Amendment 3

Immigration and Social Security Co-ordination (EU Withdrawal) Bill - Report (1st Day) – in the House of Lords at 2:47 pm on 30th September 2020.

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Lord Rosser:

Moved by Lord Rosser

3: After Clause 1, insert the following new Clause—“Impact of section 1 on the social care sector (1) The Secretary of State must commission and publish an independent assessment of the impact of section 1, and Schedule 1, on the social care sector within six months of this Act being passed.(2) The Secretary of State must appoint an independent Chair to conduct the assessment.(3) The assessment must consider the impact of provisions in section 1, and Schedule 1, on—(a) the social care workforce;(b) available visa routes for social care workers;(c) long-term consequences for workforce recruitment, training and employee terms and conditions; and(d) such other relevant matters as the independent Chair deems appropriate.(4) A copy of the independent assessment must be laid before both Houses of Parliament within fourteen days of its publishing date.”Member’s explanatory statementThis new Clause would require the Secretary of State to commission and publish an independent report on the impact of ending free movement on the social care sector, including the impact on the workforce (such as skills shortages), visa options for social care workers, and long-term consequences for recruitment, training and terms and conditions for staff.

Photo of Lord Rosser Lord Rosser Shadow Spokesperson (Home Affairs), Shadow Spokesperson (Transport)

Amendment 3 is similar to that moved by my noble friend Lord Hunt of Kings Heath in Committee. It would require the Secretary of State to commission and publish an independent assessment on the impact of ending free movement on the social care sector, including the impact on the workforce—such as skills shortages—visa options for social care workers, and long-term consequences for recruitment, training and staff terms and conditions. The independent assessment must be published within six months of the Bill being passed and laid before both Houses of Parliament within 14 days of its publishing date.

In Committee, there was little disagreement over the current state of the social care sector: low-paid, undervalued and skilled work; a very high staff turnover rate of over 30%; well over 100,000 vacancies; and some 20% of the workforce being from other countries, including the EU, with that source of staff about to be closed down in three months’ time as a result of the advent of the points-based immigration system and the overwhelming majority of care staff not being eligible for the health and social care visa. There was, I think, a large measure of agreement too that the sector needed to place greater emphasis on training and increased professionalism, and that not everyone in the labour market would have the necessary aptitude and attitude to meet successfully the demands and requirements of care work.

The Government rejected the very similar amendment moved by my noble friend Lord Hunt of Kings Heath, not on the basis that an inquiry into the social care sector was not needed but on the basis that a mechanism already existed that kept the social care sector under review. The Government, through the Minister, said:

“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.”—[Official Report, 7/9/20; col. 608.]

The Minister then went on to say that the Migration Advisory Committee had been in existence for some years, and that noble Lords should be in no doubt about the close interest that it took in the health and social care sector. It is true that the MAC reports on the social care sector. Indeed, in a wide-ranging—I think 650-page—report yesterday on the shortage occupation list, covering numerous sectors, it again expressed concern about the social care sector and argued that if the necessary domestic funding increase and pay increases it has been calling for, in its own words, “for some years” did not now materialise in a timely manner, it

“would expect the end of freedom of movement to increase the pressure on the social care sector, something that would be particularly difficult to understand at a time when so many care occupations are central to the Covid-19 pandemic frontline response.”

The MAC also said that a potential rise in labour supply to the care sector as a result of UK job losses elsewhere cannot be “predicted with any certainty”. This Bill makes an immense change to our immigration system, which will have a significant effect on our already understaffed and underresourced social care sector at the same time as we are going through a global pandemic. Our care sector has always been vital; now it is part of our front line. We need more than the regular reporting mechanisms. This amendment would provide for that much-needed specialist, timely and targeted review of social care—of workforce numbers, the impact of the Government’s decision not to include many care workers in the health and care visa, and what this all means for future planning for the sector at this crucial time, including terms and conditions and training for a talented, caring workforce.

The Government have already made the decision to change the immigration system and have said that they want to see competitive terms and conditions in the sector and not have people on the minimum wage. The Government have also said they want the right number of people to meet increasing demands with the right skills, knowledge and behaviours to deliver quality compassionate care. Those are very commendable objectives, and a recognition from the Government that they are, as my noble friend Lord Hunt of Kings Heath said in Committee, the main funder and regulator and set the whole context in which the sector operates.

With the Government having decided that this low-paid, undervalued but skilled sector, with its enormous turnover of staff and vacancies running well into six figures, is now to face, on top of that, a significant source of labour being closed down in just three months’ time, social care faces a potential perfect storm. With social care facing such an unprecedented situation, now is the time for a fresh set of eyes to make an expert assessment of the impact of the end of free movement on a sector that already has existing significant problems of pay, conditions, turnover and training that need to be addressed if ever-increasing demands for social care are to be met. We need an assessment that has a major input from people who have expertise in, and specialist knowledge of, the field of social care, and can bring a fresh perspective to bear on a sector whose existing, as well as pending, problems will have to be addressed if the Government’s goals of a better paid, more highly trained and professional workforce with much lower turnover rates than at present is to be achieved.

The amendment does not ask for too much; it does not pre-emptively write the Government’s policy for them but merely asks for a timely, thorough and independent analysis of how to support our care sector and its staff and enable it to achieve the goals set in the light of the impact of the provisions of this Bill. It will help to prevent the issue of the state of our care sector being yet again kicked into the long grass. How many times in the past decade have we been promised a plan for the social care sector that has failed to materialise? This Bill is a crucial moment, and we should use it wisely. The amendment also has support from the BMA and the Royal College of Nursing. We do not want to find ourselves in a few years’ time with a social care sector that has not progressed from its present state following the imminent change in the immigration system. We need to act now, which is why the fresh independent assessment called for in Amendment 3 is needed.

In moving this amendment, I have to say that, if the Government’s response is similar to their response in Committee to the amendment moved by my noble friend Lord Hunt of Kings Heath, I shall seek a Division. I beg to move.

