Just over two weeks ago, the United Kingdom Prime Minister Keir Starmer, delivered a speech whose content, tone and central message has been viewed with dismay by the majority of Scotland’s social care sector. The primary focus of the White Paper which his speech outlined is the removal of the designated Care Worker Visa route. In a post-Brexit landscape this Visa has enabled a significant number of Scottish care providers to recruit staff from across the world. This has helped to meet long-term vacancies within the sector.
The initial concerns of the sector upon hearing of Starmer’s intention have been further underlined by some recent research which has been undertaken by Scottish Care. A short, focused research questionnaire has detailed the significant extent of vulnerability within the sector. It has stated that perhaps as many as between 28-36% of those working in social care in Scotland are international colleagues. Further it has pointed out that at least 7000 individuals are working under international visas and perhaps even more challengingly that the geographical and organisational make up of international workers at present is a real risk to the sustainability of the delivery of social care in parts of the country. This is because there are a notable number of organisations who have a very high reliance on international staff. The report stated that for 7% of the 298 responding organisations that international workers make up over 90% of their total workforce; 14% have over 75% of their total workforce and 11% had a situation where international staff made up 50-75% of their total workforce. These are geographically critical organisations.
In the weeks that followed Starmer’s “island of strangers” speech there has been an attempt to explain why it is important that Scotland needs to continue to attract international workers. The distinctive nature of Scotland’s demographic and workforce needs should alone convince Westminster to take a more regional/national and sector specific approach to immigration.
Scotland has an ageing population and increasing demand for social care services as a result both of that ageing population and the well-known health inequalities which scar our population, alongside an ageing workforce presents a very real challenge. Taken together this is evidence of the current and future requirement of attracting people into the country in order to sustain social care provision.
The debate since the Starmer announcement has also advocated the importance of prioritising, equipping and skilling up of an indigenous workforce. Many of these comments have been made without recognition of the continuous and ongoing attempts in this field for many years. In Scotland, not least, there has been a long running campaign to pay staff salaries commensurate with their professionalism and skill. Given most workers, regardless of who they work for, are on Government resourced contracts – the obstacles to better terms and conditions lie squarely with political leadership and their fiscal priorities. Regardless of this, to withdraw a life-line of workforce supply without an alternative, or without a pathway to that alternative through substantial investment in improved terms and conditions, is singularly irresponsible.
The debate has not been helped by the comments from certain politicians which have described social care and its work as being of ‘low skill’ or indeed being ‘unskilled’. This affront to the professionalism of workers who require to be registered and regulated betrays a lack of understanding of the nature of social care. The changes in social care provision not least within the community in the last few years evidence the need of a workforce who deliver low level clinical tasks as well as other key functions which would in a previous era have been the preserve of primary and community health.
The threatened loss of critical social care services in already fragile communities will have almost immediate impact on the wider health economy not least the NHS and indeed on the ability of commerce and industry to function successfully.
One dimension that perhaps has not been as widely considered in the recent debate is the reality that Scotland in and indeed, the United Kingdom as a whole, is not alone in facing shortages of social care staff. There are many countries in Western Europe where there has been significant enhancement to terms and conditions of care staff and yet even these nations have struggled to recruit indigenous populations and have had to rely on attracting international workers.
Globally it is increasingly recognised that there is an existential challenge to developed and developing economies – and that is as a direct result of the shortage of workers willing to commit to careers in aged or social care. Every modern economic system in the western world is reliant upon a social or aged care system that enables economically contributive individuals to be able to work because the care of their family and relatives is supported and delivered by others.
It against the backdrop of such international demand that the negative rhetoric and the actions of the UK Government are so harmful and naïve. In a globally competitive employment market, it is little wonder that providers are already hearing of individual workers choosing other nations rather than Scotland as their destination of choice.
One of the saddest legacies of the last two weeks are the numbers of dedicated professionals who are questioning their own experience of Scotland as a hospitable place because of what they are watching and hearing on their televisions, radios and on social media. Given the essence of care and support is the showing of compassion to others and the bestowing of dignity on all human relationships – these seem to be standards in short supply in the recent discourse both socially and politically.
The people who are being made to feel like strangers in our nation are the amazing women and men who are caring day in and day out for some of our most valued citizens. If nothing else, we need to affirm the presence and to increase the value of those who are already working here – or our likelihood of being able to hold on to these critical colleagues becomes sharply diminished.
I hope that some of the political and advocacy approaches already underway will bear some fruit because without change the reality is one of a dramatic decline of social care provision across Scotland and in some areas in specific the complete removal of support and care.
And if social care collapses as a sector the very fabric of our communities soon disintegrates.
Dr Donald Macaskill is the Chief Executive of Scottish Care.