Annual review: Impact on health care and social care sector

Immigration and Social Security Co-ordination (EU Withdrawal) Bill – in a Public Bill Committee at 4:00 pm on 16th June 2020.

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‘(1) The Secretary of State must commission an annual report from the Migration Advisory Committee on the impact of the provisions of this Act on the health care and social care sector in the UK.

(2) In undertaking the evaluation, the Secretary of State must consult—

(a) the relevant Scottish Ministers;

(b) the relevant Welsh Ministers; and

(c) the relevant Northern Ireland Ministers

(3) The report must be laid before each House of Parliament as soon as possible after it has been completed.

(4) A Minister of the Crown must, not later than three months after the report has been laid before Parliament, make a motion in the House of Commons in relation to the report.’—

Brought up, and read the First time.

Photo of Holly Lynch Holly Lynch Shadow Minister (Home Office)

I beg to move, That the clause be read a Second time.

Photo of Graham Stringer Graham Stringer Labour, Blackley and Broughton

With this it will be convenient to discuss the following:

New clause 49—Impact assessment on the social care workforce—

‘(1) No Minister of the Crown may appoint a day for the commencement of any provision of this Act until the condition in subsection (2) is met.

(2) This condition is that a Minister of the Crown has published and laid before both Houses of Parliament an assessment of the impact of the Act on recruitment of EU citizens, EEA nationals, and Swiss citizens working to the social care sector.’

This new clause makes the coming into force of the Act conditional on the production of an impact assessment of the changes on the social care workforce.

New clause 61—Duty to commission an independent evaluation: health and social care sectors—

‘(1) The Secretary of State shall commission an independent evaluation of the matters under subsection (5) and shall lay the report of the evaluation before each House of Parliament.

(2) The Secretary of State must appoint an independent person to undertake the evaluation (“the independent evaluator”).

(3) In this section, “independent person” means a person who is independent of Her Majesty’s Government.

(4) No person may be appointed under subsection (2) unless their appointment has been consented to by—

(a) the relevant Scottish Ministers;

(b) the relevant Welsh Ministers; and

(c) the relevant Northern Ireland Ministers.

(5) The evaluation under subsection (1) shall consider an assessment of the effects of this Act on—

(a) the health and social care workforce;

(b) the efficiency and effectiveness of the health and social care sectors;

(c) the adequacy of public funding for the health and social care sectors; and

(d) such other relevant matters as the independent evaluator sees fit.

(6) In undertaking the evaluation, the independent evaluator must consult—

(a) the Secretary of State;

(b) the relevant Scottish Ministers;

(c) the relevant Welsh Ministers;

(d) the relevant Northern Ireland Ministers;

(e) providers of health and social care services;

(f) persons requiring health and social care services;

(g) representatives of persons requiring health and social care services; and

(h) such other relevant persons as the independent evaluator sees fit.

(7) The independent evaluator must prepare a report on the evaluation for the Secretary of State.

(8) The Secretary of State must lay that report before Parliament no later than one year after this Act is passed.

(9) A Minister of the Crown must, not later than six months after the report has been laid before Parliament, make arrangements for—

(a) a motion relating to the report to be debated and voted upon by the House of Commons; and

(b) a motion relating to the report to be debated and voted upon by the House of Lords.’

This new clause would require an independent evaluation of the impact of the Act upon the health and social care sectors across the UK to be produced and laid before Parliament. It would require that the devolved nations are consulted as well as other interested parties.

Photo of Holly Lynch Holly Lynch Shadow Minister (Home Office)

The new clause would require the Government to commission the Migration Advisory Committee to produce a report on the impact on the health and social care sector of ending free movement.

I very much welcome some of the new developments that the Minister outlined earlier, to do with the changes in the way that the Migration Advisory Committee will operate. The group includes a number of new clauses, and we very much recognise the merits of all of them. In essence, they all plead with the Government fully to think through the implications of putting this hard stop on free movement in place without the systemic reforms to health and social care that would be required to address the workforce issues in those co-dependent sectors.

