Background to the research
The potential impact of Brexit on the UK workforce has been a prominent theme of political and economic discourse since the result of the European Union ( EU) referendum was first announced in June 2016. To date much of the discussion has focused on the NHS and there has been comparatively less attention paid to the potential impact on the social care sector.
However, scenario-based modelling by the charity Independent Age has suggested that, even in the event of a softer Brexit and the care sector remaining attractive to EU workers, the Government’s commitment to reduce levels of net migration could leave the care sector in England with a workforce gap of more than 750,000 people by 2037  . In light of such evidence, the Scottish Government commissioned Ipsos MORI to conduct research aimed at providing an assessment of the contribution of non- UK EU27 workers in adult social care and children care services in Scotland, and the extent to which it had become easier or more difficult to recruit and retain these workers over the last year. The specific objectives of the research were two-fold:
1) to provide robust estimates of the number of non- UK EU workers in specified adult social care and childcare sub-sectors (adult day care, care at home, day care of children, childminding, housing support, and nurse agencies).
2) to provide insights into the specific roles and contributions of those workers from the perspective of both employers and non- UK EU workers.
The research comprised two consecutive strands: a mixed-mode survey of 1,572 employers from across the social care sector; and follow up qualitative interviews with 20 employers who took part in the survey, as well as with 10 workers.
The survey ran from 10 January to 16 February 2018. The qualitative fieldwork took place between 19 March and 25 April 2018.
The size of the non- UK EU workforce
The estimate of the percentage of people employed within adult social care and childcare that are non- UK EU nationals is 5.6% (including 0.2% who are from the Republic of Ireland). Overall, there are around 176,000 people working within adult social care and childcare. The prevalence estimate of 5.6% equates to 9,830 workers.
The estimate varied by sub-sector, ranging from 0.3% for childminding services to 16.5% (+/- 11.3%) for nurse agencies, with the remaining sub-sectors between 3.8% and 6.8%. In terms of absolute numbers of staff, the sectors with the most non- UK EU staff were Care Home for Adults (3,150), Housing support/Care at Home (2,850), and Day Care of Children (2,290). The sectors with the fewest were Childminding (20) and Adult Day Care (300).
In both percentage and absolute terms, non- UK EU workers were more prevalent in private sector services (6.4% +/- 1.6%; 5,410 staff), than in voluntary sector services (5.4% +/- 1.8%; 2,730) and public sector services (3.7% +/- 2.1%; 1,510). (Here, as throughout the report, differences between sub-groups have been commented upon only where these are statistically significant; that is, where we can be 95% certain that they have not occurred by chance).
Non- UK EU staff were more prevalent among NMC-registered nurses, auxiliary staff and care staff than managers and other staff. Around 7.3% of NMC registered nurses (+/- 1.2%), 5.9% of care staff (+/- 1.1%) and 5.7% of auxiliary staff (+/- 1.1%) were from non- UK EU countries. The corresponding percentage for managers was lower at 3.7% (+/-0.9%).
In terms of NUTS2 regions, non- UK EU staff account for the highest proportion of care staff in the North East (9.1% +/-4.3%) and the East (7.8% +/- 2%), compared to in the Highlands and Islands (3.8% +/-2.7%) and the South West (3.5% +/-1.3%).
Urban rural threefold classification was calculated using postcode data. The proportion of non- UK EU staff is 4.9% (+/- 4.9%) in remote rural Scotland, 5.6% (+/- 3.5%) in accessible rural Scotland, and 5.7% (+/- 1.4%) in the rest of Scotland.
Perspectives on recruitment and retention
The survey highlighted that the perceived ease of recruiting staff varied significantly depending on the types of post being recruited for. Over half (51.7%) of those who had tried to recruit NMC registered nurses and over two in five (44.2%) of those who had tried to recruit care staff or practitioners said the process had become more difficult in the last year; this compared with the 21.1% who said the same about recruiting auxiliary staff and the 19.4% who did so about recruiting managers.
The results for auxiliary posts showed some variation by sub-sector: respondents working in care homes for adults and housing support/care at home services were over two times more likely than those working in nurse agencies to report increased difficulties recruiting for such posts (22.6% and 22.4% versus 8.8% respectively).
Similar sub-sectoral variation was evident in respect of care staff or practitioner posts. Respondents working in day care of children and housing support/care at home services were more likely than those working in adult day care services and nurse agencies to report increasing difficulties recruiting for these posts (48.0% and 47.2% versus 30.5% and 24.1% respectively). Respondents working in private sector services were also more likely than average to report increased difficulties recruiting such staff (51.8% versus 28.8% of those working in local authorities and 44.3% of those working in the voluntary sector).
