Memorandum submitted by the English Community
Care Association
The new PBS has the potential to cut off completely
access to non EEA staff working as carers and senior care workers
(SCWs) in independent care homes.
Independent care homes provide care for over 400,000
people and are an absolutely vital resource to the whole health
and social care system. Without care homes, the NHS would be unable
to function properly and admissions to and delayed admission from,
hospitals would increase dramatically.
Care homes are bound by a national statutory
regulatory structure imposed by government, which states that
50% of all carers must have NVQ2. This however, is the minimum
and paints a false picture of the overall skill base of carers
and senior care workers. It limits, wrongly in our view, the application
of Tier 2 of the PBS to carers and senior care workers and will
prevent the entry of non EEA staff to work in these roles. However,
carers and senior carers have many other skills over and above
NVQ2. They must adapt and learn to provide care meeting new and
changing policy requirements for example around dignity, nutrition,
infection control and Mental Capacity Act requirements to name
a few.
The sector is seriously underfunded, limiting
the ability of care homes to pay increased wages for those who
actually take NVQ3. Pay differentials between those with NVQ2
and NVQ3 qualifications are minimal and do not provide any incentive
to take the higher NVQ. Skills for Care, Chief Executive, Andrea
Rowe was quoted in Community Care magazine on 23.8.07 as saying,
" Pay differentials between care workers and senior care
workers in the independent sector mean it is not worth staff taking
an NVQ level 3 to gain promotion"
The MAC should be required to consider carer
skills in the round rather than simply rule out access to Tier
2 because of a national minimum standards framework set out by
government that the sector have a minimum 50% of care staff trained
to NVQ2.
70% of care in independent care homes is funded
by the state through local authorities and the NHS. Independent
evidence through costs of care models around the country shows
that care homes are seriously underfunded by council and NHS commissioners.
The majority of care home costs relate to staff and the shortfall
in funding forces the sector to pay low wages. The result is that
UK and to a lesser extent EEA staff are sometimes reluctant to
take jobs in care homes. Non-EEA staff have however taken on these
roles and provide an excellent, high quality and consistent resource
to residents and care homes.
If non EEA staff are prevented from working
in care homes under the PBS there could be a crisis in terms of
care home closures and reduced capacity in some areas of the country.
Attached is a briefing sent to the MAC setting
out our concerns re carers and SCW's and stating that they should
be placed on the shortage occupation list for Tier 2. A follow
up meeting with the MAC effectively stated that as the national
minimum standards set a NVQ2 framework for the sector then no
evidence could be considered as carers were largely not NVQ3 qualified.
ECCA disputes this approach (see above).
The Department of Health recently published
an interim statement on the workforce strategy it will be publishing
later this year. It notes that the social care sector needs a
skilled and competent workforce to deliver personalised high quality
care. The position of the MAC is in essence that carers and senior
carers who provide skilled difficult work to people in great need,
are "unskilled"
If there is no Tier 3 then the route for bringing
in carers at this level has also been closed off. This is of extreme
concern to care homes. Where will the workforce to meet current
and increasing demand to cope with growing numbers of older people
come from? In addition the expected number of people over 50 with
learning disabilities is expected to also increase by 53% between
2001 and 2021.
Many recruitment initiatives have been undertaken
by the sector, but this has not meet demand. Care homes recruit
first from the UK and EEA and then non EEA countries because they
have to. There is no choice, but to follow this expensive recruitment
route.
Even the MAC has acknowledged that in some sectors
public funding constraints mean wages cannot increase to encourage
more UK applicants for jobs. The health and social care sectors
are mentioned specifically by the MAC in this respect. Despite
this no help has so far been offered to help the sector meet the
demand for carers.
We need a joined up approach across government
that ensures the call from the Department of Health for a highly
skilled competent and caring workforce in social care is actually
funded and, that the work carers in particular undertake, is recognised
and supported within government policy making and implementation.
July 2008
Appendix
1. INTRODUCTION
1.1 The leading associations representing
independent care providers for adults in England, The English
Community Care Association (ECCA), National Care Association (NCA),
and Registered Nursing Homes Association (RNHA) have come together
to present this paper to the Migration Advisory Committee (MAC)
setting out a case for including both Senior Care Workers and
Care Workers on the shortage occupation list for Tier 2 of the
Points Based System.
The associations believe that both the Senior Care
Worker and the Care Workers role are skilled occupations for which
UK and EEA applicants are in short supply. We believe migration
from non EEA countries is a reasonable and sensible approach to
meet the shortage. Indeed the care sector already depends on such
workers to meet the skills gap. It is the view of care providers
that in the main these workers offer qualified individuals, with
a caring attitude and nature, and more important relevant qualifications
and expertise together with good language skills to ensure residents
receive the care needed.