At the evidence session last week, we heard some pretty damning evidence from witnesses, even though, interestingly, none of them were there explicitly to represent the health or care sectors. Martin McTague of the Federation of Small Businesses told the Committee that the FSB felt that the £25,600 minimum income threshold

“should be lower, because there are quite a few jobs, especially in the care sector, that pay less than £25,600.”

He went on:

“That is why we have called for a care sector visa, because we think the requirements of that sector will always be uniquely different from most of the rest of the economy.”––[Official Report, Immigration and Social Security Co-ordination (EU Withdrawal) Public Bill Committee, 9 June 2020; c. 6, Q5.]

In response to a follow-up question from my hon. Friend the Member for Kingston upon Hull North, Martin McTague said:

“It is clear from the experience that we have had over the last few months that this sector is under massive pressure. Any major changes would be disastrous.”––[Official Report, Immigration and Social Security Co-ordination (EU Withdrawal) Public Bill Committee, 9 June 2020; c. 11, Q16.]

We can all agree that this Bill represents a major change in immigration.

Brian Bell of the Migration Advisory Committee made a number of scathing points, which we should all reflect on. He said that

“immigration has historically been used as an excuse to not deal with the problems of the social care sector.”––[Official Report, Immigration and Social Security Co-ordination (EU Withdrawal) Public Bill Committee, 9 June 2020; c. 21, Q44.]

He is right. The problem is, when we suddenly turn off freedom of movement at the end of December and the Government are not able to deliver the radical reforms required in that timeframe, what happens to social care?

I will answer that. Unless we have a significant breakthrough with a vaccine, care homes and the care sector will still be battling the coronavirus. If we do not do our due diligence on this, by adopting the new clause, the Bill will be set recklessly to undermine social care at a time when it can least afford it.

A MAC report is necessary, and would give the Government an opportunity to develop a coherent strategy by conducting the exercise annually for the health and care workforce. That could inform both the domestic skills agenda and our immigration policy, allowing us to create fast tracks within immigration based on our needs at the time. Without that, the NHS will struggle to function. According to the British Medical Association, 29% of doctors in the NHS are from overseas. Freedom of movement has greatly facilitated that, as for years EEA staff have benefited from the flexibility it grants, allowing them to work in the UK and EEA simultaneously.

We have discussed in earlier stages of the Committee the potential introduction of visas and the costs attached to the changes brought about by the Bill. That might act as a major disincentive against attracting the best talent to the NHS. As always, there should be a clear national commitment to training future healthcare workers. Nevertheless, it is hard to imagine that the domestic workforce alone will be able to deliver. For a long time, the workforce has been supplemented with EEA workers.

The NHS reported nearly 90,000 job vacancies between October and December 2019. That has already led to rota gaps across the medical profession, and to well-founded concerns about the ability to staff services adequately. It can take up to 10 years to train a doctor. It is unrealistic to believe that a domestic push will address that vacancy shortage or likely subsequent shortages due to the UK’s decision to leave the EU and free movement.

Domestic recruitment drives also have barriers to overcome. The Royal College of Nursing has reported that the Government’s much publicised increase of 50,000 nurses consists of 12,000 more international nurses, 15,000 student nurses and another 15,000 retained nurses who had previously left the profession. In reality, therefore, only about 27,000 nursing vacancies have been filled, and that fails to address adequately the 40,000 nursing vacancies reported in the NHS in November 2019.

In the evidence session, Brian Bell, interim chair of the MAC, stated that occupational shortages were

“a failure of the British education system”.––[Official Report, Immigration and Social Security Co-ordination (EU Withdrawal) Public Bill Committee, 9 June 2020; c. 24, Q49.]

If the Government seek to prioritise domestic healthcare recruitment over immigration, some pretty urgent steps must be taken to address that.