Photo of Baroness Jones of Moulsecoomb Baroness Jones of Moulsecoomb Green

My Lords, my Amendment 30 is along the lines of Amendment 3, but tougher and more radical. I would love to know that there is some support for it, but I think Amendment 3 will edge it. However, this amendment has huge support, and I thank the people from the Scottish National Party, who on a point of principle do not take their seats in the House of Lords—or what seats they might be offered. They have done all the work in getting together a huge variety of people, including RNIB Scotland, UNISON, Macmillan Cancer Support, Disability Wales, the Church of Scotland and the Northern Ireland Council for Voluntary Action. I could go on: more than 40 organisations and NGOs support this amendment.

An absolutely crucial point, which the Minister did not tackle when I presented this amendment in Committee, was that this proposal draws in all four nations. That is something that Amendment 3, I am afraid, does not mention. My amendment would probably enable the Government to have much more support for their work; it would strengthen buy-in from stakeholders across the four nations and increase the status and profile of the evaluation.

Many of the points I wanted to make have already been made by the noble Lord, Lord Rosser, very eloquently, but many bear repeating. The Government are closing their eyes to a potential problem. My key concern is about the health and social care workforce. The organisations that have contributed to this amendment are aware that some health and social care organisations rely heavily on workers from other parts of the EU and cannot continue in their present form without support. If they are allowed to fail, other parts of the health and social care system will be needed to fill those gaps.

On efficiency and effectiveness, research carried out by the Health and Social Care Alliance Scotland in communities across Scotland highlighted that people who use support and services have concerns about their future availability. That means that with the health and social care system already creaking, combined with an elderly workforce, some people will have to try to find their own ways to minimise any negative repercussions as a result of changes accruing from leaving the EU. Then there is the adequacy of public funding for the health and social care sectors. The alliance’s report raised major concerns about the impact of Brexit and the potential loss of EU funding in health and social care in Scotland, particularly to third-sector organisations, which have a key role in the provision of health and social care services. Any loss of funding will place a further strain on that whole sector, and it seems that the Government are not acknowledging that it will be a problem.

I would therefore like the Minister to answer my point that my amendment would create buy-in from the four nations, which the Government seem to be ignoring at the moment. Also, it is quite possible that without the extra workforce that we currently get through people coming from other countries, the whole system could start to fail. Are the Government prepared to put enough money into it to make sure that it does not fail and let down all the people who care about this service?

Photo of Lord Hunt of Kings Heath Lord Hunt of Kings Heath Labour 3:00 pm, 30th September 2020

My Lords, I am very grateful to my noble friend Lord Rosser for adopting many of the terms of my amendment in Committee and for the eloquent way in which he introduced his amendment.

No one could doubt that social care is under pressure. The social care workforce is already facing a crisis, with more than 120,000 vacancies. According to our House of Lords Economic Affairs Committee, in 2018, 1.4 million older people in England had an unmet care need. The committee found that publicly funded social care support is shrinking, as diminishing budgets have forced local authorities to limit the number of people who receive public social care.

We are in a vicious cycle: after decades of reviews and failed reforms, the level of unmet need in our care system increases; the pressure on unpaid carers grows stronger; the supply of care providers diminishes; and the strain on the care workforce continues. That is even without considering the impact of Covid, which has been huge, and before the new immigration controls come in at the end of the year.

I therefore remain bemused by the decision of the Home Office to exclude the great majority of care workers from the new health and care visa as a result of them not meeting either the income or the skills thresholds that have been set. My noble friend Lord Rosser mentioned the Minister’s comments at Second Reading. She has justified this by the need for employers 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 this sector are caused by a failure to offer competitive terms and conditions, in itself caused by a failure to have a sustainable funding model—although as my noble friend Lord Rosser today suggested, the committee’s latest report clearly shows that it is now developing a rather more nuanced position. I wonder why. In Committee, the Minister went further. She 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.”—[Official Report, 7/9/20; col. 610.]

I do not need reminding of how important skilled care workers’ jobs are. Of course I want more people training and entering the care sector at a decent wage, but as my noble friend Lord Rosser said in Committee, 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.

The Minister has never responded to the central point of my argument, which is that the major fault for the problem has to be laid at the Government’s door. 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 refuse to come up with any solution. There is no sign of the long-promised Green Paper. Mencap said today that the sector needs a credible, well-thought-out and properly funded care workforce plan to create and maintain a sustainable social care workforce—I agree with that.

I want to come back to the Minister, because if she is saying that staff should pay more, I agree, but is she going to will the means? Will she commit to increase support to local authorities? What about self-funders? Does she think they should pay more? At Second Reading, I think, I pointed out that if you took the current lifetime pension allowance of just over £1 million and bought an annuity with it at age 60, you would not be able to cover the average nursing home fees. So can the Minister tell me whether the Chancellor is going to raise the lifetime pension allowance?

If the Home Office is convinced that the woes of the sector are entirely down to the sector itself, let it produce the evidence. Let the Minister agree to a rapid review of the funding of the care sector and the impact of Clause 1 in shutting off an extremely valuable source of labour for this important but vulnerable part of our society.

Photo of Lord Patel Lord Patel Chair, Science and Technology Committee (Lords), Chair, Science and Technology Committee (Lords)

My Lords, I am pleased to have added my name to this amendment in the name of the noble Lord, Lord Rosser. The greatest risk identified for health and social care in the House of Lords report The Long-term Sustainability of the NHS and Adult Social Care was the need for long-term funding arrangements for social care and, importantly, for an appropriately trained workforce for the NHS and social care. As far as social care is concerned, the Government have not addressed either, and more than three years have passed since the publication of the report. The result is that more care homes are closed and there is a massive shortage of care home staff, as has already been mentioned.

As a nation, we are getting to a point where “shameful” is the only word that can describe our failure to look after our old and frail. The pandemic has brought hardship and pain to all our citizens, but the elderly in our care homes have paid a heavy price: 30,500 excess deaths among care home residents and 4,400 more among those receiving care at home. We have failed them in many ways. We have exposed them to greater risk from the virus, we did not protect the few staff looking after them and we did not recognise their increased risk from the virus. It seems that the only people who stood by them were nurses and poorly paid care staff, the majority of whom are from overseas.

