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Policy and Practice
The changing profile of migrant care workers in England: possible workforce and service implications

The demand for care workers in the developed world, including the UK, is set to increase dramatically in the next few decades due to both demographic and social factors (Wittenberg et al. 2008). Due to the secondary, or undesirable, position of the social care sector in the labour market, migrant workers are likely to continue to form a significant part of this workforce, whether directly recruited as care workers or domestic workers, or recruited following arrival in the UK (Anderson 2007). According to the Office of National Statistics (2006), migrants comprise approximately 16 percent of all paid care workers in England. At the same time, care work is an important vehicle of migration from the developing world to more economically developed countries. Since 2003, the enlargement of the European Union (EU) and tighter UK immigration laws applicable to people from outside the EU have restricted work permit availability to non-EU citizens.

This article reports on some of the findings of a mixed-method study conducted during 2007-2009 examining the experience, motivations and future plans of migrant care workers in England. The study was funded by the Department of Health (for the full report see Hussein et al. 2010). Given the scarcity of evidence about the migrant care workforce in England at the onset of the study, a collective qualitative research study approach was adopted (Stake 1995). This was combined with analysis of national statistics related specifically to the social care workforce in England. Following a systematic review of the literature, the study collected empirical primary data from 45 national policy stakeholders and recruitment agencies. This was followed by selecting six areas using maximum variation sampling to ensure views were captured in areas with both high and low levels of immigration. In the study sites, we interviewed a total of 39 employers, 96 migrant care workers, 27 UK care workers and 35 people using social care services and family carers (caregivers) using semi-structured interviews. We also interviewed a sample of 18 refugees and asylum seekers and 5 representatives of organisations supporting them. The research received ethics approval from King’s College London and from the six local authorities selected for the study.

Using national statistics related to the social care workforce in England (NMDS-SC) we examined the profile of recently arrived international workers in the care sector in England (5,118); workers who had their immediate previous job abroad excluding those identified as White British are used as a proxy. Using a logistic regression model we found that recent migrant workers were significantly younger, by an average of seven years. The largest age gap, of nine years, was observed amongst ‘other workers’; followed directly by eight years among registered nurses. Such wide age-gap may affect team dynamics and mobility. Asian recent migrant workers constituted a significantly large group among senior care workers and nurses; Black recent migrant workers were more concentrated among registered nurses working in social care settings. ‘White other’ recent migrant workers were over represented among ancillary, not care providing, staff. The implications of this possible stratification need exploring in the context of providing equal opportunities and in terms of work practices such as supervision and matters connected to rewards and working conditions. Findings from the interviews with recruitment agency staff and policy stakeholders (as reported in Hussein et al. 2010 and Manthorpe et al. 2010), were broadly consistent with the quantitative data analysis. The profile of recent migrant workers was significantly different from those who did not have their previous job abroad. However, the gender profile of recent migrant workers did not differ significantly from that of other workers.

We also examined the profile of all non-UK qualified social workers who are registered to work in England by the General Social Care Council (GSCC) (7,200). The analyses of these records highlight several important observations in terms of the characteristics of these social workers as well as some possible trends. First, over half (57%) of international social workers have trained in only four countries: Australia, South Africa, the United States and India. Changes are emerging, with a recent decline in social workers qualified in India and a slight increase in those from A8 countries, although these trends are not large in magnitude.  Comparing their profile with UK-qualified registered social workers, the findings revealed their younger age and different gender profile compared to UK social workers, their greater likelihood of engagement in agency (temporary) social work, and some differences in the success of applications to join the GSCC register. International social workers who have qualified in different world regions have different profiles from their UK counterparts. The variations in gender patterns suggest an interaction between cultural differences and gender patterns, given the high proportions of women in UK social work.

The in-depth interviews offered a wealth of information about a range of topics including the reasons for recruiting migrant workers, motivations to work in the care sector, experiences of working in the sector and possible implications covering various dimensions. For example, very few employers, human resource managers, frontline workers or international workers felt that vacancies in the sector would be eliminated, even temporarily, through the current higher unemployment rates among UK citizens. Most, however, were aware of the new thresholds limiting the recruitment of staff from outside the EU, especially those with no formal skills. The impact of these changes was uncertain, although some international workers had already been affected by the new criteria for renewing work permits and visas.