The threat of ending free movement for the NHS is incredibly concerning. The threat of ending free movement for our social care sector is existential. The proposal to extend the tier 2 visa system to EEA nationals would sever recruitment and compound gaping occupational shortages.

The Institute for Public Policy Research modelled the impact on EEA nationals currently living in the UK and working in social care, and found that 79% of EEA employees—about four in five—working full-time in social care would have been ineligible to work in the UK under the skills and salary thresholds proposed by the MAC. Unison reports that there are currently 110,000 vacancies in social care, and while I suspect the Minister will tell me that his aspiration is to fill those solely through domestic recruitment, I wonder what assurances he can give us that that is possible in the timeframes required.

It was encouraging to hear the MAC report that senior care workers would be eligible to be included in future shortage occupation lists, yet we fear that deterring the recruitment of care assistants and more junior care workers from overseas may lead to a further increase in job vacancies in the care sector. We have all heard the warnings from Brian Bell that migrant workers cannot continue to act as a sticking plaster, working their socks off on low pay to mask the systemic problems in social care, but it is clear that we will be exacerbating the workforce issues impacting on the quality and availability of care unless the Government undertake a full and regular review. I urge the Government to adopt new clause 21 in order to fully understand the ways in which the new immigration system will affect patient care across all health and social care settings.

Photo of Brendan O'Hara Brendan O'Hara Shadow SNP Spokesperson (Inclusive Society), Shadow SNP Spokesperson (International Human Rights and Conflict Resolution)

As always, it is a pleasure to serve under your chairmanship, Mr Stringer. I will speak to new clause 61, which seeks an independent evaluation of the specific impact of the Bill on the health and social care sectors across the United Kingdom. This independent evaluation would follow from consultation between the Secretary of State for Health and Social Care, the relevant Ministers in the Scottish and Welsh Governments, the relevant Northern Ireland Ministers, service providers, those requiring health and social care services, and others. The new clause would require the Secretary of State to lay a copy of that report before both Houses of Parliament

“no later than one year after this Act is passed”,

and would require a Minister to make arrangements

“no later than six months after the report has been laid before Parliament” for it to be debated and voted on in Parliament.

The new clause has gathered support from service users, third-sector organisations, trade unions and charities from every part of the UK, among them the Scottish and Northern Irish councils for voluntary organisations, Disability Wales, Unison, Camphill, Scottish Care, and the Welsh and Northern Irish branches of the British Association of Social Workers. I think the reason why they and many others have supported this independent assessment is that, as people who work on the frontline of health and social care every day, they are extremely worried that the Bill, which will end freedom of movement and introduce a points-based immigration system, will adversely affect hundreds of thousands of their clients: disabled people, children and young people, older people, unpaid carers and those with long-term health conditions—those who rely most on the health and social care services to look after them every day.

There is no doubt that the current coronavirus pandemic has given us all the opportunity to see just how precious our national health service and social care sector are. The NHS has risen to the challenge magnificently, as has everyone who works in it, and we are all hugely indebted to them. It has also reinforced just how lucky we are to have our national health service—should that have needed reinforcing—and we must do everything we can to protect it, so that future generations can have what we currently enjoy. We cannot afford to take chances with the future of our NHS or our social care services, and I believe that anyone who took chances with them would never be forgiven.

That is why so many in the health and social care sector are deeply concerned about what is contained in the Bill: they recognise that there is already a crisis in social care across the United Kingdom. On top of the seemingly relentless pressure on funding, we have an ageing population with increasingly complex care needs. The health and social care sector is battling every day to find and keep the workforce it requires, yet this Government have cut off a source of labour, with no clear plan as to what will replace it.

At the end of September 2019, NHS England reported having more than 120,000 unfilled posts—an increase of 22,000 on the previous year. Both the Care Inspectorate and the Scottish Social Services Council have found that 40% of social care organisations have unfilled vacancies going back over a year.

