibly have been able to satisfy themselves that not only will UK-based workers immediately appear to fill that gap but they will be there in sufficient numbers—with the right training, aptitude and caring qualities for social care work—to lower the vacancy levels in the sector as well.
One assumes in making that statement that the Government do not believe that anyone can successfully do this kind of work and that anyone available should be recruited. We are told that the Government have an “oven-ready plan” to address the issue of funding the increasingly expensive social care sector. Unfortunately, the person claiming to have this plan for more than 12 months now has been unable to figure out how to turn the oven on.
If higher pay rates did suddenly materialise in the social care sector in a few months’ time, which would apparently solve the labour shortages—as the Government seem to assume will happen as a result of the points-based immigration system and the drying up of non-British labour—there will presumably be a potentially significant increase in the cost of providing social care. What do the Government think that increase in cost will be since it is only a few months ahead of us in a sector with a 30%-plus annual staff turnover rate, a high vacancy rate and a major source of labour about to end? Will it be the elderly, vulnerable care-home residents and people receiving care at home—the self-funders—who will have to find yet more money? Will it be the already cash-strapped local authorities? Will it be the providers of care provision or will it be the Government themselves financing the cost of a much better paid, more highly valued, more highly trained and increasingly professional social care workforce? I hope that the Government will provide an answer to this point in their reply.
The care sector was in crisis before Covid-19. Local authority spending on adult social care in England has fallen, I think, by some 7% per person in the past decade, thanks to austerity and cuts in grants from central government. Councils have had to tighten eligibility thresholds as cost, rather than need, has become the dominant factor in decision-making. One inevitable result is that some 1.5 million elderly and disabled people have unmet care needs and care workers are often expected to deliver home care within a 15-minute visit or less.
The work is usually low paid and seriously undervalued. However, high-quality care is not low skilled and the Government’s apparent policy that the rising unemployment on which they are banking will solve problems of staff shortages is misguided and potentially dangerous. What is needed is a better funded and resourced care sector with a new focus on training and continuing professional development. We need a cultural change in how we view social care and the value we place on those who work in the sector, including the way in which the immigration system regards social care workers—a change that recognises that there is direct competition from the NHS for many care staff, an NHS that offers higher pay levels and a career structure. With nearly one-fifth of the adult social care workforce being from overseas, in a sector with already high levels of vacancies and turnover rates it is unrealistic to believe that the effect of shutting the door to future care sector staff being recruited in any numbers from overseas can be overcome in rapid time by finding and training appropriate personnel with an aptitude for care sector work from within the ranks of British citizens, both already employed and unemployed.
I hope that the Government will reflect further not on their apparent aim for a much better-paid social care sector, but on their view that we can achieve that better- paid, resourced and valued and increasingly professional care sector at the drop of a hat in a few months’ time simply by cutting off the supply of staff from overseas. We cannot. We need a period of time, as provided for in Amendment 57, to sort out the increased funding, the finance for the better pay the Government envisage, and to find, recruit and train—from within this country—the hundreds of thousands of increasingly professional staff with an aptitude and a desire to work in the care sector that are going to be needed. I hope the Government can give a positive reply to this group of amendments.
I thank all noble Lords who have spoken in this debate. The noble Lord, Lord Blunkett, says that we are a contradictory lot and I do not disagree with that, but what we are all consistent on is that this is a matter that, through Covid, we have seen as incredibly important. We need people with these skills; they are valued and their careers can progress in this sector. He raised a very pertinent point around the turnover. I think you can tell the state of a sector or indeed a business by its turnover. Turnover is high; it is estimated to be around 31%. That is a high turnover in anyone’s book. I will confirm that figure because it is one that I have on the top of my head but my officials might disagree with it. If it is any different, I will confirm that in writing.
The amendments cover a range of issues, all of which relate to health and social care. They can be broadly split into three themes: the need to review the effects of the new immigration system on the health and care sectors, dedicated visa routes for health and social care workers, and immigration routes for those who do not meet requirements under the future skilled workers route. I am grateful to the noble Lords who tabled the amendments because they give us an opportunity to discuss a very important issue. It might be worth reflecting that there is nothing more important than how we, as a society, look after the most vulnerable people, be they young or old.
