MAC review of adult social
care and immigration

Last July, the UK government commissioned the Migration Advisory Committee (MAC) to undertake an independent review of adult social care and the impact the ending freedom of movement has had on the sector.

The MAC is an independent body which provides the Home Office with evidence-based advice on migration issues. The report, published in April 2022, sets out a number of recommendations regarding immigration policy which could help tackle labour shortages in the sector.

The report states that:  We do not believe that immigration policy is the cause of, or the solution to, all, or even most, of the workforce problems in social care, but that immigration could potentially help to alleviate some of the difficulties, at least in the short term.”

The MAC stresses that problems in the social care sector are ultimately down to long-standing funding issues and years of policy decisions, although the end of free movement has contributed to staff shortages.

In this article, we look at the current immigration provisions in place for social care workers and explore the MAC report’s key findings and recommendations to overhaul the sector.

The Health and Care Worker visa

The Skilled Worker route – and the Health and Care Worker visa that implements the Skilled Worker route for health and social care occupations – is now the principal employer sponsored immigration route for hiring migrant workers in social care. Following the MAC’s December 2021 recommendation to include care workers in the Health and Care Worker visa, all the major occupations in social care can now access this route.

In line with the rest of the Skilled Worker route, the Health and Care Worker visa requires migrants to be paid the higher of their occupation’s going rate or an annual salary of at least £25,600. Occupations on the Shortage Occupation List (SOL) receive a discount on these thresholds, so care worker and senior care workers must be paid a minimum salary of £20,480 per year, equivalent to £10.10 per hour.

Current benefits

The Health and Care Worker visa already offers a number of benefits for applicants and their employers. It provides a fast-tracked application process with reduced visa fees and an exemption from the Immigration Health Surcharge (IHS).

It costs £247 for a 3-year Health and Care visa or £479 for a 5-year visa. In comparison, the application fees for a Skilled Worker visa are more than double that amount. Exemption from the IHS means Health and Care Workers also save £624 per year of their visa. These significant cost savings are likely to make the route more attractive for migrants and employers.

However, employers are still required to pay the Immigration Skills Charge (ISC) for every migrant worker hired under this route. The ISC is a fee levied on businesses employing skilled migrants. Sponsors are required to pay the fee for each Certificate of Sponsorship (CoS) they assign, unless an exemption applies. The amount that an employer is required to pay for the ISC will depend on the size of the organisation and the length of employment stated on the Certificate of Sponsorship. The current fees are as follows:

  • Small or charitable sponsors: £364 for the first year of employment, plus £182 for each subsequent six-month period.
  • Medium or large sponsors: £1,000 for the first year, plus £500 for each additional six-month period.

Key findings

Through its primary research and data analysis, the MAC concluded that the social care sector is not heavily reliant on EEA workers, but the ending of free movement shut off one source of workers at a critical time for recruitment and retention.

A key concern among employers and visa applicants was relating to cost. A new group of employers are now having to engage with the immigration system and the report found that they have not always found this straightforward, with concerns about both cost and complexity. Some visa costs are also not logical or affordable for low-paid, publicly funded social care workers, while other aspects of current policy are, on balance, considered to be appropriate.

Recruitment of senior care workers on the Health and Care Worker visa increased over the course of 2021, and there are early indications employers will make use of the new rule expanding eligibility to all care workers.

MAC recommendations

The report put forward several recommendations relating to immigration which the MAC believe would overhaul the social care sector, including:

  • Removing the Immigration Skills Charge (ISC) for all Health and Care Worker visas. More broadly, the MAC also recommends conducting a full review of the ISC across the entire Skilled Worker route, as the charge was introduced some years ago and there have been substantial changes in immigration policy since that time.
  • The current salary threshold for the Health and Care Worker visa should be maintained, and annual salary thresholds should not be prorated to allow for part-time work for migrants on this visa.
  • Workers who spend the full five years working in nursing or care roles on the H&CW visa should either receive a complete settlement fee waiver or pay a lower fee that is no higher than the unit cost of processing. The cost of this recommendation should not be passed on to other visa fees.
  • The decision to make care workers eligible for the Health and Care Worker visa should be made permanent, i.e., should not have an automatic sunset date.
  • Care workers should be kept on the SOL until the next SOL review is completed, when the MAC will make a further recommendation.
  • The Government could consider the introduction of a pilot umbrella scheme. Under the scheme, an umbrella body would be appointed to sponsor care workers from overseas and people who can show their level of need requires live-in care would be able to directly recruit from the umbrella body.

The government will now consider the recommendations put forward by the MAC. Smith Stone Walters will provide further updates in due course.

Sponsoring care workers from overseas

If you are an employer within the social care sector looking to sponsor overseas workers under the Health and Care Worker route, Smith Stone Walters can help.

Our experienced immigration advisors can support your organisation with all aspects of the immigration process, from applying for a sponsor licence to managing the visa process for your overseas hires. To discuss your requirements and find out how we can help, please contact us today.

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