The Brexit transition period ended at 11pm on 31 December 2020, and since then, aspects of the UK's immigration system have changed. This blog examines those changes and the potential impact for NHS trusts and foundation trusts as we adapt to a new immigration system.
Points based system
A new points-based immigration system has been introduced to manage migration into the UK. Both EU and non-EU citizens are now subject to the same immigration rules, with the exception of Irish citizens, who are covered by Common Travel Area arrangements and do not need permission to enter or remain in the UK.
Under the new system, those wishing to come live and work in the UK will be awarded points if they speak English, and if they have job offer at the appropriate skill level and that passes a salary threshold of around £26,000. There are number of different routes for those who wish to come to the UK to work, but the most relevant to the health and care sector is the "skilled worker route", which includes the new Health and Care Visa.
So far, the new immigration system appears to be supportive of trusts' ongoing recruitment of healthcare staff from overseas. The Health and Care Visa, launched last year, is a fast-track visa scheme, with a reduced visa fee for health and care workers. Health and care workers covered by the visa will be exempt from paying the Immigration Health Surcharge, which is also welcome. There have also been changes to the shortage occupation list, creating a protected status for a number of core health and care roles.
Social care
However, concerns have been raised about the likely impact of the new immigration system on the social care sector. The majority of social care workers are not eligible for the Health and Care Visa and many will fail to meet the salary and skill level thresholds put in place under the new rules. There are also concerns that despite being able to apply for a reimbursement of the Immigration Health Surcharge (which currently stands at £625 a year), some might struggle to pay the full amount up front. Prior to the pandemic, there were over 120,000 vacancies in the social care sector. COVID-19 has shone a light on the fragility of the social care system, and there is a concern that pressure on trusts and the wider NHS will be exacerbated should no workable system for international recruitment in the social care sector be found.
Bedding in the new system
Moreover, uncertainties remain around the NHS' international workforce needs and in particular the question of how many existing European Economic Area A staff will choose to continue living and working in the UK long term. Many EEA staff have already applied for settled or pre-settled status, which enables them to work in the UK, use the NHS for free, and to enrol in education or continue studying, as well as allowing them to access public funds such as benefits and pensions. However, the deadline for applications is fast approaching, with applications needing to be in by 30 June this year, and it is unclear how many current EEA staff in the NHS and social care have so far applied.
As the new immigration system beds in, we are urging the government to monitor the international workforce supply closely and work with the health and care sector to ensure a coherent cross government approach to supporting key public services. It is also vital that existing EEA staff are given the support they need to navigate the new system including support in applying for settled and pre-settled status, and that they are encouraged to continue working and living in the UK. NHS trusts and foundation trusts also need to be equipped to cope with the new system in order to make sure existing staff continue to feel supported.
As part of our work in this area, we continue to play an active role as a member of the Cavendish Coalition, a group of over 35 health and social care organisations, to address the ongoing impacts of Brexit and wider changes to immigration rules on the health and care workforce.
What does it mean for governors?
Governors may wish to use their holding to account duty to gain assurance from Non-Executive Directors (NEDs) on whether the changed immigration rules for EU workers has had an impact on your trust's recruitment policy. For example, is there evidence that it has become harder to recruit, does the board expect it to become harder to attract staff from the EU, and why are you confident that our trust doing to mitigate any negative impacts?
It may be worth asking about how NEDs are assured on the impact on existing staff – are our trust's staff from EU countries having difficulty applying for settled status and how is the trust helping? Governors especially staff governors, can also use their representing the interests of members and the public duty to feedback useful information on this topic to inform their trusts.
You may also want to ask about what evidence have NEDs looked at to assure themselves that impact on the local social care workforce is minimised, and what the knock-on effects might be for your organisation.
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