Even with the access we have had to the pool of labour from the European Union, there are serious problems in the recruitment and retention of health and social care staff. Folk are not queueing to fill the existing vacancies. Are the Government arguing that miraculously post-Brexit, having cut ourselves off from our potential pool of labour, sufficient numbers of people will suddenly become available to work in the sector?

Skills for Care has calculated that a quarter of the health and social care workforce is aged over 55 and due to retire in the next 10 years. There will therefore be another 320,000 vacancies to be filled. This crisis in recruitment and retention will get deeper. Yet the Government would have us believe that the end of freedom of movement and the introduction of this system is the answer to finding hundreds of thousands of people. I cannot see how it is possible.

More importantly, healthcare professionals, service users and those representing the existing workforce cannot see how it is possible. According to the highly respected independent charity the King’s Fund:

“Widespread and growing nursing shortages now risk becoming a national emergency and are symptomatic of a long-term failure in workforce planning, which has been exacerbated by the impact of Brexit and short-sighted immigration policies.”

That is a damning assessment, but it chimes with what much of the sector is saying.

By accepting new clause 61, the Government have a chance to prove us doubters and naysayers wrong, by allowing these huge changes to be held up to independent evaluation and scrutiny. More importantly, that would give the health and social care sector the confidence that this Government know what they are doing, that they have carefully considered the impact of ending free movement, and that they have a clear plan in place that will not harm the sector or service users.

If the Government are really confident about this new immigration Bill and what it proposes, they have nothing to fear from a comprehensive, independent evaluation, undertaken across the four nations of the United Kingdom, purely to assess and determine the full impact of the Bill on the sector. The Minister said that the Government have published an impact assessment examining what they believe will happen.

That is all well and good, but it does not go nearly far enough. It would be prudent and responsible for the Government to ensure that any changes to the immigration system do not, however inadvertently, adversely affect the health and social care of our most vulnerable citizens. This evaluation would not only ensure no harm is done to those who receive health and social care, but give any future Government a head start in planning and making decisions about the health and social care sector, particularly in terms of recruitment, retention and levels of investment.

Such far reaching changes should not happen on a wing and a prayer, without an appropriate mechanism to accurately and independently measure the effectiveness or otherwise of such radical change. Any responsible business making such fundamental changes would have put in place a means whereby it could measure precisely what the consequences of those changes would be. It is therefore inconceivable that this Government are not doing something similar, particularly with something as important as the health and social care needs of our most vulnerable citizens.

New clause 61 would not only accomplish all of that, but allow policy makers in the future to take a holistic and strategic approach to tackling the issues that will inevitably arise from the UK leaving the European Union and the introduction of a points-based system. It would further ensure that those issues are tackled from a foundation of accurate and independent research, thereby allowing Governments, local authorities, health boards, social care sectors and others to make strategic planning decisions while being fully informed by robust and independent evidence.

I do not intend to push new clause 61 to a vote, but I hope that between now and Report, the Government will reflect on the new clause and consult on it as widely as they can. I hope they accept that they have absolutely nothing to lose—and, indeed, lots to gain—from agreeing to an independent evaluation of the impact of this massive policy change.

Photo of Kevin Foster Kevin Foster The Parliamentary Under-Secretary of State for the Home Department 4:15 pm, 16th June 2020

I have great respect for the hon. Member for Argyll and Bute, but I think people outside the House listening to the debate will wonder whether he has looked at today’s worrying figures on the employment market and the economic impact of covid-19. He asks where people might be found, but a significant number of people will be looking for new employment.

I welcome the opportunity to put on the record again the fact that the Government recognise the vital nature of the health and social care sector to the United Kingdom. I recognise that, in their view, hon. Members tabled the new clauses to protect a key sector. I assure members of the Committee that health and social care will be at the heart of the UK’s new points-based immigration system. The new skilled worker route will be open to a broader range of roles than the current tier 2 general route, following expansion of the skills threshold.

