“Taking back control of immigration will allow us to become the society we want to be.” But at the moment we are apparently not sure if that society will include social care and the NHS.

Famously for the last 40 years the British Government has not been in charge of who it lets into the country. EU policy has had a role in this and has ensured that the rights of EU citizens are a part of that policy and practice.

“Taking back control” of borders, money and law have been the three main aims of Brexit and as we get closer and closer to March 29th 2019 we are getting glimpses of what those that wanted that control want to do with it.

Yesterday on the Today programme Home Secretary Sajid Javid said, “We are perfectly capable of devising our own immigration system that meets our economic and other interests”

So when we read yesterday’s Immigration White Paper we can see it as the clearest indicator of how this Government intends –  at last – to create a system which reflects what it sees as our economic and other interests.

Given that at the moment politics feels very temporary, this is an important moment.

Government White Papers matter. Having been involved in writing one I recall that at the time I felt that this piece of paper went way beyond presenting a set of good ideas.  A White Paper actually sets a new course for the ship of state.

So here we are, untrammelled by the EU, able to say what we want and who we are.

In October I posted about the Final Report of the Government Migration Advisory Committee on the impact of European migration on the NHS. If the Government were to accept this report it would have very big implications for the sustainability of the NHS. Staff shortages in every part of the NHS tell us why this is so important.

Lady Harding said recently that “The single biggest problem in the NHS at the moment is that we don’t have enough people wanting to work in it”. This may sound as though it adds little to the debate, but is actually a crystal clear statement of the problem. Training people is a good idea, but it doesn’t help the NHS if, when they are trained, they don’t want to work in the NHS. Staff shortages exist because we haven’t made the NHS a place that enough people want to work in.

But there are a significant number of people from abroad who want to work in the NHS.

The Government Migration Advisory Committee report started with a clear statement of the recent past experience,

“EEA migrants contribute much more to the health service and the provision of social care in financial resources and through work than they consume in services. EEA workers are an increasing share of the health and social care workforces though these sectors employ greater numbers of non-EEA migrants. There is no evidence that migration has reduced the quality of healthcare.”

(Executive Summary paragraph 22)

Much of the report is arguing for a cut-off point in earnings that people will need to be earning in the UK before they are allowed in. This bar is set at £30,000. Earn more than that and you can come in – less and you can’t.


Chapter 4 paragraph 16 states,

“…averaging across all household types, the net fiscal contribution of EEA and non-EEA migrants varies with annual household income. The “break-even” point seems to be about £30,000 for EEA migrants…”

There has been much discussion about this £30,000 per year figure. It has very direct implications for a number of industries – most significantly social care and the NHS. There are very few social care workers that earn £30,000 per annum. Setting this as the cut off would decimate the ability of social care to provide services for frail people. Of course the green paper on social care (which we still don’t know when it will be published) might deal with this. It might say that the Government will increase money for social care staff to £30,000 per year, but somehow I don’t think it will.

The starting salaries for NHS staff are,

  • Nurse £23,000
  • Paramedic £23,000
  • Radiographer £23,000
  • Health care assistant £17,500
  • Physio £23,000
  • Occupational Therapist £23,000

You will have noticed that many of the staff we are trying to attract from abroad to fill vacancies in the health and social care services earn less than £30,000 and would therefore not be allowed to become a part of the society that the immigration white paper is describing.

The same is true for a whole range of industries which are a part of our national and economic life.

In the end the White Paper did suggest a financial cut-off point. There will be further consultation about where it will be – at  £30,000 or £21,000.

Let’s be clear what this means.

For the first time in 40 years we have the right to construct our own immigration policy to shape the country that we want to be. But as of December 2018 we are not sure if the NHS and social care is a part of that country.

Apparently we now need a consultation to discover whether this is the case or not.

Happy Christmas – by the time the NHS Long-term Plan is finally published there will only be a short time to implement it. It will be therefore be renamed the NHS Short-term Plan….

The blog will be back on Jan 7th 2019.