Adult social care and immigration: annex (accessible)

Question 1

Annex A: Call for Evidence and Stakeholder Engagement

Accepted Answer

Introduction

This Annex details the Call for Evidence (CfE) and engagement with stakeholders that was carried out to support this commission.

Findings from these activities, as well as additional evidence submitted, have been analysed and written up throughout the report to support and illustrate the relevant sections. We also present quotes (generally anonymised to protect participant confidentiality except where explicit permission has been sought to publish the name of the respondent) from these sources. The remainder of this Annex provides more detail on those who responded to the CfE questionnaires and participated in the stakeholder engagement events that took place.

Stakeholder Engagement

As with other commissions, we carried out a programme of stakeholder engagement to inform our analysis.

This engagement played an important role in our understanding of some of the key issues impacting on the adult social care sector. Members of the MAC met with representative bodies of the sector from all nations in the UK, some on multiple occasions. There were also meetings with government in each nation to understand the complexities being faced by those responsible for policy in the sector. Furthermore, the MAC engaged with trade union representatives to get a clearer picture of the concerns facing workers in the sector.

As part of this commission, in addition to the CfE responses and research participants, we met with a number of stakeholder organisations:

Care England
Care Forum Wales
Care Minister for England (Minister Whately)
Care Northern Ireland
Cavendish Coalition
Disabled People Against Cuts (DPAC)
Homecare Association
Independent Health & Care Providers (IHCP) Northern Ireland
Local Government Association (LGA)
National Care Association
NHS Alliance
Northern Ireland Health Minister (Minister Swann)
Nursing Homes Ireland
Royal College for Nursing
Scottish Care
Scottish Ministers (Minister Gilruth and Minister Stewart)
Skills for Care
Spinal Injuries Association
Trade Union Roundtable
Unison
Welsh Care Minister (Minister Morgan)

The Call for Evidence

Overview

The CfE for this commission comprised 3 questionnaires – individual organisations, representative organisations, and individuals responding in a personal capacity. The questionnaires can be viewed at the end of this Annex. Respondents were initially directed to a landing questionnaire which forwarded them to the most appropriate of these questionnaires for their circumstances. As part of the online CfE, individuals and organisations were also able to submit other evidence directly to the MAC – either as an attachment to a completed questionnaire, or by email.

The CfE questionnaires were open for around 12 weeks, from 4 August to 29 October 2021. 145 responses were received across the questionnaires, and in addition to this, a further 22 respondents provided other evidence, either by emailing documents, or by attaching documents to their CfE response.

Because of the small numbers of responses received, and the self-selecting nature of the sample, the CfE does not constitute a formal statistical survey, and we have therefore avoided the use of percentages. The large number of unrestricted free-text questions does however mean that the CfE responses contain a lot of rich qualitative information. We have used evidence from the CfE, written submissions and the stakeholder engagement meetings we held to help inform our assessment.

Topics

The individual employer and representative organisation CfE questionnaires asked respondents about the following key themes:

The impact of location on staffing and recruitment
The impact of COVID-19 on staffing and recruitment
The impact of the end of free movement on:
- The employment of European workers in social care
- The intentions of existing European staff to remain in post
- The ability of organisations to fill vacancies
The impact if vacancies are not filled
The medium-term impact of the end of free movement

The questionnaire for those responding in a personal capacity was centred on the question of how the end of free movement has and may impact the social care sector, along with any other information the respondent felt was important to the commission.

The results were analysed for specific or potential impacts on the nine protected characteristics under the Equality Act (2010), or for differences by other factors such as geography or care setting. We are unable to draw conclusions about the extent of any specific impacts on protected characteristics through this work, although where issues were raised they have been recorded in the report. The Home Office, upon accepting any of our recommendations, should carry out a full assessment of the impacts on protected characteristics and sub-groups before implementing our proposals.

Who responded to the Call for Evidence?

A total of 145 responses were received across the three questionnaires:

51 Individual organisations
32 Representative organisations
62 Individuals responding in a personal capacity

When analysing the CfE responses, it is always necessary to acknowledge that those who respond do so from a specific perspective, whether as an employer using the immigration system, as a representative organisation representing individuals or employers, or an individual working in or interacting with the social care system. We are grateful for the contribution of all those who have participated and for the time they have taken to respond.

Respondent characteristics – Individual organisations

Of the 51 individual organisations that responded to the commission:

7 were based in Scotland, 3 in Northern Ireland, 30 across specific regions in England, 8 across all of England, and 3 across the whole UK.
29 were based at more than one site within the UK, 20 were based at a single site in the UK, 1 was based at more than one site including outside the UK, and 1 preferred not to say.
Many organisations covered multiple areas of social care, with 27 covering residential care, 27 covering domiciliary care, 16 covering community care, 14 covering day care and 9 ‘other’ (typically direct payments care)

Respondent characteristics – Representative organisations

Of the 32 representative organisations that responded to the commission:

7 represented employees, 14 represented employers, and 11 represented both.
10 represented employees or employers in regions of England, 3 were England wide, 2 in Northern Ireland, 3 in Scotland, 1 in Wales, and 13 were UK wide.
Organisations typically covered multiple areas of social care, with 19 covering residential care, 25 covering domiciliary care, 21 covering community care, 18 covering day care, 17 ‘other’ (typically direct payments care), and 1 organisation that preferred not to say.

Respondent characteristics – Individuals responding in a personal capacity

Of the 62 individuals that responded in a personal capacity to the commission:

43 were people that receive care, 6 were friends or relatives of a person needing care, 5 worked in social care, 3 were informal carers, 1 preferred not to say, and 4 ‘other’.
Of those that received care, 41 provided further demographic details:
- 5 were under 35 years old, 16 were 35-54 years old, 13 were 55-64, and 7 were 65 years or older.
- 6 described their health as good, 11 as fair, 16 as bad, and 8 as very bad.
- 25 were female and 16 were male.

Questionnaires

Call for Evidence questionnaires: Individual organisations

Social care commission - Call for Evidence

Introductory text

The Migration Advisory Committee (MAC) has been commissioned by the Government to provide an Independent Review of the impact of the end of free movement of European nationals within the UK on the social care sector.

We appreciate that the COVID-19 outbreak has placed social care organisations in an enormously difficult situation, and that many of you already took the time to respond in detail to our last Call for Evidence about the Shortage Occupation List (SOL) in 2020. The MAC has been commissioned by the Government to provide an Independent Review of the impact of the end of free movement on the social care sector by the end of April 2022, and in order to minimise the burden on you, we will use this Call for Evidence to add to the evidence on skill levels and skill shortages in social care already gathered in 2020 during the SOL Commission.

In this Call for Evidence we ask you to focus specifically on the end of free movement, its impact on your organisation and on the health and social care sector more widely. We greatly appreciate you taking the time to complete this Call for Evidence, in the current challenging context.

The Call for Evidence will remain open until 29th October 2021. All identifying and personal information will remain confidential, however, aggregated and anonymised information in the form of summary statistics will be published as part of our final report. For further details please refer to the processing of personal data document published on our website.

A About You

To start with, we’d like to get some details about you and the organisation on behalf of which you are responding.

A1 What is the name of your organisation?

WRITE IN

A2 What is your email address?

WRITE IN

Prefer not to say 1

B About your organisation – Individual organisations

In this section we ask you which occupations you employ.

The occupations are based on the standard occupational classification (SOC) coding framework. Using this allows us to make valid comparisons of occupations across different datasets.

We have included a selection of common roles within the social care sector, but if you wish to add further roles please follow the guidance below.

B1 The table below shows a number of roles within the social care profession. Please use the slider to select the annual, full time, wage^{[footnote 1]} you pay workers in these roles to the nearest £1000. If you do not employ workers in these roles, please leave the slider at zero.

For examples of common job titles, please hover over the relevant role. (Respondent moves slider from £0 to the relevant annual wage)

Job group (hover over cell for examples of job titles in group)

(example job titles to show – NB These will be in a list below the table)

Care workers (SOC 6145)

Care assistant
Care worker
Carer
Home care assistant
Home carer
Support worker (nursing home)

Nursing auxiliaries and assistants (SOC 6141)

Auxiliary nurse
Health care assistant (hospital service)
Health care support worker
Nursing assistant
Nursing auxiliary

Senior care workers (SOC 6146)

Senior care assistant
Senior carer
Senior support worker (Local government: welfare services)
Team leader (nursing home)

Nurse (SOC 2231)

District nurse
Health visitor
Mental health practitioner
Nurse
Practice nurse
Psychiatric nurse
Staff nurse
Student nurse

Residential, day and domiciliary care managers and proprietors (SOC 1242)

Care manager
Day centre manager
Nursing home owner
Residential manager (residential home)

Welfare and housing associate professionals n.e.c. (SOC 3239)

Day centre officer
Health coordinator
Key worker (welfare services)
Outreach worker (welfare services)
Probation services officer
Project worker (welfare services)

Houseparents and residential wardens (SOC 6144)

Foster carer
Matron (residential home)
Resident warden
Team leader (residential care home)
Warden (sheltered housing)

B2 Other than the occupations listed above, do you wish to submit data on other occupations within the care sector?

No 1

Yes 2

ASK ALL WHO WISH TO ADD FURTHER ROLES (B2=2)

B3 If you employ workers in roles other than those listed in the previous question, please provide further details below.

For further guidance on identifying other occupations, please use the steps outlined below the table.

	Role name	SOC code	Average salary for entry level staff in this occupation (excluding allowances & deductions)	Pay period (Annual/ Monthly/ Weekly/ Hourly)	Average hours worked per week
Role 1			^{[footnote 2]}
Role 2
Role 3
Role 4
Role 5

How to manually add additional occupations and SOC codes

In order for us to be able to make valid comparisons it is important that you match as closely as possible the job you have in mind to the correct 4-digit SOC code. To do this we recommend you make use of the Office for National Statistics Occupation Coding Tool, linked below.

https://onsdigital.github.io/dp-classification-tools/standard-occupational-classification/ONS_SOC_occupation_coding_tool.html

How to use the ONS Occupation Coding Tool

Step 1: Follow the link and enter the name of the job you want to find an occupation code for in the text box “occupation title”.

Step 2: Select the result that best matches your search.

Step 3: Check the match by reviewing the description of the occupation code, the tasks required, and the jobs related with that code.

Step 4: If you are unhappy with the match suggested by the tool, go back to step 2 and select another suggested match and/or go back to step one and alter your search term.

In this example we are happy with the match and can conclude that the job “Car Mechanic” is associated with occupation code 5231.

For ease of reference the link to the ONS Tool has been provided below:

https://onsdigital.github.io/dp-classification-tools/standard-occupational-classification/ONS_SOC_occupation_coding_tool.html

B4 Approximately how many people does your business, at the enterprise level, employ in the UK?

Include full and part time employees
Including bank/agency staff
Exclude self-employed
Exclude owners/partners, but other directors count as employees

Singlecode.

0-9 employees	1
10-49 employees	2
50-249 employees	3
250-499 employees	4
500+	5
Don’t know	6
Prefer not to say	7

B5 Of these, what proportion do you estimate are agency/bank staff?

WRITE IN %

B6 What percentage of your current staff do you estimate are UK or Irish, European^{[footnote 3]} and non-European nationals?

		%
UK or Irish	1
European	2
Non-European	3

ASK ALL WHO EMPLOY NON-EUROPEAN WORKERS (B6=3 GREATER THAN 0%)

B7 If known, do you most commonly employ these non-European members of staff through a work visa or are they employed through other means?

Sponsored through skilled worker route (formerly Tier 2)	1
Recruited them through the domestic labour market	2
Don’t know	3

ASK ALL WHO RECRUITED NON-EUROPEAN WORKERS THROUGH THE DOMESTIC LABOUR MARKET (B7=2)

B8 If known, are your non-European staff resident in the UK as;

PLEASE SELECT ALL THAT APPLY

Student	1
As a dependant or spouse	2
Youth Mobility Scheme	3
Ancestry visa	4
Already has permanent Leave To Remain or equivalent in the UK (for example temporary or permanent leave to remain, naturalised British citizen or Right of Abode)	5
Other (please state)	6
Don’t know	7

B9 In which region(s) or country(ies) of the UK are the largest population of your employees located?

Multicode.

North East	1
North West	2
Yorkshire and the Humber	3
East Midlands	4
West Midlands	5
East of England	6
London	7
South East	8
South West	9
Scotland	10
Wales	11
Northern Ireland	12
England – we operate across regions equally	13
UK-wide – we operate across the UK equally	14
Don’t know	15
Prefer not to say	16

B10 Are there any ways in which your location(s) impacts on your staffing and recruitment? (For example, travel times, or local population demographics).

Open text – 250 words

B11 Is your organisation…

Singlecode.

Based at a single site	1
Based at more than one site (within the UK)	2
Based at more than one site (within and outside the UK)	3
Prefer not to say	4

B12 What area(s) of social work does your organisation cover?

Tick all that apply

Residential	1
Domiciliary	2
Day	3
Community	4
Other (Please state)	5
Prefer not to say	6

B13 Currently, what percentage of your customers/residents are self-funding, or in receipt of partial or complete public funding (e.g. from NHS/local authority, excluding universal allowances such as attendance allowance)?

Self-funding	1
In receipt of partial public financial support (e.g. NHS/ local authority funding)	2
In receipt of complete public financial support (e.g. NHS/local authority funding)	3
Prefer not to say	4

C Impacts

C1 What has been the impact of COVID-19 on staffing levels and your recruitment?

Open text – 250 words

C2 Following the end of free movement on 1 January 2021, anyone hired from outside the UK, excluding Irish citizens, will be subject to the new points-based immigration system. This brings the regulations for European migrants in line with those for non-European migrants.

Under this system, applicants for skilled work visas must meet several criteria, including a job offer from a licensed sponsor that meets the applicable minimum salary threshold, and that is for a role categorised at RQF 3 or above (A Level and equivalent).

For example, in social care, Senior Care workers can be employed under this system, but jobs below that level cannot.

Further details on the system are available here.

What impact, if any, do you think this, and the wider implications of EU Exit will have on:

A The employment of European workers in social care?

Open text – 250 words

B The intentions of your existing European staff to remain in post?

Open text – 250 words

C Your ability to fill vacancies?

Open text – 250 words

C3 Currently, when you have vacancies you can’t fill, what is the impact on service delivery, and how do you adjust to compensate for this?

Open text – 250 words

C4 Over the medium term (i.e. in around five years’ time), what, if any, differences would you expect to see in your sector/organisation as a result of the end of free movement?

