Welcome to the Parliament Brief, where Spotlight, the New Statesman’s policy section, digests the latest and most important committee sessions taking place across the House of Commons and House of Lords. Previous editions can be found here.
Who? The Health and Social Care Select Committee welcomed Victoria Atkins for an introductory session, following her appointment as Health Secretary on 13 November. She was joined by Sir Chris Wormald, the permanent secretary at the Department of Health and Social Care.
When? Wednesday 13 December, 4pm.
What was discussed? As is usual with most new secretaries of state, the introductory session works to establish the policy positions the new minister has compared with their predecessor, on a variety of issues. Atkins was asked about the record NHS backlog, ongoing workforce industrial action, investment in the health service, and the government’s abandoned mental health reforms, among other topics.
Perhaps most pertinent were questions the new Health Secretary faced on the government’s plans to control legal migration, and their potential effects on the NHS and social care settings.
Britain’s health and social care sector is already severely understaffed, which is widely considered to be a result of poor working conditions and low pay. There were 152,000 vacancies in the care sector in 2022-23, a near record. The country is heavily reliant on international workers to fill roles. In the year to September 2023, 58 per cent of the 143,990 people who were given a health and care visa were care workers.
While the government’s headline plan to raise the minimum salary threshold for both individual and family visas to £38,700 will not apply to those seeking a health and care worker visa, other changes have caused concern for those within the sector. From spring 2024, workers who are granted the visa will be unable to bring family dependants to the UK. Additionally, care homes will be required to be regulated by the Care Quality Commission to sponsor such visas.
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So what did they say? Atkins stressed that current migration levels “are too high”, and set out the defence for the government’s position. She believes that the government has “got to a very, very sensible place” in the pay thresholds it has set, which, she added, “reflects the realities of [the UK] being in the international market” for skilled labour.
“We wanted to understand and reflect the fact that social care remains, sadly, a career that is among the lowest paid,” Atkins said. “So we have that very sensible carve-out,” she added, referring to the exemption of health and care worker visas from the higher salary threshold. Atkins attempted to justify banning dependants, telling the committee: “We[‘ve] got to a situation where we have more people coming over as dependants… [than] people who are actually working under the visas.”
According to government estimates, in the year ending September 2023, 101,000 visas were granted to care workers, while 120,000 were given to their dependants.
Not everyone on the committee was convinced by Atkins’ arguments. “Care workers who [would] come to work in this country have already proved that they are internationally mobile,” said Steve Brine, the Conservative chairman of the committee. He asked Atkins to envision herself in their position: “If it’s a choice of coming here [to Britain] but having to leave [a] husband, wife, partner, [or] children behind – or going to another country where you can take them, what would you do?”
Wormald confused matters by claiming that Britain’s labour market is currently “heavily oversubscribed”, and that “the limit on the number of people who are currently coming into the country is the number of jobs available, not the supply of international labour”. The Home Office has determined that there is already a “robust [domestic] market” of people willing to work in the sector, he added. A perplexed Brine reminded him that there are more than 150,000 vacancies in the social care sector. Wormald conceded that there are “still a substantial number of vacancies” in the sector, which “international recruitment has helped stabilise”.
Atkins claimed that the new immigration rules are consistent with the government’s aim to recruit more British people into social care jobs. “We very much want to raise the status of social care as a career,” she said, pointing to the government’s commitment to invest £600m to help areas recruit more people locally, including through bolstering wages. “At the moment,” Atkins added, “it can sometimes be seen as a [bad] job and it doesn’t quite have the same status that I think it deserves.”
Any conclusions? The visa plans have had mixed-to-negative reviews from those within the sector. Christina McAnea, the general secretary of Unison, has argued that the plans are “cruel” and “spell total disaster for the NHS and social care”.
Care England, which represents independent providers, has said that “immigration is saving the social care sector”, and that the new changes make “it harder for care providers to recruit foreign workers”. “If the government now wants to move away from international recruitment as the solution to fixing the social care workforce crisis, it must act swiftly and invest in improving the pay and conditions to drive domestic recruitment,” the organisation added.
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