Skip to main content

Internationally Recruited Health and Social Care Staff: Employment Practices

Volume 744: debated on Wednesday 31 January 2024

[Stewart Hosie in the Chair]

I beg to move,

That this House has considered employment practices for internationally recruited health and social care staff.

I am very pleased to introduce this very important debate on a very important issue, which in the hubbub of the emotional conversation around immigration has not, as far as I am aware, been thoroughly discussed or even addressed; it relates to the critical work undertaken by people in the health service and particularly in social care. What I have noticed, and what has been brought to my attention, is that because of high levels of immigration, we have brought in people who are recruited to work in our health and social care system who have often, though not always, been badly treated and poorly paid.

We all know that the health and care worker visa has been exempted from the increase in the earnings threshold for skilled workers, so a lot of the people underpinning our social care and healthcare earn very little income; they are also often very vulnerable and not particularly fluent in English. Given the concern felt by everyone in the House about human trafficking and modern slavery, there is also a real concern that a large number of healthcare and social care workers are being exploited in a way that none of us wants to see.

There is a particular issue with regard to workers who leave their contract before an agreed period. The code of practice allows for this, but there has to be a reasonable expectation; fees owed as a result of workers leaving their contracts early should be reasonable. I have heard reports of fees in excess of £10,000. That is completely unacceptable. In that situation, the contracted employee is being exploited—and it very much has the look and feel almost of extortion. I am sure that the Minister is very concerned about this issue. In the midst of a very charged debate around immigration, it is something about which any Government professing humanity, and looking after our people, should be concerned.

On top of all the exploitation, and in the context of staff who are often highly vulnerable, there are reports that rogue international recruitment agencies have extorted —that is a word I use with some degree of caution, but they have extracted payments—from people. That is really a form, dare I say it, of trafficking. Often when the workers find themselves in the UK, perhaps because of language barriers or a lack of knowledge, they find themselves with no recourse; their employment conditions are often deplorable, but they cannot find a way to push back against some of the more extreme demands. I mentioned repayment clauses, and anecdotally I hear that there is often a lack of understanding of what exactly people are signing up to.

We all understand that we need people who can operate in our social care system and support us in maintaining the health of an ageing population, but that employment needs to be regulated. One statistic that particularly horrified me was that between January and September last year there were something like 76 reports and referrals with modern slavery and human trafficking indicators in the care sector alone. That is a couple a week, and of course that could be just the tip of the iceberg. I am very pleased to be able to have this debate, and I look forward to hearing what the Front Benchers—particularly the Minister—have to say.

I have spoken about the problem and outlined the situation broadly. I think we all feel a measure of concern about it, but we have to look forward and think about ways we can improve the situation. I have spoken to friends, and liaised with people I know at the Royal College of Nursing and some of its officials, and a lot of what they say is eminently sensible: there should obviously be standards for induction; the Department of Health and Social Care needs to establish pastoral and professional support; and there needs to be some sort of structure by which we can monitor potential exploitation and even trafficking in this area.

From what I have heard, we know very little about this phenomenon: we know very little about the number of people whose lives are blighted by exploitative practices. We talk all the time—in this House and outside—about immigration. We talk about the scale of immigration, but we rarely talk about the types of immigration that we are seeing, and I am not aware that we have dealt with this specific issue.

There is a code of practice for the international recruitment of health and social care personnel in England, which was last updated in August 2023, but what is a code of practice? It seems to me that it is really only a start in investigating the seriousness of what is being alleged. Publicly available hard evidence is difficult to come by, but we all know of reports; in my constituency, I have heard pretty hair-raising stories about the conditions in which many such workers find themselves.

I think there is a question about the code of practice. We should always be trying to get the best standards. I am sure that the Minister is fully aware of that, given her experience. We must always be interrogating ourselves, and ensuring that our guidelines and codes of practice are fit for purpose and up to the job. Given reports of rising numbers of exploitation cases, there is a broader question about whether the code of practice for international recruitment is really up to scratch. I know that colleagues and friends in the RCN have questioned whether the current code is really doing its job.

I am afraid to say that the issue of human trafficking and modern slavery will always be associated with immigration and bringing people into the UK. It is a very negative side-effect of seeing huge numbers of people coming into the UK about whom we know very little. I appreciate that the Minister is here today to represent the Department of Health and Social Care, but it is an issue not just for that Department; there are wider agencies of Government and more Departments involved. I will be very interested to hear what she says and, if at all possible, about the work that her Department is doing across Whitehall, with Treasury and Home Office colleagues, to get a better measure and a firmer grip of this chronic and increasing problem.

It is a pleasure to speak in this debate.

I thank the right hon. Member for Spelthorne (Kwasi Kwarteng) for leading the debate and setting the scene so very well. I have to put on record our thanks to all the wonderful health and social care staff, who, as we all know, go above and beyond the terms of looking after us and our constituents; they give a wealth of ability, energy and time, and regardless of where we are, the job they do is undeniably challenging. We thank them dearly, and we mean that.

