It’s just after 7am on a drizzly, dark December morning and staff at Saint Cecilia’s nursing home in Scarborough are handing over from the night to the day shift. Some residents have been “a bit wandersome” in the night and had to be cajoled back to bed. One has been “quite vocal”, while another has been pinching food from someone else’s plate – an eye will need to be kept on him.
Minutes into the briefing, an emergency buzzer goes off. Registered nurse Evans sprints up three flights of stairs, two at a time. One of the residents may have fallen out of bed, or choked on their fluids; it happens often. Doors are thrown open to find the button has, thankfully, been pushed by accident. There’s a collective sigh of relief and Evans is stood down.
Returning to the nurse’s station, the 28-year-old gets medication boxes ready for the morning rounds. Evans came to the UK from Ghana a year ago under the overseas health and social care visa route, expanded to fill vacancies created during the pandemic. It was a time-intensive and costly process and he had to make significant sacrifices, but putting his medical training to use in an “advanced country” would offer professional development and opportunities rarely found in Ghana.
He began to search online for jobs in the UK, the US and Canada. Within days, he had had an interview with the team in Scarborough, who offered him sponsorship, and the visa process was under way. His father’s death, when Evans was six, is what drove him into nursing. “I never wanted to see anyone else suffer like he did,” he says.
For today’s shift, he’ll be covering roughly half of the rooms – about 20 of the 37 residents. All but one – and she’ll turn 101 early next year – have complex medical requirements. There’s hustle and bustle as staff get ready for “cares”: washing, dressing, turning residents. “You’re getting spoiled, aren’t you?” a carer jokes with one. Housekeeping mop floors and the kitchen staff prepare porridge, as teams move around each other, sharing notes on the residents.
A colleague notices that Evans is quieter than usual; he has a lot on his mind. The door that opened to him and 31 of his overseas colleagues last year is about to close. On 4 December the home secretary, James Cleverly, unveiled the government’s latest plans to cut net migration, which will prevent the spouses and children of care workers coming to the UK. For the government, it was an obvious place to make cuts: in the year to September 2023, 143,990 people arrived through this route, bringing 173,896 dependants.
The day the news broke, Evans’ colleagues watched the television in the lounge and cried.
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As a registered nurse Evans is exempt from the new rules, but his care colleagues are not. Some of his friends who work in domiciliary and residential care in London and Manchester have already started to think about a move to the US, Canada or Australia, where there are fewer limitations and higher salaries. In the US, the average salary for a registered nurse is “double or triple” the UK rates, at about $80,000 (£63,000) a year. Evans receives well above minimum wage, but less than he would get in other countries.
Mike Padgham, managing director of Saint Cecilia’s Care Group, fears the new rules will do irreparable harm to the sector. “We fought long and hard to get the overseas recruitment route open. There’s no doubt these changes will put people off coming here.”
Padgham says recruiting local workers has long been a challenge. “It’s difficult to attract people – there are higher-paid, less stressful jobs out there. We need the government to better support local authorities so that they can pay us a fairer price for the care we deliver. Then we can improve pay and make our jobs more attractive to everyone.”
The sector was just about making a recovery from the pandemic; Padgham fears these latest changes will set them back even further, making it harder to fill the 152,000 vacancies. “It has always been bad but it has never been as bad as it is now,” says Padgham. “Social care is really on a cliff-edge at the moment. Nationally, there will be many provider failures and closures if we don’t have the staff, and that will impact the NHS. If we fail, the NHS will fail, too. We try to tell the government that this is one of the biggest crises facing the country, but they aren’t listening.”
On the second floor, Evans brings paracetamol to an agitated resident. Downstairs in the lounge, a karaoke machine is rigged up next to the Christmas tree. There are moments of tenderness and love: a wedding photo clutched between paper-thin fingers, yoghurts spooned carefully into smiling mouths. A man who comes in to have lunch with his wife every day sits close, singing Christmas songs softly in her ear.
A new resident arrives with her three children, with duvets and pillows and bags of medications. They have been caring for their mother at home for years but she needs a level of care they can no longer provide. Evans inputs the newcomer’s details on to a centralised system, with dosages, expiry dates and special instructions: “Likes to have tablets from a spoon.” Community care is called, body mapping photos taken, GP records read over. It is specialist care but it is also personalised, sensitive and intimate.
After a dinner of pork hotpot and homemade cheese and onion pasties, the residents are ready for bed. There are hoists to prepare, pressure wounds and skin tears to dress, wheelchairs to push. The night shift will take over from 8.30pm, after the 13-hour day shift. Evans will do the same again tomorrow and the next day.
“People often ask me why I want to do this work, when I am so young? I tell them, even if someone doesn’t remember you, or they don’t appreciate you, there are moments of connection. In those moments, they feel warm and cared for. That is all that really matters.”