1.2 Non EEA migrants also tend to stay in the
first place of employment and as such develop significant expertise
and provide a valuable service to the care homes in which they
work. They also tend to stay in the UK for the entire duration
of the assignment thereby providing a valuable service.
2. CONTEXT
2.1 The independent care sector is of fundamental
importance to the whole health and social care system in this
country. Without this vital sector the NHS and Local Authorities
(LA's) would not be able to function. Independent care homes and
homecare providers provide the support, care and treatment necessary
to ensure that many thousands of people are not admitted to hospital
unnecessarily and can be discharged from acute care speedily.
The funding for the care given in this sector comes
largely from the state. 70% of care in care homes is funded through
local authorities and PCT's, and therefore the levels of care
applied and the basis of pay, training and other staff terms and
conditions is based on what can be afforded through state funding.
It has been demonstrated through national costs
of care models that care, particularly in care homes for older
people, has been and continues to be seriously under funded. This
limits the options open for care home employers in terms of the
salaries they can offer staff, for what is often complex and physically
and emotionally difficult work.
It is not surprising therefore, that this is
a sector that is characterised by low pay and which has recruitment
and retention problems.
For a number of years migrant workers from non
EEU locations have supported the care sector in ensuring it can
continue to provide the care needed for the most vulnerable of
our society. Withdrawal of the ability to recruit from this source
of labour could bring severe disruption to this sector resulting
in home closures, and a drastically reduced level of service within
those care homes that are able to withstand this significant challenge.
This position was outlined by the Commission
for Social Care Inspection in a letter to the Border and Immigration
Agency in February 2007. CSCI stated
"the consequences to social care providers
of closing off a recruitment avenue could be dire, especially
if the number involved is around 20,000, as was quoted by your
colleagues.
In light of the above, I believe that the Ministerial
submission should clearly spell out the consequences of closing
off a potential recruitment avenue for social care employers|||."
This is a situation, which is neither desirable
for residents, their families nor staff or for the NHS and Local
Authorities who will be forced to meet the needs of those previously
cared for in the independent sector. The situation of "revolving
doors" in the NHS would establish significant demands that
would have a dramatic impact on the ability of the NHS to continue
to provide services and it would increase dramatically the degree
of bed blocking within NHS facilities.
Underlying this is the expected growth in the
numbers of older people and those who will have debilitating conditions
such as dementia. Similarly the drive to increase the level of
expertise and training that carers require, especially those dealing
with people with dementia will require a significant increase
in the availability of staff and individuals that can supply such
a level of service.
It can be argued that migration is not the only
answer to the above problems. The trade associations accept that
higher wages could possibly ensure more UK and EEA recruits, but
while state funding remains inadequate then this solution is simply
not feasible. Indeed, the MAC report accepts this situation and
notes on page 30:
"We need to consider the case for facilitating
migration to help provide certain services at relatively low cost.
For example, the NHS and social care sector for example may not
be able to raise wages significantly to attract more local workers".
We believe that independent care homes in particular
should be considered by the MAC as being within the categories
mentioned above. Indeed far more so than the NHS, which has seen
considerable increases in funding in recent years. We have a list
of nearly 70 Local Authorities and a good number of PCT's who
are currently proposing no fee increase or a minimal fee increase
for care homes from April 2008/09. None of this allows homes to
effectively consider better financial and other rewards for staff,
which in turn might encourage more UK/EEA recruitment.
3. SKILLS
3.1 Care workers are required to undertake
important and difficult work. People in care homes depend on care
workers to undertake extremely personal care tasks, many of which
require a caring nature and the ability to administer medication,
provide physical intervention to mobilise etc, and to provide
support and encouragement to promote independence. Residents may
have complex health, physical and mental conditions that need
the ability to work with people in a caring manner, sometimes
in instances of personal aggression. These duties require considerable
understanding and the availability of well trained staff.
On joining the care home workforce carers must undertake
induction training which covers:
— Health and safety requirements.
— Moving and handing equipment and
tasks.
— Person centred approaches including
knowing how to use an individual care plan.
— Ability of staff to work in close
relationship related to issues of raising and going to bed, bathing,
toileting, personal hygiene etc.
— Ability of staff to work in close
relationship related to issues of mental health, insecurity, confusion
and even aggression.
— Recognising and responding to abuse
and neglect.
— Issues of mental capacity.
— Policies and procedures of the employer.
— Infection prevention and control.
