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Immigration Issues for the Health & Social Care Sector

Among the challenges presented by the UK’s departure from the EU is the impact on international recruitment of health and social care providers that rely on staff who are EU nationals.

With the UK now having officially left the EU, the imperative for the health and social care sector is to ensure preparation and readiness of workforce planning for the end of the transition period.

 

End of EU free movement 

The end of EU free movement in 31st December 2020 and the introduction of a new immigration system in 2021 is adding to an already competitive hiring environment for care providers.

Vacancies in adult social care are rising, currently totalling 122,000, with around 9 per cent of care worker roles unfilled. International recruitment is a key factor in addressing these vacancies.

While the policy of EU freedom of movement and mutual recognition of professional qualifications within the European Union had allowed care providers to build a reliance on care workers and healthcare professionals from EU countries, Brexit and immigration policy are already impacting the ability of social care providers to successfully fill these vacancies.

An estimated 9 per cent of the 1.3 million workers in England’s adult social care sector have come from other EU countries. Yet the availability of EU workers within the UK has continued to drop since the 2016 Brexit referendum result.

The situation in nursing is similar, in 2018/19 only 968 nurses and midwives from the EEA joined the Nursing and Midwifery Council’s (NMC) register, a decrease of 91 per cent since 2015/16. This fall has only been partially mitigated by more non-EEA nurses joining the register – their numbers increased by 126 per cent in 2018/19, with 6,157 non-EEA registrants joining during the year. As with GMC registrants the likely causes of these trends are relaxed visa restrictions, nursing being added to the shortage occupation list in 2015 and active recruitment from outside the EEA by trusts.

The consequences of these combined forces are already starting to be seen. The vacancy rate for social care workers is now three times higher than the UK labour market average, with daily staffing shortfalls of around 90,000. A 2018 study by the CIPD found that 70 percent of organisations failed to fill positions within the previous 12 months.

However, even with both EEA and non-EEA registrants taken into account, these figures are considerably below the peak of around 16,000 international nurses on the NMC register in 2001/02. Although there are other contributing factors, including the introduction of new English language requirements in 2016, Brexit has had a significant impact.

In the longer term, the potential economic impact that Brexit may continue to create could act as a powerful disincentive for health and care staff to work in social care. For example, a fall in the value of the pound would mean the money staff earn in the UK is worth less in their home country.

The government’s proposals for an Australian-style points-based system founded on skills over nationality is expected to hit the sector’s ability to hire migrant care workers further as these applicants are not expected to meet the new skills thresholds as outlined under the government’s initial proposals.

Given predicted reductions in the availability of migrant care workers, care providers are having to rethink and change their recruitment strategies with an increased focus placed on hiring UK workers. It also means greater reliance on agencies and short-term contracts to cover staffing shortfalls. These increased pressures mean that many traditional hiring processes are failing to handle today’s recruitment demands.

From an onboarding perspective, this increases the administrative demands placed on HR – having to cope with greater hiring frequency and more complex forms of employment – agencies, contractors, self-employed, freelancers.

The government published an immigration White Paper in December 2018 setting out proposals for a new skills-based immigration system to begin in 2021, which would treat EEA migrants in the same way as non-EEA migrants. It removes the limit on numbers of skilled workers, and following the MAC’s January 2020 report commissioned by the government, the annual earnings threshold is to be reduced to support recruitment of certain health professionals.

The White Paper also acknowledges England’s reliance on migrants in the social care workforce. However, it proposes that for a transitional period such workers would only be allowed to work for a limited time, with no entitlement to bring dependants. Again, this is likely to impact the ability of the social care system to attract sufficient workers. In the event of a no-deal Brexit, for an interim period EU citizens would be able to enter the United Kingdom as they do now, but if they wish to stay longer than three months they would have to apply for permission under a new European Temporary Leave to Remain scheme. People who obtain this status would be entitled to live, work and study in the country for a further three years.

One of the main priorities in the first phase of the negotiations between the United Kingdom and the European Union was clarifying the status of EU citizens currently living in the United Kingdom and of UK citizens living in other EU countries. Any EU citizen currently living in the United Kingdom, including the 165,000 EEA staff already working in health and social care, are to register the EU settlement scheme to safeguard their status in the UK. They will need to apply by June 2021 (or December 2020 in in the event of no deal) in order to be able to stay in the United Kingdom.

Separately the Prime Minister has announced that under new rules, international students will be entitled to the right to remain in the UK for two years after graduation. This will allow international graduates in medicine and nursing additional time to secure long-term employment. The previous rules only allowed four months.

In short, the impact of Brexit on the health and care workforce will depend on future migration policy and the barriers or incentives to live in the UK and work in the NHS and social care that are put forward.

The health and social care sectors have long relied on EU and other foreign nationals in all areas of the workforce and will continue to need them in greater numbers in the future. One of the key ways to alleviate the current workforce crisis in the short term is to recruit internationally; a robust and ethical infrastructure to enable health and care organisations to continue to do so will be critical.

 

Need assistance?

DavidsonMorris are established advisers to the health & social care sector. As employer solutions lawyers, we work with health & social care owners and providers to support with their full people requirements including immigration & employment legal advice and human resource consultancy. We understand the commercial and legal challenges facing employers in the sector, and work to support our clients in meeting their people management and planning needs while reducing legal risk exposure. Contact our health & social care sector specialists today.

Last updated: 2nd January 2020

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