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The UK’s new immigration rules threatens Scotland’s social care sector and disregards it’s workers

When the UK voted to leave the EU in 2016, no one could have predicted the state the world would be in four years later, as we finally come to the end of Brexit negotiations. But COVID-19 has meant that the impacts of these changes, specifically to immigration, have become more prominent.

The UK’s points-based immigration system is set to come into force at the beginning of next year, but these new rules could be disastrous for Scotland’s social care sector.

Palliative care services make up a significant part of the work done by care workers in Scotland, and end of life care is only set to become increasingly important within the social care sector, with a report from last year estimating that social care provision in the community in Scotland needs to grow to support nearly 60% more people at the end-of-life by 2040.

Despite this, in a response to the Immigration Advisory Committee, the Scottish government has recently revealed that the new immigration system could create significant under-staffing issues to the country's social care sector, including palliative care roles.

According to the report, an estimated 16,000 workers from other European countries are employed in health and social care in Scotland, with an additional 10,000 people from other overseas nations. It’s clear then that the social care sector in Scotland is heavily reliant upon foreign workers. However, these same workers are set to be excluded under the new immigration rules.

As part of the UK points-based system, workers must be able to meet a certain salary threshold of at least £25,600 to be classed as “skilled workers” and be eligible for a UK work visa. Many of Scotland’s social care workers would fail to meet the proposed salary requirement, with data from the 2018 Annual Survey of Hours and Earnings (ASHE) suggesting that less than 10% of those working in caring and personal service occupations in Scotland earn £25,000.

When the COVID-19 pandemic hit the UK, foreign workers were at the frontline of the response, working tirelessly in the NHS to save lives. As stories of heroic foreign workers were publicised, it became clear that the government's new immigration rules excluded the very same people who have been sacrificing so much to fight Coronavirus across the country from being eligible for a UK visa. In response to this, the government announced a new Health and Care Visa, intending to make it easier and cheaper for foreign workers to come to the UK to work in the NHS or for an organisation that supports the NHS.

However, the Health and Care Visa fails to include social care workers, even though they too have played a significant role during the pandemic. Scottish ministers are now calling for the government to add social care roles to the Shortage Occupation List (SOL) to prevent the sector from suffering.

Ben Macpherson, Minister for Public Finance and Migration, said: “Care professionals from all over the world have played a vital role in caring for our communities during the COVID-19 crisis. It is mind-boggling that the UK Government has introduced a ‘Health and Care visa’, intended to show the UK’s gratitude to frontline workers in these sectors, but that this initiative bizarrely continues to exclude and disregard the huge contribution of social care workers.”

Adding social care roles to the SOL would allow employers to recruit international workers at a lower salary threshold of £20,480 instead. Not including social care roles would have a significant impact because Scotland’s social care sector is already at risk, with staffing issues in many roles. A Scottish Care employer survey from 2018 indicated that 77% of care homes were having recruitment difficulties. The Coronavirus pandemic has only increased this risk, putting more pressure on health and care services. Over the next four years, it is anticipated that demand for health and social care staff will increase with estimates suggesting it could rise by as much as 10,500 more full-time social care staff being required.

And it’s not just the social care sector that is set to face damaging impacts, the Scottish government has expressed its opposition to ending Freedom of Movement, claiming it will significantly damage Scotland’s economy and heighten its demographic issues. A report from February last year, looking at the impact of the UK Government’s Immigration White Paper proposals in Scotland, estimated that migration to Scotland over the next two decades would fall by between 30% and 50%, causing the working-age population to decline by up to 5%.

There is a significant amount of evidence to suggest that the new immigration rules do not recognise the individual needs of Scotland when it comes to immigration. The new requirements put a monetary value on foreign social care workers in Scotland, but the reality is that these workers are invaluable. The impact they have on Scottish communities and lives, particularly during this difficult time, goes above any economic value they may provide to the country. If the government truly wishes to recognise foreign key workers for their efforts during the pandemic, then social care workers must be included in this.

Reanna Smith is a political correspondent for the Immigration Advice Service, a team of professional immigration lawyers dedicated to helping foreign nationals wishing to come to the UK.