ONS figures show that social care workers are at highest risk of Covid-19 mortality. Shamefully, the United Kingdom ranks number two in the world, after Russia, for the number of deaths among healthcare workers, and the majority of them worked in social care. Some of the poorly paid and so-called unskilled paid with their lives. Many of them were not citizens of our country. We saw on our televisions poorly paid staff, many from European and other countries, working in crowded nursing homes and living in tents in the back gardens of nursing homes so that they could isolate and protect our elderly and vulnerable, who were also isolated from their families and friends.

It is estimated that we have a shortfall of approximately 122,000 care workers. So what are we saying to these dedicated, hard-working people who want to come and willingly look after our most vulnerable? We are saying, “When your visa runs out, we want you to go back to where you came from. We don’t want any more of you to come. You will not meet the unrealistic criteria we set for salaries, and the visa and health charges will be unaffordable for you as these are now our new rules. Besides, we are going to have mass unemployment, and we are going to ask all those unemployed to staff our care homes and look after our elderly. We don’t recognise that it is a task that requires some skills, compassion and a caring attitude or a feeling of vocation, as you do.”

It is time for the Home Office to review the current proposals, which do not provide a migratory route for care workers. This is a modest amendment, in that it asks for a review. All it asks is that the Government produce evidence of the impact of the legislation on the social care workforce and social care. I strongly support it, and I hope that many others will do so. It is about people whom we need—those who want the opportunity to provide compassionate care for the elderly and the frail.

I know that my namesake leads the Home Office, and we know each other, but I say to her, “Priti, on this occasion, I do not agree with you”.

Photo of The Bishop of Durham The Bishop of Durham Bishop

My Lords, I speak in support of Amendment 3. First, I draw attention to my interest, as recorded in the register, of receiving support from the Refugee, Asylum and Migration Policy project.

In Committee, I spoke to an amendment that would facilitate the immigration of highly skilled people who had been forcibly displaced by war or persecution. I am glad that the Government have responded positively to that proposal, which others in this place spoke in support of.

I thank the Minister for the helpful and productive meeting that I had with her and her colleague, the Immigration Minister. I was joined by Talent Beyond Boundaries and Fragomen. I hope that she will be willing to place on the record today the Government’s commitment to developing a pilot for health workers, possibly in the education and business sectors. I and others here who are interested will be keen for her to update the House on progress in due course. Following that positive meeting and the promises made at it, I have not pressed the amendment that I tabled in Committee because of the Government’s constructive willingness to further develop the proposal, which applies to the health and social care area.

The Government, rightly, are keen to welcome those who wish to come here with the skills to support themselves and whom businesses in the UK are ready to employ. I am therefore puzzled that social care seems not to receive the attention in immigration policy that it should.

We all know that the average pay of care workers is not high. Indeed, the figures that I have seen suggest that it is typically around £17,000 per annum. This means that such workers will not qualify for a work visa, even with a reduced salary threshold. I know that the Government wish to encourage employers to increase salaries and train domestic workers, rather than allow migration to be used as a shortcut or cost-saving measure. That is welcome, although of course it will require the Minister and her colleagues to have stern conversations with their colleagues in other departments about the necessity for a better-funded care system. Such a system will also need radically better joint working between health and social care, as highlighted, for example, in the 2016 King’s Fund report, Supporting Integration Through New Roles and Working Across Boundaries.

The Migration Advisory Committee is surely right that over the long term the solution to our care crisis lies in raising wages to attract more domestic workers, rather than using migrant workers to plug the gap. Nevertheless, the MAC was also surely right to point out this week that the cliff edge of ending free movement in the middle of a global pandemic, in which care workers are very much on the front line of safeguarding our most vulnerable neighbours, friends and family, will very much increase the pressure on the system, as the MAC puts it.

Those of us who support the amendment hardly support low wages for key workers—far from it. I believe strongly in a real living wage above the national minimum wage and in care workers being appropriately recognised and rewarded for their vital work. We are concerned that the blunt treatment of social care in the new immigration system poses significant systemic problems that could include staff shortages. The impact of those shortages will be felt by the most vulnerable in our society who rely on social care. They deserve better than “fingers crossed”, which is, I am afraid, the impression that we are left with of the current approach.

I am not unused to working within institutions with byzantine processes—I am a bishop of the Church of England, for goodness’ sake, as well as in this place. Therefore, I have some sympathy with the Government’s desire to simplify the immigration system and to resist a proliferation of special routes for particular circumstances, yet simplification is not a virtue if it becomes inflexibility or bluntness in the application of rules that will exclude from coming to the UK the very people our care sector most urgently requires. The creation of a health and care visa has, of course, been welcome news, but I know that my puzzlement that social care appears not to be adequately included is shared by others.

The amendment strikes me as modest but important. It places on the Government merely a duty to publish an independent assessment of the impact of ending free movement on the social are sector. Since international workers account for one-sixth of care workers in England, we would have to be dangerously incurious not to want to know the impact that the biggest change in immigration policy in a generation has on a sector that cares for the most vulnerable among us. Such reports as we have had already from the MAC and others only confirm that there is a knotty problem still to unravel in this tangle of issues about chronic low pay and an unnecessary reliance on skilled migrant carers. I will therefore support the amendment.

Photo of Baroness Ritchie of Downpatrick Baroness Ritchie of Downpatrick Non-affiliated 3:15 pm, 30th September 2020

My Lords, I support Amendment 3, in the name of the noble Lord, Lord Rosser. He, like others, made a very comprehensive speech in defence of the arguments for the maintenance of the social care sector. If we as human beings applauded, as we did earlier this year, this sector, which is central in our fight against Covid-19, then the Government and all of us acting together in Parliament should show due recognition of it and support this amendment. It would allow a report to be carried out within six months of the Bill being passed showing the impact of the ending of free movement and the non-accessibility of visas for care workers on that sector and on our healthcare system.

I have had many letters from those involved in the caring profession, who want us to support this amendment. It is vital and is supported by the British Medical Association and the Royal College of Nursing. At Second Reading, I said that this legislation ends the free movement of citizens from the EU, the EEA and Switzerland to the UK. Many in our social care sector come from those countries. They provide an invaluable service with care, compassion, hard work and diligence to a large range of people who are deeply unwell. That work has become particularly acute during our ongoing Covid crisis. At a stroke, the decision to end free movement diminishes the UK. Not only does it break family ties and damage our economy but it creates huge obstacles for employers and degrades international research, co-operation and understanding. It also derails our social care sector.

