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Brexit: Health and Social Care Workforce

Volume 794: debated on Thursday 13 December 2018


Asked by

To ask Her Majesty’s Government what assessment they have made of the report by the National Institute of Economic and Social Research, Brexit and the Health & Social Care Workforce in the UK, published on 6 November.

My Lords, the Government are determined to recruit and retain the staff that the health and social care sectors need. This will include a robust domestic recruitment drive as well as ensuring that EU staff, who play such an important role in caring for and supporting patients, are able to stay in this country. That is why on Monday 3 December, we launched the EU settlement scheme pilot for the EU workforce in health and social care.

I thank the Minister for his response. The Cavendish report on the current and potential staff shortages across all the key health and social care professions makes for alarming reading and shows how dependent we are on the work and dedication of EU nationals. I want to focus on social care workers. What is the Minister’s response to the Government’s Migration Advisory Committee, which says that these vital staff fall into the category of “low-skilled” and therefore do not merit preferential rights here in any post-Brexit scenario? In the past he has acknowledged the skilled, caring jobs that these staff do in community services, people’s homes, nursing homes and care homes. Does he agree that they are definitely not low-skilled? What is he doing to convince the MAC otherwise? What is the strategy for recruiting the 130,000 new social care workers that we need each year just to stand still, let alone to address the future demands of the service?

I thank the noble Baroness for her question. First, we want to ensure that EU staff working in Britain are able to do so, and course that is why the EU settlement scheme pilot is so important. The social care workforce in this country has increased a lot, with a mixture of domestic and foreign staff. One of the ways in which we are increasing the attractiveness of that profession is by increasing the living wage, which has benefited so many staff in social care. Of course, many of them are highly skilled, and we want to ensure that we continue to be able to attract such skilled staff. We continue to discuss with the Home Office exactly what the right thresholds are for our future immigration system so that we do not lose out on these kinds of staff.

My Lords, does the Minister agree that the problem is caused primarily because of the low esteem given to social care staff? This is extraordinary because most people who find themselves dependent on those staff value their contribution enormously. Would it not be helpful if the Government attached greater importance to those staff, not only through reward but through training and proper support?

The noble Lord is absolutely right. The Government certainly do not hold those staff in low esteem—quite the opposite. As we know, we need increasingly to think of health and care staff as one workforce and ensure that professional paths lead through all those professions. I am sure he will be aware of the work being done by Skills for Care, which provides the overarching policy in this area, has made recommendations about pay and helped to inform our increase in the living wage, and is providing better training facilities for those staff.

My Lords, in addition to the report referred to, Coram has today published its annual survey confirming that there is not enough care available for older people, with only one in five local authorities reporting enough care in the area to meet demand. As a result, more than 4.3 million people aged 75 and over are living in an area with insufficient social care. The Minister talks about discussions with the Home Office, but we also see from the report that there was a big peak of EU staff leaving, and a big reduction in nurses, dentists and allied healthcare workers coming in from the EU. This is a perfect storm, so when will the Home Office understand that we need a range of staff in this country? Secondly, can the Minister confirm when the Government’s paper on health and social care will be published?

Of course, care needs are increasing—a fact that flows from having a growing and ageing population. I should point out that the Government have increased funding for social care by more than £9 billion over three years in recent Budgets, so we recognise the seriousness of the issue. We of course want to retain those staff—it is good that there were more EU staff in the NHS in June 2018 than in June 2016, and we want them to stay. As for the social care Green Paper, it will be issued shortly.

My Lords, I am grateful to the Minister for the value that he places on those working in the social care and health sector, but the National Institute of Economic and Social Research identifies that the sector is under considerable pressure, even before we consider Brexit. The Royal College of Nursing states that fewer nurses started training in our universities this year. Fifteen per cent of all our nursing roles have vacancies in London. Experience tells us that recruitment is complex. Can the Minister reassure the House that in an environment that uses the language of taking back control of our borders and controlling immigration, steps are being taken to reassure not just those within the EU but outside it that they remain a valued and essential part of our diverse health and social care sector?

I am grateful to the right reverend Prelate for the opportunity to say that we value every person who works in this country in those professions. We want to ensure that they are able to stay and contribute to the health and wealth of our country. I point out we are improving both recruitment and retention not only through increases in the living wage but through changes to the Agenda for Change pay deal concluded earlier this year. It will give 1 million staff at least a 3% pay increase by the end of 2018-19, and increase the starting salary of a nurse by nearly 10% to almost £25,000 by 2021.

My Lords, we all value the increased living wage—I speak as a provider of social care, and my interests are listed in the register. Will the Government ring fence the extra funding that they rightly put into social care, so that local authorities have to pass it on to providers? Providers have increased costs, and we cannot pass the money on to our care workers because we simply cannot afford it.

I recognise the picture that my noble friend paints. It is of course incredibly important that money gets to the front line. I am sure that she is aware of this, but I would point out the operation of the Better Care Fund, which brings together local authority and NHS funding specifically to support social care provision. The amounts of money going through that have been increasing over recent years.

My Lords, the statistics quoted by my noble friend on the Front Bench are pretty frightening, but the knock-on effects on the 6.5 million unpaid carers upon whom our health and social care system depends are even more alarming. In a recent survey, 70% of them doubted their ability to continue caring if more support, much of which comes from these care workers, is not available to them. Will the Minister assure the House that the forthcoming Green Paper, which we know is imminent, and the NHS plan, will take full account of the needs of carers?

I am grateful to the noble Baroness for raising the matter and for her persistence in doing so; she is quite right to. We were pleased to publish the action plan earlier in the year and I can tell her that the Green Paper, as I have said before at the Dispatch Box, will contain more policy on supporting carers.