It is also always great to be here in Westminster Hall to give a Northern Ireland perspective, as I always do in these debates. Health is devolved back home, so the processes there are slightly different. I will also make a couple of important points—everybody’s points are important—to remind hon. Members that although we are discussing internationally recruited health and social care staff, some of our own people here who wish to do the same job are restricted from doing so.

In November 2022, Northern Ireland welcomed 133 new international nurses, mostly from India and Zimbabwe, who took up permanent posts across Craigavon, Lurgan and South Tyrone hospitals. At such a challenging time for the health and social care sector—with ongoing demand for services, issues within the workforce, and lots of developments—ensuring sustainable care for others should be at the forefront of our priorities.

I am keen to say that there are clearly issues in terms of entry requirements and placements for those wanting to study nursing, medicine and so on in Northern Ireland universities. I suspect that the same problems occur in other parts of the United Kingdom. I am aware of so many people who wanted to be a nurse or in medicine, and wanted to stay in their own country to do so, but did not gain the entry requirements needed or there were no places for them. Whenever the Minister responds to the debate, perhaps she could tell us what discussions have taken place with those universities to ensure that the opportunities and number of places are increased—in Northern Ireland and across the whole United Kingdom.

For example, I have a constituent who attained 10 A* grades in her GCSEs—my goodness, this is a smart lady! She also completed her gold Duke of Edinburgh award and went to on to help with healthcare in small communities in Africa; that is very commendable. By the way, I know this lovely young lady well, and she will go far and do well. In her A-levels, she got 3 A* grades and one A, and she attended interviews but did not receive a place in university in Northern Ireland. If she had, she would have stayed in Northern Ireland. Whenever we talk about recruiting internationally—we should be doing so, and highlighting that issue—we also have to highlight the fact that we have talented people at home who wish to stay, but there is not an opportunity for them to do so.

Ultimately, that young girl went to Wales to study, with a further £5,000 of debt for each year of her degree. She is now a junior doctor in Cardiff, but the point is that she should have been given that opportunity in the place where she wanted to live, work and serve. The question for me is: will she ever come home to Northern Ireland? While Wales has gained her, Northern Ireland has lost her. I am all for securing our health and social care workforce, and if that means going international, let us do that; but there is also a source of talent back home.

There seems to be an issue with those who want to study nursing in their own country but are unable to do that because of placement issues, so will the Minister tell us whether that is one reason why we are struggling to maintain a steady workforce? If we can train them back home and keep them, we will not have to source them internationally. It all comes down to funding, which comes from Westminster. We need to increase the number of spaces that universities can facilitate. With great respect, I ask the Minister whether it is possible to engage with the Department for the Economy back home in Northern Ireland. Hon. Members have heard the news today: the Northern Ireland Assembly will be up and running, hopefully shortly. What can be done to give local students more opportunities to study in their own country?

Northern Ireland offers wonderful opportunities for international recruitment. We recruit internationally all the time. The number of people on the permanent register in Northern Ireland who were initially registered outside of the UK increased to 3,794 in 2022-23 from 3,399 the previous year—an increase of 400 international nurses. We recruit internationally and are pleased with the contribution, ability and talent they bring to Northern Ireland. I welcome the wealth of experience they bring, but I want also to be a voice for those students from Northern Ireland who cannot get a place and therefore have no choice but to leave Northern Ireland and study, work and live elsewhere.

Will the Minister engage with the Department for the Economy back home in the Northern Ireland, with the Assembly, and with local universities such as Queen’s University Belfast, Ulster University and Magee university, to see what more can be done to facilitate greater placement opportunities for Northern Irish students in our local universities and, ultimately, to ensure that they take up nursing and medicine opportunities in Northern Ireland? The health service can only gain from that, and it would reduce the numbers of people we have to source internationally.

It is a pleasure to serve under your guidance this afternoon, Mr Hosie, and it is great to follow the hon. Member for Strangford (Jim Shannon). The right hon. Member for Spelthorne (Kwasi Kwarteng) has made a great contribution to the House by securing this important debate and making his interesting opening speech.

The exploitation of workers, wherever they are from and whatever the circumstances, is unacceptable, and we should stand against it. Likewise, we should be deeply concerned about the state of social care in our country. The two things are clearly interlinked. The background, of which I am sure many Members will be aware, is a sharp rise in shortages in the social care workforce. That rise essentially followed from Brexit, but other issues will have led to that shrinking of the labour pool.

Perhaps understandably, the Government’s response in February 2022 was, among other things, to lower salary requirements and visa fees for migrant social care workers. That has had a significant impact on the numbers of people coming in on social care visas: there were 101,000 social care visas in 2022-23, up from 22,000 just the year before—a fourfold increase. As a result, vacancies have fallen. It does not feel like that in my part of the world, but the stats bear that out: there has been a reduction from 10.6% to 9.9% in 2023. The vacancy rate for the UK economy as a whole is 3.5%, so a bit of maths tells us that the vacancy rate in social care is getting on for three times above the national average. The increase in the number of care worker visas continues to accelerate, with 34,000 applications in quarter 3 last year.

One observation made by those who analyse the sector more scientifically—but it is my personal observation in my community as well—is that migrant workers are to a large degree replacing UK workers, who are moving to more attractive sectors. Incoming migrant workers are therefore not really filling gaps at all. Rather, they are filling additional gaps that British workers are vacating simply because care is not attractive financially or in other ways.