What now? Reality Brexit, and palliative and end of life care. A personal view.

After one referendum, two general elections and with the issuing of a commemorative coin Brexit is entering the next phase. During the last four years Brexit has been different things to different people - “hard”, “soft”, “EFTA”, “red/white/blue”, “in name only”, “no-deal”, “blue passport”, “clean-break”, “Norway”, “bonkers” and ”WTO”. And who could ever forget “Malthouse Compromise”? In the next year or so Brexit will start to become something different - “reality Brexit” or perhaps “harsh reality Brexit”.

Whilst there remained a possibility that Brexit might not happen SPPC articulated its considered view that “in all likelihood Brexit will significantly damage the care which people receive towards the end of life”. SPPC highlighted key concerns about how Brexit would likely negatively impact workforce, scientific research, medicines supply and funding. These concerns remain.

What may feel like the exhausted end game of Brexit is really the beginning of the most important stuff. Evidence suggests that all Brexits are likely to be harmful to palliative and end of life care, but some Brexits will be much worse than others. The Big Ben Bong phase of Brexit will be completed in a couple of days with both genuine joy and genuine sadness/anger expressed copiously. Thereafter Getting Brexit Done will be a matter of choosing where the UK will sit on a continuum of harm which runs from bad to really very bad. The UK Government will then attempt to negotiate the dull and massively complex multitudinous details necessary, within the ludicrously short timescale that it has chosen to inflict on itself.

There is an opportunity for the palliative care sector to influence the shape of this post-Brexit world. Over the past fortnight the Westminster Government has sent conflicting signals on the extent of regulatory alignment they are seeking between the UK and the EU. They have rowed back a bit on previously envisaged salary thresholds for immigration. The Prime Minister continues to wish away ( others might say “lie about” ) the customs and regulatory checks in the Irish sea which are a legal consequence of his own Withdrawal Agreement, which is now law. It is probably a mistake to attach too much significance to specific individual pronouncements. However, this is a government now trying to manage a situation where four years of essentially sentimental rhetoric about “sunlit uplands” and “Buccaneering Britain” is in slow motion collision with reality. They clearly haven’t got it sorted, stuff is in flux and the tough choices and trade-offs inherent in the Brexit project can’t be ducked for much longer.

Many organisations and individuals chose for good reasons to keep out of a Brexit debate which was divisive, polarizing and sometimes outright toxic. Those articulating concerns about negative impacts of Brexit were often accused, often fairly, of trying to stop Brexit. Now however Brexit is happening. The debate need no longer be framed as “Brexit yea or nay”. We need a trade policy, we need an immigration policy and we need a policy on scientific collaboration. The shape of each of these policies will have profound impacts on palliative and end of life care. The responsibility to inform and attempt to influence – that’s on all of us, whether we supported Brexit or not. The responsibility to decide and to account for the outcomes – that’s on the Westminster Government.

By Mark Hazelwood, Chief Executive of the Scottish Partnership for Palliative Care.

Developing an Adult Palliative and End of Life Care Plan for Angus Health & Social Care Partnership

This blog is by Elaine Colville, Senior Nurse for Palliative Care at Angus Health & Social Care Partnership.

There is a lot of good work taking place in Angus by people who provide palliative and end of life care and support across a range of settings.

As part of our work to develop our Strategic Commissioning Plan (2019-2022) we recognised the need to have more in-depth discussions on how to improve people’s experiences of palliative and end of life care and support and produce a plan to take forward improvements.

A local charity, Lippen Care, provided funding to support this work. In August 2018 a steering group was established with wide representation of staff, services and organisations that provide palliative and end of life care and support across Angus.

There was wide engagement with members of the public, carers and our workforce. This was a crucial step on developing the plan to ensure that individual experiences were at the heart of our work. We asked people what they thought good palliative and end of life care looked like and what we could do differently. A number of key themes emerged:

1. Compassionate & person centred care

2. Compassionate communication & conversations

3. Care closer to home

4. Getting it right for the family

5. Education & development for the workforce

6. Public health approaches to palliative and end of life care.

These themes were mapped and aligned to the results of a rapid review of national and international strategies for adult palliative and end of life care. The steering group developed outcomes for each of the six themes that would ensure people and their families receive the care experience that they expect and that staff are supported to care.