Social care is already under pressure not only because of Covid but because of rising waiting lists for health and medical care in the health service. If people are not allowed to remain and are no longer employed in the National Health Service, which we cherish, that will place it under a tremendous burden. We should try to remove that burden, so I make a special plea to the Minister to accept the amendment and ensure that a report is made available within six months of the passing of this legislation. Perhaps for the first time, we will be able to see, in statistical data, the contribution made by these people and by our social care sector, as well as the deficits in the sector where the Government need to plug the holes.

If the noble Lord, Lord Rosser, who I believe is already of this mind, decides to push the amendment to a Division, I will support him.

Photo of Baroness Masham of Ilton Baroness Masham of Ilton Crossbench

My Lords, in supporting Amendment 3, I congratulate the movers. However, I hope that the Government will realise that we are now in a social care crisis and that we should face up to the challenges now. There is a serious shortage of live-in carers to help disabled people, due to the combination of coronavirus and Brexit. Good social care takes the pressure off the NHS.

Many elderly and disabled people are at serious risk because they have had their benefits cut. Coupled with shrinking local authority budgets, the workforce is under pressure exactly when it is needed most. Also, the vast proportion of migrant employees in social care will be ineligible to work in the UK ,as most care workers’ earnings do not meet the threshold for the new skilled visa, as has been mentioned several times.

I wish Amendment 3 good luck.

Photo of Lord Horam Lord Horam Conservative

My Lords, I was not able to take part in Committee because of the all-consuming HS2 Committee, along with the noble Lord, Lord Liddle, who I see is in his place. However, I sat in on part of the debate and heard the remarks of the noble Lords, Lord Rosser and Lord Hunt of King’s Heath, a very formidable pair when they debate these issues. It is rather like facing Federer and Djokovic at the same time, because of their very stringent remarks. In a conversation outside the Chamber, I said to the noble Lord, Lord Rosser, that from what I had heard, I thought that he rather had a point. We all know where we want to be with social care. We want a well-paid and well-motivated workforce. We all know, sadly, where we are, and as he said in his previous remarks and repeated today, it is a question of the transition, of how we get from where we are to where we want to be.

Two things have happened since the previous debate. First, we had a report yesterday from the Migration Advisory Committee, which, as I am sure that the Minister will say when she winds up, is particularly concerned by the problem we face of a sudden end to the situation we are facing today, a precipice, before we reach any better solution. Incidentally, the MAC’s report covers 650 pages; I hope that when the Home Office look at some of these reports it cuts down the bulk. I do not know whether Ministers read all these reports, but it has become pretty much impossible. We are almost beyond despair when we see such a bulky product.

The second thing to have happened since the previous debate is the Chancellor’s Statement last Thursday. He flagged up in detail the situation which we all have been facing regarding unemployment, and finally put some numbers on it, pointing out that with the withdrawal of the very supportive job system that he has at the moment, we may well be looking at an additional 2 million unemployed people. At the moment, there are an estimated 122,000 vacancies in the social care sector, but surely it is not beyond the wit of God to find among those 2 million people some who might help in the social care sector. Indeed, it is likely that they will be exactly the sort of people who could care for people—they are people from the retail sector and from the hospitality sector. Some of them may not have exactly the right aptitudes and attitudes, as the noble Lord, Lord Rosser, said—a nightclub bouncer might not be exactly the right person to go into the social care sector—but many will have exactly the human skills that we are looking for. If you cannot find 122,000 people from that additional 2 million unemployed, you really are not trying.

It is fair to say that many of the companies in this area who manage the care homes are a motley crew. The noble Lord, Lord Blunkett, in the previous debate, made the point that many of the private equity companies got into this area and—sad to say—piled up debt on many of these companies and have sought a way out without too much care for the social consequences or the effect on their clients. That is a fair point, which I am worried about as well, but there are also many good companies in this area, trying to do good work, who really care about their clients and are trying to find a way forward. Therefore, we should give them the opportunity of recruiting from among those British people who may become unemployed.

As for the point made by the noble Lord, Lord Hunt, that this is a sector that overall is controlled by the Government, that is fair, but none the less the Government are providing £1.5 billion of extra money for the sector through additional local authority subvention. There is also the Skills for Care programme, which is ongoing. This all indicates that there may be additional support for a company which is trying to do the right thing.

The MAC also said in its report that immigration is not the answer in the long term, and I do not think it should be. It highlights that, all too often, we have looked at recruitment difficulties and said that we must import from abroad, rather than looking at it the other way around, at what the problems are and how we can recruit, train and pay properly the people in this country before we look abroad. Indeed, I had the advantage of a personal chat about this with Professor Bell, the new chair of the MAC, and he made a very interesting point. He said that, in other countries with an equivalent of the Migration Advisory Committee, its reports do not just go to the Home Office, as they do here, but in the first instance to the education, business and health departments, with the implication “What are you doing to solve the problems of recruitment yourselves, before we even consider going abroad for further support?” Traditionally, we have too easily looked at this the wrong way around.

Mention has been made of the British Medical Association’s briefing, which we have all seen today. Once again, it makes the same mistake by talking about how we must import people to help with the obvious problems of recruitment in various sectors, from doctors and nurses to social care workers, but there are two remarkable omissions in that briefing. First, there is no mention of manpower planning in the NHS. Yet, as my noble friend Lord Lilley pointed out in a previous debate on this subject, 43% of those who apply for a nursing course are turned away. I cannot believe that 43% of those who apply are inadequate for the job, but they are being turned away for some reason. Equally, we do not know the situation with doctors, where there are similar figures. But, none the less, we should look at manpower planning as a whole in the NHS sector.