That highlights the big problem that is the source of all this. Social care is an utterly vital sector on which many of us depend, yet we pay a pittance to the people who lovingly and professionally care for the most vulnerable in our communities. They often have poor job security and poor working conditions, which of course impact on recruitment and retention. If this were improved, there is no doubt that we would secure more UK workers in the profession, and perhaps not put ourselves under pressure when it comes to the obvious issues of exploitation.

There was a debate in Westminster Hall this morning on hospitality and tourism. When people like me say that part of the answer is to have less restrictive visa rules for migrant labour, the Government say the answer is simply to pay British workers more. I would say to the Government, “Take your own advice.” Social care workers are paid a pittance because we underfund social care, so if the Government believe that is the way to ensure British people work in this sector, then pay them properly, and do not exploit people who come in from overseas either, because they are hugely valuable to what we are trying to achieve.

Exploitation should seriously worry us all. There are many pieces of evidence—the right hon. Member for Spelthorne set many of them out wisely and correctly—but one figure that really blew me away comes from the charity Unseen, the modern slavery and exploitation helpline. It reported a—wait for it—606% increase in the number of modern slavery cases in the care sector from 2021 to 2022. That is an absolutely astonishing increase.

As an adjunct, talking about migration policy is often emotive. Through the Government’s Illegal Migration Act 2023—it is the Act that is illegal, rather than the act of immigration—people arriving on our shores by irregular means will not have access to this country’s modern slavery provisions, unlike others. What will be the consequence? Many victims of modern slavery will not get the care they need. I also suspect that we will find that people will to our shores and simply not claim asylum, going under the radar, and that they will be exploited all the more outrageously.

Returning to the issue at hand, the director of labour market enforcement has identified adult social care as a high-risk sector for labour exploitation, with live-in and agency care workers believed to be at particular risk. Employers who are guilty of exploiting their staff are unlikely to demonstrate any better set of ethics towards the vulnerable residents who are also in their care. The increase in the salary threshold for skilled workers will not apply to those coming in on health and social care visas, yet people on those visas will, from 11 March, not be permitted to bring in dependants. That is a cruel and demoralising thing to do to people who we rely on to care for those we need the most. It is likely to lead to fewer applications, worse retention, and therefore a bigger problem for our social care sector.

In response to the vast increase in reports of exploitation of those on the health and social care visa, the Government have announced that care providers in England will be required to be regulated by the Care Quality Commission in order for them to sponsor visas. It is a good thing that care homes will have to be regulated by the CQC to sponsor migrant workers. My question for the Minister, however, is will they be required to have a minimum CQC inspection rating of good or outstanding before they are able to do so? Secondly, have any extra resources been provided to the CQC to enable them to undertake this role with the health and social care visa, given the additional effort it will involve? What powers will they have to enforce labour standards? Surely, due to the concerns raised, recruitment should only take place via agencies on the ethical recruiters list. I would be interested to hear what the Minister has to say about that.

We need to value care work, and we need to reflect that in the pay and conditions people receive. That includes treating migrant workers well. I reiterate that the decision to end their rights to have family with them is cruel and pointless, given that those people will not have recourse to public funds anyway. It is a cruel and almost performative piece of policy. It seems that the Government feel all the more inclined to give into the temptation to put silly populism and appeasing a small number of people out on the margins of the electorate ahead of governing wisely and compassionately. Whether I agree with the Government of the day or not, I always hope they will govern wisely and compassionately, yet this is another example of them failing to do that.

Labour market enforcement needs to be better resourced. It is important to establish a single enforcement body that is accessible to workers in practice and adequately funded, that is provided with robust enforcement powers, and that has secure reporting pathways. The Government must separate all labour market and immigration enforcement activity.

I have a few other thoughts about what else the Government ought to think about doing. The Health Foundation has suggested that we need to recognise that workforce planning must take account of the range of social care services and providers, as recruitment and retention can differ from place to place, and can vary considerably by care provider. For instance, places offering contract employment will find it hard to retain staff, and in some places the availability of public transport can have a massive impact on the retention of personal assistants. For those living in Cumbria, in Appleby, Ambleside or Arnside, the existence of the £2 bus fare is completely irrelevant if there ain’t no bus for them to use. That applies to people working in social care, but also to other parts of our community.

It is worthwhile getting to the very bottom of all this, which is the way we treat social care. Had we been living to the ages that we are now, when my late, great, right hon. Friend the noble Lord Beveridge wrote that important report in the 1940s, and if families had been as they are today, then I am sure social care would have been included in the national health service right from the beginning. Yet in the decades that have followed, we have attached it to the side of the health service, like a rickety lean-to. It is time we treated social care as we always should have: as integral to, and equal to, the national health service.

The situation is awful. What are the diseases we fear —those which, I guess, we fear more as we get older? Maybe the two main ones are dementia and cancer. But what a lottery: those with cancer at least get their care provided through the national health service, while those who end up with dementia are on their own and might lose absolutely everything. That is a nonsense. I want us to channel Beveridge and do what he would do today, which I am certain would be to ensure that social care workers are considered equal in value to those working in the health service, and are paid and treated accordingly.