Under the current immigration system, only those coming to do graduate-level jobs are able to come to the UK under tier 2. In the future, our points-based skilled worker route will encompass jobs requiring school leaver qualifications. That means that all migrants—not just those from within the EU or EEA—will be able to apply for jobs meeting the skills threshold, including, as has been mentioned, senior care workers, giving a global reach to recruitment in the sector.

The general salary threshold will be set at £25,600, or the appropriate rate for the job that the person is coming to the UK to undertake. For a number of roles in health and social care, the rate will reflect the current national pay scales. We are also removing the cap and resident labour market test to make it quicker and easier to recruit workers from overseas where necessary. That will benefit all migrant workers and their employers, including those in the health and social care sector.

As with all immigration routes, we will continue to keep the points-based system under review. These changes are the first phase, and we will continue to develop and refine the points-based system based on experience.

Photo of Brendan O'Hara Brendan O'Hara Shadow SNP Spokesperson (Inclusive Society), Shadow SNP Spokesperson (International Human Rights and Conflict Resolution)

On a point of clarity, did the Minister say that there will be sufficient capacity in the labour market to move the people losing their jobs as a result of coronavirus into the health and social care sector? Was that his argument? Does he recognise that there are currently 122,000 vacancies in England alone, and that there are projected to be another 320,000 over the next 10 years due to retirement? Does he really think that that will be made up by people losing their jobs?

Photo of Kevin Foster Kevin Foster The Parliamentary Under-Secretary of State for the Home Department

Many people will be surprised to hear the hon. Gentleman suggest that one of the issues that the UK is facing at the moment is a shortage of labour. Sadly, we are seeing the impact of covid, and we know that health and social care will play a key part in providing job opportunities for those who need new employment. I am seeing that in my constituency. Many people would be surprised if there were Members in this building who did not think we should prioritise getting people who have faced the impact of the economic change into new skills and employment. That should not be a controversial point. I suspect that many of his constituents would be rather surprised if that is the point that he wished to make.

Photo of Brendan O'Hara Brendan O'Hara Shadow SNP Spokesperson (Inclusive Society), Shadow SNP Spokesperson (International Human Rights and Conflict Resolution)

I am trying to stick to the Bill, but is the Minister saying to the country and people who are losing their jobs that, contrary to what the Prime Minister and the Chancellor have been saying, those jobs are not coming back, and they had better go find something else? The message has been that this is a temporary blip, we will recover from it, and the jobs will be coming back.

Photo of Kevin Foster Kevin Foster The Parliamentary Under-Secretary of State for the Home Department

Thankfully, we will see many jobs come back. The Chancellor himself said that it will be difficult to save every role, and we can see that some of the changes in our economy, particularly in the retail sector, have been sped up. I am sorry that the SNP is looking to put its political philosophy ahead of the practical situation. I do not think it is controversial to say that, in Scotland, where there are vacancies, we should be trying to make sure Scottish-based workers are going back to work. I think the SNP will find it very interesting when it meets the electorate next May and explains why that was not its priority.

Photo of Holly Lynch Holly Lynch Shadow Minister (Home Office)

Does the Minister not accept the example that we have just been through? The Government, having recognised the labour shortage in agriculture, made a co-ordinated attempt to redeploy people who are currently out of work into the agriculture sector, but it proved incredibly difficult and the numbers have not transpired in reality. If he is saying that we can do something similar for social care, we would be keen to see the plan. What is his plan if we cannot redirect those people into social care in the timeframe that we are talking about?

Photo of Kevin Foster Kevin Foster The Parliamentary Under-Secretary of State for the Home Department

There is a slight difference between talking about temporary roles in seasonal agriculture and carers, which is not a seasonal job. I represent a constituency with plenty of seasonal roles. It would be odd to start describing care as a seasonal one; it is not, for obvious reasons. People’s care needs do not vary by the season in the way the agricultural sector’s needs do in terms of picking fruit and veg.

