The migration problem that leaves patients at risk of being stuck in hospital

Delayed hospital discharges and long A&E waits could all be features of life with a national care service if crucial funding and workforce issues are not resolved, insiders have warned. Andy Burnham’s pledge to give all older people who need it access to free personal care, regardless of their ability to pay, has been widely welcomed by those working in adult social care. But despite hopes that a universal care offer could alleviate pressure on the NHS – and in turn tackle corridor care – experts say falling overseas recruitment and funding shortfalls stand in the way of delivering a safe and sustainable service. Shorts ‘The Government is making it so hard for overseas workers’ While the Government plans to deliver universal access to free care, it is simultaneously introducing stricter immigration rules for foreign care workers. Home Secretary Shabana Mahmood announced on Monday that under new Indefinite Leave to Remain rules, care workers who arrived in the country after May 2025 will have to wait 10 years before they can qualify for ILR – double the time of those who arrived before then. It follows a crackdown last year on the international recruitment of care workers and a ban on care workers’ dependents. The King’s Fund found that if current trends continue, only 10,000 overseas care workers will be recruited this financial year – less than a tenth of the number in 2023/24 – as the number of British new starters is already falling. Michelle Hawley, a registered care manager at Caremark Preston, a private domiciliary care company, believes all care for older people who need it should be free. But she is among those who doubt the workforce gap can be addressed ahead of the rollout of a national care service, given the Government is “making it so hard for overseas workers to come into this country and do the job”. Michelle Hawley said workforce challenges are a key issue in the care sector “It’s a shame because a lot of these overseas workers, they’ve got degrees… I had a doctor apply for a care assistant role,” she said. “I do have non-English carers in the company and they are absolutely amazing.” The sector’s reliance on international workers is well-documented. Two-thirds – or 1.075 million postings – of the adult social care workforce were occupied by Britons in 2025/26. International care workers are also less likely to leave the sector, with the turnover rate for foreign nationals at 21.6 per cent, compared to 38.2 per cent of UK nationals, between March 2025 to March 2026. The number of roles filled by British workers has fallen by over 130,000 since 2020/21 – including a 40,000 drop in the last year, according to Skills for Care. ‘Bleak picture’ The British Medical Association has warned that underfunding and poor staffing in care prevents patients from being discharged from hospital and compounds the strain on the NHS. “Care workers play a vital role in keeping people well at home and in the community to prevent avoidable hospital admissions, and also do the necessary work for safe discharges that free up much-needed beds,” said Dr Tom Dolphin, BMA council chair. Skills for Care estimates that by 2040 – based on growth of the population aged 65 and above – the sector may need 410,000 extra new posts. Danielle Jefferies, senior analyst at The King’s Fund, said: ‘The divergent trend lines of the growth in demand for care workers and the expected fall in new international recruits that the sector relies on paints a bleak picture for where the social care workforce will be unless there is significant intervention from the Government.” A survey of more than 2,000 adults by homecare provider Bluebird Care found that less than a third of people would consider a career in care. “A national care service will only succeed if we value the people who deliver care in the same way as those who work in our NHS,” said Bluebird Care CEO Jonathan Gardner. The Department of Health and Social Care said it is developing a workforce plan to support recruitment, retention and career development. “We are also establishing the first ever Fair Pay Agreement for care workers and making over £4.6bn additional funding available for adult social care in 2028-29,” a spokesperson said. ‘Disabled people of working age left out’ GP Steve Taylor has often seen the failures of social care due to poor resourcing of services. He said it should not be treated as an afterthought to avoid “delayed discharges, mean delayed admissions, long waits in A&E, reduced access to hospital beds, fewer operations [and] GPs dealing with patients taking hours to resolve, reducing access for everyone”. Dr Taylor added that it is “vital the healthy and wealthy aren’t the ones who decide” what a national care service looks like. As an independent commission on adult social care is underway, Burnham has pledged non-means tested access to free social care for older people. This means many who can afford to pay for support will receive it, but disability rights organisations are concerned that some of the most vulnerable people – disabled people of working age – will be left out of the picture. Fazilet Hadi, head of policy at Disability Rights UK, said Burnham “failed to mention” the increasing care charges that working age disabled people currently have to pay “from extremely low incomes”. Hadi also worries the commission and the Government have a “very paternalistic notion” of what social care is due to the focus on personal care, centring on tasks such as washing and eating. “For us, social care is about being supported to live a life, whatever that means for people,” she said. ‘Not enough money’ Dr Jane Townson, CEO of Homecare Association, which represents over 2,100 home care organisations across Britain, welcomed plans for free personal care – but suggested inadequate pay could worsen under a national care system. “What we’re worried about is that there will be a trade-off between the number of people receiving free care and the amount of money available to deliver it,” she said. The Homecare Association estimates that a minimum of £34.42 per hour is needed to cover the cost of employing a homecare worker on the National Living Wage. However, the average council fee rate is £25.05, according to the Association of Directors of Adult Social Services. As councils struggle with soaring adult social care demand, spending is under heightened scrutiny. Townson said one of her member organisations was supporting a 97-year-old woman receiving end of life care when the council moved her to a different provider days before she died because it was cheaper. Demand for personal care is likely to increase when it’s free, but there are no guarantees yet that providers or staff will be better off, either. Many of these workers are already not paid for waiting time or travel between appointments, Townson said: “In many places, there isn’t enough money in the system to cover those costs, and that’s why many care workers don’t get paid for it, even though they should.” When commitments are not funded properly, it sometimes results in providers handing back contracts, Nuffield Trust fellow Camille Oung said. “There needs to be a conversation about how we fund these appropriately and sustainably so as not to destabilise the sector.” ‘Families shouldn’t be responsible for paying a top-up’ Simon Bottery, a senior fellow leading on adult social care at The King’s Fund, said a universal care service would need national funding to mitigate unequal access, and national criteria for assessments carried out by local authorities to determine who is entitled to support – and how much. A national care service should also include a cap on care costs, so there is a limit on the amount people contribute towards their care over their lifetime, he said. Sian Kilcoyne’s 90-year-old mother’s care is self-funded but she could benefit from a national care service Care campaign group Rights for Residents is calling for every care receiver to have the legal right to an advocate, a close relative or friend of their choice, who can support them in health and care settings. Sian Kilcoyne, 65, a former care manager from Bolton, informally takes on this role for her 90-year-old mother, visiting her several times a week and maintaining responsibility of organising her finances, appointments and wellbeing. Kilcoyne’s mother has Alzheimer’s and rheumatoid arthritis, and lives in a care home that costs more than £1,000 a week, with additional charges if she needs to attend appointments. “I understand the cost of providing care, but these arrangements create further pressure for families who remain actively involved,” Kilcoyne said. Under the Government’s proposals, Kilcoyne’s mother, who sold her house and pays for her own care could benefit from free personal care. “I do not receive Carer’s Allowance and have not yet reached the new state pension age,” Kilcoyne said. “I don’t think families should become responsible for paying a top-up… that’s forcing families to pay it and they might not have it.”