That is why I think that free personal care is something the Government should consider seriously. I am very proud that the current Scottish Government maintain a policy that we introduced when we were in power alongside the Labour party in the ’90s and noughties. These issues are particularly relevant to communities such as mine. We are 10 years above the average age in Westmorland and Lonsdale. Our need for care is that much greater than in other parts of the country, and we value it hugely.

By the way, it is also vital that we value unpaid carers, who look after loved ones at great cost to themselves, and to whom we owe a huge debt. We should do more than just say thank you; we should change payments, benefits, and all sorts of other allowances that allow them to succeed. It was an honour for me to do the Great North Run last year, to raise funds for Carer Support South Lakes. Let us make sure we back those outfits that support our carers so well.

In conclusion, I am asking that we take the issue of exploitation seriously, that the Minister answers the questions that I and others have put to her today, and that we recognise that this is all a function of our failure to treat the labour market wisely and compassionately, and our failure to treat social care as we should. If we invested in social care properly and paid carers properly, the knock-on effect would be happier people who stayed in their positions, who were easier to recruit in the first place and who had career prospects. Those who are cared for would be happier and better cared for, and the pressure on our national health service would evaporate, or at least be alleviated, almost overnight.

In my communities in Morecambe bay and the rest of Cumbria, often more than 32% of the beds in our hospitals are occupied by people who are fit to leave, but for whom there is no care package to help them to leave. That has consequences for A&E waiting times, cancer waiting times and ambulance response times, and it is all down to the fact that no one has yet been brave and compassionate enough to tackle the care crisis meaningfully. I hope this Government will do, but if they do not, I am determined to play a part in doing just that in the next Parliament.

I thank the right hon. Member for Spelthorne (Kwasi Kwarteng) for securing this debate. He made balanced and measured remarks and I share a number of his concerns.

I will begin my contribution with a huge and heartfelt thank you to our NHS and social care staff in Scotland, many of whom looked after me during the four months I spent at the Queen Elizabeth University Hospital in Glasgow back in 2020 and who care for my constituents in East Dunbartonshire in our many care homes, GP practices, pharmacies and hospitals. This debate discusses a critical aspect of an issue that I continue to raise time and again: NHS workforce shortages. The Government’s latest draconian plan to curtail immigration, banning those who come to these isles to work in the care sector from bringing their families, including children and spouses, is another shambolic and cruel attempt by the Government to shift blame. Anti-migrant and quite frankly racist rhetoric has become symptomatic of contemporary Britain, largely fuelled by the Government’s culture war. In introducing the change in legislation, they have concocted a narrative that frames migrant workers as the problem. Let me be clear: this Government are the problem.

They have allowed our health and social care workforce to crumble in front of our eyes due to 14 years of austerity, starving it of much-needed investment. Preventing overseas care workers from bringing their families is a dehumanising move, viewing migrant workers as resources to be used for work rather than as the people that they are; people with families whom we need to come to these isles. Migrating to the UK for such arduous and underpaid work might be someone’s best bet for a better future, but in doing so they are forced to leave their dependants behind, having to leave their families to care for ours.

Overseas care workers have been treated appallingly by this British Government. Many sold everything to fund their move to the UK. The Home Secretary and the rest of the Cabinet clearly do not value the social care sector since they were content to sign off on the visa rule changes. Disappointingly, the Health Secretary has defended the visa changes too. The only thing the announcement will achieve is to break up families, scare workers and erode trust.

Now, social care workers who come here face a sentence of destitution, and it is far too simplistic to suggest that there are ample numbers of people already based here to fill the gaps in the health and social care workforce. It is not a sector that pays adequately and people do not want to fill the gaps in employment, so we need people to come from overseas too to fill the skills gaps. The sector is struggling, and struggling badly, due to terrible political decisions.

Skills for Care, the workforce development and planning body for adult care in England, estimates an average 9.9% of roles in adult social care were vacant in 2022-23. That is the equivalent of approximately 152,000 vacancies. What are the Government doing to address those vacancies? They are making it harder for people to come here and fill them. The number of vacancies decreased by around 11,000 between 2021-22 and 2022-23 partly because of increased recruitment of overseas workers, demonstrating how crucial those recruits are in tackling the shortages we face.

Donald Macaskill, the chief executive of Scottish Care, has said that workforce shortages are

“an enormous challenge, and one of the reasons for that is the legacy of Brexit”.

He went on to say that

“what we need is a flexible immigration policy, which isn’t as hostile and toxic as the one we have now”.

The fact of the matter is that the social care sector cannot function without overseas staff.

Plans to prevent overseas care staff from bringing family members with them to the UK risk worsening the sector’s already significant shortages. If care workforce numbers fall, unmet needs will continue to escalate. Too many people in need struggle to access good care as it is. The plan to curb migration for care sector workers will undoubtedly only make that worse. We have an ageing population, which will need more care and we will struggle to provide that care without international recruitment. Those needs are being undercut by this British Government. Social care requires a major fix, but this certainly is not it. Without migrant staff, care homes could close and support would disappear for the vulnerable living in their own homes. The Minister must rethink this cruel visa plan before permanent damage is done.