Open text – 250 words

D Closing

D1 Would you like to be added to our stakeholder database so we can send updates on Migration Advisory Committee work?

Singlecode.

Yes	1
No	2

D2 Would you be happy for us (or our third party contractors) to recontact you in the next 12 months to invite you to take part in follow-up research regarding similar issues covered in this questionnaire?

Singlecode.

Yes	1
No	2

D3 Would you be willing for us to contact you if we needed to clarify or supplement responses you have given to this questionnaire?

Singlecode.

Yes	1
No	2

D4 If there is any additional evidence that you would like us to consider, please attach it here.

Thank you for taking the time to complete the survey, we really appreciate your contribution. The information you have provided today will help us to build a clear picture of how the end of free movement has impacted the social care sector.

Call for Evidence questionnaires: Representative organisations

Social care commission - Call for Evidence

Introductory text

The Migration Advisory Committee (MAC) has been commissioned by the Government to provide an Independent Review of the impact of the end of free movement of European nationals within the UK on the social care sector.

We appreciate that the COVID-19 outbreak has placed social care organisations in an enormously difficult situation, and that many of you already took the time to respond in detail to our last Call for Evidence about the Shortage Occupation List (SOL) in 2020. The MAC has been commissioned by the Government to provide an Independent Review of the impact of the end of free movement on the social care sector in the first half of 2022, and in order to minimise the burden on you, we will use this Call for Evidence to add to the evidence on skill levels and skill shortages in social care already gathered in 2020 during the SOL Commission.

In this Call for Evidence we ask you to focus specifically on the end of free movement, its impact on your organisation and on the health and social care sector more widely. We greatly appreciate you taking the time to complete this Call for Evidence, in the current challenging context.

The Call for Evidence will remain open until Friday 29th October 2021. All identifying and personal information will remain confidential, however, aggregated and anonymised information in the form of summary statistics will be published as part of our final report. For further details please refer to the processing of personal data document published on our website.

The questionnaire automatically saves, so you will be able to return to your response and add / edit your answers at a later stage.

A About You

To start with, we’d like to get some details about you and the organisation on behalf of which you are responding.

A1 What is the name of your organisation?

WRITE IN

A2 What is your email address?

WRITE IN

Prefer not to say

1

B About your organisation and the businesses you represent

B1 Does your organisation represent…

PLEASE SELECT ONE OPTION ONLY.

Employers	1
Employees	2
Both	3

B2 How many businesses/organisations do you represent?

PLEASE SELECT ONE OPTION ONLY.

Under 5	1
5-49	2
50-499	3
500-4,999	4
5000+	5
Don’t know	6

B3 How have you engaged with those who you represent to inform this consultation response?

PLEASE SELECT ALL THAT APPLY

Ongoing dialogue as part of business as usual	1
Specific events/contact arranged to discuss this consultation	2
Other (please specify)	3
Don’t know	4
Prefer not to say	5

B4 Thinking of those who you have engaged with, in general are their staff concentrated in specific UK countries/regions or are they UK-wide?

PLEASE SELECT ONE OPTION ONLY.

Concentrated in specific regions	1
UK-wide	2
Don’t know	3

ASK ALL WHO HAVE ENGAGED WITH IN SPECIFIC REGIONS (B3=1)

B5 And in which region(s) or country(ies) are these staff concentrated?

PLEASE SELECT ALL THAT APPLY.

North East	1
North West	2
Yorkshire and the Humber	3
East Midlands	4
West Midlands	5
East of England	6
London	7
South East	8
South West	9
Scotland	10
Wales	11
Northern Ireland	12
England – they operate across regions equally	13
Don’t know	14
Prefer not to say	15

B6 Are there any ways in which the location(s) of those you represent impact on staffing and recruitment? (For example, travel times, or local population demographics).

Open text – 250 words

B7 Thinking of those you engage with and their number of employees, select all size bands that they cover.

PLEASE SELECT ALL THAT APPLY.

0-9 employees	1
10-49 employees	2
50-249 employees	3
250-499 employees	4
500+ employees	5
Don’t know	6

B8 If known, do those you represent most commonly employ non-European^{[footnote 4]} members of staff through a work visa or are they employed through other means?

Sponsored through skilled worker route (formerly Tier 2)	1
Recruited them through the domestic labour market	2
They do not employ non-European workers	3
Don’t know	4

ASK ALL WHO RECRUITED NON-EUROPEAN WORKERS THROUGH THE DOMESTIC LABOUR MARKET (B10=2)

B9 If known, are these non-European staff resident in the UK as;

PLEASE SELECT ALL THAT APPLY

Student	1
A dependant or spouse	2
Youth Mobility Scheme	3
Ancestry visa	4
Already has permanent LTR or equivalent in the UK (for example temporary or permanent leave to remain, naturalised British citizen or Right of Abode)	5
Other (please state)	6
Don’t know	7

B10 What area(s) of social care does your organisation represent?

PLEASE SELECT ALL THAT APPLY

Residential	1
Domiciliary	2
Day	3
Community	4
Other (Please state)	5
Prefer not to say	6

C Impacts

C1 What has been the impact of COVID-19 on staffing levels and your recruitment for the organisations you represent?

Open text – 250 words

C2 Following the end of free movement on 1 January 2021, anyone hired from outside the UK, excluding Irish citizens, will be subject to the new points-based immigration system. This brings the regulations for European migrants in line with those for non-European migrants.

Under this system, applicants for skilled work visas must meet several criteria, including a job offer from a licensed sponsor that meets the applicable minimum salary threshold, and that is for a role categorised at RQF 3 or above (A Level and equivalent).

For example, in social care, Senior Care workers can be employed under this system, but jobs below that level cannot.

Further details on the system are available here.

What impact, if any, do you think this, and the wider implications of the EU Exit referendum will have on;

C2a The employment of European workers in social care?

Open text – 250 words

C2b The intentions of existing European staff to remain in post?

Open text – 250 words

C2c The ability of the organisations you represent to fill vacancies?

Open text – 250 words

C3 When the organisations/employees you represent experience vacancies that can’t be filled, what is the impact on service delivery and how do they adjust to compensate for this?

Open text – 250 words

C4 Over the medium term (i.e. in around five years’ time), what, if any, differences would you expect to see in your sector as a result of the end of free movement?

Open text – 250 words

D Closing

D1 Would you like to be added to our stakeholder database so we can send updates on MAC work?

Singlecode.

Yes	1
No	2

D2 Would you be happy for us (or our third party contractors) to recontact you in the next 12 months to invite you to take part in follow-up research regarding similar issues covered in this questionnaire?

Singlecode.

Yes	1
No	2

D3 Would you be willing for us to contact you if we needed to clarify or supplement responses you have given to this questionnaire?

Singlecode.

Yes	1
No	2

D4 If there is any additional evidence that you would like us to consider, please attach it here.

Thank you for taking the time to complete the survey, we really appreciate your contribution. The information you have provided today will help us to build a clear picture of how the end of free movement has impacted the social care sector.

Call for Evidence questionnaires: Individuals responding in a personal capacity

Social care commission - Call for Evidence

Introductory text

The Migration Advisory Committee (MAC) has been commissioned by the Government to provide an Independent Review of the impact of the end of free movement of European nationals within the UK on the social care sector.

In this Call for Evidence we ask you to focus specifically on the end of free movement, its impact on you and on the health and social care sector more widely. We greatly appreciate you taking the time to complete this Call for Evidence, in the current challenging context.

The Call for Evidence will remain open until 29th October 2021. All identifying and personal information will remain confidential, however, aggregated and anonymised information in the form of summary statistics will be published as part of our final report. For further details please refer to the processing of personal data document published on our website.

The questionnaire automatically saves, so you will be able to return to your response and add/edit your answers at a later stage.

A About You

To start with, we’d like to get some details about you to help us contextualise your response.

A1 What is your email address?

WRITE IN

Prefer not to say

1

A2 In what capacity are you responding?

Singlecode.

Social care job role – Direct care	1
Social care job role – Managerial	2
Social care job role – Regulated professional	3
Social care job role – Other	4
A person who receives care and support	5
Informal carer – a friend or relative who provides support to a person in need of care without payment	6
Friend or relative of a person in need of care	7
Other – Please state	8
Prefer not to say	9

ASK ALL RECEIPTIENTS OF CARE OR RELATIVES OF RECIPIENTS OF CARE (A2= 2 or 3)

A3 What care & support services do you use? / What care & support services does the person you care for use?

PLEASE SELECT ALL THAT APPLY

Residential (including care homes with nursing and care homes without nursing)	1
Domiciliary (Home care, including supported living and extra care housing)	2
Day	3
Community (including community support and outreach, social work and care management, carers’ support, occupational or employment-related services, and other adult community care services)	4
Other (Please state)	5
Prefer not to say	6

A4 If applicable, when recruiting, did you deal with your individual care worker(s) directly, or did you go through a third party (e.g. a company or local authority)?

PLEASE SELECT ALL THAT APPLY

Recruited domestic worker directly	1
Recruited domestic worker through a third party	2
Recruited European worker directly	3
Recruited European worker through a third party	4
Recruited non-European worker directly	5
Recruited non-European worker through a third party	6
Other (Please state)	7
Not applicable	8

B Impacts

In July 2021 the Migration Advisory Committee was commissioned to publish an independent report on the impact of the end of free movement of EU nationals within the UK on social care.

Following the end of free movement on 1 January 2021, anyone hired from outside the UK, excluding Irish citizens, will be subject to the new points-based immigration system. This brings the regulations for European migrants in line with those for non-European migrants.

Under this system, applicants for skilled work visas must meet several criteria, including a job offer from a licensed sponsor that meets the applicable minimum salary threshold, and that is for a role categorised at RQF 3 or above (A Level and equivalent).

For example, in social care, senior care workers can be employed under this system, but jobs below that level cannot. Further details on the system are available here.

B1 Please tell us how you feel this change has, and may, impact the social care sector, along with any other information you feel is important to the commission.

This could include, but is not limited to your experience of, pay, retention and the conditions of people working in the care sector.

Open text – 250 words

C Closing

C1 Would you be happy for us (or our third party contractors) to recontact you in the next 12 months to invite you to take part in follow-up research regarding similar issues covered in this questionnaire?

Singlecode.

Yes	1
No	2

C2 Would you be willing for us to contact you if we needed to clarify or supplement responses you have given to this questionnaire?

Singlecode.

Yes	1
No	2

C3 Would you like us to email you a copy of the final report once completed?

Singlecode.

Yes	1
No	2

C4 If there is any additional evidence that you would like us to consider, please attach it here.

C5 Sometimes an individual’s personal situation can impact their experience of social care.

If you would like to tell us anything about your personal characteristics, or those related to the individual you are responding on behalf of, that relate to anything you have told us above, please fill in the open text box below.

Open text – 250 words

C6 Are you happy to provide us with your demographic characteristics? Each question is voluntary

Yes	1
No	2

IF C6 = Yes

C7 How old are you?

16-24	1
25-34	2
35-44	3
45-54	4
55-64	5
65-74	6
75+	7
Prefer not to say	8

C8 How would you describe your national identity?

English	1
Welsh	2
Scottish	3
Northern Irish	4
Other (please state)	5
Prefer not to say	6

C9 What is your ethnic group?

White English, Welsh, Scottish, Northern Irish or British	1
White Irish	2
Gypsy or Irish Traveller	3
Roma	4
Other White background	5
Mixed or Multiple ethnic group - White and Black Caribbean	6
Mixed or Multiple ethnic group - White and Black African	7
Mixed or Multiple ethnic group - White and Asian	8
Mixed or Multiple ethnic group -Other	9
Asian or Asian British - Indian	10
Asian or Asian British - Pakistani	11
Asian or Asian British - Bangladeshi	12
Asian or Asian British - Chinese	13
Asian or Asian British - Other	14
Black, Black British Caribbean	15
Black, Black British African	16
Black, Black British - other	17
Arab	18
Any other ethnic group	19
Prefer not to say	20

C10 What is your religion?

No religion	1
Christian (including Church of England, Catholic, Protestant and all other Christian denominations)	2
Buddhist	3
Hindu	4
Jewish	5
Muslim	6
Sikh	7
Other	8
Prefer not to say	9

C11 What is your main language?

English	1
Other	2
Prefer not to say	3

C12 How well can you speak English?

Well	1
Not well	2
Not at all	3
Prefer not to say	4

C13 How is your health in general?

Good	1
Fair	2
Bad	3
Very bad	4
Prefer not to say	5

C14 Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?

Yes	1
No	2
Prefer not to say	3

IF C14 = YES

C15 Do your conditions or illnesses reduce your ability to carry out day-to-day activities?

Yes, a lot	1
Yes, a little	2
Not at all	3
Prefer not to say	4

C16 Which of the following best describes your sexual orientation?

Straight/Heterosexual	1
Gay or Lesbian	2
Bisexual	3
Other	4
Prefer not to say	5

C17 What is your sex? A question about gender identity will follow.

Female	1
Male	2
Prefer not to say	3

C18 Is the gender you identify with the same as your sex registered at birth?

Yes	1
No	2
Prefer not to say	3

C19 Our full privacy notice is available on the webpage where you accessed this questionnaire.

Are you happy for us to quote anonymously from your responses in our report?

Yes	1
No	2

Thank you for taking the time to complete the survey, we really appreciate your contribution. The information you have provided today will help us to build a clear picture of how the end of free movement has impacted the social care sector.

Question 2

Annex B: Primary Research

Accepted Answer

Introduction

This Annex details primary research that was carried out in-house and by our research contractors Revealing Reality to support this commission.

As with the CfE and stakeholder engagement, findings from the primary research activities have been analysed and written up throughout the report to support relevant sections. The remainder of this Annex provides more detail on the methodological details of the research.

The primary research was split into two parts, with the main analysis carried out by Revealing Reality focussing on care workers and employers in domiciliary, day and community care, supplemented by interviews carried out internally with those directly employing PAs, or introducing/supplying these staff to others.

Methodology

Qualitative research provides understanding and depth of insight into a subject and allows links to be made between themes and sub-themes. Although it cannot provide a measure of the extent to which an issue applies, it can indicate depth of feeling and illustrate the diversity of experience.

In this commission, the qualitative research also enabled us to gain insight directly from individuals within the social care sector, in a confidential and anonymised way. The main qualitative research interviews were carried out by Revealing Reality, an independent research contractor, on behalf of the MAC.