Secondly, we have also to look at the consequences for other countries of our perpetually seeking to solve our problems by recruiting abroad. It is fair to say that the BMA should not necessarily consider this; it is a British trade union, so perhaps that should not be its concern. None the less, in Lesotho, for example, which my noble friend Lord Hodgson of Astley Abbots mentioned, there was a pandemic and there were far too few doctors and nurses. I myself went to Botswana some time ago and found that it had a serious AIDS problem and there were not enough nurses. Why? The nurses had gone to the NHS because the pay was better. There is a similar problem in Malawi, and look at India, which has huge problems at the moment—its health service is collapsing—yet we are still recruiting doctors from there. Surely, there is a moral issue here. How is it that this country, which is rich and well developed, is trying to prop up the NHS by recruiting from countries with far less well-developed health systems than ours, and which are far poorer and less developed?

We should always try to solve the problems by looking at how we train, educate and pay our own people. Given that unemployment is rising to the level forecast by the Chancellor, surely, this is an inescapable requirement.

Photo of Lord Blunkett Lord Blunkett Labour 3:30 pm, 30th September 2020

My Lords, that was a very thoughtful and interesting contribution. I agreed with some of it, in particular the accolades paid to my noble friends Lord Rosser and Lord Hunt. They made such excellent speeches that I can be brief, given that many Members wish to speak today, and I have some sympathy for both Front Benches regarding the length of our sessions at the moment, not least on this Bill. However, I want to draw attention to one or two of the issues that have arisen.

Mention has been made a number of times of the Migration Advisory Committee. I heard Professor Bell on the radio yesterday making the perfectly reasonable case that, as my noble friend Lord Rosser excellently pointed out, it is important that care workers be paid more and respected more. I am fully in favour of trying to tackle head-on the understaffing, underpaying and undervaluing that currently constitutes the general attitude, despite all the sympathy often exuded towards those working in the care sector. However, Professor Bell eloquently made the point that I want to make: that you can get almost £1 an hour more working in general retail than in residential care, despite the enormous challenges arising during the Covid pandemic, as spelled out by the noble Lord, Lord Patel.

Here is a thought. I have it on the good authority of Professor Bell that, according to the Migration Advisory Committee, which concluded its main survey work in March, the consequences of the pandemic are twofold. First, yes, there will be greater unemployment, and that will be felt differently in different parts of the country and will therefore have a differential impact. I do not expect people to move for £8.70 an hour—which is the average pay in residential care, because that is the minimum wage across the country—given that they could not even afford to pay the rent; that is, if they have not been evicted by the time they get there because the moratorium has been lifted. We therefore have to have some common sense here.

There is no sign of the pay increase that should be taking place now, and the oven-ready deal promised a year ago has not yet emerged from the AGA—when it does, it will probably be grossly undercooked—so we will not have a solution. It is no good Professor Bell —I am very happy to debate him on this—going on the radio or producing a 650-page report saying, “Wouldn’t it be nice if the Government coughed up the money so that local authorities can pay increased rates?”, and that we should protect ourselves from exploitation. That is not happening. I pay tribute to the noble Lord who has just drawn attention to what I said in Committee about private equity investment in this area.

My noble friend Lord Hunt made the important point that there will be a cut-off point in three months’ time. Yes, of course we should be emphasising this and supporting people to take up jobs in social care. We should be training them properly and giving them a career pathway so that they can see the way ahead. Their career pathway is somewhat blocked at the moment by the fact that, the higher up you go, the more likely the Government are to allow someone from outside the country to come in and take the job. I tried to explain that on a previous occasion, but I do not think I was eloquent enough. I will use this example: you can come in and drive a BMW but you cannot come in to drive an elderly Robin Reliant that has rusted to the point where the brakes do not work and the doors are falling off. That is what happened in social care, as illustrated by the noble Lord, Lord Patel. There is death and fear within the sector. You will not cure that in three months, nor persuade other people to move house to take up jobs because they have just been made redundant from quite well-paid employment in areas where they hope to take up training and other opportunities.

I therefore appeal for everybody, including the Migration Advisory Committee, to get real. I appeal to the Minister to go back to government—it is not her fault but that of the Treasury—and say, “In the next three months, we as a Government will not solve this problem. We will not be able to encourage sufficient people to take up these jobs. We know that the turnover rate is massive”—it is even greater than my noble friend Lord Rosser said—“that the vacancies exist and are unattractive, and that some people will be highly unsuitable.” So, for goodness sake, let us have a continuing review. That is all Amendment 3 asks for: to get this right and ensure that the consequences of closing the door to the other 27 members of the European Union on 31 December do not have a disproportionate impact on the care of those we are supposed to care about. This is why this debate is taking place, because of the new situation arising from the way we are treating those from the European Union and the EAA. Were that not to happen, we could have a more rational debate, as appealed for by the previous speaker, on how we adjust to ensure that we are not reliant in key areas —including, apparently, butchery—on drawing in people from across the world. That includes, of course, doctors and nurses, who, under the programme that has been laid out, will be allowed to be recruited into the country.

There are such contradictions and we are in such a cliff-edge position that I have gone on longer than I intended, because the more I think about it, the more passionate I am to ask for a bit of common sense.

Photo of Baroness Smith of Newnham Baroness Smith of Newnham Liberal Democrat Spokesperson (Defence)

My Lords, I rise to speak in support of Amendment 3. Personally, I have quite a lot of sympathy with Amendment 30, put forward by the noble Baroness, Lady Jones of Moulsecoomb, which she referred to as “tougher and more radical”. I voted to remain in the European Union precisely because I recognise the importance of free movement of people. I agreed with virtually every word said by the noble Lord, Lord Blunkett, and I shall be brief, because I am aware that we are only on group 2 and the target is to get to group 14 this evening.

The social care system is in crisis. All noble Lords who have spoken have referred to the difficulties that it faces—problems that have been made clear by your Lordships’ Economic Affairs Committee over the years. The Minister should not have to answer for the social care system. She is not the Minister for Social Care; she is Minister of State in the Home Office. The noble Lord, Lord Horam, is right: the equivalent of the Migration Advisory Committee should report to not just the Home Office but to the Department for Education, the department of health, the Treasury and BEIS because they all need to understand the skills deficits in this country.

The specifics of Amendment 3 are about the social care sector. This Bill is in front of us today because of Brexit but the social care sector is highlighted because of the Covid crisis. Today’s amendment would have been necessary even without six months of a global pandemic, but that pandemic has made clear to everybody both the importance of social care and the huge numbers of EU and third-country nationals in this country looking after some of the most vulnerable people in our society.

