News updates

The Immigration Bill, Covid-19 & the social care workforce

July 2020

When the government announced its plans for a new points-based immigration system in February 2020, it was met with varying levels of concern and dismay from experts and employers across industries. On 30 June 2020 The Immigration and Social Security Co-ordination (EU Withdrawal) Bill comfortably passed its latest hurdle in the House of Commons by 342 votes to 248 and will now be sent to the House of Lords.

In the new system, prospective migrants will be assigned points based on skills, qualifications and job prospects, as well as other compulsory conditions such as a required level of English, a confirmed job offer and a job at an appropriate skills level. Despite advice from the Migration Advisory Committee that previous attempts to introduce a points-based immigration system in the UK had proved “ineffective and overly complex”[1], this move has been offered by the Home Secretary as a way of opening up the UK “to the brightest and best from around the world.”[2]

As the bill continues its passage through parliament, we’ve been considering how these new measures might impact the social care sector, including the supply of EU workers, how skilled the workforce is and what role the Covid-19 pandemic will play.

Social care’s dependence on immigration

The social care sector has been very reliant on a migrant workforce. A recent analysis of the social care workforce by Skills for Care reported that 8% of the social care workforce, or 115,000 jobs, are EU nationals (with a further 9% of workers coming from outside the EU).

At the same time, the care sector has experienced an increase in demand for labour, with an estimated 122,000 unfilled vacancies in adult social care (7.8% of total positions).[3]

Nowhere is this reliance on health and social care workers illustrated more strongly than the current coronavirus crisis; the Home Secretary recently announced that free visa extensions will be granted to “crucial overseas health and care workers” to continue to wage the fight against the virus over the coming months.[4]

So, how might The Immigration and Social Security Co-ordination (EU Withdrawal) Bill affect the social care workforce?

One consequence might be the levels of skills in the care workforce. One of the bill’s stated aims includes driving up the level of skill among the workforce. However, the impact of the bill may be counterproductive to this aim.

A 2015 study by Independent Age showed that migrant care workers are significantly more likely to be high skilled (having a qualification equivalent to level 4 or above), compared to their UK-born counterparts. Given that 69% of current EU migrants working in health and social work would have been ineligible to migrate under the new proposed system[5], a statistic that has been acknowledged by the government[6], will this supposed effort to upskill the sector actually result in the opposite effect – pushing a cohort that are more likely to be skilled out of the workforce?

Reactions from the sector to the proposed new system have been overwhelmingly negative, with experts across adult social care calling the move an “absolute disaster,”[7] one that “looks set to make our social care crisis even worse,”[8] and an immigration policy that will lead to a “vacancy black hole”.[9] Threaded through these responses is a clear message that the sector needs fewer barriers to recruitment, not more, and that “arbitrary salary thresholds” will do little to enable the social care sector to retain the number of staff needed to meet its needs.[10] The proposed changes to the immigration system will only serve to worsen these “deep-rooted problems within the care sector”.[11]

The future of social care

So what is next for the social care sector in the face of this challenge? As the bill travels through the Lords, it could be subject to a number of changes, including suggestions such as a separate migration stream for the recruitment of social care workers[12], or the designation of these positions as “shortage occupations”[13].

However, it is likely that the bill will be substantively the same when it returns to the House of Commons, so providers of adult social care will need to think about what they can do for themselves. In Independent Age’s report they identify the importance of making social work an attractive option for UK workers, through better working conditions and more appropriate levels of pay.

As Covid-19 continues to wreak havoc with the economy, social care will not face such stiff competition from the retail and leisure sector, which are already cutting jobs. Care workers have also perhaps never been held in such high esteem, given their heroic efforts during this crisis. It seems that this immigration bill will mean it is necessary for care providers to take advantage of these conditions to recruit more home-grown workers. The question is whether this will be enough to fill the gap left by the outstanding contribution of EU-workers that will no longer be able to seek work in the UK?

Sources

[1] Migration Advisory Committee, January 2020, ‘A Points-Based System and Salary Thresholds for Immigration’.

[2] House of Commons, February 2020, ‘Points-based Immigration System’.

[3] Skills for Care, October 2019, ‘The state of the adult social care sector and workforce in England’.

[4] Home Office, April 2020, ‘Home Secretary announces visa extensions for frontline health and care workers’.