Revealing Reality fieldwork

The Revealing Reality fieldwork consisted of:

Depth interviews:
- 14 with migrant employees in the social care sector
- 18 with employers within the social care sector.
3 focus groups with employers

Participants were initially recruited through targeted emails from the four care bodies across the UK – Skills for Care (England), Northern Ireland Social Care Council, Scottish Social Services Council and Social Care Wales. Whilst this provided a good initial base of participants, some gaps in the sample frame remained. A variety of additional methods were used to identify participants, including research recruiters, respondents to the CfE that had expressed an interest in participating in further research, and contacts provided by care bodies and the expert group for the commission.

The interviews and focus groups took place over video call (Microsoft Teams or Zoom) or telephone, and were between 45 minutes to 1 hour in duration. Fieldwork took place between November 2021 and March 2022. The sessions followed semi-structured topic guides (see end of Annex B below), which were jointly developed by Revealing Reality and the MAC. We have referred to research findings where relevant in this report; however, we will also be publishing a full report from Revealing Reality separately.

Table B.1 shows the sample criteria and characteristics of interviewees. We aimed to interview respondents with a spread of characteristics, which reflected the prevailing attributes observed within the sector whilst also capturing the breadth of diversity.

Table B.1 – Sampling criteria

Migrant worker strand

Location

Northern England
London and South-East England
Northern Ireland
Scotland
Wales

Job roles

Senior care workers
Care workers

Nationality

EU
Non-EEA

Size of organisation

Employer strand (focus groups and interviews)

Location

Northern England
London and South-East England
Northern Ireland
Scotland (urban)
Scotland (rural)
Wales

Care setting

Residential
Non-residential (domiciliary / day / community)

Size of organisation

Types of carers employed

Further to the main sampling criteria outlined in Table B.1, several additional characteristics were monitored, with the aim of ensuring there was a diversity of coverage. These included:

Gender
Age
Ethnicity
Country of origin for migrant workers
Length of experience in role for migrant workers
Length of time in UK for migrant workers
Employment type (full-time, part-time, contract) – employee only
Ownership model (e.g. LA, not for profit and for profit, or mix) – employers only

Supplementary fieldwork on direct employers of care workers

Supplementing the main research strand, we conducted a programme of top-up qualitative research on direct employers of care workers. Research was conducted in this area due to the relative scarcity of evidence on direct employers, as well the distinct immigration issues that exist in this area, specifically that individuals are not eligible for sponsorship status.

The fieldwork consisted of:

2 depth interviews with people who receive care and support that directly employ care workers
3 depth interviews with agency businesses that provide workers to direct payment users (all of whom also had experience of employing care workers on their own or others’ behalf)

Participants were recruited via the CfE, from those respondents who had indicated that they were a direct employer or agency supplying/introducing directly employed care workers, and had expressed an interest in participating in further research. To this extent, those interviewed may represent a different sample than might have been obtained if recruiting from the general population. Those interviewed were of working age, and all lived in England, and those employing care workers on their own behalf were all doing so because they had physical disabilities. However, we were interested in exploring the changes experienced after the end of Freedom of Movement, and in particular the reasons why and how these changes had taken place and were not aiming to assess the extent or prevalence of these changes.

The interviews were conducted in-house using Microsoft Teams and were between 45 minutes to 1 hour in duration. Fieldwork took place in February and March 2022. The sessions followed a semi-structured topic guide which built upon the Revealing Reality guide. The full topic guides are at the end of this Annex.

We have referred to findings from both strands of the research where appropriate throughout this report. Throughout the report we have taken a standardised approach to ensuring respondents are not identifiable, with respondents in case studies assigned a pseudonym. We have also minimised our use of personal identifiers, such as location or care type, only including these when it is essential to the example. In some instances, some small details have been changed to provide further anonymity, including aspects about the person such as their age or job role.

Topic guides

Revealing Reality discussion guide – Employees

Aims & objectives

To understand current practice and issues with recruitment and retainment of staff in adult social care
To understand employees’ perspectives on the push/pull factors to work in adult social care in the UK
To understand employees’ perspectives on how the sector has been impacted by the end of freedom of movement

Purpose of this document

This is a semi-structured guide for the topics that the researcher will cover in the interview. The researcher will use the guide flexibly - they may not ask questions in the order they are presented here, but in the order which makes most sense for the interviewee - the researcher may probe beyond the questions if topics of interest to the wider goals of the project come up.

Overview/ Interview flow

Topics and Objectives

Introduction and background

(5 minutes)

Build rapport with the respondent
Understand their role/responsibilities

Route to UK social care

(20 minutes)

Understand the respondent’s experience of migrating to the UK, including visa route
Identify pull factors to UK and social care sector

Working in UK social care

(10 minutes)

Gain deeper understanding of the respondent’s current role: job satisfaction and working conditions
Identify how far the respondent understands the recent changes to the immigration system and whether they feel this has impacted their job

Future plans

(15 minutes)

Learn about the respondent’s longer-term goals/ambitions
Identify push/pull factors in their organisation/the wider sector

Wrap up

(5 minutes)

Encourage reflection and wrap up the interview

Introduction and background (10 minutes)

Build rapport with the respondent; Understand their role/responsibilities

Thank you so much for taking the time to speak to us. We’ve been commissioned by the MAC for this project to explore employer and employee experiences of working and recruiting in the adult social care sector, in particular understanding how the recent end of freedom of movement has affected the social care sector. We’ll be speaking to both employers and employees about their experiences. Findings from the interviews will be used to help the MAC evaluate areas for possible change.

Interview process:

The interview will last about 1 hour
It’ll be recorded/transcribed, but it will be anonymised
You have the right to withdraw at any stage
Explain consent form and say we’ll send it after the session
Explain incentive form and say we’ll send it after the session; then they will receive a £50 Love2Shop voucher
Nothing will be shared with your organisation or the Home Office: there is no way that anything you say can be used to affect any of your dealings with the Home Office, either now or in the future
Do you have any questions?
Check if the participant is happy to continue and be recorded

Can you tell me a bit about yourself?

What country were you born in?
What is your nationality?
How old are you?
Where you do you live? Who do you live with?

Can you tell me a bit about the organisation you work at?

Where do you work?
How long have you been working at [organisation]?
What sort of care does [organisation] offer?
- Prompt: adults with SEND, elderly patient
- Prompt: domiciliary, residential
How many people does your organisation take care of?
How many people does your organisation employ?
- Probe: roles
Can you roughly estimate how many of those people who might have migrated to the UK from overseas?
- Probe: EU/ non-EU
Are there any roles that your organisation is struggling to hire?
Are there enough staff in your organisation?

Can you tell me a bit about your role?

What is your title?
What are some of your key responsibilities?
What are your hours like?
- Is this the same every week?

What is your salary?

How much do you take home each month?
What is the case for the discrepancy between these two figures?
- Are there any costs that you have to cover yourself? (Probe: PPE)
Are there any parts of your role that you’re not paid for?
- Probe: travel time, hours not covered by wage if live-in care worker
How has your salary changed over time?
- How does your salary now compare to when you were first employed?
- Do you have a sense of what your salary might be in 1/2/5 years time?
How long have you been in this role?

Identify pull factors to UK and social care sector; Understand the respondent’s experience of migrating to the UK, including visa route

When did you start working in social care?

[If in home country]

Why did you start working in social care?
What attracted you to the sector?
- Probe: pay, hours, progression, passion
What qualifications did you have when you started working social care?
- When did you receive these qualifications?
- Where did you receive these qualifications?
- To what extent did the qualifications that you had at the time impact your decision to go into the social care sector?
Did you consider the possibility of moving abroad when you started working in social care?
How was your experience of working in social care in [home country]?

[If in UK]

What work were you doing before, in your home country?
Did you know you were going to work in social care when you migrated to the UK?
Why did you start working in social care?
What attracted you to the sector?
- Probe: pay, hours, progression, passion
What qualifications did you have when you started working in social care?
- When did you receive these qualifications?
- Where did you receive these qualifications?

[If in neither home country nor UK]

What were you doing before working in social care?
- In this country?
- In your home country?
- In other countries?
Why did you start working in social care?
What attracted you to the sector?
- Probe: pay, hours, progression, passion
What qualifications did you have when you started working in social care?
- When did you receive these qualifications?
- Where did you receive these qualifications?
- To what extent did the qualifications that you had at the time impact your decision to go into the social care sector?
Did you consider the possibility of moving to another country when you started working in social care?
How was your experience of working in social care in [this country]?

Why did you decide to come to the UK?

Did you have any family or friends in the UK? What were they doing?
- Who? Where? What were they doing? How long had they been there?
Did you have any doubts about coming to the UK?
[If they started social care work in home country] Did you know anyone else who had migrated to work in social care?
What other countries did you consider migrating to, if any?
How long did you expect to stay?
Are there any particular career advantages to working in UK social care?

Could you tell me a bit about your journey to the UK? (Ask respondent to walk you through their journey to the UK and map on the timeline)

[If they migrated with the job]

How/when did you first hear about the job opportunity? (MAP)
- Probe: was it through an agency/ a recruiter/ an independent employer?
- What did you like about the job opportunity?
- Was there anything you didn’t like about it?
What was the job application process like?
- How long did it take? When did you start/ finish? (MAP)
- What documents/references/qualifications were required?
- How easy or difficult was it to have your qualifications recognised in the UK?
When did you start preparing to come to the UK? (MAP)
What route did you use to come over?

[If visa (non-EU/Post-Brexit)]

What was the visa route you used?
Why did you use that route?
Which others did you consider, if any?
Did you receive any advice on which visa route to use [from employer]?
What did you have to provide for the application process?
Did you receive any support for the application process [from employer]?
How long did the application process take? (MAP)
When did you arrive in the UK? (MAP)
How was your experience of finding accommodation?
- How long did it take? (MAP)
- Did you receive any support with finding accommodation?
How long was it until you started work? (MAP)

[If they migrated without job]

When did you start thinking about coming to the UK? (MAP)
- When did you start preparing to come to the UK? (MAP)
When did you arrive in the UK? (MAP)
What route did you use to come over?
- Why did you use that route?
- Which others did you consider, if any?
How was your experience of finding accommodation?
- How long did it take? (MAP)
- Did you receive any support with finding accommodation?
What sort of work were you hoping to do to begin with?
How did you go about looking for work?
Did you receive any support finding work?
Why did you start working in social care?
How/when did you first hear about the job opportunity? (MAP)
- Probe: was it through an agency/a recruiter/an independent employer?
- What did you like about the job opportunity?
- Was there anything you didn’t like about it?
What was the job application process like?
- How long did it take? When did you start/ finish? (MAP)
- What documents/references/qualifications were required?
- How easy or difficult was it to have your qualifications recognised in the UK?

Gain deeper understanding of the respondent’s current role: job satisfaction and working conditions; Identify how far the respondent understands the recent changes to the immigration system and whether they feel this has impacted their job

How does working in UK social care compare to your expectations?

Probe: refer back to reasons stated for getting into the sector and ask whether these still apply
Probe: if they worked in social care in home country before migrating, ask how social care in the UK compares

To what extent are you satisfied with your current job?

What do you like/dislike about it?
How do you feel about the hours that you work?
How do you feel about the pay that you receive?
To what extent does your current role offer opportunities for progression?
To what extent does your current role offer training opportunities?
How does your experience compare to other employees at your organisation?
How have the conditions of your work changed over time?
- How does the nature and conditions of your role now compare to when you first started?

As you might be aware, in January this year, EU freedom of movement ended, and a new immigration system came into place in the UK. To what extent do you feel this has affected your work?

To what extent has it affected your immigration status?
To what extent has it affected the workforce at your organisation?
Do you have a sense of the extent has it affected the social care sector more broadly?

Future plans (10 minutes)

Learn about the respondent’s longer term goals/ambitions; Identify push/pull factors in their organisation/the wider sector

How long do you expect to stay at [organisation]?

[if indefinite]

Have you ever thought about leaving?
Why?
Can you imagine any future scenarios that would make you want to leave [organisation]?
Can you imagine any future scenarios that would make you want to leave the care sector?

[if they have plans to leave]

Why?
What do you plan to do when you leave? Why?
Can you think of anything that would need to change for you to want to stay in the organisation?
Do you plan to stay in the care sector?
How do your plans compare to other employees at [organisation]?

How long do you expect to stay in the sector?

[if indefinite]

Have you ever thought about leaving?
Why?
Can you imagine any future scenarios that would make you want to leave?
Are there any other sectors that you could imagine working in?
- Why?
Are there any other sectors that are attractive to you?
- Why? And why aren’t they attractive enough to want to leave…?

[if they have plans to leave]

Why?
What do you plan to do when you leave? Why?
Can you think of anything that would need to change for you to want to stay in the sector?
How do your plans compare to other employees at [organisation]?

Wrap up (5 minutes)

Encourage reflection and wrap up the interview

Is there anything else you feel is worth mentioning?

Revealing Reality discussion guide – Employers

Aims & objectives

To understand current practice and issues with recruitment and retainment of staff in adult social care
To understand employers’ perspectives on how current practice and experience of recruitment and retainment has been impacted by the end of freedom of movement
To understand employers’ perspectives on the importance of international recruitment to adult social care

Purpose of this document

This is a semi-structured guide for the topics that the researcher will cover in the interview. The researcher will use the guide flexibly - they may not ask questions in the order they are presented here, but in the order which makes most sense for the interviewee - the researcher may probe beyond the questions if topics of interest to the wider goals of the project arise.

Overview/Interview Flow

Introduction and background

Topics and Objectives

Introduction and background

(5 minutes)

Build rapport with the respondent
Understand their role/responsibilities

Description of the organisation

(5 minutes)

Understand where the respondent’s organisation fits into the care sector
Get a sense of their key business needs

Intro into the impact of the end of freedom of movement

(5-10 minutes)

Get a sense of what the respondent knows about the recent changes to the immigration system
Learn whether the respondent feels the end of freedom of movement has impacted their organisation

Pre- end of freedom of movement

(15 minutes)

Learn about the makeup of the respondent’s workforce before the end of freedom of movement
Learn about the respondent’s recruitment and retainment of international and UK workers before the end of freedom of movement

Post- end of freedom of movement

(20 minutes)

Gain a deeper understanding of how the end of freedom of movement has impacted the respondent’s organisation
Learn about whether/how the makeup of the respondent’s workforce has changed since the end of freedom of movement
Learn about the respondent’s recruitment and retainment of international and UK workers since the end of freedom of movement

Identify which visa routes the respondent uses for international recruitment

Looking to the future

(15 minutes)

Gain an understanding of what the respondent expects the future to look like in terms of recruitment, retainment and workforce makeup
Gain and understanding of what the respondent would like the future to look like in terms of recruitment, retainment and workforce makeup

Reflections

(5 minutes)

Gather over all reflections

Objectives: Build rapport with the respondent + understand their role/responsibilities

Thank you so much for taking the time to speak to us. We’ve been commissioned by the MAC for this project to explore employer and employee experiences of working and recruiting in the adult social care sector, in particular understanding how the recent end of freedom of movement has affected the social care sector. We’ll be speaking to both employers and employees about their experiences. Findings from the interviews will be used to help the MAC evaluate areas for possible change.

