What are the experiences, motivations and plans of Health and Care Visa holders and their dependants?

Dr Kalpa Kharicha is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London. She led the Unit’s Visa Study, the report from which was published in October 2023. (679 words)

Internationally recruited care workers made the biggest contribution to reducing vacancies in frontline adult social care in England during 2022-3; 70,000 people came to the UK to work in a direct social care role. During this time the number of domestic recruits to care work fell. Vacancies in social care are currently at 152,000.

The increase in international care workers follows changes to government immigration policy in recent years. In particular, the addition of ‘Senior care workers’ and ‘Care workers’ to the shortage occupation list (on 27 January 2021 and 15 February 2022, respectively) allows people from other countries to apply for these jobs, with a licensed UK employer and if eligible for a Health and Care Visa.

Recent announcements on immigration policy mean that from early 2024 (exact date to be confirmed at time of writing), Health and Care Visa holders arriving in the UK after that time will no longer be able to bring their dependants with them Health and Care Visa holders who are already in the UK can bring dependants whilst on their current visa.

As part of our recent research to understand the impact of the Health and Care visa system on the adult social care workforce in England, we spoke to 29 internationally recruited care workers and dependants, as well as 22 social care providers, 8 brokerage agencies and 15 sector skills experts, who shared their views and experiences with us. Continue reading

How can we scale-up innovations? Lessons from the development of four local Shared Lives schemes

Carl PurcellDr Carl Purcell is a Research Fellow based in the NIHR Policy Research Unit in Health and Social Care Workforce, part of the Policy Institute at King’s College London. He is also part of the team working on the SASCI project led by Dr Juliette Malley based at the Care Policy Evaluation Centre at the LSE. This is the second of two blogs on Shared Lives. (1,315 words)

In a previous blog we considered the successful spread of Shared Lives (SLs) schemes as an alternative model of care that seeks to replicate ‘ordinary’ family life for adults with care needs. This model has long enticed national and local policymakers’ attention and SLs schemes are now established in most English local authority (LA) areas. However, it remains a very small model accounting for just 1 per cent of those drawing on local authority funded adult social care and less than 0.5 per cent of the workforce. Furthermore, SLs continues to be used predominantly for the care and support of people with learning disabilities (LD) despite efforts to promote its wider use for a more diverse range of people. This prompted us to investigate the challenges faced by local schemes trying to ‘scale-up’. Continue reading

How do innovations spread? What we can learn from Shared Lives schemes and the role of Shared Lives Plus?

Carl PurcellDr Carl Purcell is a Research Fellow based in the NIHR Policy Research Unit in Health and Social Care Workforce, part of the Policy Institute at King’s College London. He is also part of the team working on the SASCI project led by Dr Juliette Malley based at the Care Policy Evaluation Centre at the LSE. See also the second blog in this series by Dr Purcell. (1,129 words)

Innovation, or doing things differently, is commonly promoted by policymakers as a response to social challenges in the context of increased pressure on public services and stretched resources. Policy announcements on adult social care are testament to this, but we know surprisingly little about how innovations emerge and are developed, sustained, and spread. The Supporting Adult Social Care Innovation (SASCI) project – an ESRC funded study investigating innovation in adult social care in England – was set up to address this. The spread of Shared Lives (SLs) schemes across England has provided an intriguing case study. Continue reading

Fair Care Work: A Post COVID-19 Agenda for Employment Relations in Health and Social Care

Ian Kessler, Stephen Bach, Richard Griffin and Damian Grimshaw introduce their new paper, Fair care work. A post Covid-19 agenda for integrated employment relations in health and social care, published yesterday by King’s Business School. Lead author, Professor Kessler, is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. (908 words)

The courage and sacrifice of the health and social care workforce have emblazoned themselves on the national consciousness as the challenge of COVID-19 continues. While classified as ‘key workers’, along with other occupations essential to the community in times of crisis, the distinctive contribution of frontline care workers, reflected in their direct and relentless engagement with the virus, has until recently been reflected in the Thursday night applause reserved for them. This public applause sits uneasily, however, with the treatment of over two million health and social care employees, mostly women, often from black and minority ethnic backgrounds, typically in undervalued, relatively low paid and insecure employment. In a new paper, we seek to kick start a policy debate on the development of fair care work, to stimulate discussion on a refreshed employment relations (ER) agenda which acknowledges and reflects the worth of care workers to our individual and communal well-being. Continue reading

From desk to doorstep

Living well with dementia is important, though there may come a time when initiating social contact becomes a challenge. For some people living with dementia there may be increased isolation. For those living with a partner or family and friends, as dementia progresses their daily care needs may be hard to manage or support.

Attending a day service which offers stimulating activities, whilst at the same time providing respite for family carers, benefits not only the person with dementia, but also helps families continue their support.

The COVID-19 lockdown brought an end to this overnight.

