Who cares for the ‘low-skilled’ care worker? The flawed new Brexit immigration policy

By David Shaw

The UK Government has unveiled its post-Brexit immigration policy, unleashing an avalanche of criticism about the potential effects on the economy. The biggest change is the focus on “highly skilled” workers, and the imposition of a points system for people who wish to come and work in the UK. Economics aside, these aspects of the new policy are deeply flawed, with serious ethical implications – particularly for those in caring professions.

First, the points system requires a total of 70 points in order to apply to live and work in the UK. There are different ways in which this target can be reached. An applicant earns 20 points for a job offer, and another 20 for a job at the “appropriate skill level”. Applicants who can speak English earn 10 more points. But even those who fulfill all three of these conditions will still only have 50 points. To get the remaining requisite of 20, there are only two options for those without a PhD: apply for a job earning over £25,600, or a job in a shortage role, such as nursing. Anything below this salary threshold is defined as “low-skilled”. Oddly, each of the points options is a multiple of 10 for no apparent reason; a total target of 7 points, with each option representing 1 or 2 points would have been perfectly sufficient. Someone must have thought that it sounded more impressive to multiply everything by 10, which gives an idea of the level of thought that has gone into the new system.

It is quite clear that ‘low-skilled’ is a horrific misnomer, and ‘low-paid’ would be a much better descriptor. Many people earning more than the threshold will be lower-skilled than those placed below it, and nurses and trainee teachers are certainly not low skilled in the normal sense. This might seem like a pedantic point, but it has real effects. First, it is demeaning to healthcare professionals to refer to them as “low-skilled”; nurses have a vast array of skills and most are now educated to at least degree level. Second, by making it more difficult to recruit nurses, the new policy will inevitably increase workload and stress on nurses currently employed by the NHS – factors which have already been increased by a substantial exodus of nurses of EU origin following Brexit. By November 2019, over 10,000 such staff had left the NHS, which was already facing recruitment difficulties.

And nursing is, of course, just one example. The crisis in social care has been increasingly highlighted in recent years, with providers finding it impossible to hire enough carers. This is not surprising, as being a carer is a highly challenging job requiring a great deal of skill, yet is not financially rewarding: carers tend to work part-time or on zero hours contracts, often with a salary of under £16,000. How do carers feel about being officially labelled as low-skilled workers? And how can the needs of the social care system be met if no immigrants can possibly qualify as carers under the new system?

Priti Patel, the home secretary, has suggested that “over 8.45 million people in the UK aged between 16 and 64 who are economically inactive” can be trained to fill any gaps in the job market. But over 50% of these people are students, or long-term sick. Somewhat ironically, 22% are informal carers for family members, who would clearly not be able to seek employment as carers as well. And until salaries for carers improve, those among the economically inactive who do want a job may seek a different career in any case. A shortage of carers means a shortage of care for those most in need, and the new immigration policy will only increase this shortage.

The UK government statement on the new policy adds insult to injury by suggesting that people might not even be necessary for some of these jobs: “We will not introduce a general low-skilled or temporary work route. We need to shift the focus of our economy away from a reliance on cheap labour from Europe and instead concentrate on investment in technology and automation.” Even if it were not chilling to suggest that technology and robots could and should replace jobs previously done by people, the implication is that all ‘low-skilled’ jobs are amenable to this solution – even nursing and caring.

The new immigration policy falsely equates lower pay with lower skills, and in so doing demeans those in caring professions who deserve greater, not lesser recognition and reward. Unfortunately, the new post-Brexit system appears to have been designed by workers who are genuinely low-skilled in terms of literacy, numeracy and ethics.


Author: David Shaw

Affiliations: Care and Public Health Research Institute, Maastricht University and Institute for Biomedical Ethics, University of Basel.

Competing interests: the author’s wife is a highly skilled occupational therapist who works for the National Health Service.



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