Interview process:

The interview will last about 1 hour
It’ll be recorded/transcribed, but it will be anonymised
You have the right to withdraw at any stage
Explain consent form and say we’ll send it after the session
Nothing will be shared with your organisation or the home office: there is no way that anything you say can be used to affect any of your dealings with the Home Office, either now or in the future
Do you have any questions?
Check if the participant is happy to continue and be recorded

1. Can you tell me a bit about your role?

What are your key responsibilities?
- Prompt: recruiting, management responsibilities
How long have you been working at [organisation]?
How long have you been working in the adult social care sector?

Description of the organisation

Objectives: Understand where the respondent’s organisation fits into the care sector; get a sense of their key business needs.

2. Could you tell me a bit more about [organisation]?

What sort of care do you offer?
- Prompt: adults with SEND, elderly patient
- Prompt: domiciliary, residential
How many people do you take care of?
Where is your organisation based?

[If multi-site]:

Where is your own office located?
Where is the head office located?
Do you have any international presence?
How do the different sites work together?

[If single-site]:

Where are you based?

3. What have been the biggest challenges for your organisation over the last year or so?

What are the main factors that have been causing these challenges?
How do you think the way you’ve been impacted compares to other adult social care organisations?
To what extent do you think the way you’ve been impacted compares to other sectors outside of adult social care?
To what extent has this affected the quality of care that you can offer?
To what extent has this affected your workforce?

Introducing the impact of the end of freedom of movement

Objectives: Get a sense of what the respondent knows about the recent changes to the immigration system + Learn whether the respondent feels the end of freedom of movement has impacted their organisation

4. How important is international labour for your workforce?

Probe with EU/non-EU
What are the benefits to your organisation in recruiting internationally?

5. As you may know, from January 2021, the UK stopped being a part of EU freedom of movement and the new points-based immigration system came into force. This means that EU citizens now require visas to come and work in the UK. How much do you know about the new immigration system?

For researcher: some information about the new system to probe with/test against

Single, global, points-based immigration system
Need 70 points to get any visa
Immigrants need: job offer and sponsorship letter
Routes for care workers: skilled worker, health and care worker (H&CW) visa
Only senior care workers can come in (SOC 6146)
The shortage list = lower salary requirement + lower application fee
Senior care workers are currently on the shortage list
‘Going rate’ for each profession differs and can supersede general salary requirements
Immigrants need evidence of personal savings to support themselves
Skilled worker + HSC visa lasts for up to 5 years before you need to extend it – you can extend as many times as you like – after 5 years

6. Have you noticed any ways in which the new immigration system has impacted your organisation?

Are these anticipated impacts, or are they already taking place?
What has changed?
- Prompt: recruitment retainment, staff shortages
To what extent has this affected your workforce?
- Prompt: Makeup – job titles, nationality, contract type
- Prompt: personal difficulties, strain, sickness
To what extent has this affected the quality of care that you offer?
To what extent has this affected your business?
How do you think the way you’ve been impacted compares to other adult social care organisations?
- To what extent do you think the way you’ve been impacted compares to other sectors outside of adult social care?

Pre-end of freedom of movement

Objectives: Learn about the makeup of the respondent’s workforce before the end of freedom of movement + Learn about the respondent’s recruitment and retainment of international and UK workers before the end of freedom of movement

7. Could you describe your workforce before the end of freedom of movement?

What sort of roles did you employ? (Probe around job titles)
What sort of hours did your staff tend to work? (Probe around contract types)
Could you estimate the proportion of British/EU/non-EU staff?

8. Who did you want to recruit for your workforce?

Probe around nationality, job titles, contract types
Were there any job roles that were harder/easier to fill than others?
Were there any significant gaps in your workforce? Who did you need to fill them?
How important was international labour for your organisation?

9. What do you think attracted staff to work for your organisation?

What did your organisation offer in terms of progression, training and opportunities?
Was there anything you included in the job offer in order to make it more appealing?
- Probe: UK/EU/international
- Probe: pay or other benefits
- Was there any flexibility with what you could offer to different recruits?
Why do you think international workers wanted to come and work in UK social care?
Do you think workers saw social care as a long-term career?

10. Practically, what was involved with trying to recruit these people?

What channels would you use to reach people?
- Probe: UK/EU/international
Did you conduct your own recruitment or outsource to recruiters?
- Probe: UK/EU/international

What sort of qualifications, if any, did workers need to have? Were these qualifications recognised internationally?

Probe: UK/EU/international
What sort of qualifications did workers tend to have in practice?
- What proportion of your workforce had qualifications above/below the minimum requirements?
What did your organisation offer in terms of training, if anything?
- Probe: UK/EU/international
- Does this include any qualifications?
Was it easier to recruit workers from any countries more than others?
- Probe: UK/EU/international
Do you know which visa routes overseas workers tended to use? Did you have any responsibilities regarding their visas?
- For those sponsoring employees:
- What is the process of sponsoring employees?
- How easy or difficult is it to apply for a CoS (Certificate of Sponsorship) for employees?
Were there any particular costs associated with recruiting staff
- Probe: UK/EU/International
- Probe: sponsorship costs
Did you offer any additional support to new migrant workers?
Were there any differences in how you recruited for different roles?
- Probe: UK/EU/international
Were there any particular challenges involved in recruitment?
- Probe: UK/EU/international
What might have made recruitment easier, if anything?
- Probe: UK/EU/international

11. How long did employees tend to stay at your organisation?

Did you have a sense of employees professional ambitions when starting at your organisation?
Do you know whether employees tended to see social care as a long term career?
When people did leave, what reasons did they tend to cite?
Were there any particular professions that employees moved to?
Can you think of anything that might have encouraged people to stay longer?

Going deeper into the workforce post- end of freedom of movement

Objectives - Gain a deeper understanding of how the end of freedom of movement has impacted the respondent’s organisation; Learn about whether/ how the makeup of the respondent’s workforce has changed since the end of freedom of movement; Learn about the respondent’s recruitment and retainment of international and UK workers since the end of freedom of movement

12. Could you describe what your workforce looks like now?

What sort of roles do you employ now? Are there any changes here? (Probe around job titles)
What sort of hours do your staff tend to work now? (Probe around contract types)
Are there any changes to the proportion of British/ EU/ non-EU staff?
What has been the proportion of turnover in your workforce in the last 6 months?
- How typical is this?
- How has the scale of turnover in your organisation changed over time? [Probe: Compare 1/2/5 years ago]

13. Who do you most want to recruit for your workforce now?

Probe around nationality, job titles, contract types
Are there any gaps in your workforce? (Probe around whether gaps are because of lack of recruitment or lack of retainment) Who do you need to fill those gaps?
Are there any job roles that were harder to recruit for/ fill than others?
How important is international labour for your organisation?

14. What do you think attracts staff to work for your organisation?

Do you think there have been any changes in how attractive a career in adult social care is since January?
What does your organisation offer in terms of progression, training and opportunities?
Is there anything you include in the job offer in order to make it more appealing?
- Probe: UK/EU/international
- Probe: pay or other benefits
Is there any flexibility with what you can offer to different recruits?
Why do you think international workers want to come and work in UK social care?
Do you think workers see social care as a long term career?

15. Practically, what is involved with trying to recruit these people?

Has your recruitment strategy changed in any ways since the end of freedom of movement?
- Probe: UK/EU/international
What channels do you use to reach people?
- Probe: UK/EU/international
Do you conduct your own recruitment or outsource to recruiters?
- Probe: UK/EU/international

What sort of qualifications do workers need to have? Are these qualifications recognised internationally?

Probe: UK/EU/international
What sort of qualifications do your workers tend to have in practice?
- What proportion of your workforce have qualifications above/below the minimum requirements?
What does your organisation offer in terms of training, if anything?
- Probe: UK/EU/international
Is it easier to recruit workers from any countries more than others?
- Probe: UK/EU/international
Do you know which visa routes overseas workers tended to use? Do you have any responsibilities regarding their visas?

Prompt with options:

Skilled worker (NB. only works for senior care workers (SCWs) when on shortage list)
Health and care worker (what did they think of this being introduced? NB. It being introduced gave a route for SCWs)
Family visa
Youth Mobility Scheme
Temporary work visa
Student visa
Are there any particular costs associated with recruiting staff
- Probe: UK/EU/International
- Probe: sponsorship costs
Do you offer any additional support to new migrant workers?
Are there any differences in how you recruited for different roles?
- Probe: UK/EU/international
Are there any particular challenges involved in recruitment?
- Probe: UK/EU/international
What might make recruitment easier, if anything?
- Probe: UK/EU/international

16. How long do employees tend to stay at your organisation?

Do you have a sense of employees’ professional ambitions when starting at your organisation?
When people leave, what reasons do they tend to cite?
Are there any particular professions that employees move to?
Do you have any current strategies for improving retention?
Can you think of anything that might encourage people to stay longer in the future?

17. To what extent are you able to support employees who are currently looking to gain settled status in the UK?

To what extent do you have to do anything beyond your current responsibilities as an employer to support these employees?

Looking to the future

18. Do you see your workforce changing in the near future?

Do you see it changing for better or for worse?
Probe: proportion of senior care workers/care workers?; full-time/ part-time/self-employed; British/ EU/non-EU?
Probe: COVID-19 easing?

19. Do you anticipate any particular challenges in the next year or so?

Probe: shortages? Recruitment? Retainment? International versus domestic labour
Are you taking/planning to take any actions that might mitigate against current and expected future challenges?
- Probe: Changes to job offer, redesigning jobs
To what extent do you expect the future increase in the national minimum wage will impact you organisation?
- Probe: Expected implications on recruitment, retention, the wider organisation
- How easy or difficult will it be for your organisation to meet this new minimum?

20. Do you have a sense of your recruitment strategy going forward?

For international workers?
For British workers?

21. Changes have recently been made to allow care workers to come to the UK on a Skilled Worker visa.

To what extent would you make use of this visa?
To what extent do you think you could support workers to settle in the UK after 5 years of being on the Skilled Worker Visa?
- Probe: Feasibility around necessary pay progression over the 5 years.

22. Have you considered sponsoring employee’s visas?

Probe on which of the sponsorship requirements would be most/least likely to put them off the route.

23. What is your understanding of your requirements as an employer to be able to sponsor employees?

Do you know if there are any requirements that the candidate must fulfil?

Employee requirements

B1 English language requirement

How would you feel about having to find potential workers who fulfil this requirement?

What English level do you think it is necessary for potential employees to have, if any?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

Employee must have a salary of at least £20,480 per year (equates to £10.10 per hour).

Employees on the new sponsorship route must be paid £10.10 per hour to meet the salary threshold of £20,480 per year, as only 39 hours of the worker’s contract can go towards meeting the salary threshold. It is possible that they can work up to 48 hours per week, but nothing above their 39 hour/ week limit can go towards meeting their salary threshold.

How would you feel about having to pay potential workers this amount?

How feasible is this for you? Why/why not?

What impact if any do you think this would have on contracts/salaries for domestic workers?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What salary level would be feasible for you to pay?

How would you feel about having to employee new migrant care workers full time?

Employer requirements

How would you feel about having to pay this amount?

How feasible is this for your organisation? Why/why not?

How would you feel about the sponsor application process taking 8 weeks?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What fee/time period would be feasible for your organisation?

Do the costs involved in sponsoring employees feel worth it for your organisation?

Probe: How do they compare to the costs spent on agency staff if used?

Do you imagine there would be any other costs you would have to incur when sponsoring employees?

Probe: Travel etc

Potentially pay £199 per worker for a Certificate of Sponsorship

Which countries would you be looking to recruit workers from?

How would you feel about having to pay for a Certificate of Sponsorship?

How feasible is this for you? Why/why not?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What fee would be feasible for your organisation? What if it was £100? What if it was £300?

Immigration Skills Charge per worker: Small sponsors - £364 for first year, £182 for each subsequent 6 months; Large sponsors - £1000 first year, £500 each subsequent 6 months The cost of the CoS and Immigration Skills Charge for each workers who stay in the UK for 5 years would equate to roughly £5,000 for medium/large employers and £2,000 for small ones.

How would you feel about having to pay for a Certificate of Sponsorship?

How feasible is this for you? Why/why not?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What fee would be feasible for your organisation? What if it was £XX?

How would you feel about having to track and record employee’s attendance?

How feasible is this for you? How much time do you think it would take?

How do you feel about being subject to compliance checks?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

Other considerations

The new visa route for care workers (as opposed to only senior care workers) is only due to be open for 12 months, but workers who come to the UK during this time can stay as long as they want and settle.

Does the fact that the government has said the route will be open for 12 months affect your thinking about how/whether to use the route?

How effectively would this help you to recruit new workers?

What about if the route was open for 18 months? 3 years? Indefinitely? Would this change how/whether you use this route?

24. Thinking about all these considerations, how would you feel about using this visa route?

Which would be the biggest barriers for you?
What would enable you to use this route?
To what extent do you think using this recruitment route would tackle challenges you are facing as an organisation?

25. Another hypothetical option would be for there to be an unsponsored visa route, i.e. you wouldn’t have to sponsor a worker to come to the UK and workers would be able to take any job, in or outside of the care sector. This might work similarly to a Youth Mobility Visa.

[show stimulus with potential requirements]

How do you feel about this idea?

What do you think about these requirements?

How do you feel about the age criteria (18-30)? How suitable would these people be for the roles you would want to fill?
How do you feel about the 2-year duration?
How do you feel about it only being open to people from certain, mainly EU countries?
- Which countries would you be looking to recruit people from?

26. Is there any other type of immigration system/visa route that you think would be beneficial for your organisation?

27. If you were able to recruit whoever you wanted, what difference do you think this would make to your organisation?

28. Is there anything else you would like to mention?

Thank you.

