This presentation includes the ILC-UK's Ben Franklin and Cesira Urzì Brancati presenting a summary of the Moved to Care report; a response from Dr Shereen Hussein, Senior Research Fellow at King's College London; and a response from Madeleine Sumption, Director of the Migration Observatory.

1. Migration and Social Care Report
Launch
Thursday 19th November 2015
This event is kindly supported by Independent Age

2. Welcome
Professor Martin Green
Chief Executive: Care England
DH: Independent Sector Dementia Champion
Chair: ILC-UK
This event is kindly supported by Independent Age

3. Presentation of research
Cesira Urzì Brancati
Research Fellow: ILC-UK
Ben Franklin
Head of Economics: ILC-UK
This event is kindly supported by Independent Age

4. Moved to care:
The impact of migration on the adult social
care workforce
Ben Franklin and Cesira Urzì Brancati, International Longevity Centre
follow us on twitter: @ilcuk @bjafranklin

5. What will we be covering?
 Key research questions
 Policy background
 Migrants in the care workforce today
 Why migrants are so prominent in this sector
 Potential long-term implications of public policy
 Policy recommendations

6. Key questions
1. To what extent is the adult social care workforce
currently dependent on migrant workers and in what
ways?
2. How might current and future public policies
related to migration and adult social care impact on
the ability of the workforce to deliver care to an
ageing population?

7. Social care crisis and migration policy
 Underfunding plus rising demand for care limiting ability of sector to deliver for those
in need.
 Introduction of National Living Wage – supports pay but big challenge for some
providers.
 Non-EU migrants judged on points-based system, with Tiers 1 and 2 subject to an
annual cap of 21,700 people. Tier 3, for low skilled migrant labour has never been
opened.
 From April 2016, high-skilled non-EU migrants who have spent 5+ years working in the
UK, will be required to earn £35,000 per year. Recent exemption for nurses.
 Govt trying to renegotiate EU-UK rules around migration – EU migrants who haven’t
secured work in 6-months of arrival would have to leave.
 Govt likely to hold referendum on UK’s membership of the EU and to try and impose
restrictions on in-work benefits for EU migrants.

8. Migrants in the care workforce today
 1 in 5 care workers born outside of the UK.
 Non-EU migrants account for 191,000 people.
 Changes to migration policy has resulted in falling share of
migrant care workers coming from non-EU countries and
a rising share from EU countries.
 Migrants play particularly prominent role in providing
direct care to those in need, as well as professional
support.
 Private care providers utilise care workers to greater
extent than local authority run care providers.
 London and the South East are particularly reliant on
migrant workers with nearly 3 out of every 5 care workers
in London being born abroad.

9. Migrants concentrated in direct care and professional jobs

10. ….London and SE highly reliant on migrant workers
Source: Author’s calculations from NMDS-SC worker’s file and NMDS-SC 2015 report

11.  Care sector’s vacancy rate is significantly higher than for economy as a whole.
 Social care work is perceived to be low in pay, low in status, and with poor
opportunities for progression.
 Employers face shortage of workers relative to demand for care, exacerbated by the
relatively older age of the current social care workforce.
 Some employers have said migrants more reliable, flexible, and better qualified
than and they are able to pay them lower wages than comparable UK born workers.
 Migrants attracted for economic reasons. Even though it is poorly paid within a UK
context, it pays a better wage than a job in many migrants’ home countries.
 Also choose the care sector out of genuine desire to help, as a method of improving
English skills, and as a way to move to the UK.
Why are migrants so prominent in this sector?

12. “We don’t have a skill shortage coming up to
2030, we have it now. Why do we think it’s hard
to get people into this job? Well I think, for one, it
is hard work for most people… and people don’t
want to do that if they’re being paid less than the
minimum wage.”
Manager of care agency
Selected quotes

13. “We don’t have a skill shortage coming up to
2030, we have it now. Why do we think it’s hard
to get people into this job? Well I think, for one, it
is hard work for most people… and people don’t
want to do that if they’re being paid less than the
minimum wage.”
Manager of care agency
“The minimum wage for that job is not
enough. And there are a lot of agencies
that pay minimum wage to the
employees. Maybe that’s why one day
there won’t be enough staff for this job
because no one wants to do that job for
that amount of money. It’s a very difficult
job.”
Female, 27, from Bulgaria, who works for
a homecare agency
Selected quotes