There is another area in which this British Government cause a headache for our constituents. If the new restriction reduces the number of people who are migrating to the UK to work in the already understaffed care sector, it is unpaid carers who will bear the brunt. Those unpaid carers are already in a dire situation, with evidence suggesting that they are more likely than non-carers to live in poverty, to be isolated and to be depressed. Although many family members would continue to care for loved ones, even with more paid help, we should not underestimate the importance of paid care workers in providing support and respite.

Today in the UK, if someone performs unpaid family care for 35 hours or more a week and earns under £139 a week from paid work, they can claim carer’s allowance to help them get by, but that allowance is only £76.65 a week. The Minister is already struggling to attract workers within the UK to work in the care sector, and now she is facing additional barriers to overseas recruitment. That is all due to colleagues who are so obsessed with decreasing net migration that they will happily watch an understaffed health and social care service fall into further ruin.

How does the Minister justify dissuading social care workers from immigrating to these isles, when they are quite literally keeping our system afloat? When will the Government finally commit to solving the underlying problem by making care work a more attractive career path and by training, retaining and reforming in the health and social care sector? That last point was explored in depth by the hon. Member for Strangford (Jim Shannon).

This Government fundamentally are not acting in Scotland’s best interests. We want and need more people to come and work in our health and social care services, not fewer. The alleged problems that this British Government are trying to address with their new policies on overseas recruitment are not issues for Scotland. We strive to create a warm and welcoming environment that encourages people from overseas to make Scotland their home. We want and need overseas recruits here. The Tories’ hostile environment is not working, but there is another path for Scotland. The Scottish Government have outlined their vision in the policy paper, “Building a New Scotland: migration to Scotland after independence”. That policy will make it easier for people with skills and expertise to come to Scotland and contribute to our businesses, communities and economy. We would set visa fees at a fair level and offer family schemes to encourage those who come to Scotland to put down roots and make Scotland their home.

The Scottish Government are also supporting international recruitment with a pilot project that was launched in summer 2023 to support providers with sustainable and ethical international recruitment and to gather information on how we can best support both providers and the workforce through the visa sponsorship process and develop supporting materials to be shared across Scotland. We will not ask overseas workers to abandon their families to come and care for ours; that is not what Scotland is about.

Only once these decisions can be made by Scotland, for Scotland and in Scotland can we have the full power to ensure that our health service is well staffed and well looked after. It is clear that whatever party forms the next Government in this place will not make decisions based on Scotland’s specific needs, and it is only once we achieve independence that we can ensure that our NHS and the health and wellbeing of our ageing population and our population more generally are in safe hands.

It is a pleasure to serve under your chairmanship this afternoon, Mr Hosie. I shall begin by congratulating the right hon. Member for Spelthorne (Kwasi Kwarteng) on securing this important debate and on the way in which he opened the debate; it was incredibly insightful and certainly chimed with a number of the issues that have been raised by Members across the House, as well as with the concerns we share about the role of an international workforce and how we look after those people who come to this country to help those in our social care service.

I also thank my friend, the hon. Member for Strangford (Jim Shannon). I know that it is convention to call him “hon. Member”, because he is from a different party, but he is my friend, because—I do not know whether I am stalking him or he is stalking me—we are always at the same debates. He made an important point about how we get workforce planning right across the United Kingdom. I am aware that if, at some stage in the future, I were to have the Minister’s job, it would be very easy to come up with a workforce plan for social care that plugs the gaps in England by pinching staff from Northern Ireland. We have to ensure that, as we go forward with our workforce planning, there are enough people in the social care workforce across the whole of the United Kingdom. We must not create a perverse situation whereby working in social care in England becomes very attractive at the cost of social care in Scotland, Wales or Northern Ireland. We must work together on this journey of upskilling and building a workforce for the future.

Likewise, the hon. Member for Westmorland and Lonsdale (Tim Farron)—I will call him a friend too as we are all friends in this Chamber—made some really important points. He spoke about the challenges—not just workforce challenges but general challenges—in delivering quality social care and other public services in sparsely populated areas such as his constituency in the Lake district, which are linked to other issues that he speaks passionately about in the Chamber, including housing and transport. We need to join up those things if we are to attract the right kind of social care workforce to meet his constituents’ needs.

I disagree profoundly with the desire of the hon. Member for East Dunbartonshire (Amy Callaghan) for Scotland to be separate from the rest of the United Kingdom. I am a proud Unionist. I have Welsh heritage, as my surname, Gwynne, indicates. I am half-Scots, as my first name, Andrew, suggests. My Scottish gran from Lochwinnoch was very adamant that I have a Scottish name. And obviously I am English—I am Mancunian—and proud of that. I see the benefits and the strength that comes from the people of the islands that make up the United Kingdom working together for the common good. I get that under the devolution settlement Scotland has the ability and the responsibility to develop, provide and plan social care services that meet the needs that are particular to the towns, villages and cities in Scotland, but migration is a reserved power. There must therefore be a relationship between the way in which the Scottish Government meet those needs and plan health and social care, and the United Kingdom Government’s wider responsibilities on migration.