Revealing Reality discussion guide– Employer groups

Aims & objectives

To understand current practice and issues with recruitment and retainment of staff in adult social care
To understand employers’ perspectives on how current practice and experience of recruitment and retainment has been impacted by the end of freedom of movement
To understand employers’ perspectives on the importance of international recruitment to adult social care

Sections and Objectives

Introductions

(15 mins)

Build rapport
Briefly establish the context, role, and responsibilities of each participant

Awareness of factors affecting social care

(20 mins)

Understand awareness of recent changes to immigration rules/ ending of freedom of movement, amongst other factors which have impacted social care in the last few years

Attraction and recruitment

(20 mins)

Understand who have they looked to recruit in the past vs now
Understand how they have tried to attract employees to apply, including what the key challenges have been in the process and how they’ve changed over time
Understand what is involved in recruiting employees (international vs UK national) and how this has changed over time

Retention

(20 mins)

Understand strategies for retention, and how these have changed over time
Understand challenges to retention and how these have changed over time

Looking ahead

(10 mins)

Understand who are they intending on trying to recruit/retain in the future?
Understand what challenges will exist beyond COVID-19, and the place of immigrationwithin this.
Understand what strategies they will have to put in place to recruit UK national vs International workers

Overview/Interview Flow

Introductions (15 mins)

Build rapport; Briefly establish the context, role, and responsibilities of each participant

Introduction

Hello everyone. Thank you so much for taking the time to speak to us. Before we all introduce ourselves to each other, we’ll quickly run through the aims and the format of the session.

I’m X and I work as a researcher at Revealing Reality. We’ve been commissioned by the MAC for this project to explore employer and employee experiences of working and recruiting in the Adult Social Care Sector, in particular understanding how the recent end of freedom of movement has affected the social care sector. Findings from the interviews will be used to help the MAC evaluate areas for possible change.
This session is an opportunity for us to get an overview of your perspectives as employers in the sector. We’ll be asking you draw on your experiences and discuss the priorities and challenges faced by the sector.
It’s important to remember that there are no right or wrong answers. We’re aware that people may have different responsibilities and levels of understanding of some of the things we’ll be talking about in the group – this is not a test, and all answers/opinions are valid!
You don’t have to answer anything you don’t want to. Whilst understanding personal experiences related to your specific organisations might be helpful, we’re aware that some may not want to go into detail about their own organisation, which is absolutely fine. Feel free to make broader reflections about the broader social care sector as you’ve experienced it. That said, we hope to create a trusting, honest atmosphere where we see each other as collaborators, not competitors. The aim of this session is to gather reflections and workshop idea that can benefit the sector as a whole.
The session will last 1.5 hours.
We want the session to be conversational and for everyone to have their say. If there is something being said that you don’t agree with, please chip in and challenge
Everything you say during this session will be anonymised. None of the information you give us will affect your dealings with either the Home Office or your organisation.
The session is going to be recorded. This is in order to make an anonymised transcript, which with your consent will be passed onto the MAC.
At the end of the session we will be sending you a consent form and an information sheet.
Any questions?

1. Tell us a bit about yourself and your work.

Probe: Name, location, role, length of time in the adult social care sector
Tell us a bit about your organisation
- Probe: Type of organisation, size of organisation, care provided

Understand awareness of recent changes to immigration rules/ ending of freedom of movement, amongst other factors which have impacted social care in the last few years.

2. What do you think are the biggest factors which have affected your organisation in the last couple of years? Let’s take two minutes to each have a think.

Get respondents to list factors and input into stimulus flashcards (Slide 2)

Why do you say this?
How have they affected your organisation?

Show additional pre-made flash cards (Slide 2)

What do you know about these factors?
- Probe for flash cards on immigration: How important is international labour for your workforce?
How would you rank these factors in terms of the largest impact on your organisation and workforce? (Get respondents to order cards on stimulus scale- Slide 3)
- Why did you put them in this order?
To what extent do you think this is the same for the wider social care sector in your region? (Get respondents to reorder cards - Slide 4)
- Why did you put them in this order?
- How do you think each of these factors have affected other sectors in comparison?

We’re particularly interested in the role of immigration and the ending of freedom of movement in relation to the sector. Of course, as we have seen, there are several factors which have affected the sector in the last year. Let’s try to unpick these factors where we can for the rest of the interview.

Attraction and recruitment (20 mins)

Understand who have they looked to recruit in the past vs now; Understand how they have tried to attract employees to apply, including what the key challenges have been in the process and how they’ve changed over time; Understand what is involved in recruiting employees (international vs UK national) and how this has changed over time

3. How easy or difficult is it to get the right workforce at the moment?

How does this compare to a year/two years ago?

4. How easy/difficult is it to attract workers into the sector now?

Who are you trying to attract? Probe: qualifications, experiences, skill set
- What proportion of your workforce have qualifications above/below the minimum requirements?
How do you try to attract them?
- What do you need to offer?
- [Probe] pay and progression

To what extent does the offer differ depending on international/UK national employees?

To what extent can you vary the terms of your offer based on the applicant?
- [Probe] experience, qualifications
How does what you do to attract employees compare to a year/two years ago?
To what extent do you attract the right people for the job?
What are the challenges in attracting the right employees?
- To what extent are you competing with other sectors?
- What is the impact of these challenges on your organisation?

5. To what extent has the ending of freedom of movement impacted your ability to attract the right people?

6. What is the recruitment process once people have expressed interest in working in your organisation?

How does this compare for UK national vs international applicants?
- What are the main routes that you use for international workers?
- How does the process change depending on the route?
- Do you sponsor workers? What does this process involve?
- To what extent has the process of getting employees into the organisation changed over the last one/two years?
What are the key challenges in getting people into the organisation?
- How has this changed over time?

Retention (20 mins)

Understand strategies for retention, and how these have changed over time; Understand challenges to retention and how these have changed over time

7. What are they main challenges in retaining staff in your organisation? Let’s take two minutes to have a think of ideas

Get respondent to list out challenges on stimulus – slide 6

Why do you say this?
How long do employees tend to stay in your organisation?
- To what extent does vary between roles?
- Why do you think this is?
- How has the scale of turnover in your organisation changed over time? [Probe: Compare 1/2/5 years ago]
How do these challenges compare to the challenges you faced one/ two years ago?
To what extent are you competing with other sectors?
- Which sectors?
- How does this compare to a year/ two years ago?

8. What do you think might encourage employees to stay longer?

Probe: pay, training and opportunities, hours
Have you made any changes to your retention strategy in response to recent changes?
- Probe: COVID-19, new immigration system, [any other challenges they have mentioned]
What do you think could be done to make retention easier?

Looking ahead (15 mins)

Understand who they are intending on trying to recruit/retain in the future?; Understand what challenges will exist beyond COVID-19, and the place of immigration within this; Understand what strategies will they have to put in place to recruit UK national vs International workers

9. What are your recruitment and retention plans for the future?

Do you see there being any changes in who you recruit?
- Probe: UK/ international; different roles
Do you see there being any changes in how you recruit British/international workers?

10. Do you envision your recruitment challenges changing in the future (for better or worse)?

Probe: shortages? Recruitment? Retainment? International versus domestic labour
Are you taking/planning to take any actions that might mitigate against current and expected future challenges?
- Probe: Changes to job offer, redesigning jobs
To what extent do you expect the future increase in the national minimum wage will impact you organisation?
- Probe: Expected implications on recruitment, retention, the wider organisation
- How easy or difficult will it be for your organisation to meet this new minimum?

New visa route

11. Changes have recently been made to allow care workers to come to the UK on a Skilled Worker visa.

To what extent would you make use of this visa?
To what extent do you think you could support workers to settle in the UK after 5 years of being on the Skilled Worker Visa?
- Probe: Feasibility around necessary pay progression over the 5 years.

12. Have you considered sponsoring employee’s visas?

Probe on which of the sponsorship requirements would be most/ least likely to put them off the route.

13. What is your understanding of your requirements as an employer to be able to sponsor employees?

Do you know if there are any requirements that the candidate must fulfil?

Employee requirements

B1 English language requirement

How would you feel about having to find potential workers who fulfil this requirement?

What English level do you think it’s necessary for potential employees to have, if any?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

Employee must have a salary of at least £20,480 per year (equates to approx. £10.10 per hour). This means it’s likely the job would need to be full time.

How would you feel about having to pay potential workers this amount?

How feasible is this for you? Why / why not?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What salary level would be feasible for you to pay?

How would you feel about having to employee new migrant care workers full time?

How feasible is this for you?

Employer requirements

How would you feel about having to pay this amount?

How feasible is this for your organisation? Why / why not?

How would you feel about the sponsor application process taking 8 weeks?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What fee/ time period would be feasible for your organisation?

Potentially pay £199 per worker for a Certificate of Sponsorship.

Which countries would you be looking to recruit workers from?

How would you feel about having to pay for a Certificate of Sponsorship?

How feasible is this for you? Why / why not?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What fee would be feasible for your organisation? What if it was £100? What if it was £300?

Immigration Skills Charge per worker: Small sponsors - £364 for first year, £182 for each subsequent 6 months; Large sponsors - £1000 first year, £500 each subsequent 6 months The cost of the CoS and Immigration Skills Charge for each workers who stay in the UK for 5 years would equate to roughly £5,000 for medium/large employers and £2,000 for small ones.

How would you feel about having to pay for a Certificate of Sponsorship?

How feasible is this for you? Why / why not?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

What fee would be feasible for your organisation? What if it was £XX?

How would you feel about having to track and record employee’s attendance?

How feasible is this for you? How much time do you think it would take?

How do you feel about being subject to compliance checks?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

Other considerations

The new visa route for care workers (as opposed to only senior care workers) is only due to be open for 12 months, but workers who come to the UK during this time can stay as long as they want and settle.

Does the fact that the government has said the route will be open for 12 months affect your thinking about how/whether to use the route?

How effectively would this help you to recruit new workers?

What about if the route was open for 18 months? 3 years? Indefinitely? Would this change how/whether you use this route?

14. Thinking about all these considerations, how would you feel about using this visa route?

Which would be the biggest barriers for you?
What would enable you to use this route?

15. Another hypothetical option would be for there to be an unsponsored visa route, i.e. you wouldn’t have to sponsor a worker to come to the UK and workers would be able to take any job, in or outside of the care sector. This might work similarly to a Youth Mobility Visa.

[show stimulus with potential requirements]

How do you feel about this idea?

What do you think about these requirements?

How do you feel about the age criteria (18-30)? How suitable would these people be for the roles you would want to fill?
How do you feel about the 2-year duration?
How do you feel about it only being open to people from certain, mainly EU countries?
- Which countries would you be looking to recruit people from?

16. Is there any other type of immigration system / visa route that you think would be beneficial for your organisation?

17. If you were able to recruit whoever you wanted, what difference do you think this would make to your organisation?

18. Is there anything else you would like to mention?

Thank you.

MAC Discussion Guide – Direct employers

Aims & objectives

To understand current practice and issues with recruitment and retention of staff by personal budget holders (direct employers)
To understand direct employers’ perspectives on how current practice and experience of recruitment and retention has been impacted by the end of freedom of movement
To understand direct employers’ perspectives on the importance of international recruitment to adult social care

Purpose of this document

This is a semi-structured guide for the topics that the researcher will cover in the interview. The researcher will use the guide flexibly - they may not ask questions in the order they are presented here, but in the order which makes most sense for the interviewee - the researcher may probe beyond the questions if topics of interest to the wider goals of the project arise.

Overview/Interview Flow

Topics and Objectives

Introduction and background

(5 minutes)

Build rapport with the respondent

Understand more about their personal situation

A bit more about your situation

(10 minutes)

Understand what the individual’s history of employing care workers has been like (how long for, how many, what type, what for, who)

The end of freedom of movement

(5 minutes)

Get a sense of what the respondent knows about the recent changes to the immigration system

Learn whether the respondent feels the end of freedom of movement has impacted their personal situation

Impact of the end of freedom of movement

(20 minutes)

Learn about the makeup of the respondent’s carers before the end of freedom of movement – where did their carers come from, how were they recruited

Learn about the respondent’s recruitment and retainment of international and UK workers before the end of freedom of movement

Gain a deeper understanding of how the end of freedom of movement has impacted the respondent’s ability to recruit

Learn about whether/ how the respondent’s ability to recruit has changed since the end of freedom of movement

Learn about the respondent’s understanding of the current rules they would have to follow if they were to recruit internationally

Looking to the future

(5 minutes)

Gain an understanding of what the respondent expects the future to look like in terms of availability and recruitment of carers/why

Gain and understanding of what the respondent would like the future to look like in terms of availability and recruitment of carers/what would need to happen for this to come about

Introduction and background

Objectives: Build rapport with the respondent + understand more about their situation

Thank you so much for taking the time to speak to us. I work for the MAC’s research team. The MAC has been commissioned by the Home Secretary to report on the current situation in Adult Social Care, and to make some recommendations about migration. As part of this the MAC is speaking to some people who employ carers, whether on their own or another person’s behalf, to find out more about their experiences of recruiting and employing carers, and in particular understanding how the recent end of freedom of movement has affected the social care sector. Other research being carried out by other people on our behalf will involve speaking to larger employers, and to carers themselves, about their own experiences. Findings from the interviews will be used to help the MAC evaluate areas for possible change.

Interview process:

The interview will last about 45 minutes
It’ll be recorded/transcribed, but it will be anonymised – nothing will be used that would identify them.
You have the right to withdraw at any stage.
Thank for consent form (check own records to see this has been received)
Nothing that would identify you will be shared with the wider Home Office: there is no way that anything you say can be used to affect any of your dealings with the Home Office or any other government department, either now or in the future.
Throughout the interview we will be asking about your individual situation. We are interested in the different circumstances in which people employ carers, and details about things like the types of work they do, the numbers of carers they employ and the amount of time they spend with you. Please do not feel that you have to share details about your personal medical situation or history, and we won’t be asking directly about this. However, please also feel free to share anything you think would be helpful and are happy to talk about.
As we go through the questions, let me know if there is anything you’d prefer not to answer.
Do you have any questions?
Check if the participant is happy to continue and be recorded.

1. Can you tell me a bit about your situation? (We are not asking for any confidential or medical details, or anything you do not feel comfortable talking about)

(Establish whether care is required on their own behalf or someone else’s behalf)

How long have you required care/has this person required care?
And how long have you been a personal budget holder?
- Reasons they became a personal budget holder
- Advantages of being a personal budget holder over having care supplied by the local authority
- Any disadvantages of being a personal budget holder

A bit more about your situation

2. Could you tell me a bit more about the carers you employ?

For how many hours a week do you employ carers?
- Is this as many hours as you would ideally like? (Probe on why not more – e.g. budget, availability)
And how many carers do you employ?
- Is this the number you would ideally like? (Probe on whether the individual would prefer more, fewer carers)
What sort of hours do your carers tend to work?
Could you tell me more about what a typical day or week might look like in terms of the carers who attend?

