Memorandum by COMPAS (SC 54)
SOCIAL CARE
INTRODUCTION
This evidence is submitted by researchers Dr.
Alessio Cangiano, Dr. Isabel Shutes and Sarah Spencer, CBE, at
the ESRC funded Centre on Migration, Policy and Society (COMPAS),
University of Oxford. Sarah Spencer is also Chair of the Equality
and Diversity Forum and is currently serving on the advisory group
to the Government Equality Office (GEO). COMPAS is a research
centre of excellence with expertise on migration and labour markets.
It has conducted a series of research studies on care and migrant
labour.
The evidence in this document is based on a
study conducted between Spring 2007 and Spring 2009—funded
by the Nuffield Foundation and the Atlantic Philanthropies—which
investigated the current and future demand for migrant (foreign
born) workers in the provision of older adult social care; the
experiences of migrant care workers, of their employers and of
older people in residential and home care settings; and the implications
of these findings for social care and migration policies. The
research included a survey of 557 social care providers (residential
and nursing homes and home care agencies), 56 interviews with
migrant care workers and five focus groups with older people (both
current and prospective users).
EVIDENCE
1. Migrant care workers have remained largely
invisible in debates on future social care provision. The recent
Adult Social Care Workforce Strategy surprisingly makes no mention
of their role. Nevertheless, in 2008 18% of all social care workers
in the UK were foreign born (122,000). In London, the migrant
share of the social care workforce is over 60%. The reliance on
migrant care workers has been significantly growing in the last
decade: foreign born care workers accounted for only 7% of the
social care workforce in 2001. In older adult care, 28% of care
workers recruited in 2007 across the UK were migrants.
2. The overriding reason for the recruitment
of migrants given by providers of care for older people was the
difficulty of finding UK born workers—nearly 50% of employers
reported a shortage. Recruitment difficulties were attributed
by employers to low wages and poor working conditions in the sector
and associated with low rates paid by local authorities subcontracting
care provision. The median gross hourly pay for care workers in
adult services (Dec 2008-Feb 2009) is £6.56, only slightly
higher than the National Minimum Wage (set at £5.73 in October
2008).
3. Most migrant care workers are recruited
from within the UK. Although no accurate breakdown by immigration
status is available, our estimates suggest that the migrant care
workforce comprises large numbers of people who have entered the
UK via non labour related channels—as refugees, family members,
students, working holiday makers, or on ancestral visas. Therefore,
the policy debate on migrant workers in the care sector, by focusing
only on EU nationals and non-EU workers recruited on senior care
workers visas, is partly misplaced.
4. Since the start of the recession there
has been some evidence that applications from UK-born applicants
are increasing. However, employers have reported that they may
not have the necessary skills and/or motivation for care work.
Nor it can be assumed that in the future there will be a large
supply of care workers from within the EU—inflows of Easter
European migrants have already declined and many are leaving the
UK.
5. This study found that the contribution
by migrants to the quality of care in this sector is appreciated
by employers and older people: 71% of employers agreed that migrants
have a "good work ethic", 82% that they are willing
to work all shifts and 68% that migrants are more respectful towards
older people. A majority of employers (62%) stated that the quality
of care provided by their organisation had not changed as a result
of employing migrants, and 31% thought that the quality of their
services had improved.
6. The main challenges concerning the migrant
social care workforce are:
6.1 66% of employers reported the lack of English
language proficiency as a possible challenge of employing migrant
care workers. Nuances in the language used in relation to care,
regional accents and customs of older people were reported as
particularly challenging.
6.2 41% of employers reported that migrant care
workers were not always well accepted by older people; in some
cases migrant workers referred to verbal harassment by older people
and a refusal to be cared for by them. The study found that employers
were often unsure how to manage such situations.
6.3 Self-reported national wage data (from the
Labour Force Survey) suggest that a significant proportion of
all care workers (close to one in five) may be paid below the
National Minimum Wage, with recent migrants most often in that
position. However, other data sources collected from employers
provide different estimates, making it difficult to assess the
actual proportion of the care workforce paid below the statutory
pay levels.
6.4 Migrant care workers interviewed for this
study reported discrimination and abuse of employment rights,
in terms of pay, less favourable shifts, unpaid overtime, non-payment
of tax and NI, distribution of less popular tasks, and treatment
by co-workers. They also reported little access to information
or advice on employment rights.
6.5 Live-in care workers face particular challenges
and have fewer employment rights. Those working directly for older
people were particularly vulnerable in relation to time worked
and pay. There can be a tension between the personalisation agenda,
promoting user choice and control, and the responsibility not
to discriminate in the appointment or treatment of the carer.
7. Current demand for migrant care workers
raises concerns in the light of future demographic trends. In
the UK there is currently one care worker in older adult care
for every 15 older people, and the projected increase in the number
of older people means that, other things being equal, the size
of the direct care workforce in the sector will need to grow by
400,000 over the next 25 years if this ratio is to remain at the
current level. If the current percentage of migrant care workers
in the workforce remains constant, the stock of migrant care workers
working with older people will need to increase by an average
annual growth of 3,000 migrant care workers (2.5%) to 195,000
in 2030.
8. Future demand for migrants in the care
sector will depend on whether the root causes of care worker shortages—low
pay and the low status of care work—will be addressed.
RECOMMENDATIONS
1. With regard to the future funding of
social care, efforts should be made to make care work more attractive
to the local labour force on a long-term basis by improving pay,
conditions, status and career paths. Such efforts should also
be targeted at men.
2. The Government should retain the limited
migration entry channel for senior care workers and monitor the
need for a legal channel for lesser skilled migrant care workers
if pay and conditions in the sector do not attract sufficient
and suitable job applicants within the UK. The alternative, if
employers cannot recruit legal migrants to maintain care services,
could be an increase in migrants working without permission—as
is already the case in other EU countries. The possible impact
of changes made to other immigration routes—eg for refugees,
students, family members—on the supply of migrant care workers
should also be taken into account when migration regulations are
revised. Better coordination between migration and social care
policies is needed.
3. Government and employers should ensure
that migrant care workers have access to English language provision
and adequate social care training, accommodating the hours and
shifts involved in care work.
4. The Equality and Human Rights Commission
needs to address the discrimination experienced by migrant care
workers, including guidance for employers on handling the hostility
of some older people and their families towards migrant care workers,
particularly in the light of the personalisation of social care
services.
5. There is a need to improve access to
advice and guidance on employment rights for migrant care workers.
Trade unions, professional associations, local authorities and
migrant organisations all have a role to play.
6. With regard to the personalisation of
social care services, the Care Quality Commission, and local authorities
funding home care, should monitor the implications of the employment
of migrant care workers by older people in their own homes; and
ensure that older people and their families have advice and support
in relation to their responsibilities as employers, which includes
treating staff appropriately and avoiding discrimination.
7. The contribution which migrant care workers
are making to the care of older people should be given greater
public recognition in debates on the future of social care.
November 2009
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