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The United Kingdom’s Social Care Crisis


Before the United Kingdom withdrew from the European Union and introduced a more restrictive immigration policy, the country attracted tens of thousands of immigrant social care workers yearly. The new policy, commonly referred to as the Points-Based Immigration Policy, is a system for managing immigration that assigns points to various factors to determine an individual’s eligibility to migrate to the U.K. Significantly, this policy excludes “lower-skilled workers,” a phrase that is both poorly defined and highly consequential to this demographic. A significant portion of the U.K.’s social care workforce is comprised of immigrant workers either employed as live-in caregivers or caregivers in homes for the elderly. Since the policy was implemented, the U.K. has suffered a shortage of care workers; there is a severe potential for this shortage to turn into a major crisis due mainly to the rapid growth of the country’s elderly population. Accordingly, U.K. citizens in need of care must pay a high premium. Parliament’s lack of recognition of the contributions of immigrant social care workers has led to a workforce shortage, an increase in the cost of care, and a higher incidence of physical and psychological abuse among care workers.

The U.K.’s National Health Service defines a social care worker — commonly referred to as a domestic worker in the United States — as someone who “provide[s] the practical support to help people cope with the day-to-day business of living.” Despite the immense contribution of care workers to the physical and mental well-being of U.K. citizens, there is little appreciation for them on the part of Parliament and citizens alike. According to Virginia Mantouvalou, a professor of human rights and labor law at University College London, care workers are undervalued in the U.K. because many come from marginalized groups and work in the privacy of homes. As a result, Parliament has failed to account for them when drafting legislation. The charity organization Age UK revealed that the new immigration policy was created to prevent immigrant care workers from receiving work permits. This policy was devised by the U.K.’s Migration Advisory Committee, an independent governmental advisory body that listed social care workers as low-skilled and therefore not eligible for work visas. Ultimately, this misclassification of skill level regarding social care workers reflects Parliament’s lack of recognition of the technical skill required for a social care worker.

According to the home care provider Helping Hands, live-in care services entail hiring trained workers to provide specialized care for the elderly at their residence, thereby eliminating the need to transition into a nursing home. Live-in care workers provide companionship, medical and personal care, meet nutritional needs, and perform household chores. They enhance living conditions and improve the mental, physical, and social well-being of the elderly who would otherwise be isolated from their families in the secluded environment of a nursing home. They play an invaluable role in maintaining the quality of life for those they care for daily. Additionally, care workers are necessary not only for ensuring the day-to-day quality of life of those receiving their care; by extension, they also provide an invaluable service to the families of those in their care. The restriction of working visa access for immigrant social care workers represents an obstacle to immigrants seeking a better life for their families in the U.K.

Parliament’s failure to value the competencies of social care employees means that it does not provide adequate funding for social care and has failed to invest in the qualifications, training, and career advancement of social care workers. Social care requires excellent communication skills, a general concern for others, consistency, customized care, and, above all, emotional labor. “Emotional labor” is defined as a form of work “requir[ing] one to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others.” This form of labor should not be considered low-skilled because it deals directly with the care and well-being of individuals with various pharmacological, physical, and psychological needs. Additionally, care workers must be able to cope with immense stress while on the job due to exposure to the trauma, poverty, and social and racial inequalities that form an inextricable part of their status as immigrants. Emotional labor, however, is not recognized by economic analysts, who use quantifiable technical skills in rating economic sectors. Due to the relative invisibility of social care workers and the challenge of quantifying their efforts and contributions to the economy, authorities often overlook social care workers when creating policies related to government assistance, health, insurance, and citizenship requirements.

Immigrant workers have played a crucial role in the U.K.’s social care sector for decades, with women making up much of this workforce, but any restrictions on their employment could have a disproportionate impact on their already-challenging working conditions. Immigrant care workers in general make up 18.4% (266,000) of the U.K.’s social care workforce. According to the University of Oxford’s Centre on Migration, Policy, and Society, immigrant care workers have historically come primarily from Poland and, more recently, from Jamaica, Germany, and Ireland. Additionally, 69% of immigrant care workers in the U.K. are women, and any restriction on immigrant social care work therefore affects primarily women. Furthermore, not only has their role historically been poorly compensated, but the struggles of female immigrant care workers are also complicated because women are more likely to work as live-in care workers, which requires a higher level of emotional labor.