3. Employing carers

What are your carers like? (Probe on personal qualities, skills, anything else needed e.g. car)
How do you normally find your carers?
What do you look for when you recruit someone?
- How easy is it for you to find someone you are happy to recruit?
- Probe on extent to which they are able to choose between different candidates

The end of freedom of movement

Objectives: Get a sense of what the respondent knows about the recent changes to the immigration system + Learn whether the respondent feels the end of freedom of movement has impacted their own personal situation

4. How important has it been in the past to be able to recruit carers who are not British?

What proportion of previous carers have not been British?
- Could you estimate the proportion of British/ EU/ non-EU staff you have employed over the years?
Probe whether EU/non-EU, which specific countries
Why do you think this has been the case?
What have been the benefits to you in being able to recruit this group of people? (Probe on whether just ease of recruitment/number of recruits, or anything else)
Why were the carers you employed before working in UK social care?
To what extent did these workers see social care as a long-term career?
When they left, do you know where they went? Probe on:
- Next career step
- Where they went geographically – elsewhere in UK, back to home country, somewhere else

5. As you may know, from January 2021, the UK stopped being a part of EU freedom of movement and the new points-based immigration system came into force. This means that EU citizens now require visas to come and work in the UK.

Do you know any details about the new immigration system? (Don’t worry if not – we are just trying to find out any elements that people do know about)
Do you know any details about what is involved in employing someone on a visa? (Again don’t worry if not – we’re just trying to find out whether there are any elements people are more likely to know about)

For researcher: some information about the system to probe with/ test against

Freedom of Movement has ended for EU workers and now the same system as for non-EU workers applies
The application process takes around 8 weeks
Immigrants need: job offer and sponsorship letter
Routes for care workers: skilled worker, health and care worker (H&CW) visa
- Only senior care workers were able to come in (SOC 6146) at a rate of at least £20,480 per year and at least £10.10 per hour (this is changing following MAC recommendation and any care worker earning this salary can)
The shortage list = lower salary requirement + lower application fee
- Senior care workers are currently on the shortage list
The employer needs to have a sponsorship licence (£536 for a small employer) and pay an Immigration Skills Charge (£364 per year) plus for non-EU countries a Certificate of Sponsorship (£199 per worker)
Immigrants need evidence of personal savings to support themselves
Skilled worker + HSC visa lasts for up to 5 years before you need to extend it – you can extend as many times as you like – after 5 years you may be able to settle permanently
Employers need to track and record workers’ attendance and there may be Home Office compliance checks
Have you noticed any changes to your own situation following these new rules?

i. Probe on any changes to situation with existing carers (have they settled, moved on, returned to their previous country)

(If had EU staff: did they settle? Were they involved in this process at all?)

ii. Probe on any changes to ability to recruit carers when needed

Extent of any impact on quality or quantity of care received
Do you know anything about how these new rules affect the agency/agencies you use?
Individuals are not currently allowed to sponsor care workers’ visas. If this were allowed, would it be something you would consider?
- Why/why not
- Probe on which of the sponsorship requirements would be most likely to put them off the route.
- Probe on which of the sponsorship requirements would be least likely to put them off the route.
Thinking about the rules I outlined earlier – how far do you think individuals in a similar situation to yours would be able to use this system if they were able to?
Why is this? (Probe on)
- Costs
- Complexity
- Are there any rule changes that sound less difficult for individual employers?
- And are there any rules that sound more difficult for individual employers?

6. Could you describe what your carer workforce looks like now?

How many carers/who do you employ now? Are there any changes here? (Probe around nationalities; if not British are they settled EU, here on another route, etc.)
What sort of hours do your carers tend to work now?
- To what extent has this changed/stayed the same?
What working patterns do your carers tend to work now?
- To what extent has this changed/stayed the same?
Can you find carers with the qualifications/training you need?
- To what extent has this changed/stayed the same?
What has been the proportion of turnover in your carers in the last 6 months?
- How typical is this?
- How has the amount of turnover in your carers changed over time? (Probe: Compare 1/2/5 years ago)
Do you currently have any vacancies within your carer team?
- Probe on extent to which (they believe this is) related to end of Freedom of Movement
- Who do you most want to recruit for your carer team now?
- Probe on how they expect to fill these vacancies (extent to which they expect that this will be more difficult following the end of Freedom of Movement)
- Are there any specific areas it is more difficult to recruit for? (for example type of work done, types of shift, types of work pattern, days of the week)
- Extent to which this has changed following Freedom of Movement

Looking to the future

7. Do you see your workforce changing in the near future?

Do you see it changing for better or for worse?
- Probe: proportion of senior care workers/ care workers?; full-time/ part-time/ self-employed; British/ EU/ non-EU?
- Probe: COVID-19 easing?
Do you anticipate any particular challenges in the next year or so?
To what extent do you expect the future increase in the national minimum wage to impact you?

Is there anything else you’d like to mention?

Thank you so much for speaking to us. Your views will really help shape the recommendations we make to the Home Secretary. To reiterate, we won’t use your name or any identifying quotes in our report, we’ll report on generalised themes and anonymised quotes that won’t disclose your identity. We are due to report back at the end of April, and I can send you a copy of the report then if you would be interested in receiving it? (If so, we will retain your email address until then so we can email a copy).

MAC discussion guide – Care suppliers

Aims & objectives

To understand current practice and issues with recruitment and retainment of staff in adult social care
To understand care suppliers’ perspectives on how current practice and experience of recruitment and retainment has been impacted by the end of freedom of movement
To understand employers’ perspectives on the importance of international recruitment to adult social care

Purpose of this document

This is a semi-structured guide for the topics that the researcher will cover in the interview. The researcher will use the guide flexibly - they may not ask questions in the order they are presented here, but in the order which makes most sense for the interviewee - the researcher may probe beyond the questions if topics of interest to the wider goals of the project arise.

Overview/Interview Flow

Topics and Objective

Introduction and background

(5 minutes)

Build rapport with the respondent
Understand their role/ responsibilities

Description of the organisation

(5 minutes)

Understand where the respondent’s organisation fits into the care sector
Get a sense of their key business needs

The impact of the end of freedom of movement

(30 minutes)

Get a sense of what the respondent knows about the recent changes to the immigration system
Learn whether the respondent feels the end of freedom of movement has impacted their organisation
international and UK workers since the end of freedom of movement
Identify which visa routes the respondent uses for international recruitment
Look at the feasibility of complying with the visa requirements, on the organisation or its clients’ behalf

Looking to the future

(5 minutes)

Gain an understanding of what the respondent expects the future to look like in terms of recruitment, retainment and workforce makeup
Gain and understanding of what the respondent would like the future to look like in terms of recruitment, retainment and workforce makeup

Introduction and background

Objectives: Build rapport with the respondent + understand their role/responsibilities

Thank you so much for taking the time to speak to us. I work for the MAC’s research team. The MAC has been commissioned by the Home Secretary to report on the current situation in Adult Social Care, and to make some recommendations about migration. As part of this the MAC is speaking to some people who employ carers, whether on their own or another person’s behalf, to find out more about their experiences of recruiting and employing carers, and in particular understanding how the recent end of freedom of movement has affected the social care sector. Other research being carried out by other people on our behalf will involve speaking to larger employers, and to carers themselves, about their own experiences. Findings from the interviews will be used to help the MAC evaluate areas for possible change.

Interview process:

The interview will last about 45 minutes
It’ll be recorded/transcribed, but it will be anonymised – nothing will be used that would identify them.
You have the right to withdraw at any stage.
Thank for consent form (check own records to see this has been received)
Nothing that would identify you will be shared with the wider Home Office: there is no way that anything you say can be used to affect any of your dealings with the Home Office or any other government department, either now or in the future.
Throughout this interview I’ll be asking various questions, which you’re very welcome to respond to with reference to any types of carer you offer (if you offer different types), but this strand of the research is specifically looking at issues relating to direct payment/personal budget holders, and so if there is anything specific to that type of care/carer, it would be really helpful if you could highlight it.
Do you have any questions?
Check if the participant is happy to continue and be recorded.

1. Can you tell me a bit about your role?

What are your key responsibilities?
How long have you been working at [organisation]?
And what does your organisation do?
- Probe on whether it’s an introductory agency only, or whether it supplies and manages carers
- Type of carers supplied
- Client base
- Extent/proportion of direct payment clients in their client base

Description of the organisation

Objectives: Understand where the respondent’s organisation fits into the care sector; Get a sense of their key business needs.

2. Could you tell me a bit more about [organisation]?

What sort of carers do you supply?
- Prompt: adults with SEND, elderly patient
- Prompt: domiciliary, residential
Where is your organisation based? (If multi-site, do they have any international presence?)

3. What have been the biggest challenges for your organisation over the last year or so?

What are the main factors that have been causing these challenges?
How do you think the way you’ve been impacted compares to other adult social care organisations?
- Probe on any issues specific to direct budget holders
To what extent has this affected the quality of care that you can offer?
To what extent has this affected your workforce?

The impact of the end of freedom of movement

Objectives: Get a sense of what the respondent knows about the recent changes to the immigration system + Learn whether the respondent feels the end of freedom of movement has impacted their organisation

4. How important is international labour for your workforce?

Probe with EU/ non-EU
What are the benefits to your organisation in being able to access international labour?

5. As you may know, from January 2021, the UK stopped being a part of EU freedom of movement and the new points-based immigration system came into force. This means that EU citizens now require visas to come and work in the UK. How much do you know about the new immigration system?

Box is for reference/questions, no need to probe as there are other questions later

For researcher: some information about the system to probe with/ test against

Freedom of Movement has ended for EU workers and now the same system as for non-EU workers applies
The application process takes around 8 weeks
Immigrants need: job offer and sponsorship letter
Routes for care workers: skilled worker, health and care worker (H&CW) visa
- Only senior care workers were able to come in (SOC 6146) at a rate of at least £20,480 per year and at least £10.10 per hour (this is changing following MAC recommendation and any care worker earning this salary can)
The shortage list = lower salary requirement + lower application fee
- Senior care workers are currently on the shortage list
The employer needs to have a sponsorship licence (£536 for a small employer) and pay an Immigration Skills Charge (£364 per year) plus for non-EU countries a Certificate of Sponsorship (£199 per worker)
Immigrants need evidence of personal savings to support themselves
Skilled worker + HSC visa lasts for up to 5 years before you need to extend it – you can extend as many times as you like – after 5 years you may be able to settle permanently
Can only recruit senior care workers under the new system, not standard care workers)
Employers need to track and record workers’ attendance and there may be Home Office compliance checks

6. Could you describe your workforce before the end of freedom of movement?

What sort of roles did you employ? (Probe around job titles)
What sort of hours did your staff tend to work?
- Probe around contract type, carer contracts supplied, extent to which carers took one job to fit around other things, or 2-3 different contracts to work simultaneously
Could you estimate the proportion of British/ EU/ non-EU carers you were placing?
Were there any job roles that were harder/easier to fill than others?

7. What do you think attracted staff to work in the placements arranged by your organisation?

Was there anything you found it beneficial for clients to include in the placement offer in order to make it more appealing?
- Probe: UK/EU/international
- Probe: pay or other benefits
- Was there any flexibility with what clients could offer to different recruits?
Why do you think international workers wanted to come and work in UK social care?
Do you think workers saw social care as a long-term career?
- Probe on why leaving, where to, whether carers took one or successive postings, extent to which carers left to become permanent employees of clients

8. Practically, what was involved with trying to recruit these people?

What channels would you use to reach people?
- Probe: UK/EU/international
Did you conduct your own recruitment or outsource to recruiters?
- Probe: UK/EU/international
What sort of qualifications, if any, did workers need to have?
What did your organisation or your clients offer in terms of training, if anything?
- Probe: UK/EU/international
Was it easier to recruit workers from any countries more than others?
- Probe: UK/EU/international

9. Have you noticed any ways in which the new immigration system has impacted your organisation?

Are these anticipated impacts, or are they already taking place?
What has changed?
- Prompt: recruitment, churn, calibre of staff, staff shortages, ability to meet client requests

To what extent has this affected the carers looking for placements?

Prompt: Makeup – job titles, nationality, contract type
- Probe on anything specific to direct payment clients as compared to other clients
Prompt: personal difficulties, strain, sickness
Have you/clients had to change what you offer?

To what extent has this affected the quality of care that you offer?

Have there been any requests/contracts that you have not been able to fulfil?
- Any particular roles that are now more difficult to place
To what extent has this affected your business?
How do you think the way you’ve been impacted compares to other adult social care organisations?
- Probe on anything specific to direct payment carers
- To what extent do you think the way you’ve been impacted compares to other sectors outside of adult social care?
Have you previously had any responsibilities regarding their visas?

Do you have any responsibilities now?

Prompt with options:
- Skilled worker (NB. only works for senior care workers (SCWs) when on shortage list)
- Health and care worker (what did they think of this being introduced? NB. It being introduced gave a route for SCWs)
- Family visa
- Youth Mobility scheme
- Temporary work visa
- Student visa

10. To what extent are you able to support employees who are currently looking to gain settled status in the UK?

To what extent do you have to do anything beyond your current responsibilities as an employer to support these employees?

11. Changes have recently been made to allow care workers to come to the UK on a Skilled Worker visa.

To what extent would you make use of this visa?
To what extent do you think you could support workers to settle in the UK after 5 years of being on the Skilled Worker Visa?
- Probe: Feasibility around necessary pay progression over the 5 years.

12. What is your understanding of your/your clients’ requirements as an employer to be able to sponsor employees?

Do you know if there are any requirements that the candidate must fulfil?
Have you considered sponsoring care workers’ visas?

Probe on visa requirements, and how feasible it would be for clients to manage this (or the organisation to do so on their behalf – NB individuals are not allowed to sponsor workers themselves)

Employee requirements

B1 English language requirement

How would you feel about having to find potential workers who fulfil this requirement?

What English level do you think it’s necessary for potential employees to have, if any?

How big a barrier would this requirement be for your organisation? How might your organisation overcome it, if at all?

Employee must have a salary of at least £20,480 per year (equates to approx. £10.10 per hour). This means it’s likely the job would need to be full time.

How would you feel about your organisation having to pay potential workers this amount?