I will say another general thing about the health and social care sector, not as a Home Office Minister or even a Member of your Lordships’ House but as someone who formerly led one of England’s major metropolitan councils—which, as with all local authorities, was a significant user of care services, which consumed a substantial portion of the council’s budget. I became leader in 2004; it was an issue then and it is even more so now. I assure noble Lords that the Government very much appreciate the contribution of the social care sector, and its value to this country has never been better demonstrated than during the Covid crisis, as the noble Baroness, Lady Lister, and the noble Lord, Lord Patel, said. The Government are working alongside the sector to ensure that the workforce has the right number of people to meet increasing demands with the right skills, knowledge and behaviours to deliver quality, compassionate care.
I will respond to the point of the noble Baroness, Lady Lister. The Department of Health and Social Care has recently launched a new national recruitment campaign, called “Every Day is Different”, to run across broadcast, digital and social media. The campaign highlights the vital role that the social care workforce is playing right now during this pandemic along with the longer-term opportunities of working in care.
The Government have commissioned Skills for Care to scale up capacity for digital induction training, provided free of charge under the DHSC’s workforce development fund. This training is available for redeployees, new starters, existing staff and volunteers through 12 of Skills for Care’s endorsed training providers.
Finally, of course, I must mention—and I am sure noble Lords have heard me saying this before—that the Government are also providing councils with access to an additional £1.5 billion for adults and children’s social care in 2021. This is a significant funding uplift.
On the amendments, I will start by addressing Amendment 2 from the noble Lord, Lord Hunt of Kings Heath, and Amendment 93 from the noble Baroness, Lady Jones of Moulsecoomb, which are similar in intent. Both would require an independent review of the effect of our new points-based immigration system on the care sector. I very much agree that it is essential that policies are kept under review, particularly when the Government are introducing a new, points-based immigration system from January. Independent scrutiny and review are a good thing, but I am not sure that we need to legislate to provide a whole new mechanism.
We are very fortunate in already having the Migration Advisory Committee, a body that is widely recognised for its expertise and impartiality. It is testimony to the MAC’s standing that it has operated under a Labour Government, a coalition Government and Conservative Governments. In each instance it has been valued for the quality of its advice, and its recommendations have been accepted. Noble Lords should be in no doubt about the close interest that the MAC takes in the health and social care sectors. To put it into context, social care featured prominently in the MAC’s report from January of this year on salary thresholds and the points-based immigration system, just as it did in its report from last year on the shortage occupation lists, where there was a dedicated section on the sector, and in its 2018 report on EEA migration. I can assure noble Lords that the MAC will continue to look at these issues, particularly as the effects of the new immigration system start to be felt.
I also remind noble Lords that the Government has expanded the MAC’s remit. It is no longer constrained to reacting only in response to specific commissions from the Government; it now has licence to consider, and comment on, any aspect of immigration policy. To that end, we have asked it to start producing annual reports that not only cover issues such as its budget or staffing but provide a commentary on the operation of the immigration system. The MAC has accepted this challenge with customary gusto, and I understand we can look forward to the first such annual report later this year.
Therefore, while I totally understand the sentiment behind Amendments 2 and 93, they are not necessary. We already have a world-class, independent body to review the operation of our immigration system. Accordingly, I hope that the noble Lord will withdraw the amendment.
I turn to Amendment 47 from the noble Baroness, Lady Hamwee, Amendment 57 from the noble Lord, Lord Rosser, and Amendment 66 from the noble Baronesses, Lady Masham, Lady Finlay and Lady Thomas. I join noble Lords in having been profoundly moved by the words of the noble Baroness, Lady Masham. These amendments seek to introduce a dedicated route for health and care workers to come to the UK. I do not think that any of us would disagree about the value of the work that migrants and all staff working in the health and care sector do, and I recognise that these amendments were tabled to highlight and enhance this vital sector. That is obviously of great importance to those individuals with severe disabilities and care needs, who will rely even more on the support of health and care workers.
