For years, Mike Padgham couldn’t get the staff. When he posted vacancies in his five care homes in Yorkshire, he received very few responses.
But early last year the government opened a new immigration route, expanding the visa scheme for health workers to include healthcare workers. Since then, Padgham’s company, St Cecilia’s Care Group, has hired 32 foreign staff – mainly from India, Ghana and Zimbabwe.
It’s not a “cheap solution”, says Padgham: the company covers the costs of recruitment, and when they arrive, employees are paid the same as their British colleagues.
But without the foreign recruits he believes at least two of his care homes, which could not meet minimum safe staffing levels, would have been forced to close.
“It’s a lifeline right now,” he says. “Many providers would not be here today if it were not for these staff from abroad.”
The story of Saint Cecilia is repeated throughout the country. Nationally, more than 123,500 people have arrived to work as healthcare workers and senior care workers since the route opened.
But last week Padgham, who has worked in the industry for 34 years, saw headlines that made him fearful for the future.
Immigration Secretary Robert Jenrick has drawn up plans to limit foreign health and care workers to bringing one family member each to Britain. Some reports suggest the Home Office could ban them from bringing dependents. Other plans being considered include a cap on the number of NHS and social workers hired from abroad, and changes to the minimum wage foreign workers must be paid.
The proposed policy changes, drafted under former Interior Secretary Suella Braverman, have not been confirmed. But they are being pushed by Jenrick in response to high net migration figures – a record 745,000 in 2022 – which Prime Minister Rishi Sunak is under pressure to crush.
Padgham believes that a limit on the number of caregivers, or a limit on the number of dependents, would spell disaster. “If that option isn’t available, it will put people off,” Padgham said. “How can you go to another country, work for someone and leave your family on the other side of the world? It’s a big question. It’s a big deterrent.”
Changes to minimum salary thresholds would be a “double whammy”, he says. St. Cecilia’s and other health care providers depend on money from municipalities, whose budgets – determined by central government funding – are already tight. Currently, foreign healthcare providers must receive a minimum of £20,960 per year. If this were increased – without significant additional investment in government social care – the cost of hiring people from abroad would become unsustainable, says Padgham.
He is not alone in his fear. This weekend the government’s immigration adviser warned that while the proposed policy changes could reduce overall migration rates, they could devastate social care.
Professor Brian Bell, chairman of the government’s Migration Advisory Committee, told the Observer that implementing policies to reduce migration without tackling staffing problems in social care could cause “enormous damage” to the sector. “Until that missing piece is solved, I would personally say it is very dangerous to play with the social care figures,” he said.
Professor Martin Green CBE, chief executive of Care England, said such changes could force some providers into bankruptcy. “If the government imposes a cap, refuses to allow dependents into the country or changes wage requirements for foreign staff, making them more expensive, this will result in more healthcare services struggling to staff and potentially reducing the amount of care provided they have to grant will decrease. can offer,” he said. “In some cases, this could lead to them leaving the market.”
There is talk of limiting the number of dependents under heavy pressure from the right wing of the Conservative Party to reduce net migration. The Tories have repeatedly promised to reduce the figure to “tens of thousands”. Targeting health and care workers is an obvious choice: they are by far the biggest users of the skilled worker visa route, with 143,990 people arriving via the health and care visa last year, along with 173,896 people at dependent.
Changes to the rules for dependents may not have the devastating impact on hiring that some fear. It is not yet clear whether any restrictions would only apply to healthcare workers or also to other healthcare workers. But Madeleine Sumption, director of the Migration Observatory at the University of Oxford, said: “I think in the case of healthcare workers it is very likely that there are plenty of people around the world who are willing and interested in those jobs that Great Britain Britain wants. are still able to recruit healthcare workers.” If the same rules applied to people higher up the skills spectrum, such as doctors, things could become more difficult, she said.
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In addition to the practical implications for the health and social care sectors, the policy proposals have also been attacked for their potential impact on individual families.
Unison, the trade union, said the policy ‘demonised’ migrant workers, while Migrants’ Rights Network said: ‘Separating families because of arbitrary numbers is cruel.’ The Joint Council for the Welfare of Immigrants argued that restrictions on dependents would “tear families apart” and “make people’s lives worse.” “Low-wage migrant workers are treated as disposable economic commodities,” said Caitlin Boswell, policy and advocacy manager.
Mictin Ponmala, 38, a health worker from India living in Luton, might never have come if restrictions had been put in place for dependents.
For him and many of his international colleagues in health and social care, “the only reason” they chose Britain was because nuclear family members were also allowed in, he says. Wages are better in the Middle East and Australia, where the number of migrants in health and care is also high. But family restrictions are stricter there.
“Not allowing dependents will have a negative impact. People will think about leaving Britain, and some people won’t come,” said Ponmala, who works as a nurse in the NHS. Three months after he arrived in Britain, his wife, who also works in healthcare, followed. They have since had a son.
“It’s not a matter of money. It’s life,” he says. “Preventing families from being reunited is a denial of human rights.”
The Home Office declined to comment on the plans or concerns. The Ministry of Health also declined to comment. The government is expected to announce migration measures in the coming weeks.
Padgham called on ministers to abandon any plans to focus on health and social care. He understands the “political pressure” to reduce migration, but said: “You can’t cut off supply and still underfund social care and expect everything to work.
“Do they want the waiting lists to get longer? Are healthcare providers going bankrupt? Are people not getting the care they need? That is the result of the policies they are talking about.”