We mapped these outcomes to the Strategic Framework for Action (2015) and Scottish Government (2018 ) Strategic Guidance for Commissioning of Palliative and End of Life Care 2016-2021. We asked key stakeholders for feedback on the draft themes and outcomes. The feedback was evaluated and the outcomes were reviewed again. By June 2019 the final draft plan and outcomes were presented to our Strategic Planning Group and they gave it their approval and support. The Adult Palliative and End of Life Care Plan for Angus Health and Social Care Partnership can be accessed at

Publishing the plan is not the end of our work. The next steps are to develop a purposeful Action Plan to transform words into reality to ensure every adult who wishes it receives high quality palliative and end of life care at the right time and in the right place. For more information contact

A poster about this work is available here: Developing an Adult Palliative and End of Life Care Plan for Angus HSCP

Work experience at the Scottish Partnership for Palliative Care

I’m an S4 student at Portobello High School. This year everyone in my year group got the opportunity to experience a working environment for one week. You could choose from a list of suggested placements or find one yourself.

I decided to come to the SPPC as I’m very interested in working with people and helping those around us – this is the sort of work I would like to do when I’m older. My aunty Caroline who runs The Truacanta Project has spoken about her work and I’ve always thought it sounded great. I like the fact that it is breaking the stigma around talking about death, dying and bereavement. As I feel that in our society it is a topic which is so often avoided.

I knew a little bit about the work beforehand, but my knowledge and understanding has grown immensely. I learnt a lot about the Truacanta Project and the different events that are on throughout the year, for example, To Absent Friends and End of Life Aid Skills for Everyone. I know lots about Death Cafes and think they sound like a brilliant idea. I have been working on a proposal for a teenage death café which has been fun.

I’ve learned so much from my time with the SPPC. Being in an office environment is very different from school. Everyone was working on different tasks including me which gave me a sense of independence. I have been asked to do things I normally wouldn’t do such as write a blog post, create flyers and leaflets, write a proposal, and manage their social media. I attended a meeting with one of the shortlisted Truacanta communities where I learnt about their goals and hopes for their community. It was interesting to hear how they hoped to improve the conversation around death, dying and bereavement and how they wish to bring awareness and support into the local community.

I will take lots away from my time at SPPC. I gained an insight into how a charity works and saw how a good idea can turn into a reality. You don’t need to be a powerful person to make a change - if you have an idea you can make it happen with hard work and determination. I saw ordinary people wanting to make an impact on society and people’s perception on death, dying and bereavement.

Overall, I think work experience is a great opportunity for high school pupils as it gives us an insight into working life and the adult world and gives the chance to learn new skills and do tasks we might not normally do.

Lastly, I would like to thank SPPC for being so welcoming to me as it can be quite intimidating going somewhere new.

By Poppy Gibb-Kenny

My QNIS Experience - Reflections of a CHAS Diana Children's Nurse

The Queen’s Nurses Institute Scotland (QNIS) celebrates its 130th Anniversary this year. Its aims have always been to promote excellence in community nursing to improve the health and well-being of the people in Scotland. Here Caroline Porter, Diana Children's Nurse at CHAS describes her experience of the QNIS 2018 Development Programme:

It wasn’t until I was in the programme that I realised how much I needed it. I have been a nurse for 30 years working in acute, community and hospice settings. If I am honest I was struggling. I found myself looking for opportunities to run away and escape the pressures I found myself under. I was close to burnout but was too afraid to admit this to myself never mind anyone else. I am my own harshest critic and although I didn’t realise it at the time, I was making my own role harder than it needed to be.

Every nurse does a difficult job and I am no different. I work for a brilliant organisation Children’s Hospices Across Scotland CHAS. My role requires strategic, educational and clinical commitment. I meet families in hospital, often at a point of crisis in their lives, who may be facing the potential imminent death of their beloved child. I quickly have to form an intense, trusting relationship with families to explore potential choices around preferred place of care and preferred place of death.