Foreseeing the psychological or emotional consequences of the loss of day centre support, one day centre has switched to offering daily support via phone calls to its former attenders and their carers. Additionally, as day centre staff have great experience in providing ‘customer care’ to relatives, they quickly became part of the COVID-19 Emergency Shielding Residents Response. Continue reading

Cameos of Care Homes: stories from social care Vanguards

Jess Harris is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She led the Cameos of Care Homes project. (616 words)

Six ‘Vanguard’ areas across England have been developing approaches to enable care homes to better support the increasingly complex health needs of their residents. These six, focusing on ‘Enhanced Health in Care Homes’, were among 50 Vanguard pilot areas (2015 to 2018) tasked with developing models of care that can be sustained and replicated across England, helping the health and social care system tackle financial pressures and rising demands.

A recent National Audit Office (NAO) report has examined the Vanguards’ impact so far, in terms of value for money, and concluded: ‘there are early signs of a positive impact on emergency admissions’. However, at this early stage it cautions that ‘the longterm impact and sustainability of Vanguards is still not proven’. (page 47)

Staff members taking part in ‘Cameos of Care Homes’

Continue reading

Providing Support and Care from a Distance

Caroline White of the University of Hull is seeking participants in a new study. (462 words)

Family members and friends often provide support, help and care to others, instead or in addition to paid sources of care and support. These people (often referred to as carers, although this term is not embraced by all) are collectively estimated to save the UK economy £132 billion per year (according to figures from Carers UK in 2015) and have been the subject of much research and policy development. The majority of existing research about carers concerns those who support someone who lives with or near to them. However, as we become an increasingly geographically mobile population many parents, adult children, siblings, other relatives and friends find themselves living at a distance from those they care for and about. A new research project at the University of Hull is working to find out more about the experiences of those who provide help, care and support to a relative or friend who lives at a distance from them (we are meaning that they have to travel for one hour or more to visit them). Continue reading

Beyond measurable outputs: What matters in social work practice with older people?

Valerie D'AstousVal D’Astous is a PhD candidate at the Institute of Gerontology, King’s College London. (969 words)

As I walked past a small group of men for the second time, in search of the location, a cheery, ‘Can we help you luv?’ was offered. Paper in hand with the address, I knew I was close, but gladly accepted their offer. Two gentlemen ended up walking me around the corner to the place I was seeking, the Burrell Street Sexual Health Clinic. ‘Hope all goes well for you,’ one gentleman wished me, as I thanked them and said goodbye. I laughed as I entered the building, the site for the Making Research Count Conference: Rethinking Social Work Practice with Older People: Threats and Opportunities. I knew I was in for a great day! Continue reading

Men? Have your circumstances changed?

Valerie LipmanDr Valerie Lipman is Honorary Post-Doctoral Research Fellow at the Social Care Workforce Research Unit. (553 words)

We don’t see much about the lives of older men in the field of social care. The focus tends to be on older women, partly because women’s life expectancy is longer and perhaps, because in the care field, women are more visible in the traditional care settings, such as day centres and care homes. Have your circumstances changed?’, a triptych of duets between an ageing man and a boy of about 10-12 years of age, stages the daily routine of a single older man.

The three short pieces, about 15 minutes each, are set in sequence in a kitchen, living room and bathroom, showing a different older man managing life on his own. The performance takes place in the windows of a former furniture shop in a former shopping mall in Islington, north London. There’s no dialogue but just a series of noises of daily living. In the kitchen the man accidentally tips his rice crispies all over the floor, the sink gurgles, he thumps his knife into an onion, and butter splutters in a frying pan on the cooker all against the background of Radio 2. In the living room the TV blares out quiz shows, football and the Generation Game. And in the bathroom we hear the toilet flush, medicines fall out of the cabinet and imagine the scraping of shaving and the sizzing of false teeth in the glass. Continue reading

New models of social care

Dave MartinThe Centre for Policy on Ageing (CPA) and Co-operatives UK arranged a roundtable event on 18 February 2015 to foster greater understanding and consider the development of social care co-operatives. Dave Martin (an associate with CPA) reports from the gathering. (753 words)

‘Hardly a month goes by without another scare story about aspects of our health and care services. Is there a democratically accountable ownership model for health and care services that could make a difference? Could the active membership and co-operative ownership of workers, service users, volunteers and family members rebuild public trust in services and put an end to cruelty and neglect through a socially inclusive solution where the system of care is owned by the recipients?

In a growing number of countries, from Europe to Canada and Japan, diverse co-operative models of social care are expanding. We believe these approaches can be further developed in the UK and that they would benefit the lives of vulnerable people by empowering them directly in decisions that affect their care.’—Pat Conaty (Research Associate, Co-operatives UK) in The Guardian, 4 July 2014.

The roundtable event was attended by a diverse group of people, described as three circles of interest—first, people who had been involved with the co-operative movement for some time, secondly people seeking to develop (or convert to) a co-operative model for the delivery of care, looking for support and assistance, and thirdly policymakers and commissioners sniffing around—is this the way for the future? Continue reading