How feasible is this for your clients? Why / why not?

How big a barrier would this requirement be?

How might you overcome it, if at all?

What salary level would be feasible?

How would you feel about your organisation itself having to employ new migrant care workers full time?

Employer requirements

How feasible is this for you? Why / why not?

How big a barrier would this requirement be?

Potentially pay £199 per worker for a Certificate of Sponsorship.

Which countries would you be looking to recruit workers from?

How feasible is paying for the CoS? Why / why not?

How big a barrier would this requirement be for your organisation? How might you overcome it, if at all?

Immigration Skills Charge per worker: Small sponsors - £364 for first year, £182 for each subsequent 6 months; Large sponsors - £1000 first year, £500 each subsequent 6 months The cost of the CoS and Immigration Skills Charge for each workers who stay in the UK for 5 years would equate to roughly £5,000 for medium/large employers and £2,000 for small ones.

How would you feel about having to pay the Immigration Skills Charge?

How would your clients feel about having to track and record employees’ attendance?

How feasible is this for them? How much time do you think it would take? Would it be feasible to do this on their behalf?

Other considerations

The new visa route for care workers (as opposed to only senior care workers) is only due to be open for 12 months, but workers who come to the UK during this time can stay as long as they want and settle.

Does the fact that the government has said the route will be open for 12 months affect your thinking about how/whether to use the route?

How effectively would this help you to recruit new workers?

What about if the route was open for 18 months? 3 years? Indefinitely? Would this change how/whether you use this route?

13. Thinking about all these considerations, how would you feel about using this visa route?

Which would be the biggest barriers for you?
What would enable you to use this route?

Looking to the future

14. Do you see your carer workforce changing in the near future?

Do you see it changing for better or for worse?
- Probe: proportion of senior care workers/ care workers?; full-time/ part-time/ self-employed; British/ EU/ non-EU?
Are you taking/planning to take any actions that might mitigate against current and expected future challenges?
To what extent do you expect the future increase in the national minimum wage will impact your organisation?
Probe: Expected implications on recruitment, retention, the wider organisation
How easy or difficult will it be for your clients to meet this new minimum?
- Anything specific to direct budget holders

Is there anything else you’d like to mention?

Thank you so much for speaking to us. Your views will really help shape the recommendations we make to the Home Secretary. To reiterate, we won’t use your name or any identifying quotes in our report, we’ll report on generalised themes and anonymised quotes that won’t disclose your identity. We are due to report back at the end of April, and I can send you a copy of the report then if you would be interested in receiving it? (If so, we will retain your email address until then so we can email a copy).

Question 3

Annex C: Data and definitions

Accepted Answer

Adult social care (hereafter referred to as ‘social care’) encompasses a diverse range of activities, settings, and people. There is no universally recognised definition of the social care sector or workforce and national surveys have, in general, not been designed with the sector in mind. This Annex sets out our approach to data analysis for this commission, covering data sources and statistical definitions of the sector and workforce. As with the qualitative analysis, it has not been possible to make a full assessment of the extent to which any of the issues raised apply to protected characteristics, although any such findings have been recorded in the main report.

Data sources

We identified and explored a wide range of data sources for this commission, including official statistics produced by the Office for National Statistics (ONS), job vacancy data from platforms such as Indeed and Burning Glass (BG), administrative data from the Home Office (HO) and data collections led by the social care sector. A list of the main data sets we have used is provided below. Each of these sources provided a distinct perspective, and none acted as the single source of information for all of the questions answered in our work.

Table C.1 Examples of data sources used in this commission

Official statistics*

Annual Population Survey (APS) / Labour Force Survey (LFS)

Annual Survey of Hours and Earnings (ASHE)

ONS population projections

Administrative data

Certificate of Sponsorship (CoS) data

Sponsor registration data

Job vacancy data

Indeed

Burning Glass (BG)

Sector-led data collection

Adult Social Care Workforce Data Set (ASC-WDS)

Scottish Social Services Council (SSSC) data

Social Care Wales (SCW) data, including registration data

Northern Ireland Social Care Council (NISCC) registration data

PA Pool data

*We have also used care user projections data from the Care Policy Evaluation Centre (CPEC), produced on commission for the Department of Health and Social Care (DHSC), as an input into our workforce demand projection. These are not official statistics but are used in DHSC’s own analysis. This list is not exhaustive.

Official statistics produced by the ONS have played a central role in the MAC’s data analysis historically and continued to do so for this commission. ONS data provides a consistent and coherent basis for labour market analysis within and across sectors, between UK nations and over time, albeit with well-documented sampling issues during the pandemic. The major difficulty in using ONS data is that its Standard Industry and Occupation Classifications (referred to as SIC and SOC, respectively) do not precisely capture the full depth or nuance of social care activities in terms of the diversity of roles and particular care settings. This is discussed below. A further difficulty arose in that sample sizes were often limited for the social care sector outside England. We note the ONS’s efforts to improve the understanding and coverage of social care data and we are grateful for their assistance.

Administrative data collected by the Home Office provided a timely picture of how the social care sector is interacting with the immigration system – but also uses SIC and SOC codes with their inherent limitations. The Indeed platform generally uses its own classification system, while BG uses a combination of this and other classifications.

Sector-led data collection played an important role in confirming the picture from ONS data and our stakeholder engagement, providing occasional challenge to official statistics and filling in the gaps, particularly by care setting. We are grateful to Skills for Care (SfC), the Scottish Social Services Council (SSSC), Social Care Wales, and the Northern Ireland Social Care Council for their assistance in accessing and making best use of their data. These data sources are tailored more closely to the diversity and nuance of social care provision, with greater sample size (sometimes effectively acting as a census) outside England. There would be challenges in relying solely on this data: it cannot give us a consistent and comprehensive view across sectors or UK nations, and official statistics generally provide a richer array of variables.

In our data analysis and our report, we have relied on official statistics in the first instance to identify key trends and make conclusions about the social care sector. Administrative and job vacancy data have supplemented this picture as with other MAC commissions. We have also used sector-led data collection to add nuance to our findings and we have highlighted where there are notable disagreements between data sources. Often these may be driven by differences in non-random response rates and associated weighting techniques, rather than fundamental differences in sampling. We are confident that this approach balances the coverage and comparability of official statistics with the granularity and insight available from sector data.

Table C.2 sets out how APS and ASHE data (for England only) compares to SfC data on the size of the social care workforce.

Table C.2: Comparison of APS, ASHE and SfC workforce (employees) data in England

Occupation	APS	ASHE*	SfC
Care workers	624,000	517,000	895,000
Senior care workers	75,000	57,000	84,000
Nurses	22,000	30,000	34,000
Care managers	44,000	36,000	52,000
Other care providing roles	45,000	62,000	99,000

Sources: APS March 2021; ASHE 2021 provisional; Skills for Care data provided on request for March 2021. Notes: APS and ASHE observations filtered for England only. APS and ASHE workforce estimates based on individuals by main job; there are around 50,000 individuals reporting care worker as a second job in the APS, some of whom work in social care as their main job. SfC care manager estimate is the sum of ‘Middle Management’, ‘Registered Manager’ and ‘Senior Management’. *ASHE is not designed to provide comparable estimates of workforce size.

In general, SfC estimates of the size of the social care workforce are larger than the equivalents from ONS statistics, even focussing on the occupations in our scope. Some of this discrepancy is due to limitations in how SIC and SOC codes define the sector and the activities within it, and some is likely due to differences in weighting. We find that the characteristics of and trends in the workforce are similar regardless of the data source used, so we are confident that our analysis has picked these up accurately. Table C.3 provides comparisons on the distribution of hourly care worker pay in England across data sources.

Table C.3: Comparison of APS, ASHE and SfC care worker hourly pay data in England

Percentile	APS (stated pay)	ASHE (stated pay)	ASHE (actual pay)	SfC (stated pay)
25th percentile	£8.72	£8.72	£9.00	£8.78
Median	£9.07	£9.03	£9.93	£9.04
75th percentile	£10.00	£9.94	£11.63	£9.64

Sources: APS March 2021, ASHE 2020 revised, Skills for Care data provided on request for March 2021.

The main differences here are in the way pay is measured rather than the data source. Measures of ‘stated’ pay in the APS and ASHE are based on the contracted hourly pay rate of the subset of employees for whom this is defined. This also corresponds to SfC’s data, which allows employers to benchmark their pay rates against other employers. The ASHE measure of ‘actual’ pay is derived from the responses for gross pay and hours worked elsewhere in the survey. This is our preferred measure as it reflects actual earnings and the ONS’s published hourly earnings. SfC also estimate that the upper tail of the distribution is narrower.

Statistical definitions

We have used a consistent definition of social care throughout the data analysis in this commission and we have made clear where we have had to depart from this. Our definitions of the sector and the workforce are guided by the overall focus of this commission:

Adult, and not child social care
Social care, and not social work
The direct provision of care, and not supporting work – though this is vital to the functioning of the sector

For ease of presentation and given their limitations in describing social care activity, we have avoided repeated mention of SIC and SOC codes in our report except where this is relevant, e.g. in discussing the design of immigration policy. But our data analysis has assumed a consistent set of SIC and SOC codes, or their closest equivalents outside official statistics. Table C.4 details our definition of the social care workforce.

Table C.4: Statistical definition of the social care workforce

SOC (2010) code	SIC (2007) codes	Generally referred to as
1242 Residential, day and domiciliary care managers and proprietors	All	Care managers
2231 Nurses	87.1 Residential nursing care activities 87.2 Residential care activities for learning disabilities, mental health and substance abuse 87.3 Residential care activities for the elderly and disabled 88.1 Social work activities without accommodation for the elderly and disabled	Nurses, registered Nurses
6141 Nursing auxiliaries and assistants	87.1 Residential nursing care activities 87.2 Residential care activities for learning disabilities, mental health and substance abuse 87.3 Residential care activities for the elderly and disabled 88.1 Social work activities without accommodation for the elderly and disabled	Other care providing roles
6145 Care workers and home carers	All	Care workers
6146 Senior care workers	All	Senior care workers

Notes: this breakdown is largely preserved into SOC 2020, with the exception of nurses which are split into more disaggregated occupations – we count all of them within the relevant SIC codes. In SOC 2000 there is no distinction between care workers and senior care workers, but this breakdown is otherwise preserved.

Where possible we have captured workers in an occupation across all sectors, for consistency with previous MAC analysis (notably the Shortage Occupation List) and given the statistical noise and sample size limitations incurred through industry filtering. We assume that, regardless of their stated industry in the data, the vast majority of individuals in these occupations work in adult social care. This is borne out in the APS. As the majority of nurses and nursing auxiliaries and assistants work in the healthcare sector, we have applied a set of SIC code filters that best captures the overall approach of our commission, explained above. We recognise that ‘nursing auxiliary’ is a term not widely used or recognised in social care in the UK – these are nonetheless reported in significant volumes in ONS data, and we assume those employed in this occupation broadly do work similar to that of care workers.

A notable absence from this list is directly employed care workers. The often informal and transitory nature of their employment means that they may both intersect and be separate to the workforce defined above in unpredictable ways. We have used data from SfC and PA pool to better understand this segment of the workforce. It is, however, regrettable that there is a data gap in this area – particularly in the live-in care sub-sector, where care needs may often be greatest.

SfC and SSSC use their own occupation classifications in their data collection. These are similar, but not directly comparable, to ONS SOC codes. This inevitably leads to some differences across data sources, particularly in the estimated workforce headcount. But on most other features, including the personal characteristics of social care workers, the share of migrants in the workforce and the proportional growth in the workforce over time, these sources and official statistics largely tell the same story.

Competing occupations

In this report we also refer to ‘competing occupations’ against which the social care sector vies for workers in the labour market. We have identified these occupations by pooling the five-quarter Labour Force Survey from the first quarter of 2016 to the first quarter of 2020 and tracking the past and future labour market status of those who were employed as a care worker in either the first or final quarter of a survey wave. Individuals in the care worker occupation at the end of the survey but not the beginning are classified as entrants, while for exits the converse is true.

Excluding those who entered from or exited to unemployment and inactivity, and the other occupations in our scope, competing occupations are defined as SOC codes that account for more than 3% of observed entrants to or exits from care worker roles over the period. The occupations are social worker (SOC 2442), housing officers (3234), welfare and housing associate professionals not elsewhere classified (3239), other administrative occupations not elsewhere classified (4159), personal assistants and other secretaries (4216), teaching assistants (6125), educational support assistants (6126), sales and retail assistants (7111), retail cashiers and check-out operators (7112), cleaners and domestics (9233), kitchen and catering assistants (9272), waiters and waitresses (9273) and bar staff (9274). This lines up with similar analysis done by SfC and insights from our stakeholder engagement.

Question 4

Annex D: Workforce projection and wage bill estimates

Accepted Answer

In Chapter 1 we present illustrative projections of the demand for social care workers up to 2033, to give an indication of the future recruitment required. In Chapter 2 we set out some indicative wage bill costs of raising pay in social care. This Annex provides technical details behind these estimates.

Workforce projections

At the outset, it should be noted that these estimates are highly and intentionally illustrative and make no assumptions with regard to future changes in policy and the capacity of the system to function amid persistent labour shortages. Our projection draws from previous work commissioned by the Department for Health and Social Care (DHSC), the ONS population projections and workforce data. We acknowledge the work done by the Devolved Administrations to understand the future demand for social care. For our purposes, and to avoid spurious accuracy, prior work commissioned by DHSC provides a useful basis for our projection.

We first estimate the future number of people who receive care and support (hereafter referred to as ‘care users’). We take the Care Policy Evaluation Centre (CPEC)’s 2018 care user projections (PDF, 185 KB), produced for DHSC, across working-age and old-age care users in residential, domiciliary and community settings in England, and scale them by the ratio of the UK adult population to the adult population of England in the ONS population projections.

Scaling up CPEC’s estimates in this way accounts for different demographic trends across the UK.

We convert this estimate of social care users to an illustrative projection of social care workers by observing the historic ‘staffing ratio’ of users to FTE workers (assuming a 39-hour week) for each of the occupations in our scope. The ‘ideal’ ratio assumes all vacancies are filled.

We use the average ratio observed between 2018 and 2020. By accounting for vacancies, using Skills for Care’s latest vacancy rate data, we assume that filling all vacancies within the sector would mean all demand for social care services is fulfilled. Our projections are then calculated by multiplying the observed staffing ratio for each occupation by our estimate of future care users to 2033, and summing across all occupations.