Difficulties recruiting NMC registered nurses had been felt most acutely among respondents working in care homes for adults and nurse agencies (66.4% and 52.4% versus 15.7% of those working in day care of children and 29.5% of those working in housing support/care at home services respectively). And, again, respondents working in the private sector were more likely than those working in local authorities and the voluntary sector to report increased difficulties (65.7% versus 13.5% and 15.9% respectively)  .
For managerial posts, there was no sub-sectoral variation in the results but, here too, respondents working in the private sector, along with those working in the voluntary sector, were more likely than their local authority counterparts to report increased difficulties (27.0% and 18.1% versus 8.5% respectively).
Notwithstanding the varied general picture reported above, the majority of managers reported no change over the last 12 months in the number of applications they had received from non- UK EU27 nationals. The proportion reporting no change ranged from 63.0% in the case of applications for care staff or practitioner posts, to 85.2% in the case of managerial posts. Indeed, in respect of care staff and practitioner posts, 15.1% of managers reported having received more applications from non- UK EU nationals over the last 12 months.
In terms of retention, over four in five respondents reported that there had been no change over the last 12 months in the ease with which they were able to retain auxiliary staff (81.7%), managers (85.5%) and ‘other’ types of staff (82.8%). Fewer, though still a majority, said the same in respect of NMC registered nurses (70.3%) and care staff or practitioners (66.6%). Still, it was notable that just over a quarter (25.7%) reported increased difficulty retaining care staff or practitioners.
Respondents working in care homes for adults were more likely than average to have experienced increased difficulties retaining NMC registered nurses over the last year (24.2% versus the average of 18.0%), and those in the private sector were more likely than those in other sectors to report increased difficulties retaining all types of staff.
With respect to the retention of non- UK EU staff specifically, the results were again more positive than the general picture. Around eight in ten respondents reported no change in the ease with which they had been able to retain non- UK EU registered nurses (82.1%) and care staff and practitioners (84.1%). Around nine in ten said the same about non- UK EU auxiliary staff (88.3%) and managerial staff (91.4%). The proportion reporting that it had become more difficult to retain non- UK EU staff was consistently below the 10% mark, ranging from just 2.5% in respect of managers to 8.2% for care staff or practitioners.
Although most care service managers who took part in the survey had not experienced increased difficulty recruiting and retaining staff in the last 12 months, the qualitative research confirmed that staffing was nonetheless a significant challenge for the sector.
Managers discussed recruitment challenges in terms of both the numbers of applications they received for posts and the quality of candidates. On numbers, and consistent with the quantitative findings, there was particular mention of a lack of applicants for nursing posts. In terms of quality, participants commonly said that applicants often had no suitable qualifications and, indeed, appeared to see care work as an easy option.
In terms of other factors participants identified as having contributed to recruitment challenges in the sector, low pay was commonly mentioned. In contrast, the UK’s decision to leave the EU was cited spontaneously by only a small number of participants. These were all managers of services, the specific circumstances of which meant they had a long tradition of employing, and/or were unusually reliant on, non- UK EU staff.
Consistent with the survey findings, few managers who took part in the qualitative research reported problems with staff turnover at their service. That said they were sometimes quite qualified in their comments, saying, for example, that there was "room for improvement" or that their situation was "not as bad as some".
Further, they often described having two broad ‘streams’ of staff: an older grouping that had been with the service for a long time (usually between 10 and 20 years) and a younger grouping, members of which tended to stay for shorter periods, whether because they proved not to be suitable for their roles, because they found the work too challenging or because they saw it purely as a ‘stop gap’. There was a sense from some of the interviewees that the number of staff not up to the job, or finding the work too challenging, was increasing somewhat.
As with recruitment, pay was commonly identified as another factor contributing to staff turnover, with managers and workers recounting occasions when members of their team had gone to work for higher paying providers – in particular, a few private sector managers and workers said that some of their staff/colleagues had gone to work for local authorities.
Brexit was not mentioned spontaneously as a factor currently impacting on retention.
Generally, managers felt that difficulties in recruiting or retaining staff were having a negative impact on their services, compromising the provision of care and putting a strain on their time and resources. Most managers that had encountered such difficulties had taken some steps to try to address them. The single most common such step was the use of agency staff but this was not seen as a viable long-term solution due to the greater costs associated with employing agency staff. In terms of longer-term steps managers had taken, the most common was to have enhanced or increased their service’s training offer.