As nurses we tend to focus on our patients, their families, our colleagues, our own family and friends but rarely ourselves. That is what the QNIS programme has done for me. It has made me stop running and made me pay attention to myself and value my own needs.

During the five day residential workshop in Balbirnie, we were introduced to the concept of Action Learning. We were grouped geographically and our group became affectionally known as the Westies. Our group very quickly developed a profound, strong bond and connection based on trust and new found friendship. The group became a safe place to explore where I really was. I have always found it easier to say I am ok, rather than to actually express to myself or another, how I was really feeling. I had such a fear of exposing my own vulnerabilities as I perceived this as me showing weakness. It was emotional for all of us but I learned that it is ok, not to be ok. I learned that most of us have similar feelings, but as nurses we bury them quite deeply. What I learned through the programme was that my vulnerabilities were my strengths and not my weakness as I had previously thought. Creativity is fed on vulnerability and it is what makes me good at what I do.

Following Action Learning we met our Coaches for the programme. Again I wasn’t really prepared for the impact. How could talking to someone for an hour a month make me a better Diana Children’s Nurse and how could this impact on the issue for exploration I had identified? The focus of my coaching was primarily on Caroline the person not Caroline the Nurse. I have been historically taught through my two modular RGN and RSCN trainings, that you left your personal life in the locker when you put your uniform on for the shift. I have learned that we come to work each day as a whole person, not just Caroline the Nurse. It is impossible to fully separate the two things, it’s the combination that makes us so valuable as nurses. Kate my coach explored with me what I wanted from the coaching. I felt I wanted to bring the old Caroline back, the less stressed, good fun and care free Caroline. We explored what I had being doing to myself and focussed on the internal saboteur that reigned firmly in my head. The imposter syndrome that plagued me at most strategic and clinical meetings but neither strangely present when I worked directly with children and families. This was always my comfort zone.

I discovered that both my internal saboteur and imposter syndrome where predominately creating the level of stress that I felt under. It was me that was creating this stress not anyone else. I was making my role far harder than it needed to be.

Kate pushed me out of my comfort zone and requested I approach ten people to acknowledge me in three different ways. This felt really awkward as surely people would consider this fishing for compliments. Prior to the programme I physically batted compliments away. “Oh it’s just my job” or “anyone would do the same” were my normal responses to any compliments, I think this is the same of many nurses. If you think about it, it’s quite rude not to acknowledge, accept and thank someone who has taken the time and effort to compliment you. I have learned to accept compliments and to bank them as a resource of strength. Towards the end of the coaching programme, Kate asked me had we brought Caroline back. My answer was no. We didn’t need to because I was comfortable being the Caroline I am today, not needing to be someone of the past. I am enough!

Kindness is such a powerful, free resource that we all possess. I have always considered myself a kind person. I have never doubted that I am extremely kind to my patients, their families, my colleagues and my own family and friends. The only person I wasn’t kind to was myself. Kindness has been weaved throughout the QNIS programme. Learning to take time for myself was a hard lesson but I have learned to embrace it. I was a sceptic of the concept of Mindfulness but now I am a complete convert. Again a simple free resource, giving yourself three minutes a day to focus on the simplistics of breathing and relaxation. It is something that everyone can achieve. The hardest part I have found is sustaining it. I have slipped at times, forgetting to place that importance on myself but the network I now find myself in with the other 20 Queens Nurse reminds me often to reconnect.

So the reality was I was close to burnout. I was hanging on by my fingertips, looking for any opportunity to run away. But it was me that placed this pressure on myself, not others. QNIS has got me looking forward to the next ten years of my career. I am ambitious, I am going on to do great things within Children’s Palliative Care. As nurses we need to learn to start by being kinder to ourselves. I firmly believe that my story is not too different from the many others who strive to do the best for the babies, children, young people, families and patients we all look after. I hope my honesty resonates with others.

Caroline Porter is a Queen’s Nurse and Diana Children’s Nurse, West of Scotland, Children’s Hospices Across Scotland. She can be contacted at:

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