It cannot be right to say that those people should not be here and should not be working. We value people being here. Although the noble Lord, Lord Horam, is undoubtedly correct that we need to ensure that British people are adequately skilled, can we really assume that we will suddenly go in the next 14 weeks from no training to saying that someone who is unemployed can take on a job in the care sector that is being vacated by an EU national who has gone home and will not be replaced by another EU national? There might be medium and long-term aspirations for change, but we must accept that the change on 1 January will be immediate.

For that reason, I ask the Government to take this modest amendment very seriously. In her letter to noble Lords earlier today, the Minister referred to Amendments 3 and 30. She stressed that the MAC is a “world-class, independent body” and that it will report. Well, it reported yesterday and expressed its concern about the social care sector. If she cannot give us an answer today, will she come back before Third Reading with some recommendation of how she plans to reconcile her letter to your Lordships, the MAC’s report and the importance of ensuring that, on 1 January, the social care system is not even more vulnerable than it is already? I strongly support Amendment 3.

Photo of Baroness McIntosh of Pickering Baroness McIntosh of Pickering Conservative

My Lords, I will speak to Amendment 3 in particular and Amendment 30. It is a pleasure to follow the noble Baroness, Lady Smith. I want to follow up on the remarks of the noble Lord, Lord Blunkett. I remind my noble friend the Minister that she will have encountered in her previous life many of the problems that are being rehearsed by noble Lords speaking to Amendment 3. I remember being a local MP. For the first 13 years, I did not have a jobcentre in my constituency; only in the last five years was I able to visit a local jobcentre in my constituency. When we got the figures on unemployment, I always asked for the figures on job vacancies. Inevitably, the majority of them were for social care workers and were the hardest to fill.

I know from personal experience of two care providers for young people requiring social care—there was Leonard Cheshire initially, then Wilf Ward, both of which do marvellous work; I pay tribute to them—that they are unable to match the basic starting salary of someone in a supermarket who may want to come off the current unemployment list to take any job. Stacking shelves in a supermarket is less demanding, less physically onerous and pays more. I do not know whether my noble friend the Minister shares my pessimism but I do not foresee a rush of people—who in any event may not be suited to be a carer. The clue is in the name: you have to care, to be incredibly patient and to be quite physically fit. Many will simply not qualify.

Following on from what many noble Lords have said in the debate on this little group of amendments, I want to curtail my remarks to nudging my noble friend the Minister to come forward with an alternative to Amendments 3 and 30, grasp the bull by the horns and come up with a proposal somehow to increase the funding per hour for social care. I realise that there is not a Budget now so there may be a delay. Going back eight years, I know from having a parent who was in self-funded social care in his own home—in my father’s case, for some three years—that it amounts to something like £40,000 a year, at a conservative estimate.

We are in the midst of a care crisis and potentially are about to lose those who come here and make up not quite the 20% of the workforce that we heard in the figures presented in this debate, but among the 20% that comes from outside the UK a large number of people will be from the EU. I hope that my noble friend the Minister will use her best offices to ensure that we grasp the bull by the horns now so that we have a safe and secure supply of workers coming from countries with which we are used to dealing. They have a fantastic work ethic. We must ensure that they continue to come here and are paid a higher rate than currently; that may also attract more indigenous people who find themselves out of work at this time.

Photo of Lord Judd Lord Judd Labour 3:45 pm, 30th September 2020

My Lords, I thank my noble friend Lord Rosser very much for moving this crucial amendment in such a powerful and forceful way. I should declare an interest because my grandson, who is very close to me, took the opportunity of the longer summer break for schools after the public examinations to go and work on the front line in a care home. He is intelligent, perceptive and caring, so I learned a great deal from what he told me.

What troubles me in our considerations is this: just how many of us would have thought of using some of our available time working in a care home? Would the noble Lord, Lord Horam, for example? We expect all sorts of other people to do it but we are not prepared to commit ourselves. Of course, this is also coupled with the extraordinary way in which we are so sentimental about workers in the care sector. We clap our hands and celebrate—I have done it—but where is the recognisable esteem in which we hold these people? We all know that they are grotesquely underpaid. We talk about them and how we will find sufficient numbers and all the rest of it; perhaps we should have at the top of our list proper remuneration for this highly demanding work.

A lot has been said about workers from outside Britain. It was quite insensitive because some of the most dedicated, loving care for those with serious conditions has come from those workers. Why can we not talk about them as people—fellow members of the human race—rather than as immigrants?

The amendment is important because we all know that the past summer—goodness knows what will happen this winter—has demonstrated an interesting contradiction. On the one hand, dedicated staff, against all the odds, have been doing their best in so many places to help those in great need, while we have failed to accord proper status in our social order to the people doing such work. It is surely because we have become a society in which success is regarded as a matter of how much money you make and how quickly you make it, rather than a society in which care, support and service to the community are regarded as of the highest order and significance. We have had a terrible crisis in the care sector this past year. May it not be repeated. Let us look at some of the underlying issues and put them right at once. The amendment will help us to introduce the necessary disciplines if we are to approach issues of this kind.

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Deputy Chairman of Committees, Deputy Speaker (Lords)

The noble Lord, Lord Young of Norwood Green, has withdrawn, so I call the noble Baroness, Lady Hamwee.

Photo of Baroness Hamwee Baroness Hamwee Liberal Democrat Lords Spokesperson (Immigration)

My Lords, the noble Lord, Lord Judd, has clearly passed on to his grandson the importance of contributing to service in its widest sense. I very much agree with his analysis but then I almost always do.

By definition, members of the largest cohort in the social care sector do not fall within paragraph 1 of Schedule 1 but are very much affected. They are certainly part of the social care workforce and are impacted by the availability of social care workers employed in the sector. I mean, of course, the many people who support and care for someone older, disabled or seriously ill at home. According to Carers UK, one in eight adults—6.5 million people—are so engaged. The carer’s allowance is around £67 a week. I could go on but I do not get the impression that noble Lords need to be convinced of the importance of the sector, including those who do not have formal, paid-for care at home or in a care home. The informal carers and those for whom they care are impacted as well as those in public or private employment. The number of those in private employment is considerable. The noble Baroness, Lady Masham, referred to the NHS.

