Migration Advisory Committee Call for evidence - impact of ending freedom of movement on the adult social care sector: Scottish Government response

Section 5: Impact of Ending Free Movement on Social Care in Scotland

At this early stage, after the end of the transition period, it is difficult to empirically assess the impact of the ending of free movement on the social care sector^[24]. However, we have sought to outline below the available evidence from a variety of qualitative and quantitative sources. Many of these sources of evidence refer to the most up-to-date data on the abilities of care providers to recruit and retain workforce which, while not directly measuring the contribution of EU and non-EU workers, they are a good proxy by which to measure the impact of Brexit on the sector.

Scottish Government/COSLA analysis of myjobscotland vacancies

In preparation for this call for evidence, the Scottish Government and COSLA have worked together to gather and analyse job advert data and applications data from myjobscotland. This data were combined to quantify the number of public sector adult social work job adverts and whether they were filled^[25].

The number of job adverts does not fully describe the demand on services because one job advert may be intended to advertise more than one post. Similarly, even if at least one person was hired for that job, not all posts may have been filled. It is important therefore to note that this data is therefore likely to show an under-representation of the scale of the challenge.

Overall, there were 3,773 social care job adverts on myjobscotland in 2019 and 2,752 in 2020. Of those 2019 posts, in 2,752 adverts at least one person was hired. Of those 2020 posts, in 1,614 adverts at least one person was hired. These figures give a percentage of 62% in 2019 and 59% 2020. While 2019 and 2020 percentages are similar nationally, the % fell from 70% to 60% in urban with substantial rural areas and increased from 47% to 52% in island and remote areas.

In 2019:

• 50% job adverts had an annual salary of less than £20,000. Of those job adverts, 59% hired at least 1 person.
• 73% of public sector adult social care job adverts on myjobscotland were in mainly rural or urban with substantial rural areas.
• Areas with the highest % job adverts where at least one person was hired were: urban with substantial rural areas in the £0 - £10,000 salary band (80%); urban with substantial rural areas in the £20,001 - £30,000 salary band (75%) and larger cities in the £0 - £10,000 salary band (75%). However, some of the figures in these categories were small so caution must be used when comparing the percentages.
• Areas with the lowest % job adverts where at least one person was hired were: island and remote areas in the £10,001 - £20,000 salary band (45%) and mainly rural areas in the £40,000+ salary band (55%).

In 2020:

• 44% job adverts had an annual salary of less than £20,000. Of those job adverts, 56% hired at least 1 person.
• 73% of public sector adult social care job adverts on myjobscotland were in mainly rural or urban with substantial rural areas.
• Areas with the highest % job adverts where at least one person was hired were: urban with substantial rural areas in the £30,001 - £40,000 salary band (67%) and larger cities in the £20,001 - £30,000 salary band (66%).
• Areas with the lowest % job adverts where at least one person was hired were:

urban with substantial rural areas in the £0 - £10,000 salary band (40%); island and remote areas in the £10,001 - £20,000 salary band (46%) and larger cities in the £20,001 - £30,000 salary band (53%).

It is clear that the number of jobs going unfilled in the Scottish social care sector is very significant. Furthermore, despite there being fewer jobs advertised in 2020 than 2019, a higher percentage of those jobs went unfilled. This suggests that recruiting for workers became more difficult over this period. In addition, there was a geographical variation in abilities to fill vacancies, with more jobs where no one was hired in rural and island areas. Preliminary findings suggest the job adverts where no one was hired were mainly jobs in social work and social care work with the exception of mainly rural areas, where home carers and support workers mainly went unfilled.

Scottish Care Workforce recruitment and Retention Survey

There is abundant evidence of the difficulties experienced by care providers with recruitment and staffing. SC, the organisation that represents the largest group of independent sector social care providers across Scotland, run a workforce recruitment and retention survey, which revealed that these services are not able to scale up to meet demand.

The survey results provided much needed clarity on the key issues affecting recruitment in the sector. When asked whether recruitment and retention was problematic; 87.8% responded 'Yes,' 10.5% responded 'No' and 1.7% were unsure. When asking about the roles that providers are struggling most to recruit, the top three selected were Care Home Care and Support Worker (43.6%), Care at Home, Care Staff (41.7%) Care Home Nurse (34.6%). There is almost equal challenge for Care Home and Care at Home support workers/staff to recruit

Scottish Care: A Look Into the Future – Achieving the Nursing Vision

Scottish Care also issued a nursing survey to members in late spring 2021. The responses stated that the majority (73%) of providers have found it more difficult to recruit nurses. Scottish Care posited that this may be due to deterrents from applying due to visa sponsorship. In their response to this call for evidence, Sottish Care noted that in 2018 they had warned a lack of certainty and assurance related to Brexit would have a negative impact on recruitment, and argued that these effects are now tangible. Noticeably, half of respondents felt strongly concerned about their ability to continue to recruit from outside the UK due to current paygrade barriers in the UK's points system. Scottish Care warns that although 'we have yet to see the full implication of the exit referendum, we are experiencing the short-term impact of staffing absences that would previously have been filled by migrants'.

