What does Brexit mean for the Welsh health and social care workforce?

Regardless of what happens on the broader Brexit negotiations, change is coming on January 1; free movement will end, and the new “points-based system” will be introduced.  In new research for the Wales Centre for Public Policy, Craig Johnson, Elsa Oommen and I looked at what this will mean for the health workforce in Wales; and since our report was published, the Migration Advisory Committee has produced its latest review of the Shortage Occupation List.

Our conclusions are both good news and bad news. Crucially, the new system is considerably more liberal than that originally proposed by Theresa May. Not only has the salary threshold for the new Skilled Worker Visa been reduced from £30,000 to £25,600 but a new Health and Care Visa has been introduced. For this visa, which covers not just medical staff but a broader range of health professionals, the salary threshold will be set at the appropriate NHS pay scale – in other words, for such roles the NHS can hire non-UK workers without meeting the general salary threshold.

So while the system is considerably more restrictive for those coming from the EU, it is much less so for those coming from outside the EU. Of the 7.5% or so of current NHS staff who are not UK nationals, our analysis suggests at least two thirds would qualify for a work visa.  Some EU nationals would be ineligible, especially those in the “additional clinical services” group, including ambulance drivers, dental surgery assistants and healthcare assistants.

Although those currently working here are entitled to continue to live and work here under the EU Settled Status Scheme, there is likely to be some effect on future recruitment.  It will be vitally important for the sector – and the Welsh Government – to continue to provide support and encouragement to current EU-origin residents to register. And the liberalisation for non-EU nationals might actually help the NHS, particularly in medical grades, where 1 in 5 staff are already from outside the UK or EU.

However, the implications for social care are considerably more severe. Given both the importance of social care provision for NHS service provision and the desire for an integrated health and social care system in Wales, the particular challenges presented here represent a potential vulnerability.

Many essential social care roles are defined as “low skilled”, so far fewer roles will qualify for the Health and Care Visa or Skilled Worker visa, and the greater turnover of staff in the sector presents particular challenges; with likely knock-on impacts for the NHS.  Average earnings in the sector are only about £17,000, far below the salary threshold.

The Migration Advisory Committee report recognises the depth of concern, not just in Wales but across the UK, of the impact of the end of free movement; indeed, it talks about the “stark consequences”. It does recommend some adjustments, in particular adding senior care workers and nursing assistants to the shortage occupation list.

But more broadly the MAC sticks to its long-held view that the problem with recruitment and retention in the sector is one of low wages, driven in turn by underfunding – and that the answer is therefore more funding, not migration.  It’s hard to argue with this in principle – but in practice this will be of little comfort to those in the sector who will have to deal with the immediate pressures on both demand and supply in the coming months.

And the MAC has little to offer specifically for Wales – the only occupation to be added to the Wales-specific SOL is that of health professionals, and as the report says “the practical benefits of being included on the SOL for this occupation are somewhat limited”, because they are already covered by the Health and Care Visa.

The migration landscape, and the implications for the health and social care workforce, is undergoing the most important set of changes for perhaps forty years; and this at a time when the Coronavirus pandemic has introduced a huge amount of uncertainty. Fortunately, the new system is considerably better attuned to the needs of the NHS and Wales than seemed likely two years ago: however, significant challenges remain, especially for the social care sector.