That is why I am pleased to be able to confirm that the Government launched the health and care visa on
That leaves two further points for discussion. First, if inserted into the Bill, these amendments would require the Government to establish a scheme to admit care workers. I am not sure that that would be a wise way to proceed. The decision not to offer a general immigration route for those who do not meet the skills and salary thresholds is not one the Government have taken lightly. We have done so on the advice of the MAC which, as outlined earlier, are the Government’s independent advisers on migration issues. We also need to respect the wishes of the people of the UK, as expressed in the referendum vote four years ago.
The MAC has been very clear that the solutions to the challenges which the care sector faces do not lie in migration. My noble friend Lord Lilley and the noble Lord, Lord Green, made this point, as, largely, did my noble friend Lord Hodgson of Astley Abbotts. I draw your Lordships’ attention to the evidence which the chair of the MAC, Professor Brian Bell, gave to the committee in the other place. When asked about a visa route for care workers, he said:
“If people say that the response to the social care issue should be, ‘Well, employers should be allowed to bring in as many migrants as they want at the minimum wage’, first, that does not sound like the low-wage problem of the social care sector is being dealt with and, secondly, it suggests that one of the groups that will really suffer from that is the social care workers. You are saying that you are going to keep on allowing their wages to be held down by allowing employers to bring in workers at the minimum wage, whereas we want to see wages rising in that sector.”
That is a telling point. It would be a very odd position for this Government and for noble Lords to take if we were to conclude that the best way to reward those working in the care sector—the vast majority of whom are British—for their selfless and unstinting actions over the past few months was to institute a visa regime which, as the MAC chair has indicated, has the effect of depressing their wages.
Amendment 57 from the Official Opposition suggests putting in place a scheme for three years to tide the sector over and allow for some adjustment. Again, it is worth reflecting on the wise words of the chair of the MAC—this time when he appeared before the Home Affairs Committee in June. On the issue of some sort of temporary or transitional scheme for those working in social care, Professor Bell said:
“The risk is that you say that there needs to be a temporary arrangement for social care to make sure it can still access workers at usually minimum-wage wages from the rest of the world. That often then becomes a permanent solution”.
Indeed, I note that Amendment 57 explicitly contains a provision to allow it to be extended beyond its three years.
In the very next question, the chair of the Home Affairs Committee asked Professor Bell whether there would be a transitional scheme for social care workers, something my noble friends Lady Altmann and Lady McIntosh of Pickering talked about. He explicitly said that he did not advise that course of action. He went on to say:
“If unemployment rises very substantially in the next few months, of which there is certainly a risk when the furlough scheme unwinds, there will be a large supply of workers in the UK looking for work. If social care is ever to succeed in attracting workers, that is a pool of workers that they should be able to attract. If they can’t, I go back to my point that there is something fundamentally wrong here and it is nothing to do with immigration.”
These amendments seek to exempt health and care sector employers from paying the immigration skills charge. However, we consider it is right that the immigration skills charge continues to apply. In its September 2018 report on the impact of EEA migration in the UK, the MAC supported continued application of the immigration skills charge, without exceptions for particular sectors, alongside salary thresholds, as a way to protect against employers using migrants to undercut the domestic workforce, as my noble friend Lord Lilley and the noble Lord, Lord Green, said.
The Government stand by this requirement, given our desire for immigration to be considered alongside investment in, and development of, the UK’s resident workforce. My noble friend Lord Hodgson of Astley Abbotts made the point very strongly about the sector taking responsibility here; my noble friend Lord Lilley and the noble Lord, Lord Green, also made these points. This has only become more important due to the uncertainty that many UK resident workers will face as a result of the current pandemic.
On Amendment 82 from the noble Lord, Lord Patel, I recognise that he is looking for the Government to reassure Parliament that we will continue to support our essential health and social care sector and ensure that it has the staff it needs to support the health and well-being of the citizens of the United Kingdom. I hope that I can provide that reassurance today.
