Hundreds of thousands of care workers could be exempted from the home secretary’s plans to toughen up the immigration system under proposals being considered by Andy Burnham as he looks for ways to relieve pressure on the social care sector.
The prime minister will give a speech next week spelling out his determination to start creating a National Care Service before the next general election as he looks to accelerate the process set up by his predecessor, Keir Starmer.
In a highly personal speech, Burnham will talk about his experience of the care system through his father, Roy, who has Alzheimer’s, and announce that he is bringing forward Louise Casey’s review into the sector, which was due to conclude in 2028.
He is now also considering granting widespread exemptions from Shabana Mahmood’s plans to make it harder for people to achieve settled status in the UK.
The measure is not likely to be included in next week’s speech but could come later in the year once the Home Office has considered responses to a public consultation on the issue.
One person briefed on the plans said: “Andy is determined to do something about the social care system, and quickly. This is highly personal for him, and he will talk about why he wants to push some of it through before the election, even if that comes at a political price.”
Burnham has put reform of the social care system near the top of his list of priorities, having tried and failed to do so as health secretary more than 15 years ago.
He told broadcasters this week: “I think it’s about being prepared to grasp the nettle. I’ve got personal experience of the system. My dad has Alzheimer’s, and you see what the staff have to put up with. It’s not their fault. The system’s broken.”
He added: “You can’t leave social care like this. And this is part of my criticism of Westminster. It has flinched over the years from these big decisions.”
The prime minister has previously argued for replacing inheritance tax with a 10% levy on all estates once a person dies to pay directly for a universal care system, but those proposals were scrapped after the Conservatives labelled them a “death tax”.
People in England get state-funded care if they have less than £23,250 in assets, but those with more must pay the entire cost themselves.
Meanwhile, social care providers say they are financially stretched and increasingly unable to provide the services for which they have been contracted given the low value of their contracts with local authorities.
Many have complained bitterly about the likely impact of Mahmood’s plans to double the length of time it takes migrant workers to qualify for settled status, known as indefinite leave to remain, which could disproportionately affect the care sector.
Andrea Egan, the general secretary of Unison, the country’s biggest union, said: “Vulnerable people and those with complex needs won’t get the help they deserve unless ministers focus on recruitment and retention. That means dropping plans to push migrant care workers out of the UK.”
Mahmood has said she will consider exemptions to the new ILR (indefinite leave to remain) rules, though carving out those on social care visas would make a significant dent in the numbers affected.
The Home Office has granted about 200,000 health and care worker visas in the last five years, with many more coming as their dependants.
Burnham is understood to be considering exempting those already in the country from the changes but allowing them to be applied to new entrants.
While the changes are not likely to be included in his speech next week, he is set to lay out some short-term fixes to alleviate the burden on the sector.
They could include putting more money into the £9bn Better Care Fund, a ringfenced pot of money designed to be used to boost social care where doing so would relieve pressure on the NHS.
One option he is understood to be looking at is increasing the fund to offer patients free short-term care once they leave hospital in an attempt to prevent them having to go back into acute care.
The prime minister will also leave the door open to levying extra taxes to pay for a new system in the longer term, saying that funding options should be considered as part of Lady Casey’s review.
Casey was commissioned by the former health secretary Wes Streeting to publish an interim report this year and a final one in 2028 but those close to the process say she could now simply accelerate her final report instead.
Burnham told the Guardian last month he would like to see the review published by the end of the year, though sector experts said this is likely to prove overambitious.
Casey has said the UK faces a “moment of reckoning” over its longstanding failure to match sufficient resources and action to the demands of growing numbers of frail elderly people and disabled adults.
She has been scathing of the way patients with dementia or Alzheimer’s are undermined by institutional fights over whether a person qualifies for free NHS care or is means-tested and charged for social care, and smoothing the fault lines between the services is expected to be a key focus of the review.
Casey will launch a public consultation in the next two weeks calling for a “challenging conversation” with the public this summer.
Sources said she wants to answer a series of questions including who should qualify for social care, how far families should provide care for loved ones, and how far individuals should pay for care.
