A new report based on research led by Nottingham Rights Lab in partnership with FLEX, the Institute of Public Care at Oxford Brookes University, and the London School of Hygiene and Tropical Medicine has identified the factors that put live-in migrant carers at greater risk of exploitation and modern slavery.

Following an 18-month study into the working conditions of paid, migrant, live-in care workers in London, the report explores what can be done to mitigate these risks and sets our recommendations for policy changes to reduce workers’ vulnerability to labour exploitation, particularly for those with precarious immigration status.

Live-in care, where care workers provide around the clock personal assistance in their client’s home, is a growing sector of the social care market. The majority of live-in carers are migrants, including a high proportion of circular migrants who travel between the UK and their home country.

The study used a Feminist Participatory Action Research (FPAR) approach, which FLEX has helped to pioneer, involving live-in care workers as paid peer researchers, helping to design the research tools, collect data, and provide feedback on data analysis and giving them the opportunity to have their voices heard in debate around national policy.

Risks of exploitation in the care sector

Adult social care has been identified by the Director of Labour Market Enforcement as a high-risk sector for labour exploitation, with live-in and agency care workers believed to be at particular risk. Despite this, the working lives of paid, live-in care workers, many who are extremely isolated, have remained largely unexamined.

Through interviews conducted by their peers, they identified five main risk factors to exploitation:

• Employment status, business models, and the role of intermediaries
• Information asymmetry between care workers and intermediaries
• The emotionally and physically intensive nature of live-in care work, and blurring of boundaries between work and private life
• Barriers to exercising rights at work: sick leave, time off, redundancy/notice, health and safety at work
• Individual risk and resilience factors

Participants highlighted issues with being able to open bank accounts, payslips that were unclear on the number of hours worked or tax paid and unscrupulous agencies that would deduct pay for accommodation charges, place novice carers with the most difficult clients that others declined to work with, and would pay some carers at a higher rate or offer more favourable conditions for doing the same job.

They also spoke of the emotional pressure associated with being closely involved in the everyday lives of their clients and their families, including sleep deprivation from getting up in the night to offer care, not being able to get the breaks they were entitled to, or being asked to run errands for their client in their own time. Others cited inappropriate behaviour including racism/xenophobia and sexual harassment, and being made to carry out non-caring duties for the whole family including cooking, cleaning and gardening.

Despite this, the participants interviewed all had a sense of awareness of the risks of exploitation and importance of peer support. Being able to draw on advice and help from fellow care worked was highlighted as one of the ways they maintained their resilience in the face of these challenges.

Recommendations

In response, the report sets out recommendations and policy options which include:

• UK Visas and Immigration (UKVI) to remove the obligation for care workers to update their visas when they move within the sector to provide greater freedom to move without risk to immigration status; reduce or remove related visa fees for both the worker and the sponsoring employer and ban or regulate the use of exit fees on these visas to make sure that they aren’t used to tie workers
• The Home Office to establish a Memorandum of Understanding with labour market enforcement bodies, especially the GLAA, to separate immigration control from labour inspection so that people feel safe about coming forward if they are experiencing labour exploitation without fearing immigration enforcement or deportation.
• The GLAA, EASI, or Single Enforcement Body (once established) to introduce the registration and licensing of approved social care recruitment, staffing and immigration agency sponsors.
• UKVI to allow live-in care workers or personal assistants to be directly recruited by care users via GLAA accredited recruitment agencies and sponsors
• UK Government to legislate for the regularisation of currently undocumented migrant workers, including those in the live-in social care sector.
• The Department of Health and Social Care to expand the role of the Care Quality Commission to ensure live-in care workers’ employment rights are respected and that staffing levels and roles enable care workers to take legal rest breaks and rest periods
• UKVI to ensure that everyone who is coming in under the new Health and Care Visa scheme has a written contract prior to arrival given to them in their first language, detailing fees and deductions for accommodation charges.
• Require business sponsors to show UKVI that employees’ contracts are legal under UK law.

Three further recommendations were also generated through peer researcher-led focus groups:

• Agency pay rates that more fairly reflect the nature of the work and skills of the carer
• Standardised risk assessments of both the condition of the property and of the care plan, to be conducted by both staffing and introductory agencies
• The Health and Safety Executive to review the Working Time Regulations for rest periods and breaks for live-in care workers employed in a domestic setting and issue a separate set of legal guidelines

The full list of recommendations can be seen in greater detail within the report, The vulnerability of paid migrant live-in care workers in London to modern slavery.

FLEX Research Manager Meri Ahlberg said: ‘It is vital for policymakers to listen to the lived experiences of migrant live-in care workers so as to understand and actively mitigate the specific modern slavery risks affecting them. The need for care, including live-in care, will increase as the UK’s population ages, and much of this indispensable work will be done by people coming from outside the UK. It is our duty to ensure they can help fill these roles without compromising on their rights or safety.’

Peer Researcher Natalia Byer said: ‘Our research clearly highlights severe shortcomings of the conditions under which live-in carers are employed, as well as the extent of exploitations and lack of remedies that would be easy to put in place. It’s an important milestone in the ongoing discussion of the broken care system. What’s most important for me as an ex-care worker is that our research identifies crucial regulatory and systemic changes that we all need to work on. I think that we should unify the public around this issue to create unbreakable pressure on the government as, one way or another, each of us is affected.’

The full report and policy brief can be found here. Videos accompanying the report can be found here.

This research was funded by Trust for London.