Review by Jill Manthorpe of research on migrant care workers

The UK is heavily reliant on migrants to provide care in residential homes and clients’ own homes. What are the implications of this for providers? Social work professor Jill Manthorpe reviews recent research

Research title: Migrant care workers in ageing societies: research findings in the United Kingdom

Authors: Alessio Cangiano, Isabel Shutes, Sarah Spencer and George Leeson

Abstract

The contribution of care workers to society is often overlooked and even more so when they are foreign born. Social care relies on migrant workers for much care and support of older people but there are uncertainties about the sustainability of this source of labour within the new systems of social care. This report, by policy research centre Compas is based on a range of data collection sources and analyses. The authors conclude that the area of migrant working in social care is one where there are several tensions between different parts of policy, not simply those related to social care.

Methods

This report is part of an international research programme, 2007-9, reporting on the implications of migrant labour in the care of older people, funded by the Nuffield Foundation and Atlantic Philanthropies. This is the UK report; others will follow on Ireland, the US and Canada. The UK report also draws on background papers not contained in the full report. It offers an analysis of existing data sources about migrant workers in the UK social care system, the results of a postal and online survey of 557 social care employers and 30 interviews with a sample of these, the findings of face-to-face interviews in 207 with 56 migrant workers and the conclusions of five focus groups or discussions with older people, some of whom were users of social care services. Projections of future demand for social care by older people are used to offer two scenarios:

● A reduced need for migrant labour

● Continuing problems with recruitment in the sector resulting in higher demand for migrant workers.

Findings

Across the globe, labour migration to staff social and healthcare services takes place between and within states. Social and health care services may recruit staff directly from their home counties or after their arrival. In social care this covers formal and informal employment, including domestic service, live-in care workers, cash-in-hand working, and working for regulated home care agencies or within care homes.

This report sets out current patterns of social care work, observing that there is little public or political recognition of the role played by migrant workers in the care of UK older people. In London, more than 60% of care workers are migrants, based mostly in the private sector of care. In the UK as a whole 19% of care workers are migrants, with over a third, 35%, of nurses working in social care (typically in care homes with nursing) being migrants.

In the UK there is a long history of social and health care services seeking staff by drawing on relationships with the former British Empire and the Commonwealth. This may explain why most migrants come from countries such as Zimbabwe and Nigeria. Similarly, as Yeates points out, there are countries that deliberately encourage their citizens to work abroad, such as the Philippines and India.

More recently, the European Union has increasingly been employing labour from the A8 states, the eight Accession states (former Soviet republics and eastern European countries) that joined the European Union in 2004. Poland is now a source of much social care labour across the UK. The authors suggest that this may change with the recession and in the wider context of political concerns about unemployment and immigration. Devolution may mean that regional contexts become more sharply differentiated.

This report looks at patterns of demand and supply, noting that social care is one area where vacancies have been high and some working conditions remain unattractive to local potential workers. It moves to explore the experiences of migrant workers in different settings, noting, in particular, that there are few supports for managers who want to learn how to handle problems such as discrimination and harassment, still less for migrant workers who may face these problems and are unlikely to be members of trade unions.

They suggest that managers would benefit from guidance on what to do and how to support staff in such situations while responding to the needs of older customers.

The tensions exposed in this report in the context of the growth of direct employment of care staff are also discussed. The authors point to the need for dignity and respect to be seen as the rights of care workers as well as people using services. They suggest that local authorities may need to take on mediating roles when there are problems arising between an older people and individual social care workers, such as personal assistants or home care staff employed directly through personal budgets or direct payments. While these may apply to any workers, they suggest that live-in migrant workers will be particularly vulnerable, because their immigration status may be unclear, because there may be tensions over their working time, and because their contracts and conditions of work may be uncertain.

The integration of migrant social care workers in local communities is also addressed. The authors found little attention to reception and integration for such workers, or where they do exist they are variable. There are limited opportunities to access language courses, especially those that might be especially helpful to social care workers by offering insights into local customs, colloquialisms and social expectations. Induction for new staff in many social care settings does not always seem to cover such skills. Such programmes may help address some of the concerns voiced by some older people that they find problems in communicating and understanding some migrant social care workers.

The authors conclude that migration should be planned and that while social care systems may wish to follow the NHS in aiming for more self-sufficiency in staffing, there is a long way to go before this becomes possible. Under the current system of social care support for older people, where low wages and low status work predominate in the workforce, the chances of moving to self-sufficiency seem remote, particularly for nurses working in care homes. The authors do not favour temporary working for the very reason that most users of social care services prefer continuity. Seemingly perverse limits on access to publicly funded NVQs for recently arrived care workers should be addressed.

Planning should also encompass greater appreciation of the role of migrant social care staff whose contribution to the care of older people is undervalued. The authors suggest that criteria for citizenship should not insist on volunteering contributions to the nation when so many social care workers are already making a significant impact to the UK’s well-being.

Conclusion

This is a timely report for adult services in their debates with other parts of the local authority over social cohesion and responses to the recession. It potentially sees councils as having responsibility for older citizens and for social care staff rather than simply adult social care providers and individuals.

The report is likely to be useful to human resources staff and other managers in setting out the issues for employers and employees, and for those responsible for social care transformation and the greater use of self-directed support.

Finally, the report notes that migrant social care staff are often overlooked in debates over social care in later life; these must take the realities of workforce problems into account.

Jill Manthorpe is professor of social work and director of the social care workforce research unit, King’s College London

Resources

● Alessio Cangiano, Isabel Shutes, Sarah Spencer and George Leeson (2009)

● Migrant care workers in ageing societies: research findings in the United Kingdom, Compass (ESRC Centre on Migration, Policy and Society), University of Oxford, www.compas.ox.ac.uk

● Yeates N (2009). Globalising Care Economies and Migrant Workers,: explorations in global care chains, Palgrave.

Implications for practice

For social care providers: What support do you provide for migrant social care workers to help with language and social proficiency? How can staff raise matters of concern about working conditions and their treatment by service users?

For adult service managers: In carrying out the process of transformation of social care, what strategies are in place to ensure that migrant workers are not exploited and that aspects of quality of care include relationships?

For planners and commissioners: Do the local workforce strategies in social care rely on continued import of migrant workers? How far are local employers involved in promoting migrant workers’ access to training and skills developments?

When working with direct payment clients: What role do you have in mediation and help with contracts between individual employers and their families and migrant workers who may largely be “invisible” locally? What guidance do you offer to individuals who wish to advertise outside the UK for staff, for example?

For social workers: In drawing up support plans with individuals how will you raise the need for fair employment conditions so that neither party is exploited?

Published in the 3 September 2009 edition of Community Care under heading ‘Migrant Care Workers in an Ageing Society’