We can be in no doubt that we have a workforce crisis in health and care services right across the country. Members have said that there are 152,000 vacancies in social care alone. I have been meeting providers and representatives of local authorities, and they tell me that the challenges are massive. That is why we need a proper grasp of how we build the workforce of tomorrow responsibly. It takes only the opening of a new supermarket in somebody’s area for social care to lose a whole swathe of low-paid workers because they get paid more to stack shelves, so there is something fundamental there.

We are failing to recruit the staff we need, and staff in the services are leaving. That is not sustainable. Our health and care workforce so often represents the best of Britain, going above and beyond to keep us and our loves ones safe. We cannot and must not exclude from that recognition those who come from overseas to support our health and care system. They make huge sacrifices day in, day out, and they deserve our immense gratitude and respect. They must not be used to score political points, as is too often the case.

As we have heard, overseas workers, particularly those in social care, often face very challenging environments and are vulnerable to shoddy employers, so it is vital that we ensure we have a system in which the exploitation of overseas workers is simply not tolerated. Steps must be taken to stop those who perpetrate abuse. That is not only good for them; it is essential if we are to ensure a decent quality of care. That should not detract from recognising that most workers from overseas come here to do legitimate jobs and are employed by legitimate care companies, including some that enjoy high CQC ratings for the quality of care they provide. However, those people still face abuse and exploitation in the workplace.

We must also recognise that the contribution of overseas care workers to our care economy has been, and continues to be, crucial to the functioning of health and social care. We should be deeply grateful; without them, many more care services would have closed in the last few years, leaving thousands without the support they need. Even with their contribution, Age UK estimates that 1.6 million older people in our country have some form of unmet need for care, and because our population is ageing, the demand for care is increasing all the time.

The hon. Member for Westmorland and Lonsdale referred to Beveridge and old age. An ageing population is a massive challenge to this country because of care needs and things such as pensions and the sustainability of the welfare state, but the real challenge in adult social care—this links to the issues related to our ageing population—is that in the past, people born with severe learning or physical disabilities did not live long into adulthood, if at all, and they are now living way into adulthood. Huge cost pressures are building in the system around working-age adults with disabilities, which we also need to address; it is not just about the ageing population.

We need to recruit and retain more care workers to give the sector the workforce it needs to deliver for those needing care, and we will support that. That is why we do not just have a workforce plan for the NHS; we have ensured that we have considered social care as well. The next Labour Government will introduce the first sectoral fair pay agreement in adult social care, which is testimony to the persistent battling of my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), who started her working life as a social care worker. We will ensure that pay, terms and conditions and training and development meet the needs of staff. As part of our 10-year plan for fundamental reform of the sector, which culminates in the creation of a national care service in England, we will ensure that social care is no longer a route for those seeking to abuse overseas staff and fuel the perception of care being the bottom rung of a ladder.

We must make sure that we build a career pathway that incorporates training and has parity with caring responsibilities in the NHS as part of our workforce plan, so that there is more fluidity between the NHS and social care. Somebody who starts off as a nurse should be able to have a career pathway that ultimately leads them to be the chief executive of a major care provider. Why shouldn’t somebody who starts as a social care worker have a career pathway that leads them to be the chief executive of an NHS trust? We can only do that by building a workforce that has some form of parity.

We will ensure that, in future years, comprehensive independent workforce assessments are made, so that NHS and social care staff can keep up with the demands of a growing and ageing population, rather than falling behind. I get so frustrated at the lack of progress on some of these issues. I know the Minister is trying her best, but for too long, under too many different Governments, social care has been seen as that lean-to, as the hon. Member for Westmorland and Lonsdale put it. It is time that we have a Government committed to fixing social care and to developing the services we need, built around the needs of the people who require social care services, and it is time that we have a workforce plan that drives up quality, ensures career progression and fills those gaps. We need that general election—the country is crying out for change after 14 years of this Tory Government delivering an NHS and social care system that is broken. It is time to fix that broken system—it is time for Labour.

I am grateful to my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) for opening the debate and setting out some of the challenges we face in international recruitment in health and social care. I pay tribute to our international health and care workers, who play an important part in our health and care system, looking after people and bringing their skills, equipment and compassion to look after loved ones. We benefit enormously across the UK from their knowledge and skills. In return, it is imperative that employers, whether in health or social care, provide a safe and supportive environment for their staff to work in.

I want to be clear that international recruitment is not the long-term answer to our health and social care workforce needs. We have been clear about that as a Government, and I have been clear about that personally. That is one of the reasons why, on the NHS side, we have our long-term workforce plan, investing in training our home-grown healthcare workforce. On the social care side, we have a 10-year vision for social care, which includes ambitious workforce reforms, which are in progress, including the first ever national career structure for care workers and new national qualifications. I am determined that care workers—indeed, care professionals —be recognised for their skills and supported in their work and career.