[5] IPPR, February 2020, ‘Immigration plans analysis: Two thirds of current EU migrants in health and care sector would have been found ineligible’.

[6] Home Office, February 2020, ‘Home Secretary announces new UK points-based immigration system’.

[7] UNISON, February 2020, ‘Immigration plans ‘spell disaster for care sector’, says UNISON’.

[8] The Health Foundation, February 2020, ‘New points-based immigration system looks set to make our social care crisis even worse’.

[9] GMB Union, March 2020, .Care system risks 460,000 vacancy black hole thanks to immigration policy’.

[10] Social Care Today, February 2020, ‘New immigration system ‘won’t meet population’s health and care needs’’.

[11] NHS Providers, February 2020, ‘New immigration system will be difficult pill to swallow for social care’.

[12] Macmillan Cancer Support, February 2020, ‘Macmillan responds to government plans to move to a points-based immigration system’.

[13] Nursing Times, February 2020, ‘New social care warnings as government confirms immigration plans’.

Cordis Pulse: June 2020

June 2020

This month we have continued to work with clients to support them with the Covid-19 pandemic. As part of this we have worked with the Making Every Adult Matter (MEAM) coalition to rapidly identify and document the adaptations and flexibilities that have been put in place to support people facing multiple disadvantage during the pandemic. Part of this work focussed on how local areas may be able to sustain these changes as the Government moves to the next stage of the Covid-19 response. This report can be seen here.

We have also been working with clients on the integration of health and social care and have produced a set of slides concerning real-time evaluation approaches. We believe these approaches can be used to support systems and organisations make evidence-led decisions and support the sustainability of innovation as we collectively move into the recovery phase of the pandemic.

The slides outline five system behaviours in response to the pandemic, many of which can manifest simultaneously: Revert, Status Quo, System improvements, Rapid adoption and Innovation and transformation. We would welcome the opportunity to hear your thoughts on these approaches.

Fulfilling Lives: national evaluation and learning

June 2020

Cordis Bright participated in a webinar as part the national evaluation and learning for Fulfilling Lives, focused on the theory and practical examples of evaluating system change. Alongside Cordis Bright’s contribution, there were presentations from Dr Matt Egan from the London School of Hygiene and Tropical Medicine and from Hannah Mahoney from Golden Key Bristol, an organisation working to improve services for people in Bristol who experience multiple disadvantage. The webinar is likely to be of interest to people involved in planning, implementing and funding system change, and to those who commission or conduct evaluations of system change programmes. Slides from the webinar can be downloaded below. 

Health & care responses to the Covid-19 pandemic

June 2020

The Covid 19 pandemic is placing unprecedented pressures on services, systems and society.

Cordis Bright has identified five system behaviours in response to the pandemic, many of which can manifest simultaneously:

• Revert
• Status quo
• System improvements
• Rapid adoption
• Innovation and transformation

Real time evaluation rapidly generates valuable insight that can be used to take stock and support decision making. Our approach to real time evaluation is multi-method  and multi-stakeholder, creating a robust evidence base. It is quick to deploy, provides rapid learning, and focuses on outcomes for citizens. Our approach is delivered by trained, highly experienced evaluators with a successful track record of undertaking evaluations on complex, whole systems change involving multiple partners.

Read more by downloading the PDF below. 

Shared Lives Plus

June 2020

Our report for Shared Lives Plus focuses on the Scaling Shared Lives in Health programme, which ran from 2016 to 2019, and its impact across 70 Shared Lives schemes in England.

Key findings include a high percentage of schemes (79%) currently with exposure to health arrangements, with some developing more substantial portfolios. The report also identifies further challenges and solutions to enable further growth, such as a call to clarify overall strategic focus on whether to expand services for anyone with a health need, or those that could be funded through health budgets. To emphasise this point, evidence suggested many health-related arrangements were still found to be funded via social care channels.

Other overall recommendations include a focus on local relationships to identify gaps in service provision, further evidence gathering of the impact on the sector and a structured approach to a shared case study tool, which would allow greater inter-scheme learning.

You can download the report below and also visit the Shared Lives website here. 

Evaluating systems change

June 2020

Efforts to tackle enduring issues – such as domestic abuse, climate change, an ageing society, and knife crime – using the concepts of complexity and systems have gained increasing traction in recent years. This work, systems change, focuses on taking a wider approach to improving outcomes for individuals and communities than lone, narrowly targeted interventions. As this approach has become more prominent, a parallel discussion has developed about how best to evaluate systems change.