Legal obstacles hinder this valuation of social care in the U.K. According to Mantouvalou, U.K. labor laws threaten the working rights of care workers by not regulating work hours, health, safety, and wages. The most prevalent bias against care workers is the government’s tendency to avoid acknowledging them as workers, which precludes them from finding legal protection. Furthermore, the International Labour Organization has previously excluded care workers from the benefits of so-called “flexibility clauses,” which cover wage protection, night work, and maternity leave. Parliament has established strict legislation that requires immigrant care workers to remain with one employer or risk losing their work visas. Immigrant care workers who arrive lawfully in the U.K. accompanied by their employer must remain in the service of that employer regardless of the work conditions. Failure to observe the rules may result in loss of employment, imprisonment, or immediate deportation. These regulations have drastically reduced immigrant care workers’ rights and relegated them to undervalued and underpaid jobs. The disparity between immigrant social care laws and the labor laws that apply to U.K.-born citizens reveals how Parliament discriminates against immigrant social care workers.

Abundant evidence indicates that social care workers are physically and psychologically abused in the U.K. Mantouvalou, citing one charitable organization’s 2010 report, outlines the mistreatment and abuse of workers: 60% of care workers registered with the organization said they lived under constant monitoring, 65% said their passports were withheld, 54% had incidents of psychological abuse, 18% had physical abuse, 3% had experienced sexual abuse, 49% lacked a safe place to sleep, and 26% lacked proper nutrition. These statistics are alarming, and they paint a bleak picture of the working conditions of social care workers in the U.K. Mantouvalou also delineates the challenging working demands: 67% of workers had no days off, 48% worked more than 16 hours a day, 56% were paid less than £50.00 a week, and more than 58% had to be available 24 hours a day. In 2019, the E.U.’s Fundamental Rights Agency reported that the U.K. had one of the highest rates of care worker abuse in the E.U., citing severe gaps in Parliament’s legal and administrative measures as the culprit. The lack of action by Parliament reveals a blatant disregard for the quality of life and work of care workers, and it has not taken any meaningful action to address the abuse of social care workers despite concerns raised by prominent individuals and nongovernmental organizations. Better working conditions for social care workers in the U.K. will not improve until Parliament passes legislation that ensures proper working conditions for social care workers.

The U.K. is also currently witnessing significant demographic shifts attributable primarily to an increase in the elderly population and a decrease in the working-age population. In 2016, the Institute for Public Policy Research (I.P.P.R.) projected that by 2030, the number of U.K. citizens over the retirement age of 65 would increase by 33% — from 11.6 million to 15.4 million. Furthermore, the I.P.P.R. projected that the number of U.K. citizens over the age of 85 would nearly double. On the other hand, the I.P.P.R. projected that the U.K.’s working-age population would increase by only 2%. This growing age gap will therefore reduce the availability of care workers for the elderly. These demographic shifts suggest that immigrant workers are critical to ensuring that the required social care resources are available for the elderly; however, due to recent policy shifts on the national level, immigrant care workers are finding it increasingly difficult to find employment in the U.K.

The Boris Johnson-led Parliament was primarily responsible for the social care crisis in the U.K. However, their mismanagement was at least partially a response to pressure from constituents likely unaware of the broader impacts of immigration restrictions. According to the political economist and commentator Philippe Legrain: “Britain’s decision to leave the European Union was motivated in large part by a desire to ‘take back control’ of immigration. The voters in northern English towns … are particularly hostile to immigrants. They accuse low-skilled Eastern Europeans in particular of depressing local wages and straining public services such as health care.” The Johnson-led Parliament therefore demonstrated a lack of recognition for the role of immigrant care workers in the U.K. economy and citizens’ physical and mental well-being. This immigration policy, Legrain argues, was fueled by citizens whose anti-immigrant sentiments blinded them to the benefits provided by immigrant care workers to the U.K.’s elders and its economy. Without reversing this immigration policy, the shortage of workers will likely increase government expenditures on elderly care and assistance.

According to Age UK, 130,000 new social care workers are needed each year to cover the current level of demand. The social care workforce’s ability to cope with this level of demand is further strained by the new immigration policy. There are currently over 110,000 vacancies in the social care sector, a number that is likely to result in 30% of care workers leaving the workforce each year. According to the charity Independent Age, 18.4% (266,000) of social care workers are foreign-born. Furthermore, among these foreign-born workers, 28% originate from the E.U. Despite clear evidence underscoring the need for immigrant workers for social care, Parliament has placed strict regulations on immigrant care workers and, in doing so, has revealed its apparent lack of concern for the citizens in need of their services. Parliament argues that shortages in the social care workforce result from market forces, not regulations barring immigrant care workers from entering the U.K. As demonstrated above, however, the data does not support this stance.