We assume that the observed staffing ratios will remain constant in the future: an increase in the ratio would imply that, on average, care users have more labour-intensive care needs in future or that labour productivity in the sector declines; a decrease in the ratio would imply the reverse. There has not been an update on CPEC’s work since 2018 and given that the pandemic places both upward and downward pressures on future care demand, we assume that CPEC’s 2018 estimates constitute a ‘central’ path for the future.

Note: the exact formulas used cannot be represented here and are detailed in the PDF version of this document.

Table D.1 sets out our projected demand for each occupation, in terms of FTEs.

Table D.1: Projected demand for social care occupations (FTEs)

Occupation	2023	2028	2033
Care workers	644,000	714,000	807,000
Senior care workers	77,000	85,000	96,000
Nurses	41,000	45,000	51,000
Care managers	66,000	73,000	83,000
Other care providing roles	53,000	59,000	66,000
Total FTEs needed	881,000	976,000	1,100,000

Source: MAC analysis.

It should be noted that this demand projection only captures social care activities in the labour market, and those in the labour market that can be readily observed. Unpaid care work has long been substantial across the UK and may well become even more prevalent with future demographic pressures. The way this interacts with the social care system, and labour market, is complex and outside the scope of our commission.

Wage bill estimates

We provide indicative estimates of the yearly wage bill cost of raising pay in social care. These are neither comprehensive estimates of the change in the wage bill, nor estimates of the system-level costs accounting for means-tested public spending. Instead they provide an indication of the magnitude of spending that may be required.

Our estimates are based on setting the following minimum hourly pay rates on care workers and senior care workers:

We first considered how the distribution of stated hourly pay (see Annex C) might look in 2022 following the NLW uplift to £9.50, using provisional 2021 ASHE data. We assumed that, compared to 2021, increases in pay would taper from the rate implied by the NLW uplift to the compound average growth rate (CAGR) from 2016 to 2021, as shown in tables D.2 and D.3.

Table D.2: Estimated 2022 stated hourly pay distribution for care workers

Decile	2021	CAGR*	Assumption	2022
Minimum (0)	£8.91	4.4%	6.6%	£9.50
10th	£8.95	4.4%	6.6%	£9.54
20th	£9.18	4.5%	5.8%	£9.72
30th	£9.47	4.3%	5.5%	£9.99
40th	£9.79	3.9%	4.9%	£10.27
50th	£10.19	3.7%	4.4%	£10.64
60th	£10.80	3.7%	4.1%	£11.24
70th	£11.55	3.5%	3.5%	£11.95
80th	£12.78	3.5%	3.5%	£13.23
90th	£14.88	3.5%	3.5%	£15.41

Source: ASHE 2016 revised-2021 provisional. *From 2016 to 2021. The uplift in the NLW from 2021/22 to 2022/23 is 6.6%.

Table D.3: Estimated 2022 stated hourly pay distribution for senior care workers

Decile	2021	CAGR*	Assumption	2022
Minimum (0)	£8.91	4.4%	6.6%	£9.50
10th	£9.32	5.2%	6.1%	£9.89
20th	£9.76	5.2%	5.9%	£10.33
30th	£10.10	5.0%	5.7%	£10.68
40th	£10.49	4.9%	5.5%	£11.07
50th	£10.93	4.9%	5.3%	£11.51
60th	£11.36	4.6%	4.6%	£11.88
70th	£11.99	3.7%	3.7%	£12.44
80th	£13.15	4.1%	4.1%	£13.69
90th	£14.32	3.1%	3.1%	£14.76

Source: ASHE 2016 revised-2021 provisional. *From 2016 to 2021. The uplift in the NLW from 2021/22 to 2022/23 is 6.6%.

Against this baseline, we considered two ways in which an hourly pay increase could be implemented:

A ‘pay floor’ ensuring that workers are paid at least the rates above. Pay rises taper to zero or to rates that preserve the ordering of the deciles in the distribution, which narrows.
A ‘whole distribution’ pay rise which preserves the structure of the distribution, giving each decile the same proportional increase in stated hourly pay.

Table D.4 sets out how this translates into potential increases in hourly pay for each decile.

Table D.4: Assumed gross stated hourly pay rises

Pay rise	Pay floor - Care workers	Whole distribution - Care workers	Pay floor - Senior care workers	Whole distribution - Senior care workers
£10.50	+£1 at the NLW, tapering to zero at the 6th decile	+£1 at the NLW, up to +£1.62 at the 9th decile	+£1 at the NLW, tapering to zero at the median	+£1 at the NLW, up to +£1.55 at the 9th decile
£11.53	+£2.03 at the NLW, tapering to zero at the 8th decile	+£2.03 at the NLW, up to +£3.29 at the 9th decile	+£2.03 at the NLW, tapering to zero at the 8th decile	+£2.03 at the NLW, up to +£3.15 at the 9th decile
£13.21	+£3.71 at the NLW, tapering to zero at the 9th decile	+£3.71 at the NLW, up to +£6.01 at the 9th decile	+£3.71 at the NLW, tapering to +£1.48 at the 9th decile	+£3.71 at the NLW, up to +£5.76 at the 9th decile

Source: MAC calculations based on ASHE 2016 revised-2021 provisional.

Our estimate of the total wage bill cost is composed of the increase in gross hourly pay, an assumed statutory employer pension contribution of 3% on the marginal increase in pay, and employer National Insurance contributions of 15.05% on the marginal increase in pay, net of pension. The increased wage bill cost is applied to the APS estimate of the UK care worker and senior care worker workforce – as such, these estimates would be significantly larger if based on Skills for Care workforce estimates.

Question 5

Glossary

Accepted Answer

AfC

Agenda for Change.

APS

The Annual Population Survey is a continuous household survey, covering the UK, with the aim of providing estimates between censuses of main social and labour market variables at a local area level.

ASHE

Annual Survey of Hours and Earnings is a comprehensive source of information on the structure and distribution of earnings in the UK.

BG

Burning Glass is a platform which provides real-time data on job growth, skills in demand, and labour market trends.

BREXIT

The withdrawal of the United Kingdom from the European Union.

CfE

Call for Evidence to submit information and evidence to the MAC. This usually takes the form of an online questionnaire, and the submission of written evidence.

CMA

Competition & Markets Authority.

CoS

A Certificate of Sponsorship must be assigned to each foreign worker that a UK company employs. It is an electronic record rather than a physical document. Each certificate has its own number, which (once the CoS is issued) a worker can use to apply for a visa.

COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. It caused the worldwide pandemic, the effects of which still resonate today.

CPEC

Care Policy Evaluation Centre.

CQC

Care Quality Commission.

DA

The Devolved Administrations (Scottish Government, Northern Ireland Executive and Welsh Government).

DHSC

Department of Health and Social Care.

DN

The Devolved Nations of the UK (Scotland, Northern Ireland and Wales).

EEA

Throughout this report we use the term ‘EEA’ migrants to include European Union (EU) countries plus Iceland, Liechtenstein and Norway. We also include Switzerland as part of our definition, but exclude migrants from the Republic of Ireland, as it remains part of the Common Travel Area following the UK’s exit from the EU.

EU

The European Union: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden.

EUSS

EU Settlement Scheme.

FoM

Freedom of Movement. Within this report this is used to describe the reciprocal travel rights that existed for citizens of the UK and the EU prior to 31 December 2020.

FTEs

Full-time equivalents.

H&CW visa

The Health and Care Worker visa is an immigration route which allows medical professionals to come to or stay in the UK to do an eligible job with the NHS, an NHS supplier or in adult social care.

HMT

HM Treasury is the government’s economic and finance ministry.

HMRC

HM Revenue & Customs, the UK’s tax, payments and customs authority.

HSCT

Health and Social Care Trust, specific to the Northern Ireland health care system.

IHS

Immigration Health Surcharge is a fee paid by migrants coming to live in the UK for longer than 6 months to gain access to the NHS.

ILR

Indefinite Leave to Remain, also called ‘settlement’, gives a migrant the right to live, work and study in the UK for as long as they like.

ISC

Immigration Skills Charge is an additional charge for each foreign worker recruited by a UK employer.

LA

Local Authority.

LFS

The Labour Force Survey is a study of the employment circumstances of the UK population. It is the largest household study in the UK and provides the official measures of employment and unemployment.

LPC

Low Pay Commission.

MAC

The Migration Advisory Committee is an independent, non-statutory, non-time limited, non-departmental public body that advises the government on migration issues.

MWS

The Migrant Workers Scan contains information on all overseas nationals who have registered for and allocated a National Insurance Number.

NCS

The National Care Service in Scotland.

NDPB

Non-departmental public body.

NHS

England’s National Health Service.

NICs

National Insurance Contributions.

NI

Northern Ireland.

NISCC

Northern Ireland Social Care Council.

NLW

National Living Wage.

NMW

National Minimum Wage.

Non-EEA

Countries outside of the EEA.

NVQ

National vocational qualification.

OECD

The Organisation for Economic Co-operation and Development is an intergovernmental economic organisation with 38 member countries, of which the UK is one, to stimulate economic progress and world trade.

ONS

Office for National Statistics is the executive office of the UK Statistics Authority, a non-ministerial department which reports directly to Parliament. It produces official statistics on immigration, emigration, and net migration, amongst other areas.

PA

Personal Assistant.

PBS

Points-based system.

PPE

Personal Protective Equipment.

RQIA

The Regulation and Quality Improvement Authority in Northern Ireland.

RQF

Regulated Qualifications Framework categorises qualifications in England based on their size, and their level of challenge or difficulty. Equivalent qualification frameworks are in place in the Devolved Nations.

SCW

Social Care Wales.

SCWDP

Social Care Workforce Development Partnership.

SfC

Skills for Care.

SIC

The UK Standard Industrial Classification of economic activities is a five-digit classification, providing the framework for collecting and presenting a large range of statistical data according to economic activity.

SME

Small and Medium-sized Enterprise. The UK government definition of SMEs encompasses micro (less than 10 employees and an annual turnover under €2 million), small (less than 50 employees and an annual turnover under €10 million) and medium-sized (less than 250 employees and an annual turnover under €50 million) businesses.

SOC

The Standard Occupational Classification is the ONS’s common classification of occupational information for the UK.

SOL

Shortage Occupation List.

SSSC

Scottish Social Services Council.

ST

Salary Threshold.

SW

The Skilled Worker route is an immigration route for skilled migrant workers to access a skilled role with a UK employer.

Tier 2/Tier 2 (General)/T2(G)

Prior to 1 December 2020, all routes for skilled work in the UK were under Tier 2 of the immigration system. These routes now come under the skilled worker route and others.

UC

Universal Credit, a means-tested payment to help with living costs for people on a low income, out of work or unable to work.

UK

United Kingdom comprising: England, Northern Ireland, Scotland and Wales.

YMS

Youth Mobility Scheme.

Include - All pay before deductions for PAYE, National Insurance, pension schemes, student loan repayments and voluntary deductions. Include paid leave (holiday pay), maternity/paternity pay, sick pay and area allowance (e.g. London). Exclude - Pay for a different pay period, shift premium pay, bonus or incentive pay, overtime pay, expenses and the value of salary sacrifice schemes and benefits in kind. ↩
Include - All pay before deductions for PAYE, National Insurance, pension schemes, student loan repayments and voluntary deductions. Include paid leave (holiday pay), maternity/paternity pay, sick pay and area allowance (e.g. London). Exclude - Pay for a different pay period, shift premium pay, bonus or incentive pay, overtime pay, expenses and the value of salary sacrifice schemes and benefits in kind. ↩
European includes all European Union countries (except Republic of Ireland), Norway, Iceland, Lichtenstein and Switzerland. ↩
Excludes all UK, Republic of Ireland, or European nationals. European includes all European Union countries (except Republic of Ireland), Norway, Iceland, Lichtenstein and Switzerland. ↩

Cookies on GOV.UK

Annex A: Call for Evidence and Stakeholder Engagement

Introduction

Stakeholder Engagement

The Call for Evidence

Overview

Who responded to the Call for Evidence?

Respondent characteristics – Individual organisations

Respondent characteristics – Representative organisations

Respondent characteristics – Individuals responding in a personal capacity

Questionnaires

Call for Evidence questionnaires: Individual organisations

Introductory text

A About You

B About your organisation – Individual organisations

C Impacts

D Closing

Call for Evidence questionnaires: Representative organisations

Introductory text

A About You

B About your organisation and the businesses you represent

C Impacts

D Closing

Call for Evidence questionnaires: Individuals responding in a personal capacity

Introductory text

A About You

B Impacts

C Closing

Annex B: Primary Research

Introduction

Methodology

Revealing Reality fieldwork

Migrant worker strand

Employer strand (focus groups and interviews)

Supplementary fieldwork on direct employers of care workers

Topic guides

Revealing Reality discussion guide – Employees

Overview/ Interview flow

Introduction and background (10 minutes)

Route to UK social care (15 minutes)

Working in UK social care (10 minutes)

Future plans (10 minutes)

Wrap up (5 minutes)

Revealing Reality discussion guide – Employers

Overview/Interview Flow

Description of the organisation

Introducing the impact of the end of freedom of movement

Pre-end of freedom of movement

Going deeper into the workforce post- end of freedom of movement

Looking to the future

Employee requirements

Employer requirements

Potentially pay £199 per worker for a Certificate of Sponsorship

Using the Sponsor Management System to track and record employees’ attendance. Compliance checks may be carried out by the Home Office.

Other considerations

The new visa route for care workers (as opposed to only senior care workers) is only due to be open for 12 months, but workers who come to the UK during this time can stay as long as they want and settle.

Revealing Reality discussion guide– Employer groups

Introductions (15 mins)

Factors affecting social care (20 mins)

Attraction and recruitment (20 mins)

Retention (20 mins)

Looking ahead (15 mins)

New visa route

Employee requirements

B1 English language requirement

Employee must have a salary of at least £20,480 per year (equates to approx. £10.10 per hour). This means it’s likely the job would need to be full time.

Employer requirements

Potentially pay £199 per worker for a Certificate of Sponsorship.

Using the Sponsor Management System to track and record employees’ attendance. Compliance checks may be carried out by the Home Office.

Other considerations

The new visa route for care workers (as opposed to only senior care workers) is only due to be open for 12 months, but workers who come to the UK during this time can stay as long as they want and settle.

MAC Discussion Guide – Direct employers

Overview/Interview Flow

Introduction and background

A bit more about your situation

The end of freedom of movement

Looking to the future

MAC discussion guide – Care suppliers

Overview/Interview Flow

Introduction and background