I would say to the SNP spokesperson, the hon. Member for East Dunbartonshire (Amy Callaghan), that she should read up on these care workforce reforms, as should the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who called a moment ago for a care workforce pathway. I know he is relatively new to this role—we have not done that many debates opposite each other—so I ask him to go take a look online. He will see our care workforce pathway programme, which we have published and which we worked closely with the sector on to develop this national career structure. We did so exactly because it was one of the things we knew was missing from social care, and because when people come into social care, they want to see that they have an opportunity to progress in that career. We are also developing national training that will be recognised across different employers. Those are just two of the headline policies of a truly ambitious reform programme for the social care workforce.

I do not particularly appreciate being given homework by a Minister who is doing so much damage to the health and social care sector in Scotland. I have certainly done my homework already—I do not need to be given some by her.

I think it is probably helpful if I move on, rather than our having some sort of back and forth.

I turn to the question in hand, which is specifically to do with international recruitment and the reasonable concerns raised by my right hon. Friend the Member for Spelthorne about the exploitation of some workers who come to support us in this country in health and social care. One of the things he spoke about was the code of practice. He is absolutely right that we have a code of practice for the international recruitment of health and social care personnel, which sets out ethical recruitment and employment standards that employers must adhere to. The code is kept under regular review. In fact, my right hon. Friend referred to the update of the code last year. I can assure him that my Department works closely with the Royal College of Nursing and other trade unions and stakeholders to strengthen that code and make sure it addresses the current issues and ethical concerns. For instance, we have set out stricter principles on the use of repayment clauses in employment contracts, and the code is now explicit that charging recruitment fees is illegal under UK employment law. I absolutely agree with my right hon. Friend that we should continue to make sure the code of practice truly captures all that it needs to, and is as effective as it can possibly be.

Alongside the code of practice, we have the ethical recruiters list. This contains a cohort of recruitment agencies that have agreed to operate in accordance with the rules of the code. The list is run by NHS Employers, and it makes it easy for employers in the NHS and the social care sector to check that recruitment agencies are signed up to meet the high ethical recruitment standards we expect. Any organisation suspected of breaching the code will be investigated, and can be removed from the list.

Most overseas staff have a positive experience working in the UK, but I acknowledge that, regrettably, this is not the case for all. We know there are some rogue agencies and employers that take advantage of people who want to come to the UK to work. We have published guidance for prospective overseas candidates to help them make informed decisions and prepare for life in the UK. The guidance sets out what candidates should check in their employment contracts before signing them, what working rights and standards they can expect in the UK, and how to recognise and deal with exploitation, should that unfortunately be something they experience.

My Department is working with colleagues in the Foreign, Commonwealth and Development Office to disseminate that guidance effectively, so that it reaches prospective candidates at an early stage and helps make informed decisions and avoid scams and unethical practices. We want them to be able to do that in their home countries, before they even apply to work here in the UK.

My right hon. Friend the Member for Spelthorne mentioned punitive repayment clauses in employment contracts. We are clear that those are unacceptable, and in certain cases illegal. There are some instances where repayment clauses may be used legitimately to cover some up-front costs incurred, should an employee decide to leave their job after a short time. But in all cases, employers must make it clear in contracts what is to be reclaimed, and how and when that will take place. Instances where repayment clauses are excessive, or extended over a lengthy period, have the effect of trapping international workers into jobs, and that is unacceptable. Repayment clauses cannot be used by employers to cover the cost of agency fees, certificates of sponsorship or the immigration skills charge.

As I mentioned, the code was updated to address that issue. The NHS has gone further, producing additional bespoke guidance for NHS employers to explain how to implement the code’s principles when using repayment clauses. That will ensure transparency and fairness in employment contracts for all international recruits working in the NHS.

Another issue raised by my right hon. Friend is that of recruitment agencies charging international candidates high fees to find them work in the UK. For UK-based agencies the law is clear: charging a candidate any recruitment fee to find them a job in the UK is illegal. The Employment Agency Standards Inspectorate is the organisation responsible for regulating employment agencies, and it will investigate such misconduct and prosecute where appropriate.

However, we do face the challenge of agencies based overseas that fall outside the UK’s jurisdiction. Regrettably, we have limited direct levers to stop the unethical treatment of workers overseas, but we have taken steps to try and mitigate the risk as far as possible. First, our international candidate guidance, which I mentioned a moment ago, warns potential candidates that they should not be paying any kind of fee to find work in the UK, and that they should not work with any agency that requests such a fee. Secondly, our embassies and high commissions are actively working with higher-risk countries to tackle exploitative practices by recruitment agencies overseas. NHS Employers, as holders of the ethical recruiters list, undertakes regular spot checks of agencies on that list to ensure they are complying with the code of practice.

As a Department, we are working collaboratively with the labour enforcement agencies that take action against those breaking the law in the UK. Those include the Gangmasters and Labour Abuse Authority, UK Visas and Immigration, and the Employment Agency Standards Inspectorate. We therefore have a multi-agency approach across Government which uses our collective intelligence, capabilities and resources to respond to concerns about exploitation. That includes providing insight, advice and guidance to businesses and supply chains in relation to possible labour market offences.

My right hon. Friend mentioned language skills and the potential challenge for somebody whose English might not be fluent, to navigate the landscape and know their employment rights, for example. It is clearly important that the language skills of anyone providing care in England are good enough to communicate with their employer, the people they provide with care, and other care and healthcare professionals.

