Migration policy: A homecare provider’s perspective

The new UK migration system will not include a visa option for the dismissively named “low-skilled” workforce after Brexit. This has caused huge concern for homecare providers working in a seriously underfunded care system. Non-British nationals make a major contribution to the UK’s social care system.

A homecare provider in England vividly describes how the changes are likely to affect his business, his workforce and the people they support with vital care.

“We need to realise that the complete failure of social care is about to happen. Although the headlines are about ‘not selling your house to pay for care’, the fundamental issue is an insufficient number of careworkers. We cannot have a Brexit immigration policy that doesn’t have careworkers as an exempted status. In my opinion we actually need an overseas drive to encourage immigration of people that want to work in care. The recent message that essentially says Britain is open for business to high worth individuals at the expense of the hospitality and social care sectors, fails completely to understand the potential complete disruption of normal life. This is especially true if you can’t find someone to care for your needy elderly mum or dad.

I started my homecare business ten years ago with a commitment to only offer high quality care. I’ve never wavered from that purpose. For me, it has always been about getting good staff to build a caring relationship; after that all the other issues should fall into place. Certainly, the business has needed to be run at a profit to ensure sustainability of the service, but I’ve always believed profits are a result of good performance, whatever business I have previously run.

Finding good staff has been an issue for each of the last ten years. It is clearly a difficult job, demanding adaptability, managing relationships with customers who are prone to being tired, unwell and consequently irritable.  The essential requirement for staff to cover unsociable hours, 365 days of the year, is compounded by wages being poor. I have constantly favoured a registration scheme to reward the role with some status.

I believe that wages are low, and zero hour contracts inevitable, because of the price people are prepared/able to pay, combined with the degradation of service standards by the huge influence of under-funded local authorities. How did we arrive at a point where we accept paying less for a careworker (managing individualised care and medication assistance) than an unskilled garden labourer? I blame councils’ influence for also setting an expectation that customers only have to pay when they receive a service. I also blame their influence for contracts being allowed to stop and restart whenever people are hospitalised/have visitors/have respite, all with no commercial penalties or compensation to the careworker. 

Over the past year I have spent a considerable sum advertising for staff. I have tried advertising on Facebook, hosted ‘get togethers’ amongst many other methods.

Since Brexit, we have lost all of our careworkers that were not already married to local people, or who have put down roots over many years. I think our competitors have experienced the same. Today there were nearly 150 careworker vacancies being advertised in my area alone (population 50,000). Sadly, the national recruitment campaign didn’t appear to touch us.

Our politicians must be aware of the economic lesson that making a resource rarer makes it more expensive? Government says that it is committed to funding social care, and yet their actions will make the ultimate solution far more expensive. We have no long term solution if we don’t have a short term supply of careworkers. Why on earth create a further supply shortage? The prospect of cheap, mass-manufactured, programmable robots might arrive in 15 years, but how do we cope until then?

One of the problems I encounter is that people think that anyone can provide care. They consider it as an unskilled, low paid job because it doesn’t require graduate qualifications. The thinking is “if you just increase wages then you’d have lots of applicants”. I would really like the Chair of the Migration Advisory Committee to spend a day with our careworkers. No PR, no cameras, just turn up and ride with a careworker, as she makes her home visits.

For some time I have been concerned about the market sustainability of providers taking-on uncommercial contracts they cannot afford to service. I stopped working for my local authority to avoid this.

However, the full picture is that we are now offering employment terms that can only be afforded by increasing prices to people who fund their own care. Homecare may soon only be available to the very wealthy. We are adding to the number of people with real care needs that cannot afford to purchase.

I must be able to reassure my own staff that our requests for them to ‘help-out’ will not become a permanent feature of their employment. It’s not fair on them either and we shall soon start losing people with genuine caring abilities. They don’t want to feel as if they are letting our customers down and hate being put in a position of stress about choosing between domestic responsibilities and the needs of our customers. While the careworkers welcome the extra pay (and who wouldn’t, they deserve it!), they still can’t be in two places at the same time. It’s a genuine shortage of resources not a co-ordination problem.

As a business we now find ourselves on the cusp of having to tell long-term customers, that we simply cannot continue to source sufficient numbers of careworkers to fulfil our commitments, without putting their safety at risk. I feel complete despair at our situation and I’m disappointed in myself for not having the brains nor ability to change things. I fear the headlines will be of ‘greedy’, profit driven care providers withdrawing from the market. The reality is that I am not even taking a salary from the business. I can assure you it’s not about greed, it’s economics.

Sadly, I don’t believe I have any choice but to try and compete on what resources are out there. I have made promises to families that we will support their loved one to stay at home for as long as they wish and it is safe. I wouldn’t want to give up unless I’ve exhausted my efforts and my own energy reserves. It’s clear that the unregulated, non-tax paying, non-pension paying ‘grey market’ in care will benefit from good homecare providers being priced out of the market. Neither Government, nor the regulator or HMRC appear interested in the inevitable consequences.“