14. “We don’t have a skill shortage coming up to
2030, we have it now. Why do we think it’s hard
to get people into this job? Well I think, for one, it
is hard work for most people… and people don’t
want to do that if they’re being paid less than the
minimum wage.”
Manager of care agency
“The minimum wage for that job is not
enough. And there are a lot of agencies
that pay minimum wage to the
employees. Maybe that’s why one day
there won’t be enough staff for this job
because no one wants to do that job for
that amount of money. It’s a very difficult
job.”
Female, 27, from Bulgaria, who works for
a homecare agency
“It is a hard sector to work in and sometimes,
because of our background, we are used to things
like that, so we don’t think it’s anything, so we do
it. We are thorough. We are committed. We do it
well even when it is hard.”
Female, 51, from Nigeria, works in residential care
Selected quotes

15. Start with the simple notion that in order to adequately meet future
demand for care we must keep the ratio of care workers to those aged
over 65 constant over time.
Then we make certain assumptions regarding future workforce
participation in the care sector (gradual increase/gradual decline)
Apply different ONS population projections based on high, central and
low migration variants.
Calculate the care gap (the extent to which supply fails to meet demand)
under the different migration and workforce participation scenarios.
How do we get there?
The long-term workforce challenge

16. Critical assumptions for scenarios
Sector unattractive, low migration
 ONS low migration population projection for England.
 Proportion of the current working age population who work in the care sector falls by 0.04%
per annum for the next twenty years.
Sector unattractive, high migration
 ONS high migration population projection for England.
 Proportion of the current working age population who work in the care sector falls by 0.04%
per annum for the next twenty years.
Sector attractive, low migration
 ONS low migration population projection for England.
 Proportion of current working age population who work in the adult social care sector
gradually rises by +0.04% per annum up to 2037.
Sector attractive, high migration
 ONS high migration population projection for England.
 Proportion of current working age population who work in the adult social care sector
gradually rises by +0.04% per annum up to 2037.

17. Gaps by 2037
Sector unattractive, low migration
1.05 million
Sector unattractive, high migration
1.00 million
Sector attractive, low migration
0.43 million
Sector attractive, high migration
0.35 million
How the workforce gaps evolve over the scenarios

18. Some key takeaways from the scenarios
 Current status quo - which seeks to curb migration +
continue to underfund care - could lead to substantive
care workforce gaps.
 Alternative approaches seeking to plug gap either
through migration, or, separately by increasing the
attractiveness of the sector unlikely to succeed.
 Need to raise both the attractiveness of working in care
for UK born workers and encourage more foreign born
workers. But still 353,000 gap.
 Only substantive policy change including dramatic shift
in the perceptions of UK born workers about working
in the care sector can ensure we close the gap
altogether. Otherwise greater reliance on informal
care giving.

19. Policy recommendations: short term
 Skilled care worker roles, including senior care worker, be included in the current
Migration Advisory Committee’s Tier 2 Shortage Occupation List.
 Non-EU migrant care workers who have entered the care sector through Tier 2
should be exempt from £35,000 income threshold.
 Tier 3, which is for low-skilled workers filling temporary labour shortages, be
opened up for care workers in order to help the sector meet immediate staffing
needs.

20. Policy recommendations: medium to longer term
 Step up to adult social care: Intensive Postgraduate Diploma to equip
future generation of adult social care workers with the right mix of
knowledge and practical skills to drive the sector forward.
 Care-prentices: Offering care-prentices – structured on the job training
with formal mentoring and support for those over 50 – could be one
way to entice older workers into the sector.
 A national campaign to attract more male care workers: Government
and industry could work together to deliver a joint campaign calling out
for more male care workers.
 Support for informal carers: With more emphasis on informal care
likely there is clear case for providing better support for unpaid carers
to alleviate the financial, mental and physical costs that they can face.

22. Policy recommendations: improving funding arrangements
 Underfunding contributes to many of the workforce challenges
highlighted in this report. It limits the resources available for
providers to invest in their staff and recruitment.
 Agree with the principle of a single ring-fenced budget for health
and social care. However, integration must not result in both health
and social care fighting over one increasingly limited pot.
 Recommend creation of an independent committee to continually
monitor current and projected health and social care needs at the
national level and to recommend future funding levels.