Certainly, there is a need to make sure that we have the appropriate structure. Again, I think that people outside this room would be stunned that Opposition Members do not think that, at the moment, we should prioritise getting UK workers back to work. That might explain why, in December, people did not feel that those were the parties they wished to trust with being in government.

Moving on, our new firmer, fairer and swifter immigration system will have benefits for all sectors of the economy, but we recognise the special role that the NHS and those connected with it have in our society, which the events of the last few months have demonstrated clearly. That is why, in line with our election manifesto, the Government are introducing a healthcare visa, which will provide eligible health and social care workers with fast-track entry, the support of a dedicated team in UK Visas and Immigration and reduced visa fees.

As I said earlier, we are looking to exempt all those working in health and social care from paying the immigration health surcharge. We are also investing in social care. For example, in response to the coronavirus crisis, we have announced £2.9 billion to help local authorities respond to pressures in key services, such as adult social care, and to enhance the NHS discharge service, which allows patients to return home safely. No one should doubt our support for that critical sector of our society.

The hon. Member for Halifax talked about damning evidence, so it is worth remembering the evidence that the chair of the Migration Advisory Committee, Professor Brian Bell, gave to the Committee on 9 June. 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”.––[Official Report, Immigration and Social Security Co-ordination (EU Withdrawal) Public Bill Committee, 9 June 2020; c. 22, Q44.]

On new clause 21, the MAC is an independent non-departmental public body that advises the Government on immigration matters. It has a UK-wide remit and works across Government to provide transparent, independent, evidence-based advice. It currently undertakes work based on commissions from the Government; the Government determine the matters that they believe require consideration and ask it to consider and advise. As we have touched on, the Government are committed to expanding that role. This will be the first year that the MAC has produced an annual report, which is an important development to increase transparency and provide more regular evidence on issues relating to immigration.

In future, in addition to specific commissions from the Government, the MAC will be able to undertake other work that it considers necessary, including regular reporting on migration matters. I therefore cannot support a clause that requires it to look annually at a specific sector. As hon. Members will be aware, its reviews are thorough, and it takes time to seek views and analyse a broad range of evidence from across the UK. That means that the reports often take many months to complete, and we must be mindful of its finite resource and time. Requiring it to undertake an annual review on health and social care may prevent it from undertaking reviews on other issues where there may be a more pressing need, or may duplicate work that it plans to do.

I am also unable to support new clause 49, which would require the Government to consider the impact of the Bill on EEA citizens, but which ignores the new points-based system that we will implement at the beginning of January 2021. The Government have already published an impact assessment of the points-based immigration system, which sets out the impacts on all those who will use the system, not just those from the EU or the EEA.

We understand fully that ending free movement and the proposals for the future immigration system will have an impact. However, with the dramatic changes that we have seen in the UK labour market over recent weeks, it is right that we focus on getting UK-based workers back into employment and ensuring that employers are investing in and retaining the existing workforce. Migration policies need to be considered alongside that work, not in isolation from it. The Migration Advisory Committee will have the opportunity to decide what it wishes to consider alongside its annual report.

The hon. Member for Argyll and Bute said that he did not wish to push new clause 61 to a vote. I appreciate his comments. We will continue to engage and I would encourage stakeholders in Scotland to work together, particularly as the MAC draws up its advice for the shortage occupation list that will apply under the new migration system. With that, I emphasise that the Government will not be able to accept the two new clauses.

Photo of Holly Lynch Holly Lynch Shadow Minister (Home Office) 4:30 pm, 16th June 2020

I heard the Minister’s comments. I would stress, once again, that new clauses 21, 49 and 61 are genuine attempts to ask the Government to recognise our concern about health and social care when free movement comes to an end. We are not attempting to play politics; our concern is genuine. We would be very happy for the Government to go away and look at any one of those options. Without pushing this to a vote, we ask the Minister to consider these issues in all further deliberations on the future immigration system. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.