Here we lay out a range of approaches to evaluating systems change based on our own experience plus review of the growing range of guides and literature. There are also some signposts towards practical tools, guidance, and sources for further information.

ADASS Covid-19 budget survey

June 2020

ADASS have published results from their coronavirus survey which was completed by Directors of Adult Social Services. Cordis Bright provided analytical support and helped to identify the following key findings:

• Directors have seen significant changes in the way that people’s needs present to them since March 2020.
• Overall, the onset of the pandemic has led to an increase in the number of people presenting adult social care needs to local authorities and unmet need.
• There is a concerning decline in people approaching some local authorities for support for domestic abuse and safeguarding issues.
• Councils have rapidly adapted to changing circumstances.
• Directors see that coronavirus has made extremely fragile care markets even more susceptible to market failure at the detriment to those people accessing care and support services.
• Local authorities have been proactive in engaging with and taken a range of measures to support providers.
• Help is needed from government in relation to testing, additional funding, better access to PPE, testing and having more influence on NHSE decision making.
• Directors have significant concerns about the availability of testing for people receiving social care, unpaid carers and personal assistants.
• Additional funding is required from Government, above and beyond that already committed, to support the adult social care response to the pandemic.
• The focus on rapid discharge from hospital without taking account of the needs of the whole health and care system has had tragic consequences.
• An absence of testing for people leaving hospital during the period of Rapid Discharge could have accelerated the spread of Coronavirus in care settings.
• There is a concerning proportion of Directors who believe that there are insufficient primary and community services in their local areas to support local people’s needs.
• A significant proportion of people leaving hospital rapidly did not receive an assessment of their needs as part of discharge to assess.
• Concerningly, only 11% of Directors believe that every individual in their local authority area was discharged to the right place for them first time to best meet their needs.

You can download a full copy of the report below. Further information is also available on the ADASS website.

Flexible responses during the coronavirus crisis

June 2020

On behalf of the MEAM coalition, Cordis Bright produced research examining the flexibilities that homelessness, substance misuse, mental health and criminal justice services have put in place to support people during the Covid-19 crisis, and how some of the positive aspects of these changes might be maintained in the future.

You can read more here. 

Summary of findings

There were flexibilities across a range of sectors, including:

• Substance misuse treatment: Individuals assessed and offered support more rapidly; increased regular virtual support contact; reduction in supervised consumption of medication and prescriptions covering longer periods of time.
• Homelessness support and housing services: Emergency accommodation to support the ‘everyone in’ policy; in-reach support for individuals residing in this accommodation provided by a wide range of partners on multiple issues; increased flexibility by housing associations and other housing providers in relation to who they accepted in their properties.
• Criminal justice: Improved safe accommodation for people released from prison in some areas; increased partnership working between police and other agencies; continued face-to-face contact with probation. It was noted that conditions in prisons have worsened during the pandemic, with prisons implementing internal lockdown measures and not allowing visits.
• Mental health: Relatively limited adaptations compared to other service areas, however; greater provision of mental health assessments and psychological support in some areas; improved discharge planning for people receiving in-patient care; some specialist mental health services.
• Women specific support: Domestic abuse services in several areas received additional resources to expand their work, but there was also a recognition of the lack of suitable accommodation for women facing multiple disadvantage.

The report looked at why and how these changes occurred and the impact on local systems. It found that:

• Shared purpose: There was a clear shared purpose to prevent individuals contracting the virus. This drove reforms quickly and provided direction for people making decisions together across agencies.
• Risk: There was a change in the balance of risk, with the risk of making bold decisions and trying new ways of working being less than the risk of leaving people without support. This drove innovation in service delivery.
• Staff autonomy: Greater autonomy was given to front line staff to adapt how they worked. Managers allowed staff to quickly work with individuals and agree with them what support would be most suitable for their needs and circumstances.
• Local accountability: Local accountability to protect the most vulnerable increased, with agencies and services reporting that they could no longer ‘not be sat around the table’ to work with this group.

The research found that the changes had a mix of positive and negative impacts on people, including:

• Adapting well: Many clients had adapted well to their new circumstances, were engaging with more services and had displayed considerable resilience.
• Trust: There was increased trust between clients and support workers.
• ‘Knock-back’: Some clients experienced ‘knock-back’ to progress due to lockdown restrictions.
• Remote support: Remote support was welcomed by some and less effective for others.