— Importance of communication and communication
techniques.
— Understanding of medication.
— Support and supervision arrangements.
— Knowledge and skills development.
— Promotion of values including rights,
privacy and dignity.
— Equal opportunities and respecting
diversity.
The National Minimum Standards (NMS) laid out
under the Care Standards Act includes standards on staffing and
qualifications. Care Homes since December 2005 are expected to
have a minimum ratio of 50% of their care staff NVQ 2 qualified.
None of the legislation nor NMS specifies or defines the role
of a Care Worker or Senior Care Worker by component functions,
responsibilities and/or qualifications.
In addition the care worker must by law meet
the General Social Care Council Code of Conduct for a competent
workforce
3.2 It is government policy to raise the
status and skills of the social care workforce. A Workforce Strategy
is being prepared, which will recognise the need to support this
workforce in attaining the skills and competence necessary to
undertake the demanding work required of it.
The government is also proposing that social
care workers are registered with a workforce regulator, the General
Social Care Council, to ensure that they both receive the recognition
and status they deserve, but also that this workforce maintains
its skills/knowledge set through regular updating and training
in order to stay on the register.
It would be completely inappropriate to suggest
in this context that care workers are not skilled occupations.
4. SHORTAGE
4.1 Care providers report that they consistently
struggle to recruit care workers of all levels and in particular
Senior Care Workers. Local government and the NHS are large competitors
for staff, but are able to pay higher salaries because of more
government funding directed into these services than that given
to independent sector providers.
4.2 Providers equally struggle to recruit from
the EEA. Some providers have reported that during repeated adverts
through Job Centre Plus in EEA they have no response whatsoever
from EEA sources. Other care providers report that whilst some
jobs have been able to be supported by EEA immigrants there is
not sufficient supply of EEA workers that are suitably qualified,
to undertake carer roles. Therefore whilst employment opportunities
have been there for EEA workers they have chosen not to enter
care worker employment, whereas the non-EEA have been motivated
to apply and have proved to be both caring and competent.
In addition, cultural and language barriers
are also significant in this group of staff. A good knowledge
of English is absolutely vital to ensure safe and good quality
care to vulnerable people. Providers report that people from non-EEA
countries often have a higher standard of English, with proven
experience and suitable qualifications which enables them to give
more appropriate care to individuals as soon as they arrive in
the UK. The lack of ability to communicate clearly has been the
centre of a growing number of adult safeguarding inquiries conducted
by local authorities in respect of care homes.
4.3 The sector has instituted many recruitment
and retention initiatives, which include widespread advertising
including in Europe, the care ambassadors scheme, close working
with local authorities, supporting people back into the care workforce
to name a few. This has to be set alongside the fact that the
changing demography in this country and the exponential growth
in the numbers of over 85's means that a growing workforce will
be required to meet demand for care.
4.4 In addition, the government wishes to
change the way in which social care is given and have launched
a wholesale transformation of social care—"Putting
People First".
It is the intention of this personalisation
policy that many more state funded people will organise their
own care through direct payments (DP's). In essence, DP's will
be used by people to employ their own carers to give support and
care within their own homes. The result of this policy shift will
also be that a huge growth in the social care workforce will be
needed to deliver this care in people's own homes. We do not believe
that current care needs, let alone future care needs, can be met
from the resident UK/EEA workforce, particularly when this is
a poorly funded sector.
This approach when related to the changing demographics
and the drive to provide more suitable care to the increasing
number of residents with dementia, establishes a significant increase
in staff requirements in a market that already struggles to fill
available jobs and vacant positions. This potential scenario can
only impact on the number of homes that fail to meet CSCI staffing
levels and may also sadly increase the number of Safeguarding
Adult issues than exist at present.
5. CONCLUSION
5.1 This is an extremely large and diverse
sector currently estimated to be employing over a million workers.
There are estimated to be 27,000 provider organisations providing
over 420,000 care beds and 800,000 recipients of community based
services. These employers provide the bedrock of long term care
for adults in the country.
Without this sector the Local Authorities and the
NHS would not be able to function and government policy in improving
public services in these areas would fail.
A skilled and competent workforce is required
to meet the support and care needs of dependent adults and it
is the government's intention that these skills be properly recognised
and that this workforce be registered alongside social workers
and nurses.
Migration from non EEA countries is therefore
absolutely necessary to ensure care needs can be met and sustained
high quality care given to the most vulnerable of our society.
We look forward to discussing these issues in
more detail with the MAC and to seeing care workers being placed
on the Shortage occupation List for Tier 2 of the Points Based
System.
July 2008
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