The UK care system is in crisis - what must be done?
Whether residential or nursing care homes, adult day-care centres, home care or hospices, the UK’s care system plays a crucial role in providing essential support for daily living to older and disabled people.
Most work in the sector is temporary and workforce turnover is high. Workers must look after people needing round-the-clock care, whether at home or in a residential care setting, and there are several key challenges facing the system:
This last point is in the media spotlight this week, with the BBC reporting that a national helpline for victims of modern slavery reporting a steep rise in calls from overseas workers helping to plug staffing gaps in the care sector.
The ‘staff plug’ followed a government initiative in 2022 making care work a ‘shortage’ occupation - resulting in nearly 70,000 people arriving in the UK to work in the sector. The BBC highlights unscrupulous individuals and organisations using the system to exploit people - charging thousands of pounds for travel to the UK and sponsorship certificates. In some cases, this cost is as much as £25,000, plus interest, with the inevitable debt deducted from wages.
The Unseen report lists a depressing catalogue of control and exploitation exercised against workers, many of whom have borrowed in their home country. Many cannot repay the debt, making them more vulnerable to exploitation in the UK.
Unseen has brought these shocking practices to light in its ‘Who Cares?’ review of exploitation in the sector. Unseen operates the UK’s Modern Slavery & Exploitation Helpline, which has seen a significant rise in the number of recent cases indicating labour abuse and forced labour in the care sector. Many involve foreign nationals.
From seven cases in the whole of 2017, the helpline indicated 106 cases in 2022, and that figure continues to grow. Average debt for recruitment, visa, and travel costs was reported to be £11,800. As with many forms of abuse and exploitation, women are disproportionately represented - between January 2022 and June 2023, most potential exploitation victims were female (235 out of 378). The most prevalent nationality was Indian, comprising 48% of all potential victims. Zimbabwe and Nigeria were also highly represented.
The Unseen report lists a depressing catalogue of control and exploitation exercised against workers, many of whom have borrowed in their home country. Many cannot repay the debt, making them more vulnerable to exploitation in the UK. Financial control is rife, with practices such as withholding of wages, non-compliance with minimum wage requirements and, as already mentioned, debt bondage. Poor living conditions, confinement, monitoring and multiple forms of emotional, physical and racial abuse are frequently reported.
Many workers who come to the UK do not know their employment – or human – rights. This must be addressed and there is promising research that investigates, for example, how workers’ insecure status affects their ability to resist unreasonable demands and exploitative working conditions.
Policy and practice changes are crucial. We need a co-ordinated approach to commissioning, with tighter rules for issuing visa licences to organisations. However, what the sector needs most, is policies that address the staffing crisis, through improving pay and working conditions. We must tackle the root causes of one of the main, contemporary problems facing the UK’s care sector.
Professor of Gender Based Violence and Health
Staff profile for Dr Caroline Bradbury-Jones, Professor of Gender Based Violence and Health, School of Nursing and Midwifery, Institute of Clinical Sciences at the University of Birmingham
