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Ageing, Demand for Care and the Role of Migrant Care Workers in the UK


In recent decades, rapid population ageing has dramatically increased the need for older adult care provision in the UK. A prominent role in meeting the care needs of the older population has been played by migrant workers. The aim of this paper is to explore the characteristics of the UK social care system that shape demand for migrant labour, the conditions under which migrant care workers are employed, and older people’s and migrant care workers’ experiences of the quality of care. Our analysis draws on the findings of a survey of providers of social care for older people, in-depth interviews with migrant care workers, and focus groups with older people. The findings show that the underfunding of social care and interrelated workforce shortages are largely responsible for the extensive reliance on migrant workers among social care providers, and raise concerns for workforce inequalities and for the quality of care.

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  1. 1.

    See Cangiano et al. (2009). Further details on the research are available at

  2. 2.

    Laing & Buisson is an independent company providing data and analysis on the UK health, community care and childcare sectors for research and marketing purposes. Its annually updated database of residential homes and nursing homes across the UK includes fields on the sector of the organisation (private, voluntary or local authority), region, main type of clients and size (number of beds and rooms).

  3. 3.

    For example, providers employing migrant care workers under irregular terms and conditions might be reluctant to participate in the survey. This potential type of selectivity could not be controlled for.

  4. 4.

    The employers surveyed were asked to identify their migrant workforce according to country of birth to allow for data comparisons between the UK and other countries participating in the research (see Cangiano et al. 2009). Employers are able to identify migrant workers according to passport and visa checks for those who are non-UK citizens. They may, however, underestimate numbers of foreign-born workers among their staff who are UK citizens.

  5. 5.

    Mid-year population estimates were accessed at

  6. 6.

    In the case of institutional care, the financial criteria for assessing eligibility for means-tested support are determined by national rules (except for Scotland), while in the case of home care services, local authorities have determined their own criteria. This has led to geographical inequalities in access to publicly funded provision (Howse 2007).

  7. 7.

    In real terms (i.e. after adjusting for the change in prices), gross expenditure for older adult care has increased by 7 per cent relative to 2003/4, but decreased by 2 per cent relative to 2006/7 (Information Centre for Health and Social Care 2009).

  8. 8.

    In recent years there has been a rise in the number of large corporate providers, including multinationals (Drakeford 2006), leading to the invention of the word ‘caretelization’ (Scourfield 2007: 156).

  9. 9.

    Local authorities are the main purchasers of home care. According to the UK Home Care Association (UKHCA 2010), 60 per cent of independent providers rely on local authority funding for more than three-quarters of their business, with almost 15 per cent having local authorities as their only purchaser of services.

  10. 10.

    The breakdown by year of entry to the UK of the current stock of migrants working as care workers is a very crude measure of past inflows, excluding migrants who have left the UK or have shifted to other occupations and including those who have joined the care workforce after their migration to the UK. Retrospective information on the year of entry may lead to a significant under-estimation of less recent inflows, a larger proportion of whom may have left the UK.

  11. 11.

    ‘Accession Eight’ (A8) nationals—EU citizens of the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia—are entitled to work in the UK provided that they register with the Worker Registration Scheme. Registrations to work in the care sector peaked in 2005 at 6,880, falling to 3,000 by 2008.

  12. 12.

    In a previous report we tentatively estimated the breakdown by current immigration status of the migrant care workforce, showing that a high proportion—about 40 per cent—of foreign-born care workers are British nationals or permanent UK residents (Cangiano et al. 2009).

  13. 13.

    Employers are responsible for applying for and renewing work permits for senior care workers. Although, in principle, work permit holders are entitled to change employer, this is dependent on a prospective employer re-applying for a new work permit.


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We gratefully acknowledge the contribution of Sarah Spencer to this paper and of George Leeson, with whom we carried out the research on migrant care workers in the UK. We are grateful to The Nuffield Foundation and The Atlantic Philanthropies for their financial support for this research. We also thank two anonymous referees for their useful comments.

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Correspondence to Alessio Cangiano.

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Cangiano, A., Shutes, I. Ageing, Demand for Care and the Role of Migrant Care Workers in the UK. Population Ageing 3, 39–57 (2010).

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  • Migration
  • Social care
  • Older people
  • Labour market
  • Discrimination
  • UK