The U.K.’s new immigration policy favors specific demographics employed in sectors such as manufacturing and construction. According to GOV.UK, the new immigration policy requires immigrant workers to “demonstrate [that] they meet a specific set of requirements for which they will score points.” To qualify for a work visa, an immigrant worker must earn a total of 70 points: they can earn 40 points for having a “skilled” job offer; 20 points for a job that is in shortage; 20 points if the job pays £25,600 or more per year; 10 points for having a Ph.D. relevant to their job; 10 more points if the Ph.D. is in STEM; and, lastly, 10 points for speaking English. Because these jobs are not highly visible or well compensated, this immigration policy fails to recognize the high-skill nature of care workers’ jobs and the central role they play in the economy and in improving the well-being of citizens. This failure constitutes a blatant disregard for immigrant care workers and for those in need of their care.

Despite appeals to relax the U.K.’s immigration requirements, Parliament has refused to budge. Some appeals have included a plea to reduce the 20-point income threshold for immigrant visas from £30,000 to £25,600. However, the higher figure of £25,600 would exclude most immigrant care workers because their pay is typically below that threshold. For care workers to meet this requirement, they would need to be paid at or above the real living wage of £9.50. According to the charity Skills for Care, only 10% of care workers were paid at or above this wage in 2019, a 16% decrease from 2012. Parliament’s lack of recognition of the work that immigrant social care workers do shows a clear undervaluation of their overall contribution not only to the U.K. society but also to the U.K. economy. Ultimately, therefore, this immigration policy will harm its economy and the general quality of life.

The new immigration policy will limit the pool of available care workers and force employers to pay higher premiums for their services. This, in addition to the difficulties employers face in retaining care workers who desire better-paying and more respectable jobs, will eventually result in unsustainable living expenses for the elderly population and their families. Furthermore, remedial measures within the population will likely force some elderly citizens to move to nursing homes, thereby stripping them of the option of remaining at home, assisted by care workers. The result of restrictions on social care workers in the U.K. will be the disenfranchisement of the elderly because they are left without the assistance needed to maintain independence.

The U.K.’s immigration policy aims to reduce immigration while boosting local capacity. As a result, Parliament states that more than eight million inactive people in the U.K. could occupy social care positions. However, this argument fails to consider crucial factors, such as the fact that some students and the elderly do not or cannot work. Moreover, although the immigration policy appears logical from a local policy perspective, its objective — national independence from the international social care market — is unattainable due to the socioeconomic and cultural factors contributing to social care work.

The COVID-19 pandemic not only exacerbated the health of social care workers but also reduced their quality of life overall. In the case of COVID-19, care workers were typically at the front line dealing with family emergencies. According to the Inter-Agency Standing Committee, some risks care workers faced included exposure to COVID-19 while caring for the elderly. Additional consequences affected the workers, such as delayed pay or reduced salaries, pandemic-related economic difficulties, gender-based violence, sexual abuse, increased workloads, and deportation. Furthermore, many care workers were left homeless after losing their jobs due to pandemic control measures, such as lockdowns and a ban on international traveling. Parliament’s lack of recognition of the importance of social care workers was therefore further complicated by COVID-19 and contributed to socioeconomic distress experienced by care workers. Even though restrictions have been lifted, the same trends remain in motion.

With the elderly population growing exponentially, the U.K.’s social care dilemma will inevitably cause a crisis for the country. Perhaps only then will the country wake up to its undervaluation of social care work. This analysis of current care work conditions demonstrates the urgent need for legislative protection for care workers, especially those who are immigrants. Parliament must enact legislation that will create better protections for care workers. To date, however, Parliament has not created laws that would increase wages and improve working conditions for live-in care workers. Furthermore, despite the reliance on the services of care workers, few citizens are willing to stand up for them. Attitudes toward social care workers reveal the extent of prejudice and discrimination against immigrants and other marginalized groups in the U.K. and a deep-rooted disregard for the value of emotional labor. U.K. citizens must acknowledge their dependence on the often-invisible social care sector. This acknowledgment should come from both the highest levels of Parliament and the general population. Neglecting the rights of social care workers, and of immigrant care workers more specifically, may lead to their own struggles and will unquestionably be detrimental to elderly citizens, their families, and the U.K. economy.



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