23. Many thanks
Ben Franklin and Cesira Urzì Brancati
International Longevity Centre - UK
benfranklin@ilcuk.org.uk
CesiraUrziBrancati@ilcuk.org.uk
02073400440
Twitter: @ilcuk @bjafranklin

24. Dr Shereen Hussein
Principal Research Fellow
King’s College London
Response to Research
This event is kindly supported by Independent Age

25. Response: Migrants and social
Care
Dr Shereen Hussein
Principal Research Fellow
King’s College London

26. 19/11/15 shereen.hussein@kcl.ac.uk 26
Social care and migrant labour
Past Present Future
• Reliance on migrant workers is not a new
phenomenon
• But many changes has been happening
• Including changes in the profile and
characteristics of migrant workers
• How did we get here links to how social care work
has evolved

27. Narrative from the front line
Of course, it’s a national problem. I mean, the health
service is full of agency staff … with the free movement
of labour in Europe, you are getting nurses that have
trained in Romania, Poland, Bulgaria, they are not of the
standard that I would accept.
….. The best group, that is the Filipino nurses. They are
amazing. We’ve had quite a lot of students, brilliant.
That has sort of died down now, really. I don’t know why
that is. I don’t know whether again, immigration is a lot
stricter.
Manager, nursing home, LoCS T3 - 2015
19/11/15 shereen.hussein@kcl.ac.uk 27

28. 19/11/15 shereen.hussein@kcl.ac.uk 28
Reliance on migrants is partly due to the
inability of the sector to attract enough
quality staff
•I think women migrant workers will be
channelled into private nursing homes, private
old peoples’ homes, because they could be paid
minimum wage, not going to make a lot of
demands, work hard and work shifts, being
available.
Residential care home manager, 2011

29. 19/11/15 shereen.hussein@kcl.ac.uk 29
Which has a lot to do with the level of
investment we put in the sector …
• The value we place on social care as a society
• How adequately social care is funded
• the state funds between 20 to 25% of adult social care only
• How we treat care workers: poor wages; increasingly
fragmented work; lack of employment protection .. General
casualization of work
• Commodification of care
• With no or little consumer choice – a commodity that you are forced
to buy ..

30. 19/11/15 shereen.hussein@kcl.ac.uk 30
How sustainable is social care provision?
•Think short, medium and long term
•Projections of demand are escalating
•Migrants will continue to play an important role
• Around 20% of the workforce, rising to nearly 50% in the
capital
•There is a global and European competition on
migrant care workers
•Enable the sector to maintain its ability to select and
retain quality migrant workers
• at least for the short to medium term

31. 19/11/15 shereen.hussein@kcl.ac.uk 31
In the long term .. the only option is to
make social care work a desired and
respected job that..
• Attracts a broad range of British people
• The young, the old and the in-between
• offers a secured line of work .. (not temporary or vocational)
• Improved contracts with secured rights and employment
benefits
• requires a clear set of recognised skills
• Enabling a fluid transfer of skills between health and social
care
• Creating opportunities for specialism and higher qualifications
• rewarded both through decent wages but also other support
mechanisms

32. 19/11/15 shereen.hussein@kcl.ac.uk 32
Key points
•Current state of funding social care is not sustainable
•Care workers, both British and migrants, should be
rewarded adequately to improve severe turnover and
vacancy rates
• Not only pay needs to be improved by employment terms
and conditions
•Older people and their families need to have a say of
how care is organized and delivered
•Quality care is a ‘right’ not an option for British older
people

33. Shereen.hussein@kcl.ac.uk
0207 8481669
19/11/15 shereen.hussein@kcl.ac.uk 33
THANK YOU FOR
LISTENING

34. Madeleine Sumption
Director
The Migration Observatory
Response to Research
This event is kindly supported by Independent Age

35. Discussion and Q&A
• Research Findings: reflections and challenges
• Impact on Migration Policy: is it just marginal, or will it have a major
effect on workforce supply?
• Attractiveness of the care sector: what would help boost the
attractiveness of the care sector to the degree the research
highlights is required?
• Next steps: what would make the greatest practical differences to
closing the care workforce gap, and to what extent can we look to
alternative models of caregiving to help plan for the future?

36. Migration and Social Care Report
Launch
Thursday 19th November 2015
This event is kindly supported by Independent Age