The impact of Brexit on the country as a whole has been a key point of discussion over the past two years as we grapple with the decisions made via a badly run and informed referendum, which tied us up in knots. Clearly, there are complex issues to unravel when a ‘divorce’ of this magnitude is being negotiated but those of us who have to remain focused on the day job are faced with the fallout of the fiasco politicians have created.

Social care is a sector which has been neglected by politicians of every colour over the past four decades. We have moved the sector from one which supported those who independently made the choice to not remain at home and took their social security allowance to a local provider for ‘board and lodgings’ in safe and comfortable surroundings, to a state led bureaucracy which assesses the individuals ‘need’ to be cared for in a service of their choice. The driver for this being an ageing population with increased care needs against a backdrop of funding challenges.

Quite rightly, the options available to those who need care and support now includes the option to stay in their own homes and be supported through homecare services, but of course with that came the need for a larger workforce and more external support being put into place to ensure that increased demands are met. This coincided with the closure of long stay wards which meant that the social care system was now faced with people whose care needs verged on health rather than the traditional definition of social care.

With a greater need for social care there is inevitably a greater need for staff working in the field. The sector, as is true of the NHS, has relied on a migrant workforce and as the need increased so did the call on foreign workers as the indigenous population did not see social care as a career option. This has been further hampered by the poor image of social care which was mitigated by increased regulations making social care one of the most regulated of all industries in the country. 

The challenge of funding in social care is equalled by the shortage of social care staff to meet the growing demands of the sector. Funding, without the workforce to deliver, is of no value. The sector is faced with vacancies with little prospect of substantial improvement:  we have become increasingly reliant on EEA nationals with a 68 per cent increase (between 2011 to 2016), and are under considerable strain with a vacancy rate of 12.3 per cent and will have to navigate a transition period in which a critical portion of its workforce considers its future.

What we need in health and social care is an immigration system which is responsive, agile and easy-to-use for both employers and those applying. The implications of Brexit has made this ever more urgent to address. It is essential that we use public service value as a key factor in assessing skill levels and setting entry requirements, rather than using salary as a proxy for skill. Currently, many social care and health jobs do not fulfil the requirements for the minimum skills or salary levels of the current non-EEA immigration.

I remain extremely concerned about whether the visa proposals in the immigration white paper will encourage the numbers of care staff we need to sustain services. The new immigration system must adjust skills and salary levels to ensure that health and social care provision can be properly staffed by the skilled staff it needs.

I believe it is crucial that all levels of government work together to review career routes within social care. In particular, I think it would be advisable to investigate the potential for opening up routes from support and social care roles into nursing and allied health professionals and vice versa.

One of the most serious consequences for health and social care of Brexit has been the debates on settled status for our migrant workforce. It is imperative that the government needs to deliver on its commitment that it’s settled status programme for EEA nationals will be honoured in the event of a no-deal Brexit. EEA nationals are vital to our sector but the number of EEA nurse joiners to the NHS in England fell by 17.6 per cent in the 12 months following the referendum and the number of leavers rose by 15.3 per cent. It is absolutely imperative we stop – or at least, slow down – the outward flow of EU nationals from our sector.

It is crucial that our workforce gaps are taken extremely seriously by those negotiating our departure from the EU. A recent report commissioned by the Cavendish Coalition shows the NHS could be short of 51,000 nurses by the end of the Brexit transition period. This is on top of existing vacancies, which stood at 41,722 (11.8 percent of all positions) at the end of June 2018. To put these figures in context, the Royal Surrey County Hospital NHS Foundation Trust employed 1,141 nurses in June 2018.

Clearly, the impact of decisions made to exit from the EU has added to the challenges faced by social care, which was already facing shortfalls in recruitment. The fact that the migrant workforce we relied on to stem the shortfalls are now themselves feeling unsure about their status is in itself unsettling. We need to ensure that the UK remains an attractive prospect for colleagues from the EU and the rest of the world.

Add to that the persistent delays in the publication of the Green Paper on the funding of Social Care which promised long term solutions meaning changes will not kick-in quickly enough for a sector struggling to recruit and retain workers.

Author: Nadra Ahmed OBE, Executive Chairman of National Care Association & Co-Convenor of The Cavendish Coalition

Photo credits: Laurence Cawley, BBC 

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The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of The Care Workers Charity