The research asked local areas what they were doing to plan for the transition. It found that:

• Learning and reflection: Most respondents were confident that their areas were taking the opportunity to learn and reflect (but couldn’t always point to where this was happening).
• Leadership: Leadership on ‘transition planning’ was coming mainly from housing, with less evidence of wider ‘cross-sector’ planning.
• Involvement of lived experience: There was little evidence of involvement of people with lived experience.
• Challenges: People were worried about funding, timescales and a “return to the status quo”.

The research concluded that as we transition out of the crisis, local areas and national government are likely to need to consider the following in order to maintain some of the positive changes that have been developed during the pandemic:

• Reflecting closely on learnings from the crisis period: Local areas and national government may wish to consider which new flexibilities have been effective at improving outcomes for people facing multiple disadvantage as well as which changes have been less effective and why. A clear process will be needed for reflection and learning.
• Cross-sector leadership and planning to ensure positive changes can be maintained: Local areas and national government should build on the reflection and learning above, identifying the flexibilities that they wish to maintain and developing plans to ensure that this can be funded and commissioned. The provision of suitable, permanent accommodation for all who need it will be a key part of this, but wider cross-sector flexibilities will also be important.
• Ensuring the involvement of people with lived experience of multiple disadvantage: Local areas and national government should ensure that people experiencing multiple disadvantage are at the centre of conversations regarding the next stage of the response.

Cordis Pulse: May 2020

May 2020

This month we have been considering the impact of the Covid-19 pandemic on care homes. Back in early March the Government was clear that even before a decision had been taken to introduce extreme social distancing that it would be necessary to shield vulnerable people and, in particular, older vulnerable people with additional underlying health conditions.

It is clear now that both the planning and execution of this shielding strategy has failed in relation to care homes. Indeed, the latest data would appear to indicate that not only has the strategy failed to protect people in care homes from dying from Covid-19 but that the strategy of shielding may also have contributed to additional early deaths.

There is already research underway looking to see if the discharge of untested patients back into care homes occurred, and looking at the possible spread of the virus via the use of agency staff, the quality of the advice on how to safely isolate and limit transmission of the virus, and the extremely low rates of testing of both staff and residents.

One factor which is not in dispute is access to Personal Protective Equipment (PPE) which appears to have been exceptionally poor in the early part of lockdown when the NHS was struggling to get sufficient equipment. Arguably the NHS need for PPE was pursued at the expense of PPE for social care.

Deaths in care homes are falling and no doubt will return to the expected levels over the next six weeks or so. However, with no vaccine and limited access to a reliable antibody test the need for regular and possibly weekly testing of both staff and residents is pressing. Without a large scale and sustainable testing regime care homes will have to wait probably for nearly a year to return to anything like normal operation.

It is important not to forget that people living in care homes and the staff that support and care for them have paid a heavy price for this failure. It will be many months before the final tally is known but at the time of writing there have been excess deaths of some 21,800 people living in care homes and 131 of the staff that support them.

It is not too early to ask why this has happened, and to try to understand in forensic detail the specifics of what occurred in some homes, and it is certainly not too early for the government to start to account for the decisions and action it has taken.

There will almost certainly be flare ups of infection. If this does happen, nothing can be done for the thousands who have already lost their lives, but there is an opportunity through effective action to ensure this tragedy is not repeated.

As is so often the case, the problem is not about knowing the answer but making sure that it happens. The minimum performance standard for care homes must now be:

• Regular systematic testing of staff and residents
• Secure a reliable supply of PPE
• World class evidence-based advice and training on how to isolate and limit transition of the virus.

Anything less risks further avoidable deaths.

Cordis Pulse: April 2020

May 2020

In March the WHO designated Covid-19 a global pandemic and the UK started to grapple with arguably the greatest heath crisis in 100 years and an associated severe real-economy challenge. 

Over this period, we have been taking time to discuss and reflect with our clients how best we can help and provide support. This has included thinking about how the pandemic may affect the future of adult social care and the integration of health and social care. See here. We have also developed real-time evaluation approaches. More about this is summarised in a post by our colleague Jane Harris here.

A wide range of useful resources about Covid-19 are emerging and we have highlighted a selection that we think are most useful.