We recognise that the proposals under the UK points-based immigration system represent a significant change for employers in the UK and those migrants who would previously have benefited from free movement. It does not mean that employers will not be able to fill vacancies in the health and social care sector. As mentioned earlier, the Government are working closely with Skills for Care to help employers to train new recruits and volunteers and refresh the skills of their current workforce, in addition to introducing a proper career structure, as the noble Baroness, Lady Lister, talked about. This will provide opportunities for those in the sector and make it an attractive profession for prospective careers.
We must also keep in mind that, sadly, many people have lost their jobs because of the pandemic. It is right that the Government encourage employers to look first at the domestic labour market. As is now the case, there will continue to be a source of people with general rights to work in the UK: for example, people who come as dependents, on a youth mobility scheme, and on some family routes. We have already guaranteed the rights of many EU family citizens and their family members who are working in the social care sector; as noble Lords will know, there have been over 3.8 million applications to the EU settlement scheme. I can absolutely assure noble Lords that we will continue to keep labour market data under very careful scrutiny to monitor pressures in key sectors.
I hope that noble Lords can see that there are a range of options for those working in health and social care. Ultimately, it will be for individuals to consider the most appropriate route for them based on their specific circumstances. The sector, as my noble friend Lord Hodgson of Astley Abbotts says, needs to rise to that challenge. I hope that with those words, the noble Lord will feel happy to withdraw his amendment.
My Lords, this has been an excellent debate, and I am grateful to noble Lords who have given their support to my and other noble Lords’ amendments.
The Minister and the noble Lords, Lord Lilley and Lord Green, say we should not be using migrant labour to undercut our own workforce. Let me make it clear: I absolutely agree. I also agree with the noble Lord, Lord Hodgson, that the current turnover of care staff is appalling and cannot possibly be defended. But, as my noble friend Lord Rosser said in his marvellous winding-up speech, you will not solve the care sector’s problems by suddenly snapping off its ability to recruit staff from abroad from the end of the year. All you will do is tip it into an even bigger crisis than it is in. This is complete madness. We know what is going to happen; towards the end of the year, or at the beginning of the new year, there will be a total panic in the Government and they will reverse the decision. They have had practice at reversing decisions in the last few months, have they not?
On those pressures, noble Lords who oppose what I am saying seem to think it is the care sector’s fault. This is a government-controlled sector. The Government are the main funder and regulator; they set the whole context in which the sector operates. They have had countless reviews but will not face up to coming forward with a costed solution. We all know that the Green Paper, if it eventually comes, will be about funding the sector 20 to 30 years in the future. It will not deal with the issues as they now are.
The noble Baroness, Lady Williams, says that, if you go for my noble friend’s amendment, which I commend, a transitional arrangement will become permanent. That is the point: it is down to the Government to make sure that it is not permanent. The beauty of my noble friend’s amendment is that it sets the challenge to Government. Let us go for a transitional arrangement but, if the Government want it to end, they have to come forward with effective proposals to reform and sort out the care sector, once and for all.
I do not see the Migration Advisory Committee in the same way that the noble Baroness does. She quoted the chair of that committee presumably proclaiming the rise in unemployment that he foresees as the solution to the care sector problem. I have been trying to ponder the Government’s Brexit strategy. Clearly they are prepared to let the automotive and aerospace industries go to the wall and, presumably, they are happy about that, because the care sector’s problems will be solved as a result of the decimation of people working in those sectors. You could not make it up. This is the worst Government there has been in my lifetime. From issue to issue, they clamber around with some ideological nonsense about what the British people were supposed to have voted for in the referendum, and we end up in this dire situation. Having said that, it has been a great debate, and I beg leave to withdraw my amendment.
Amendment 2 withdrawn.
Schedule 1: Repeal of the main retained EU law relating to free movement etc.
Amendments 3 to 6 not moved.
My Lords, we now come to the group consisting of Amendment 7. I remind noble Lords that anyone wishing to speak after the Minister should email the clerk during the debate. Anyone wishing to press this amendment to a Division should make that clear in the debate.
Schedule 1: Repeal of the main retained EU law relating to free movement etc.