Steps managers had taken to try to limit staff turnover in their services included enhancing the induction process to include monthly one-to-one meetings with staff members to help them settle in; and improving pay and other conditions. They felt these strategies had been largely effective.
While only a small number of the qualitative participants spontaneously identified Brexit as a factor currently impacting on recruitment in the sector, more were concerned that it may impact on recruitment and retention in the future. As might be expected, managers whose services had a relatively high ratio of EU to local staff were the most likely to express this concern.
There was a sense in which some managers felt the contribution of their EU workers was greater than their basic numerical representation might suggest. Specifically, managers spoke of these employees’ strong "work ethic", exemplified through a willingness to ‘go the extra mile’ to get the job done and to continually learn and develop. Relatedly, managers sometimes said that non- UK EU workers appeared to be motivated by an "ethos" of care, manifest in a high level of commitment to their work. Less commonly, there was reference to non- UK EU workers being more highly qualified and/or experienced than local applicants. This perspective was advanced mainly by managers of childcare services, who described how their EU workers often had specialist degrees in childcare or in teaching.
All of the non- UK EU workers interviewed were keen to remain in Scotland for the foreseeable future. All had begun considering applying for UK citizenship, though there was evident confusion about the temporal eligibility criteria. Awareness of ‘settled status’ as an alternative to citizenship was low.
Both managers and workers displayed at best a limited awareness of the UK Government’s and European Commission’s current position with respect to the future status of EU workers in the UK. Further, there was repeated reference to a lack of information on the subject that might enable services and workers to plan ahead. In the perceived absence of information and planning from government, none of the managers interviewed had formally taken steps to prepare for Brexit.
Both managers and staff were asked what they thought could be done to attract more people to work in the social care sector. In response they commonly suggested emphasising: the meaningful and rewarding nature of the work, and the impact it can have on people’s lives; the opportunity to learn new skills; and the flexible hours available.
In terms of other measures or changes they thought might encourage more people to work in the sector, better pay was frequently suggested, along with improvements to the overall benefits package, and efforts to improve public perceptions of the sector.
The estimate of the percentage of non- UK nationals employed within adult social care and childcare services in Scotland emerging from this study is in line with that recorded in some previous research, at 5.6%. This aggregate result conceals some notable sub-sectoral variation, however; in particular, the higher prevalence of non- UK EU nationals in nurse agencies (16.5%) (as well as in auxiliary and care roles).
These results take on added significance in the context of the survey finding that half of services that had tried to recruit NMC registered nurses over the last 12 months, and around two in five that had tried to recruit care staff or practitioners, had found this more difficult than previously.
While the survey suggested that retention was somewhat less of an issue than recruitment in the sector, it was nonetheless notable that 25.7% of respondents reported increased difficulty retaining care staff or practitioners – another group among whom non- UK EU nationals are relatively prevalent. As in respect of recruitment, the problem appeared most acute in the private sector.
In respect of the recruitment and retention of non- UK EU staff specifically, the survey findings were somewhat more positive than those for workers in general. And while respondents did report non- UK EU workers having left their service in the last 12 months, Brexit-related concerns appeared to have been a factor in only a small number of these cases.
The qualitative research reinforced the survey findings that Brexit appeared to have had a limited impact on the sector to date. Nonetheless it did point to concerns that Brexit could prove more of a challenge in the future, with both managers and workers unsure as to what had been decided thus far. These findings suggest a clear need for both audiences to be provided with more information about the UK Government and European Commission’s agreement on the matter.
Beyond the Brexit issue, the qualitative research highlighted other ways in which the sector might best be supported to meet current, and potential future, recruitment- and retention-related challenges. Asked what they thought could be done to attract more workers to the sector, managers and employees suggested campaign work to raise the profile and reputation of the care sector, with messaging focusing in particular on: the importance and rewarding nature of the work; the provision of training and the opportunity to learn new skills; and the flexible hours available in many types of service. They also called for higher pay for workers at all levels, but particularly ‘frontline’ staff.
In addition to these suggestions made by participants themselves, the qualitative research pointed to an evident need for more guidance for managers on effective recruitment strategies to ensure higher quality applicants and thereby reduce the burden of the process on services; as well as greater sharing of best practice in respect of training, development, and other strategies to promote retention.