How Immigration may Help Alleviate Staff Shortages in Adult Social Care

Adult Social Care (“ASC”) has been facing staff shortage issues. Brexit and the pandemic only compounded workforce problems faced by ASC providers. The Migration Advisory Committee (“MAC”), which is an independent, non-departmental public body, reviewed these issues and published a report (“Report”) in April 2022 with recommendations to the Government on how to tackle them. The Report focuses on how immigration policy can be used to help alleviate the workforce pressures that ASC has historically faced and in particular in a post-Brexit context.


The Minister for Future Borders and Immigration commissioned the MAC to “…undertake an independent review of adult social care, and the impact the ending freedom of movement has had on the sector”.

The Workforce

Data gathered by MAC revealed that care workers account for three-quarters of social care employees. Further, vacancy rates indicate that ASC needs an additional 66,000 workers to meet demand today and 236,000 to keep up with growing demand. It is estimated that by 2033 ASC will need to employ 4% of the working age population to meet demand. Currently it only employs 2%. This implies that the demand is growing faster than the workforce and will only make the current workforce issues worse in years to come. Additionally, as the economy opened up after the COVID-19 pandemic lockdowns, vacancy rates only increased. ASC was disproportionately impacted by this for several reasons: low pay rates, increased costs of living, and competition with NHS to name the major ones.

Further, in ASC there is little standardisation of qualifications. This means that there is little by way of difference between the lowest level care worker and the highest. As a result, there is little role and pay progression within ASC, which contributes to the recruitment and retention issues that ASC faces. Adding to this, in 2016 National Living Wage (“NLW”) was introduced and set above National Minimum Wage (“NMW”). This increased wages for the lowest paid jobs, while also compressing the distribution of pay. This further added to the problems of having little to no incentive to stick with ASC and progress through roles because there is little pay increase.

Immigration Policy

ASC, unlike other sectors, has not relied on European Economic Area (“EEA”) workers in the same way. For other sectors, EEA workers were just part of the pool of workers they recruited from. This was less so for ASC. However, in light of Brexit and a decreased labour market to draw from, shortages in the general workforce will be acutely felt by ASC because the competition pool is now even smaller across the UK.

The Skilled Worker  and Health and Care Worker (“H&CW”) visa are now the means that employers can use to hire migrant workers. From January 2021 to December 2021, sponsorship applications made by the Health and Social Care sector nearly doubled from 18% to 30%. In December 2021, the Government adopted MAC’s recommendation to add care workers to the H&CW visa, widening the pool of workers that ASC could potentially draw from. Additionally, on 24 December 2021 the Government adopted MAC’s recommendation to add care workers to the shortage occupation list (“SOL”).  This helped to reduce the cost of hiring migrant health care workers because the SOL roles benefit from reduced minimum salary levels employers are required to pay and lower costs of applying for visas for workers. However, adding care workers to the SOL is a short term solution because the reduced mandated salary suggests that workers are not getting paid the correct value for their skills. Further, low salaries make visa fees less affordable than for other occupations with higher salary thresholds, even with the discounted application fees. Additionally, a set minimum salary that is higher than NMW means that UK born workers will find the role less attractive and may even make it hard for employers to meet salary requirements due to funding shortages. Ultimately, it would be cheaper to hire a UK citizen over a migrant worker, but the pay is not enough incentive for UK citizens.

Key Findings/Recommendations

The final outcome of the Report made the following suggestions to the Government:

  • Invest in training and career development to attract more UK born workers to the sector;
  • Introduce joined up role recruitment campaigns for NHS and wider health and social care providers to help mitigate competition for care worker roles;
  • Introduce a fully funded minimum pay rate that is higher than NLW;
  • Introduce more highly skilled roles to the SOL so employers have a wide workforce pool; and
  • Pay care workers for hours even when their time is spent travelling and sleeping.

Importantly, MAC emphasises that immigration policy is not the solution, but can help to alleviate the problem. Most importantly, there needs to be a significant increase in the levels of pay for all health and social care workers so that it is commensurate to the value they provide and the level of work that they do.


So what does this mean for ASC Providers? The good news is that independent bodies are recognising the need for increased funding which ASC has been begging for. Hopefully this will prompt the Government to reassess how funding is distributed to and within health and social care.

MAC believes that the best and most effective solution would be to increase funding to allow for better pay and incentive to join the ASC workforce, but this will be a long term goal. Meanwhile, providers can and should take advantage of the reduced costs associated with hiring overseas workers via the skilled worker route while they are on the SOL. Hopefully with workers who are reliant on a specific employer to remain in the UK this will increase retention. It will take time for providers to become accustomed to the nuances and burdens associated with applying for sponsorship, but once they are on the system it will widen the workforce pool that they can readily access and draw from.

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