That is not the only reason we support the amendment. The noble Baroness, Lady Finlay, in Committee, reminded us that there are 115,000 European nationals in the social care workforce, despite high vacancy rates. It is, as other noble Lords, have said, a skilled profession with some skills that cannot be trained into a person and come from one’s personality and often culture, and include physical fitness, as we were reminded by the noble Baroness, Lady McIntosh. At a previous stage of the Bill, the noble Lord, Lord Lilley, said that he would have supported similar amendments but for the absence of a reference to training, which is now included in the amendment—rightly so—because training in practical and technical matters is important. However, that does not detract from my observations about personality.

The need for carers will not diminish. My noble friend Lady Barker reminded us, although I do not need reminding, that many of us are ageing and do not have children to shoulder the work—and it is work —done by families, however lovingly. She gave us the figure of 1 million but one should add families with a disabled child, for instance.

Like my noble friend Lady Smith, I have a lot of sympathy with Amendment 30 and many of my comments apply to it. In Committee, the Minister relied on the MAC having licence to consider any aspect of migration policy. However, when prompted by yesterday’s report, I looked at the website—it may have been changed now—which referred only to commissions by the Home Secretary. However, the committee’s pursuit of the matter is welcome. The noble Lord, Lord Horam, will note that in quoting the chair’s reference to the

“struggle to recruit the necessary staff if wages do not increase as a matter of urgency”,

I am relying on a press release, not the 600 pages of the report.

As regards the amendment of the noble Lord, Lord Rosser, it is right that the assessment should be commissioned by the Home Secretary, because she should own the work. We are not “incurious”, as the right reverend Prelate said, and will support the amendment.

Photo of Baroness Williams of Trafford Baroness Williams of Trafford The Minister of State, Home Department

My Lords, I thank all noble Lords who have spoken in one of the most thoughtful debates on the Bill. I want to reflect first on the point made by the noble Baroness, Lady Smith of Newnham, who said that had it not been for the pandemic, we might not be having this debate. I honestly think that we would have been doing so in some form or other. I am not taking issue with what she said but I want to make a further point.

Photo of Baroness Smith of Newnham Baroness Smith of Newnham Liberal Democrat Spokesperson (Defence)

I said that we would have been having this debate but the pandemic made it worse.

Photo of Baroness Williams of Trafford Baroness Williams of Trafford The Minister of State, Home Department

In that case, I agree with the noble Baroness. However, the main part of my point was related to the issue on which my noble friend Lady McIntosh challenged me. She asked whether, given my background, I could see the problems to which noble Lords are referring. I can absolutely see them. In fact, in 2005, when I was a new leader of a council, and David Cameron a new leader of the Opposition, he asked me what the biggest challenge was for local authorities. Straight off, I said social care, and, 15 years later, that remains the case. The noble Lord, Lord Judd, referenced those who care voluntarily. There are so many that they save the state billions of pounds a year for the work that they do without being paid. I therefore join noble Lords in paying tribute to this sector, which has done so much, particularly during the pandemic. As the noble Lord, Lord Patel, said, people in social care have given and lost their lives to the fight against the disease.

I turn next to points about the Migration Advisory Committee. First, I turn to the comment of the noble Lord, Lord Blunkett, which he has made before, about the contradictory nature of what we are debating. In one sense, we highly value our social care workers and in another, as someone else said, they earn less, in some cases, than retail workers. That is the challenge at the heart of this: social care needs to be paid decently and seen as a decent career path for people to want to go into it.

I could stand at this Dispatch Box and give my view on the silver bullet that would sort this all out, but I am afraid that I cannot. It is not that it is above my pay grade but, as my noble friend Lord Horam said, this is a challenge for every department and government —and, actually, every one of us. I had a chat with my noble friend Lord Hodgson before this debate; he is probably sitting there very frustrated because he did not put his name down to speak, and I know that he would have wanted to talk about the report that the MAC issued yesterday on the review of the shortage occupation list. One of its key findings is that senior care workers, nursing auxiliaries and nursing assistants should be added to the UK-wide shortage occupation list. The Government want to take time to consider carefully what the MAC has said—as noble Lords I have said, it is a 650- page document—before we take any final decisions, and we will of course respond in due course.

The noble Baroness, Lady Smith of Newnham, challenged me for a timescale, and “in due course” is about as far as I can go at this stage. The noble Baroness, Lady Jones of Moulsecoomb, talked about the devolved Administrations’ part in all this. Of course, it is a reserved matter. The new system will work for the whole of the UK and we have a national advisory group, with which we are engaged on the proposals, but it includes the Welsh NHS Confederation, Social Care Wales, NHS Scotland and Scottish social carers.

I turn to the amendments at hand. Amendment 3 returns to issues raised by the noble Lord, Lord Hunt of Kings Heath, in Committee, but it also incorporates a requirement to report on immigration routes for social care workers, which was raised during Committee by the noble Lord, Lord Patel, and goes to the essence of the amendment of the noble Lord, Lord Rosser, in Committee, about a specific route for the social care sector. During our debate in Committee, the noble Lord, Lord Hunt of Kings Heath, rightly highlighted the significant shortages in the social care sector, as did the noble Baroness, Lady Masham, amounting to around 120,000 vacancies. The noble Lord, Lord Blunkett, also talked about the high turnover, which I think I said was 31%, but he thinks might be even higher.

We must keep it in mind that that is the situation despite the fact that EEA and Swiss citizens have had, and continue to have, free movement rights up to the end of this year. The noble Lord also highlighted the fact that the social care workforce is made up of approximately 83% British citizens, 7% from the EEA countries and about 9% from non-EEA countries. What struck me as interesting about those figures is that a higher percentage of people from non-EEA countries than from EEA countries are working in social care, even though they have no dedicated route to do so. Currently, while social care workers do not meet the skills threshold, a range of other immigration routes are available to them which provide a general right to work, such as dependants, those on family routes or youth mobility.