Care providers must ensure that their chosen candidates have the skills needed to work in care and should assess a candidate’s English proficiency at the interview stage of recruitment. For somebody to work in social care, employers should ensure a good standard of English. For staff from overseas, the Home Office sets English language proficiency requirements. Individuals are required to prove they can speak, read, write and understand English to at least level B1 on the common European framework of reference for language scale.

My right hon. Friend also asked about cross-Government work in general on tackling exploitation. I can assure him that we are working across Government. My Department is working particularly with the Home Office and UKVI, both at official and ministerial level. I have had several conversations with Home Office Ministers about our care worker visa scheme and what we are doing to tackle the risk of exploitation and abuse.

I worked closely with Home Office colleagues on the recent changes to the care visa. We agree about striking the right balance with overseas care workers, who are supporting us in some of the challenges of meeting the social care and healthcare need in the UK. We also need a balance between international workers and our home-grown workforce, ensuring that there are safeguards for international recruits.

Following those conversations, we have announced changes to the care visa scheme, as referred to during this debate. One is that, as of March, we will no longer allow care workers to bring dependants with them. Another safeguard is that we are restricting sponsors to CQC-registered care providers. At the moment, as long as someone is providing social care, CQC-registered or not, it depends on the sort of care provided.

The Government do not have all the answers at the centre, and I feel strongly about that. That is one reason why, as we have introduced the care worker visa, we put £15 million funding into regional partnerships of local authorities, to have established leads around the country for international recruitment, to support employers and recruits. I meet our regional leads, to hear what it is like in their areas, and to discuss what they are doing on the ground to support employers and social care staff. For instance, they are supporting providers with legal and HR advice on recruiting and employing international staff.

There is a specific example relevant to this debate. East of England has commissioned Unseen to run seminars and provide one-to-one support for care providers on safeguarding and spotting signs of exploitation. I continue to work with those leads to get the best possible insight on the ground on the extent to which internationally recruited workers may face difficulties. That could happen if someone has been brought here for a job with a particular sponsor who loses the licence to employ them, and the leads are working hard, trying to support recruits in that situation. I am also setting up a meeting directly between our regional leads and the Home Office and UKVI, to ensure that they share their intelligence directly, making the most of the leads’ work and insights.

I want to come briefly to some of the points made by the hon. Member for Westmorland and Lonsdale (Tim Farron). He mentioned the connection between social care supply and delayed discharge in his local area, which is something that I have done a huge amount of work on over the past year. I want to be clear, particularly on this topic, that social care does not exist just to discharge and support the discharge of patients from hospital. Social care is absolutely an end in itself, supporting both older people and those of working age with care needs.

We know that there is a connection between discharge delays from hospital and social care, because some people who are delayed in hospital, when they are medically optimised for discharge, are in need of social care packages. That is why we put in an extra £600 million in funding to support discharge over the past year, and there is another £1 billion coming this year. We have also put in an extra £570 million of funding to support social care. Just this morning, I was talking to a number of directors of adult social services from local authorities who assured me that that funding has made a meaningful difference to social care funding and supply.

I know that there are still significant financial pressures, and the national living wage increase puts an additional pressure on care providers and local authorities for the coming financial year. While that increase is a good thing for those at the bottom of the pay scale, it also places financial pressure on employers and those funding social care. I assure the hon. Member for Westmorland and Lonsdale that that increase in supply, thanks in part to the extra funding, has helped to speed up discharges over the past year and reduced some of the delays, and we have seen an increase in the number of people being discharged both overall and particularly with social care support. We have made progress on that point.

I come back to this point in closing. I want to be categorically clear, in the light of this debate, that no member of staff in health or social care should face abuse of any kind, and illegal and unethical international recruitment and employment practices will absolutely not be tolerated. Internationally recruited staff play a really important part in caring for people across health and social care. They have helped us to build and increase our health and social care workforce. On the NHS side, we have achieved our manifesto commitment of 50,000 more nurses. On the social care side, we have over 20,000 more care workers in the care workforce. We have seen vacancies come down and retention improve, so we have been making progress on both the social care and the NHS workforces. While international recruitment plays an important part, it goes hand in hand with our work as a Government to build up our home-grown workforce both on the NHS side, with our NHS long-term plan, and the social care side, with our ambitious social care workforce reforms.

We have had a wide-ranging and generally quite even-tempered discussion, although people have occasionally strayed into the political stuff. The point of these debates is to have a broad and tempered discussion, and the spirit with which we have debated this matter does the House proud.

This issue has not had the attention that it deserves, and it is clear that Members on both sides of the House and from all parties are concerned about it. It is also abundantly clear that, whoever the election decides will form the next Government, it will be even more important and critical that this issue has our focus, whether that Government is Conservative or Labour. I am delighted that the Minister spoke at length, showing her understanding and experience. This is only really the beginning, and I look forward to more debates in the future on this sensitive and difficult subject.

Question put and agreed to.


That this House has considered employment practices for internationally recruited health and social care staff.

Sitting suspended.