Care work is thought to be stratified by various divisions, typically gender and ethnicity, which are associated with different experiences and working trajectories (Yeates 2009). Within the analytical framework developed for this study, we explored a range of perspectives. Employers reported their difficulties finding willing recruits from the local population, highlighting the secondary position of social care in the labour market. In a smaller number of cases, employers were actively recruiting overseas, usually to meet specific shortages in certain qualified posts, such as social workers or senior care workers. However, in addition to filling vacancies, some participants identified a number of important attributes associated with migrant workers, bringing added value for employers and users of the care sector. The most commonly mentioned benefit was the belief that migrant workers are ‘hard workers’, followed by a perception that such workers offered a ‘caring approach’.  These two attributes are particularly important to the nature of care services, which are both emotionally and physically demanding (Dyre et al. 2008). Many employers held the view that migrants valued their jobs, and were thus easier to retain, but simultaneously recognised that care work for many might be a temporary stop gap or stepping stone, particularly among those who have fewer immigration restrictions, such as workers from the EU. However, consistent with research in the US (Rodriguez 2004), the main motive of the English care sector in recruiting migrants is their willingness to do work that may be seen as unattractive and hard to fill by the host population, such as managing continence, end of life care and night or shift work.

The literature points to a mix of financial and stability factors motivating migration, which interact with motivations to work in social care. For example, workforce shortages in the sector have led to a particular development in the rules governing migration to the UK from outside the EU that permit some migrant workers from outside the EU to work in social care, thus increasing the relevance of this kind of motivation to work in the sector.  In terms of motives to move to the UK, most migrants held very positive views of the country. However, EU migrants were particularly interested in developing English language skills. Proficiency in English was perceived as an important asset, which could potentially facilitate mobility to other developed countries. Economic motivations were also apparent, particularly among migrants from the Philippines who spoke at length of the opportunities for their offspring from their remittances.

Demand for international social care workers is unlikely to decline substantially in the near future unless there are substantial changes in applications to work in this sector and a reduction in staff turnover. EU staff may enter the UK social care workforce without any restriction and so changes in immigration rules may make far less difference than might be presumed. At the same time, there are a number of valuable attributes that international workers may bring to the sector with positive implications for the workforce, standard of care and service users. There look set to remain several issues to consider to maximise the benefits for workers, social care users and the sector as a whole. At national policy level, we recommend that the sector explore the case for removing residence type rules for publicly funded training relevant to social care work. Such vocational training, when offered to international workers (non–EU), is very likely to benefit users quickly. This would support other government policy goals, such as training for all staff working with people with dementia and the UK’s ambitions to be in the top quartile of OECD countries at every skill level by 2020 (http://www.ukces.org.uk/our-work/research-and-policy/ambition-2020/).

For employers we recommend the importance of considering what individuals’ motivations were in joining the sector, and whether these are being fully met, to improve retention rates. This might include, for example, talking to individual staff about ways to improve their qualifications or experiences in areas of work where the UK takes a particular lead, such as Dementia Care Mapping, reminiscence, and psychosocial support in dementia. The UK has also been at the forefront of self-directed support and in the involvement of users and carers in education, recruitment and quality assurance. International staff may welcome such managerial and educational input as well as face to face care work and skills development. Knowledge about which features of social care work are seen to be attractive is likely to be useful to those seeking to recruit to specific posts, when devising marketing and recruitment strategies. Whilst some of these features may be instrumental (wages, terms and conditions), others are likely to be more relationship-centred.

A ‘duty’ of care may be owed to all staff and to staff who are recruited specifically from abroad. We found evidence that support needs to be provided beyond initial induction. The potential importance of human resources (HR) staff in managing face to face, teamwork and supervisory relationships in care work emerged, as well as their role in recruitment and appointment, training and inductions. We suggest that HR staff may wish to share good practice and what works, to be better equipped to address instances or allegations of racism and discrimination in staff groups and hierarchies. As a number of participants in this study pointed out, behaviour by older people and other service users may need to be managed in different ways than those in other sectors or relationships. More generally, support for international workers needs to be embedded within care-providing organisations; even among international workers who were directly recruited from abroad, there was a sense of fading support levels once they arrived to the UK. Both work-related and practical support is very important to facilitate integration processes and enhance the likelihood of high quality care for older people and other service users.

References
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Dyre, S., L. McDowell and A. Batnitzky (2008) 'Emotional labour/body work: The caring labours of migrants in the UK's National Health Service.' Geoforum 39 (6): 2030-2038.

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