As part of the UK’s new points-based immigration system, we are expanding the skills threshold, which will bring jobs such as senior care workers within scope of the skilled worker route. Increasingly, people of all nationalities will be able to benefit from this offer providing they meet the other requirements, such as salary threshold. However, I want to be clear that, as my noble friend Lord Horam points out, the Government do not see the immigration system as the solution to all issues in the social care sector. I think there is now general acceptance across your Lordships’ House that that is the case.

With that in mind, we 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 approach to deliver quality, compassionate care. The Department of Health and Social Care has 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 during this pandemic, along with the longer-term opportunities of working in care.

The Government have also commissioned Skills for Care to scale up capacity for digital induction training provided free of charge under 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. The Government are committing record investment to the NHS, including the NHS long-term funding settlement, which has now been enshrined in law. At the Budget, the Chancellor outlined over £6 billion of further new spending in this Parliament to support the NHS. This includes £5.4 billion to meet our manifesto commitments of 50,000 more nurses, 50 million additional appointments in primary care, more funding for hospital car parking and establishing a learning disability and autism community discharge grant to support discharges into the community.

As my noble friend Lord Horam pointed out, we are also investing in social care. DHSC is providing councils with access to an additional £1.5 billion for adult and children’s social care in 2021. We have also announced £2.9 billion to help local authorities in response to the coronavirus crisis. The Department of Health and Social Care is also working closely with Skills for Care to help employers train new recruits and volunteers and to refresh the skills of its current workforce.

In Committee, the noble Baronesses, Lady Hamwee and Lady Masham of Ilton, highlighted that working in social care, especially when caring for people who have severe disabilities, requires much more than just technical skills. I totally agree. Social care jobs will not be for everyone. However, it is a sad consequence of the current pandemic that many people have lost their jobs. While not all of them will have the necessary caring skills, I think there are many people in the UK who really do care, and it is vital that we take the opportunity to emphasise the importance of social care work and ensure that it is a rewarding job for people.

The view that migration is not the solution to the challenges faced by the care sector is supported by the Migration Advisory Committee. My noble friends Lord Hodgson of Astley Abbotts and Lord Lilley referred to that in Committee. We need to make changes to the way we train, recruit , attract and, crucially, retain staff in health and social care, but without making changes, the immigration system will continue to be used as a failsafe to maintain a broken system that relies on bringing people in on minimum wage and holding down wages.

The Government continue to commission and fund a range of training opportunities to help recruit people into the sector and develop leadership within social care. This includes the Think Ahead programme, which has taken on more than 400 applicants since it was launched in 2015. It trains graduates to become mental health social workers. There is also the workforce development fund, which helped nearly 2,800 establishments to support nearly 14,500 learners in 2018-19. This fund will continue to focus on key priorities in future.

Turning to the specifics of the amendment, it is of course sensible that policies are kept under review—something the Government stand by in the current system and will ensure continues under new arrangements. We already have the MAC, and its advice has been accepted by all types of Government over many years. I know that some noble Lords do not share my views on the expert advice provided by the MAC, but surely there cannot be disagreement that the MAC has repeatedly considered the needs of the social care sector, as referenced by the report yesterday.

We should not take for granted the Government’s own extensive engagement with stakeholders across the whole of the UK, and indeed the critical role that this House plays in scrutinising policies and intentions. So I do understand the intent of the noble Lord’s amendment to ensure the protection of a vital sector. We already have a world-class independent body with new autonomy to review any part of our immigration system, as referenced today, in the last 24 hours. I hope the noble Lord will therefore feel that Amendment 3 is not necessary and will be happy to withdraw it.

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Deputy Chairman of Committees, Deputy Speaker (Lords)

I have received no requests from noble Lords wishing to speak after the Minister, so I call the noble Lord, Lord Rosser, to reply.

Photo of Lord Rosser Lord Rosser Shadow Spokesperson (Home Affairs), Shadow Spokesperson (Transport)

First, I share the views that the Minister expressed about the quality and value of this debate. I thank all noble Lords who have spoken and I thank the Minister for her response.

I think that there is a general acceptance that the social care sector is in crisis, with low-paid and undervalued skilled work, a very high staff turnover rate and a very high level of vacancies. On top of that, the crisis could well be exacerbated by abruptly closing down a significant source of labour from abroad in three months’ time. In response to my amendment, the Minister referred to the role of the Migration Advisory Committee. But the MAC is not a specialist committee on the social care sector, as, frankly, was indicated very clearly by its recent 650-page report, Review of the Shortage Occupation List: 2020, which simply indicates that it covers a wide breadth of sectors and occupations within those sectors and is looking at migration issues.

However, it is clear from the MAC’s recent report that it feels that the views it has expressed in the past have not had much impact, because it has made reference to “again” expressing concern about the social care sector, and to issues that it has been pressing “for some years”. I think this means that, while the work that has been done by the MAC over a number of years is to be welcomed, clearly it does not feel that that it has had much impact. Perhaps that is because it is not a specialist committee on the social care sector; it is a committee that looks at migration across the board.

I think that that makes the case that, in view of the crisis in the social care sector, which may well get worse at the end of this year in light of the changes to the immigration system, there is a clear-cut case for a stand -alone, in-depth, specialist report on the social care sector and the impact of the provisions of the Bill, as provided for in the amendment, and that it is needed now if the goals that have been set for the sector—goals relating to better pay, training, professionalism, a reduction in turnover and a reduction in vacancies—are to be achieved. We badly need this in-depth specialist assessment to be made, as called for in the amendment, and I do wish to test the opinion of the House.

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Deputy Chairman of Committees, Deputy Speaker (Lords)

The Question is that Amendment 3 be agreed to. The Question will be decided by a remote Division. I instruct the clerk to start a remote Division.

Remote Division on Amendment 3 called.

Photo of Baroness McIntosh of Hudnall Baroness McIntosh of Hudnall Deputy Chairman of Committees, Deputy Speaker (Lords) 4:32 pm, 30th September 2020

My Lords, I am afraid that the technology has let us down and that the attempt to vote on Amendment 3 has failed. I believe that the intention now is to adjourn the House briefly while we sort out the problems, and then rerun the vote.