In the same survey, 75% of nurses that are from the EU and are not UK citizens applied for settled or pre-settled status; most were aware that they could apply for the visa as they are considered skilled workers. The extent to which this applies to care staff more generally is not clear at present.

CCPS September 2021 Survey: Evidencing the Current Recruitment Picture

In September 2021, the Coalition of Care and Support Providers in Scotland (CCPS) ran an anonymised survey among its 82 registered members. The survey sought to measure the staffing level across its members, as well as the key recruitment challenges.

The survey attracted responses from over a third of the members, and although its results have not been published, they have informed discussions between the CCPS and its members, as well as with the Scottish Government. We have found it of relevance and thus will provide some key findings.

CCPS members reported serious concerns related to their ability to cover vacancies, as well as the detrimental effects that workforce shortages were having on their capacity to deliver adequate services. 90% of respondents, affirmed that recruitment had become more difficult over the last 3 months, and that the cost of recruitment had also increased in the last 2 months.

Members were asked about the impact of current recruitment challenges on their services and workforce.

Service delivery:

• 63% said they had reduced service delivery
• 7% have already returned care packages and a further 33% (n=10) have considered doing so or are considering doing so
• 53% have refused or would refuse new care packages
• 70% have increased their use of agency staff
• 10% reported an increase in reportable accidents

Workforce

• 97% said that hours for existing staff have increased
• 90% said that workload for existing staff has increased
• 83% reported lower levels of workforce wellbeing
• 70% reported an increase in staff turnover

Scottish Government engagement with stakeholders

On 30 September 2021, Scottish ministers held a round table engaging representatives from Scottish Care, CCPS, SSSC, Social Work Scotland, Scottish Association of Social Work, Carers Scotland and COSLA. Stakeholders, recognised that the issues of the skills shortages in the social care system that existed before Brexit are significantly worse now. One factor now at play is the issue of increased competition from the wider job market (especially the retail and hospitality sectors) on the ability of providers to attract and retain workers. This issue is particularly acute in rural areas (for example Argyll and Highlands) but it is also a major factor in Edinburgh. One stakeholder highlighted a particular provider in Argyll which had recently lost 10 staff to the hospitality industry.

There was considerable concern amongst stakeholders that the UK Government would seek to implement a "quick fix" to the immigration system to address severe staff shortages, such as a temporary visa system similar to the one that the UK Government has introduced for HGV drivers. Stakeholders stressed, there was a need for a fundamental, long-term change to the points based system (which one stakeholder defined as "not fit for purpose") which allows providers to access the skills that they need in a flexible way. This should include re-examining the SoL and fundamentally reviewing how a "skilled worker" is defined.

It was highlighted by more than one stakeholder that immediate action is needed on these issues and that the current system lacks the flexibility to deal with such changes to the market. Indeed, the MAC's current review itself was highlighted as an example of how the system simply cannot deal with a situation of acute labour shortages. By the time that the MAC reports in spring 2022, the damage to social care providers will have been done and it will be too late.

Stakeholders highlighted the need to find a way of introducing all social care workers on to the SoL. It was recognised that there is currently an issue in relation to the criteria as to how a skilled worker is defined. There is a need to challenge how we see care workers as skilled or not. There remains a perception that care workers are low skilled when the modern care worker does extremely skilled work including the administration of medication and manual handling and hoisting. There is a need to widen the conversation on skills as it relates to how we assess individuals applying to come to the UK to take up employment.

The Scottish Government previously received feedback from stakeholders in a range of sectors that the SoLs as they stand are not an adequate mechanism for responding to labour market demands. Stakeholder from a range of sectors generally agreed that the shortage lists needed to be independent, to be reviewed more frequently, with increased stakeholder input and must incorporate a way of reacting to regional labour shortages.

The current approach to defining 'skilled worker' within the immigration system by reference to salary and qualifications does not reflect an appreciation of the skills required to do a wider range of roles. Furthermore it privileges certain elements of the economy and certain geographies. The Scottish Government has previously set out our interest in exploring options which recognise the social value of roles within the immigration system.

Stakeholders highlighted the barrier of immigration fees to recruitment under the new points-based system. The majority of roles in the Social Care system are not on the SoL and do not qualify for the Health and Social Care visa so do not qualify for the associated reduced fees. This means that most social care roles attract visa fees of up to £1,220 and providers are liable to pay sponsorship fees into the thousands to recruit in this way. This is prohibitive for both individuals and employers, many of whom are small independent businesses in the social care sector.

Stakeholders have highlighted that care providers are considering withdrawing from being an immigration sponsorship body as the administrative and cost burdens of the immigration system outweigh the benefits they received from it. If they do, it will mean they will no longer undertake any visa arrangements, potentially impacting all sectors they employ, including social workers.

Finally, stakeholders highlighted the essential need for the MAC's review to take account of the key distinctions of the Scottish social care system in assessing the appropriate policy response to labour shortages in the sector. Key distinctions in the way that social care is organised, funded and regulated as well as key demographic differences must be taken account of in the assessment. This should include employing necessary expertise of the Scottish social care system as part of the review.